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

David R. Jones, The Urban Agenda

The Republican Congress’s 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. The House-passed American Health Care Act 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. 

If the Republican Congress’ health insurance takeaway scheme becomes law, the clock will start ticking for NYC public hospitals to react.  Nationally, about 20 million new people gained coverage under the ACA.   Of that total, 2.8 million African Americans and 6.2 million Hispanics -- the minority group most likely to lack health insurance -- accessed coverage through the ACA, according to a survey by the Robert Wood Johnson Foundation.  The number of uninsured patients is poised to skyrocket, resulting in more patients without coverage showing up at NYC public hospitals, walk-in clinics and private hospitals.

It is worth noting, once again, that the Trump and Republican Congress’ goal is to deliver a windfall to the well-to-do. The ACA repeal would benefit the rich and young people, retroactively providing an average $197,000 tax cut to the top 0.1 percent of households, according to the Tax Policy Center.  This is a body blow to the poor and middle class.   Former President Barack Obama blasted the Senate bill as “a massive transfer of wealth from middle-class and poor families to the richest people in America," emphasizing that "discrimination" could become the norm again and that millions of families could "lose coverage entirely."

Sadly, there’s more misery on the horizon.  Still pending is Trump’s proposed fiscal 2018 spending plan, which would slash $910 million in federal aid to the city for everything from housing subsidies and homeless services to police anti-terror funding to community block grants, which are used by many New York City agencies to fund basic services.

The 2018 budget negotiated by Trump and the Republican Congress promises to be horrific.  It will destroy safety net protections, shrink federal agencies, and diminish resources for folks at the bottom. Our elected representatives in Congress must push back aggressively against callous policies that will destroy lives and harm New Yorkers who rely on Medicaid and our public hospitals.

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