“We need to reward the states like New York that have done well,” said Marian Wright Edelman, the director of Children’s Defense Fund, during a slow moment at the rally. “How can we conceive that in the richest nation on earth they are talking about reform legislation that would leave children worse off?” While the debate over federal health care reform legislation continues, in New York City, local health experts look on warily as they expect potential massive changes to the city’s health system.
S-CHIP, the public children’s health plan, faces elimination if its current provisions expire after 2013, as currently planned in the House. The Senate must choose between an expiration date of 2013 or 2019 for the program.
But Medicaid coverage is perhaps the biggest issue for New York, a so-called “do-gooder” state that provides far more coverage than the federal government requires. Tom Duane, the chair of the State Senate Health Committee, has said for months that the state will lose out if the federal government does not continue to provide matching funds for New York’s extensive coverage.
The cost of private insurance is almost as much a concern. Most experts say that the Senate bill as it stands will not make insurance cheaper for New Yorkers who buy their own plans or employers who provide group coverage, and the bill is expected to make Americans legally required to buy coverage.
Meanwhile, public hospitals in the city continue to struggle. The Health and Hospitals Corporation announced a hiring freeze and service cuts last March, and advocates say that public hospitals have reached a breaking point between the recession and this year’s budget cuts.
Judy Wessler, the director of the Commission on the Public’s Health System, an independent advocacy organization, says that a higher cost of insurance will drive more people to public hospitals, but the reforms threaten to reduce their funding without looking at demand, in the name of shifting funding to primary care. That spells trouble for the city, she said.
Adding to New York’s potential problems is the large population of recent immigrants who are subject to different laws, as well as the undocumented immigrants who rely on charity care. Experts are waiting to see whether the reforms will cut back not only on charity-care funding, but also on options for documented immigrants who would not be covered for the first five years.
“Not only are people who are undocumented not being covered, but as well, people who have documents are not going to be covered initially either, and that’s a very serious problem,” Wessler said.
Meanwhile, Paul Howard at the Manhattan Institute has also been tracking how New York will maintain its primary care services, especially in the city. He argues that universal coverage should be held off or abandoned to prevent the kind of squeeze that both he and Wessler described.
“You’re going to put millions of new people into the system when we already have a lack of primary care,” he said. “My concern is that in the name of expanding coverage you could wind up creating headaches for access to care for people lower down on the economic ladder.”
