Health Care

DiNapoli: No Special Needed If Congress Reverses Health Care Cuts

From the Morning Memo:

Gov. Andrew Cuomo this week raised the specter of a special session before the year ends to address the deficit caused by federal health care cuts – both already realized and potentially pending.

But state Comptroller Tom DiNapoli, New York’s chief bean counter, said during a CapTon interview last night that he doesn’t believe state lawmakers will be forced to return to the Capitol prior to the January start of the 2018 session if Congress reaches a deal in the coming weeks on averting reductions to the Disproportionate Share Hospital payments and Children’s Health Insurance Plan.

“The DSH cuts have been on the table for a long period of time, they keep getting pushed off though,” DiNapoli said. “We’ve heard from some of our Senate leaders, and (Senate Minority Leader Chuck Schumer) is cautiously optimistic, that Washington they will in fact come to some agreement, if not all, to put off some of these cuts again. So, I think part of what we need to do is to wait and see what gets sorted out in Washington.”

Cuomo has been sounding the alarm about the damage that will be done to New York’s bottom line – a loss of several billion dollars over the next several years alone – if Congress does not reverse funding cuts to safety net hospitals, which took effect Oct. 1. The SHP cuts have been scheduled for some time as part of the Affordable Care Act, but Congress has repeatedly pushed them back.

Congress also failed to reauthorize the program that provides coverage for some 330,000 low-income kids across the state who aren’t eligible for Medicaid. That program, known as CHIP, technically ran its course at the end of September as a result of federal inaction, and New York stands to lose $1.1 billion if it is not reauthorized, the governor said.

And the situation will be even worse, the governor has warned, if the tax reform plan currently under negotiation on Capitol Hill eradicates New Yorkers’ long-standing ability to deduct their state and local taxes, helping to take the sting out of the fact that they live in the state with the nation’s highest property tax burden. (Thanks to pushback on both sides of the aisle, it now appears Republicans are backing down from an outright repeal, though some changes are still under consideration).

What’s more, New York also stands to lose a big chunk of its federal Medicaid funding if Congress ever manages to get a deal on repeal and replacement of Obamacare, with the most recent proposal – Cassidy-Graham – calling for block granting those funds, in a move that would hurt New York more than any other state, Cuomo said.

DiNapoli declined to pick sides in the latest fight between Cuomo and NYC Mayor Bill de Blasio over funding for NYC Health + Hospitals, the nation’s largest municipal public hospital system and New York’s largest provider of safety-net care.

“No one has a crystal ball, but I think we’ll see some, my hope is, we’ll see some federal action on this sooner or later, so some of what’s being discussed is a dire consequence, having a special session, some of the things we’re talking about, probably, hopefully will not come to pass,” DiNapoli said when asked if the mayor should, as the governor maintains, pick up the tab for H+H funding, or, as the mayor insists, the state should pony up the $380 million it is currently withholding from the system.

The comptroller did say that he believes the Republican members of New York’s congressional delegation need to “step up to the plate and say to their leadership: this is really going to hurt us.”

“We already know there’s going to be many competitive House races in the state,” DiNapoli said. If anything like what’s being proposed goes through, I think people are going to be outraged – as well they should be.”

“…It’s very important that New York push back. What the governor is saying, what the mayor is saying, all of that is accurate, because if we don’t win some of these battles in Washington, then we’re going to be back home fighting each other over a diminished pot.”

“That’s going to be very hard for the Legislature at the state level to then have to figure out how we’re going to keep all these local governments from going over the edge in terms of providing services versus raising taxes to keep providing the services that New Yorkers expect.”

Electeds, Advocates Push Back Against Senate Health Care Bill

The organizations that showed up Friday outside of a federal building in Albany to rally against the Senate’s latest bill to repeal the Affordable Care Act included a variety of groups that have been either kind or skeptical of Gov. Andrew Cuomo.

Rallying against the bill included groups like Citizen Action, which have sought to further push Cuomo to the left on a variety of issues (Cuomo continues to enjoy a strong approval rating from self-identified liberals, even as advocates have faulted him for not doing enough).

But at the same time, and potentially underscoring the push for unity in the fractious left, two Cuomo allies attended as well: Lt. Gov. Kathy Hochul and Rep. Paul Tonko.

Speaking with reporters, Hochul knocked the bill as a transfer of health care spending from blue states like New York to Republican red states.

“It’s going to result in a partisan transfer of money from Democratic states to Republican states,” Hochul said. “We’re taking care of people in our state. It’s fundamentally unfair to New Yorkers.”

The measure would block grant Medicaid, ending the open-ended entitlement and, advocates fear, limiting what services New York could provide.

“I don’t want to even entertain that specter,” Hochul said when asked what state officials would have to do if the bill was approved. “There’s going to be huge hits to our hospitals, our nursing homes, our facilities.”

That’s a sentiment that was echoed by Ron Deutsch of the Fiscal Policy Institute.

“We provide the federal government with billions more than we currently get back in services,” he said. “So don’t take away our health care to give it to people in Mississippi. Let’s have health care for everybody.”

