Shifting Health Care Back to Patients

In New York City's low-income communities of color, public health programs like Medicaid, Family Health Plus, and Child Health Plus are nothing less than lifesavers. But with the costs of health care soaring, public officials across the country are looking for ways to cut back on funding for these types of programs. The Bush administration has just proposed cutting Medicare and Medicaid by billions of dollars.

Governor Eliot Spitzer has put forward an agenda in his first executive budget that would ultimately cut costs while refocusing health coverage programs back to the reason why they were designed: for patient care. The governor's plan is a breath of fresh air, an innovative approach to health care that potentially works for the people that most need it.

Medicaid alone costs New York State about $45 billion a year, consuming 40 percent of the state's budget. By addressing the costs and administration of health care in New York State, Governor Spitzer wants to shift the focus back to patients.

The Governor's decision not to cut benefits and not to shift costs to already strapped New Yorkers is a huge relief and marks a turning point in the debate over Medicaid. His decision to move forward on expanding coverage for children and simplifying the Medicaid application process is long overdue.

Redirecting Funding

The governor proposes to redirect funding for the delivery of health care from hospitals and nursing homes to less costly primary and preventive care, with a concentration on outpatient care at community-based facilities. These are outposts where the great majority of Medicaid patients go for their health care needs and where most Medicaid dollars should be spent.

By putting patients back at the center of the state's health care system, the governor hopes to be able to cover a larger number of New Yorkers without increasing costs. More New Yorkers covered by health insurance would bring down the cost of health care.

While 2.6 million New Yorkers are uninsured, New York spends more on Medicaid per capita than any other state. Because of the large number of uninsured, New York has a higher percentage of deaths due to chronic disease than any other state. Reducing the uninsured would save hundreds of millions annually on emergency room charity care and lower the cost of treating chronic medical problems among low-income residents.

A policy that
makes sense

The governor wants to provide access to health coverage to the state's 400,000 uninsured children by expanding Child Health Plus to cover children in families up to 400 percent of the federal poverty level. The current ceiling is 220 percent of the federal level.

Thanks to the success of Child Health Plus, the majority of New Yorkers without health insurance are adults. The theory in our health care system is that most working adults would get their coverage through their jobs. In New York City, however, many low-wage workers are employed by small businesses that cannot afford to offer health care benefits. And where offered, employer-based insurance is all too often too expensive for many low-income families.

The recent Community Service Society (CSS) survey of low-income New Yorkers revealed that one-in-five full-time working poor are uninsured and less than half get employer-based coverage. Nearly one quarter of working poor households could not fill a needed prescription last year. With employer health care benefits shrinking, the need is even greater for expanded coverage for adults through government-sponsored programs. It is an investment that yields significant public benefits.

Removing Barriers

One barrier to coverage is the annual renewal process for Medicaid, so cumbersome that as many as 40 percent of those trying to renew end up losing their coverage, either for a period of time or, in some cases, permanently. The governor wants to streamline the process by no longer requiring families to produce documents that prove their continued eligibility, documents that the state already possesses.

Removing the bureaucratic hurdles to the enrollment process could encourage some 900,000 uninsured adults and children to obtain Medicaid coverage. Once in the Medicaid system, these individuals will have access to the care they need, leading to less reliance on more expensive hospital visits. Through our Managed Care Consumer Assistance Program (MCCAP), CSS has been working with community-based organizations throughout New York City to help eligible residents navigate the health care system and receive the benefits to which they are entitled.

These reforms should move us closer to the ultimate goal of universal health coverage. Until then, we must find innovative ways to cover more people while holding costs down.

No doubt, these policy changes will generate a certain amount of opposition. Any change in public policy produces a reaction. But refocusing the spending of public health care dollars to primary and preventive care is a policy that makes sense.

The governor's policy changes would provide for better facilities and greater coverage in the city's Black and Latino neighborhoods. Also, a policy that reduces the number of uninsured and delivers health care in a way that best meets the needs of patients would reap real savings for New York's taxpayers.

From the New York Amsterdam News
February 8 - 14, 2007