On health care reform, special concerns for NY State
Other Columnists
As President Barack Obama faces the Congress Wednesday, the most accessible story arc will concern his ability as a rookie to drive some version of health-care reform. In clarifying his goals, he must answer his detractors against a backdrop of lower approval ratings during his first summer in office.
Comparisons to the famous Clinton health-reform failure are in the air, eclipsing the difficult details of how to pay for and carry out expanded, if not universal, access to health care.
Much of the public impact of this drama, however, rests not with Washington's winners-and-losers sweepstakes, but with the opaque language of health policy. The meaning of it all will come in the dizzying jargon about community rating, coverage mandates and safety-net hospitals.
Part of this, but far from all, will be about the poor.
New York State's government, which has a big Medicaid program - not to mention massive health providers inside its borders - finds itself with special concerns that other states don't have.
Gov. David A. Paterson, while urging passage of a reform bill in Washington this year, warned weeks ago that some federal proposals could shortchange New York by rewarding coverage expansion only in other states that have done much less.
"Medicaid covers over 4 million low-income, elderly and disabled New Yorkers and is the single largest payer of health care services in the state, at almost 30 percent," Paterson told the state's Congressional delegation in a letter July 21. Still, Paterson said, there are 2.5 million uninsured New Yorkers, "half of whom are eligible but not enrolled in these programs." He speaks of efforts to improve access despite a deteriorating economy.
State programs subsidize coverage to kids in families with incomes up to 400 percent of the poverty line, parents up to 160 percent, and single adults up to 100 percent, he notes.
Paterson's concern centers on the prospect that states that have not done as much as we have will be funded by the U.S. government for the full cost of their expansions - but New York will not.
Jennifer Cunningham, a private consultant for the health care workers union 1199, said, "The concern here is that we not be penalized as a do-gooder state." As it appears now, "not the House bill, but the Senate bill could be problematic," Cunningham said.
Another concern is that the economics of states with generally lower costs will become a standard for insurance payments, hurting higher-cost states such as New York.
Also of note is this portion of Paterson's missive to the delegation:
"Disproportionate Share Hospital (DSH) payments to safety-net hospitals should be maintained. While the need for DSH may diminish over time as coverage expands, it would be premature to cut funding levels until there has been a documented decrease in the number of uninsured patients.
"Given the large number of undocumented immigrants in New York, many patients are likely to remain uninsured and dependent on safety-net hospitals."
Taking illegal immigrants into account, isn't that controversial? Said 1199's Cunningham: "It may be controversial, but they still get sick and show up in emergency rooms."
Major New York hospitals, with leading citizens on their boards of directors, will have their own sets of concerns about the potential to be squeezed by new rules.
So will citizens and corporations concerned about taxes and costs - including small businesses with slim profit margins.
All the interested parties will be tuned in Wednesday. Health care is one of those vortex topics, like education. Start to discuss it, and sooner or later you're comparing social philosophies.
That said, the outcome of this legislation will be, if anything, a patchwork of funding formulas, insurance tables, claim systems, medical protocols and technologies - all as gnarly and complex as the system you have now.
No matter what they do in D.C., the challenge will be in figuring out what it means.