The bill’s chances of passage on Friday took a blow with the stated opposition of Sen. John McCain of Arizona, making him the second Republican to oppose the legislation.

Still, the demonstrators at the Friday rally sought to paint a picture of the bill’s strong chances. Tonko, a Democrat from the Albany area, said the opposition was united against the measure.

“I think they are,” Tonko said. “We know as a state we will be impacted very severely by this effort and it will be very difficult for us to pick up all the pieces lost from the federal perspective.”

Collins Won’t Predict Cassidy-Graham Future

From the Morning Memo:

Three votes is all it would take to sink the Cassidy-Graham healthcare overhaul bill.

The eleventh-hour attempt by Republicans in the U.S. Senate to repeal the Affordable Care Act once seemed like the longest of long shots, but now appears to have a chance – albeit slim – at passage, even though it has been deemed the most “radical” of all the Obamacare reform efforts the GOP has debated thus far.

Western New York Rep. Chris Collins said he would love to see the House get an opportunity to weigh in on this proposal, too, but he’s acutely aware Senate Majority Leader Mitch McConnell & Co. need 50 of 52 GOP senators’ support to get it through their chamber.

That’s a tall order, but so far not completely out of the question. Still, the congressman isn’t holding his breath.

“I know they’re vote counting, so I’m just going to just watch like everyone else,” Collins said. “I don’t want to be a Debby Downer and say it’s not going to pass, but I’m not overly optimistic.”

Neither would Collins make a prediction about whether Congress would restore scheduled funding cuts to Disproportionate Share Hospital (also known as “DSH” – pronounced “dish”) payments. Lawmakers need to take action before Oct. 1 to protect the funding stream, which reimburses public and safety net hospitals that treat uninsured and underinsured patients.

Gov. Andrew Cuomo has said New York stands to lose billions of dollars if the DSH payments get cut.

New York also would lose a massive amount of Medicaid and Medicare funding – second only to California in the nation – if the block grant plan outlined under Cassidy-Graham passes.

That has led some of Collins’ fellow GOP delegation members – including Long Island Rep. Pete King, New York’s most veteran House Republican – to already go on the record saying they’ll likely vote “no” if given a chance.

Collins said he and his colleagues tried to address the DSH problem before the recess that followed the failure of the last GOP healthcare plan. But he also said hospitals are sending mixed signals by both lobbying against that bill and asking for help.

“There’s a bit of an irony here, a little bit of hypocrisy here, and I can’t predict where it’s going to go right now,” he said. “They’re asking us to help shore up a piece of Obamacare that we had fixed in the American Health Care Act that they lobbied against.”

Hannon, Gottfried Push For CHIP Renewal

The leading health committee lawmakers in the state Senate and Assembly on Thursday called on Congress to re-approved the federal Child Health Insurance Program at the enhanced match rate before it expires at the end of the month.

Republican Sen. Kemp Hannon and Democratic Assemblyman Richard Gottfried are renewing their call after initially pushing for the re-approval in August.

The state’s own version of the program, which pre-dates the federal government, provides health care access to 300,000 children in New York.

“Our state was among the first to create the Child Health Plus Program and has led the way in expanding access to the important services it provides children under 19,” Hannon said.

New York has since expanded its program by raising income eligibility levels and raising the age of children covered since it was enacted in 1990. The federal program came on line in 1997. The changes largely hinged on federal matching dollars.

“New York’s Child Health Plus ensures health care access for over 300,000 young New Yorkers,” Gottfried said. “The increased CHIP funding that was part of the Affordable Care Act is critical to maintaining this extraordinary success story.”

Schumer, Reed Say They’ll Do Their Best To Fight Medicaid DSH Cuts

A day after the governor called on the New York Congressional Delegation to stop imminent cuts to a specific Medicaid program, two members on opposite sides of the aisle both said they’d do their best.

Senate Democratic Leader Chuck Schumer said he’s been a leading voice against the cuts to so-called Disproportionate Share Hospital (DSH) payments. If Congress doesn’t take action before October 1, New York could lose $2.6 billion in funds used to reimburse hospitals for uncompensated healthcare costs.

Hospitals that serve uninsured and under-insured patients would stand to lose the most revenue. Schumer said rural hospitals, in particular, would be devastated.

“Many of them would have to close. Most others would have to lay off hundreds of people if this, these cuts went through,” he said.

Despite the serious consequences, Schumer called his chances of passing legislation to avoid the cuts “neck-and-neck.” His colleagues seem to agree it won’t be easy.

Republican Congressman Tom Reed also said he plans to try and help strike a deal to alleviate the cuts, but he chastised the hospitals for putting him and others in a tough spot. That’s because Reed said when the Affordable Care Act originally passed, the hospitals agreed to the future cuts as part of the process.

“Now to come in and say, ya know, that deal that they struck somehow has to be undone, to me is troublesome, but at the same time, I understand the impact this has on the people that these hospitals serve,” he said.

Reed also noted, a major reason he supported the failed previous GOP healthcare plan, was because it addressed DSH funding.

