In over four decades of public service, I have never witnessed such a deliberate and destructive assault on our nation’s healthcare system. The policies of the Trump administration, including Secretary of Health and Human Services Robert F. Kennedy Jr., and codified by Congressional Republicans, represent a dangerous unraveling of the public trust and institutional integrity that Americans rely on for their health and safety.
For the mayor of the nation’s largest city, where three out of five residents rely on public health insurance, the stakes could not be higher. The next city administration will have to confront policies aimed to gut Medicaid and the state’s Essential Health Program, and threats that undermine science-backed vaccine guidance and public health policy.
These threats come as Democrats in Congress are fighting to protect healthcare access during contentious federal budget negotiations that have led to a government shutdown. They deserve credit for holding the line – demanding the restoration of Medicaid funding and the extension of enhanced advance premium tax credits that keep coverage affordable for millions of families.
New York City also needs bold leadership to protect New Yorkers from harmful federal policies, expand access to care, and even build a stronger, more resilient system than we’ve had before.
Here’s where the next mayor should focus to safeguard the health of our city.
Help New Yorkers Enroll in and Keep Their Coverage
Nearly one million NYC residents may lose coverage as the devastating impact of H.R.1 is realized in the coming years. This includes cuts to the Essential Plan, Medicaid work requirements, Medicaid biannual renewal requirements, the elimination of eligibility for LEGAL immigrants, and many, many other onerous rules designed to deter enrollment. In addition, about 140,000 New Yorkers may see a huge spike in health insurance premiums due to the Republican’s determination to terminate the enhanced Advance Premium Tax Credits.
The next mayor must be prepared to meet this coverage crisis head-on. That means robustly funding community-based health consumer assistance programs like MCCAP and Access NYC, which help New Yorkers navigate the maze of enrollment, red tape, and renewal requirements. It also means ensuring strong, stable support for NYC Health + Hospitals and NYC Care, which is the city-funded health care program for residents who don’t qualify, or no longer qualify, for health coverage.
Fix the Tale of Two Cities in Our Hospitals
Healthcare access in New York is also shaped by stark inequities between the city’s hospitals. Wealthy hospitals in Manhattan’s Upper East Side post healthy profit margins by charging exorbitant rates, while safety-net hospitals in the outer boroughs struggle to keep their doors open. The next mayor should take steps to regulate the City’s hospitals to make sure any New Yorker that needs hospital care can access high quality hospital services in their own neighborhood.
To help achieve this goal, patients, workers and policymakers need basic information to allocate precious city resources responsibly. The Office of Health Care Accountability should be empowered to shine a light on hospital pricing, financial assistance practices, and the availability of hospital beds in underserved neighborhoods. With real data in hand, the next mayor can use tools like zoning, land use, and tax-exempt status to hold private non-profit hospitals accountable for providing financial assistance and equitable access for consumers with public insurance.
While we’re discussing hospitals, New York City’s maternal mortality rate is a scandal—and has been one since I was a teenager, when my babysitter died delivering her baby in a Brooklyn hospital. Having a baby in New York is a dangerous proposition with twenty-two out of every 100,000 births resulting in deaths. Making matters worse, women of color are nine times more likely to die from pregnancy or childbirth than White women. The next mayor must make reducing maternal mortality a top priority by: (1) requiring hospitals to audit every maternal death and file corrective action plans; (2) ensuring all women are discharged with an affordable blood pressure cuff to prevent post-pregnancy complications; and (3) funding post-delivery home visits by nurses or community health workers.
Combat Disinformation with a Shadow CDC
Finally, we cannot stand by as President Trump and his unhinged Health Secretary gut the CDC and spread dangerous misinformation about vaccines, medications, maternal care and public health. The NYC Department of Health and Mental Hygiene has a long, illustrious history as a public health leader. The next mayor should appoint a health commissioner with deep scientific credibility and charge them with creating a “mini–shadow CDC” that issues factual guidance around vaccinations, medications, and other health care matters to fill the truth void created by the Trump administration.
The federal government may be intent on tearing holes in our healthcare safety net, but New York City doesn’t have to let its residents fall through them. With bold leadership, the next mayor can safeguard access to care, ensure equity in hospitals, and ground public health in science, not misinformation.
This moment is a chance to defend and expand progress toward a fairer, more affordable healthcare system. If Washington retreats, New York City must lead.
David R. Jones, Esq., is President and CEO of the Community Service Society of New York (CSS), the leading voice on behalf of low-income New Yorkers for more than 175 years. The views expressed in this column are solely those of the writer. The Urban Agenda is available on CSS’s website: www.cssny.org.