URBAN AGENDA: Repeal of Obamacare is a Disaster for City’s Public Hospitals

David R. Jones | 6/29/2017, midnight
The Republican Congress’ plan to take away insurance coverage and roll back Medicaid would be a disaster for New York ...
David R. Jones Contributed

The Republican Congress’ plan to take away insurance coverage and roll back Medicaid would be a disaster for New York City’s Health + Hospitals and New York’s communities.

Immigrants and communities of color disproportionately depend on NYC’s financially beleaguered public health system. If insurance coverage is taken away, it will place an impossible burden on Health + Hospitals to provide the care that New Yorkers need. On average, NYC public hospitals serve 1.2 million people annually, of which more than 425,000 are already uninsured, according to city figures.

The Trump Administration’s focus on immigration and health coverage may already be harming New York City residents. There is anecdotal evidence that immigrants, even those with Green Cards and valid visas, are avoiding community health centers and doctors’ offices out of fear of Immigration and Customs Enforcement. Medical centers have traditionally been considered “sensitive locations,” where federal agents usually would not enter. Even so, the Trump inspired anti-immigrant fervor has increased fear in immigrant communities, with residents reluctant to leave their homes, go to the doctor, or take other actions believed to place them at risk.

Facing resistance within its own conference, Senate Republican leaders delayed this week’s vote on their health bill which would leave 22 million fewer Americans with health coverage by 2026 according to the nonpartisan Congressional Budget Office. A similar health bill approved by the Republican-led House would strand 23 million Americans. Both plans would slash Medicaid, a program that serves one in five Americans. Medicaid not only covers the poor but also pays for the long-term care of almost two-thirds of people in nursing homes. About half of all births in the country are covered by Medicaid, and nearly 40 percent of children are covered through the program.

The Affordable Care Act (ACA) repeal proposals are very bad news for Health + Hospitals’ 11-hospital system, which is reliant on Medicaid reimbursements to cover uninsured or under-insured patients. NYC public hospitals this month eliminated 476 management positions, a cost-saving step that does not impact patient care. However, the GOP repeal plan, if it becomes the law of the land, means the NYC system faces future financial pressure from uninsured “hardship” patients, accelerating the growth of expenses at hospitals and community clinics that already outpace revenue.

Nothing short of H + H’s survival hangs in the balance. Mayor Bill de Blasio and the City Council face a herculean challenge to save NYC public hospitals from the death spiral of declining revenue and endless budget deficits projected to reach $1.8 billion by FY2020. Full disclosure: I am a member of the blue-ribbon commission the mayor created this year that recommended the city hospital system consolidate and "substantially" reduce its inpatient care in order to improve its finances and sustain the system going forward. The panel recommended, and the mayor agrees, that the system should shift resources from inpatient care to expanded community-based health services. The mayor promised that the city would not close any hospitals or stop using the buildings as hospitals.