Still Millions of Uninsured New Yorkers

The biggest problem facing the health care system in New York State is the large number of people without insurance. Three million New Yorkers statewide are uninsured; 25 percent of New York City's population does not have coverage.

New York City's poor and communities of color are heavily reliant on public health insurance, especially Medicaid, which has come under the threat of billion dollar cuts by both state and federal governments. Cutting Medicaid funding is extremely shortsighted. Instead of saving money, the cuts will end up costing us more as the numbers of uninsured people needing medical care increase.

Cutting Medicaid
is shortsighted

Although New York State's Medicaid program is expensive, the "traditional" Medicaid population is not at the root of this problem. While low-income individuals, families, and children represent the largest number of Medicaid beneficiaries, these are the least costly group. Representing 70 percent of enrollees, they generate only 20 percent of the total program expenditures. Reducing eligibility or cutting benefits would cause real hardships to these people without generating substantial savings.

African American and Latino New Yorkers are the most likely to be without health insurance coverage. As a result, they are less likely to receive needed care for serious or chronic medical conditions, resulting in personal and financial distress for themselves and their families.

There is also a public cost to large numbers of people without insurance. The uninsured often turn to publicly supported hospitals and clinics for help. They delay care and have more acute health care needs when they show up. They go to hospital emergency rooms because they worry that they will be turned away if they try to get care in other settings.

The state has an obligation to low-income New Yorkers to help them obtain and use the health coverage they are eligible for. About one million of New York's uninsured are people who are eligible for one of the state's public health coverage programs: Medicaid, Child Health Plus, or Family Health Plus.

Barriers to Enrollment

But the current application and documentation processes act as significant barriers to enrollment. Streamlining the application process could lead to one million fewer uninsured New Yorkers. Simplifying the recertification process would ensure that people who have already been found eligible would not lose their coverage due to administrative barriers.

Most New Yorkers enrolled in Medicaid have been shifted into managed care organizations. Many need assistance in getting necessary care through their HMOs. They need to know where to go to enroll in programs; how to select a health plan; how to navigate the managed care system; and what to do if they have a problem getting services.

Two changes could help ensure the enrollment of all eligible New Yorkers. First, simplify and streamline the eligibility determination and recertification processes. The current renewal system causes as many as half of all beneficiaries to lose coverage in spite of eligibility. Streamlining will save money, eliminate waste, and promote better health care.

Understanding the System

Second, we need to ensure that beneficiaries get necessary information about public health programs. Understanding the system will not only foster people's ability to get preventive care. It will allow them to seek care earlier, when treatment is less costly, and it will decrease reliance on hospital emergency departments.

To inform all managed care enrollees about their coverage, CSS helped to create - and acts as coordinator of - the New York City Managed Care Consumer Assistance Program (NYC MCCAP). (If you have a problem with your HMO, call the NYC MCCAP phone number: 212-614-5400.) This type of program should be established statewide.

Strengthening public health programs is a smart move. It will not only promote better health care for more New Yorkers, but it will also save millions of tax dollars that currently pay the medical bills of those who are still uninsured.

From the New York Amsterdam News
December 18 - 24, 2003