Cuomo Calls On NY Congressional Delegation To Consider Impending Healthcare Issues

Gov. Andrew Cuomo, D-NY, called on the state’s congressional delegation to take several actions regarding healthcare in the coming days and weeks.

At a press conference Tuesday in New York City, Cuomo voiced his concern over scheduled cuts to Medicaid for so-called Disproportionate Share Hospital (DSH) payments. They are federal reimbursements to hospitals for uncompensated health care costs.

Cuomo said New York would lose $2.6 billion, roughly 16 percent of the scheduled cuts, if Congress doesn’t take action before October 1. He said of that $2.6 billion, the state would lose $1.1 billion in just 18 months.

“There is no way the state can pick up this cost. The state is already facing a $4 billion deficit going into next year, $4 billion deficit. There is no way we can close a $4 billion deficit and absorb an additional $1 billion, and then $2.6 billion cut. It is mathematically impossible,” he said.

The governor said the DSH cuts would affect about 3 million people served at more than 200 hospitals. The first and most severely affected would be public and safety net hospitals both of which serve uninsured and under-insured patients.

Cuomo said as concerned as he is about that issue, he’s even more concerned about the potential for Congress to pass the proposed Graham-Cassidy healthcare bill and repeal the Affordable Care Act. That, he said, would cost New York roughly $19 billion as the legislation plans to block grant Medicaid funds.

Cuomo said the state would essentially be punished for utilizing the system better than other states.

“I would not trade $19 billion for the flexibility because if they cut us $19 billion, if I was as flexible as a Gumby doll, we could not fund our healthcare system.”

The governor said the Republican healthcare proposal would also put 2.7 million New Yorkers at risk of losing their coverage, not to mention he has ideological disagreements about issues like defunding Planned Parenthood.

Higgins Offers ‘Practical’ Health Care Alternative

From the Morning Memo:

Legislation was introduced in Washington this week that its sponsor said could potentially change American healthcare – but it’s not the “Medicare for All” bill championed by Vermont Sen. Bernie Sanders you’re probably thinking about.

Rep. Brian Higgins, a Buffalo Democrat, has been discussing his plan to tweak the Affordable Care Act for months. He quietly introduced the bill in the House yesterday – the same day Sanders debuted his single payer proposal with much public fanfare.

The Higgins proposal calls for the government to allow citizens between the ages of 50 and 64 to buy in to Medicare, which he says would address the massive (multi-trillion-dollar) cost of Sanders’ plan that renders it more or less a non-starter in D.C.

“We’re seeking to drive down the cost of healthcare for those between the ages of 50 and 64 and drive up dramtically the quality,” the congressman said.

Higgins said Medicare is better than any healthcare plan available on the exchange, and currently would cost about 40 percent less. He also says 98 percent of patients in the system have access to a primary care physician and a specialist.

Higgins said he doesn’t have a philosophical issue with the single-payer model, but while some are estimating Sanders plan could cost more than $30 trillion over a decade – with no plan from the senator at the moment on how to cover that cost – his comes at no extra charge to the government.

“I think Senator Sanders is making a very sincere contribution to a very important debate in America,” Higgins said. “My bill is just a much more practical bill.”

The congressman said he believes as the health care reform conversation continues, his proposal could emerge as a middle ground to the more extreme plans being pushed at the moment by lawmakers on both the left and the right.

(Conservatives unveiled their own proposal yesterday, calling for all the funds currently allocated under the Affordable Care Act to be distributed to the states via block grants).

“It could be a compromise because we have 34 original co-sponsors,” Higgins said. “We’re getting more every single day. We’re looking to make this a bipartisan bill with both Republican and Democratic support.”

The bills introduced by Higgins and Sanders do have one thing in common: Both would allow the government to leverage the Medicare system to negotiate lower prices for pharmaceuticals.

Northwell’s Marketplace Exit Deemed A Credit Positive

A Moody’s report on Monday found it made financial sense for Northwell Health NY to exit the health insurance business next year amid losses after entering the state’s health care marketplace.

The hospital group reported $26.5 million in losses in the first quarter of 2017, coming after losing $168 million last year and $41 million in 2015.

The full 2017 losses are expected to exceed $100 million.

Northwell, the state’s largest hospital system, announced last week it was shuttering CareConnect, an insurance unit that had been offering coverage in the exchange. The move is expected to impact the tens of thousands of customers who had purchased insurance.

Moody’s found the move to leave the marketplace is a credit positive for Northwell given the financial problems, even as the losses to date have considered manageable. Northwell reported $9.9 billion in revenue last year and has a $620 million cash flow.

Report Warns Latest Health Care Bill Would Cost NY $22 Billion

A report released Thursday raised concerns over the loss of federal funding that would hit New York if the latest measure to overhaul the Affordable Care Act is approved.

All told, the legislation would cost $22 billion in funding to New York from the federal government for health care coverage by 2026, according to the report released by the Washington-based Center on Budget and Policy Priorities.

The report was highlighted by the left-leaning Fiscal Policy Institute. The FPI is concerned that, in part, the new measure is being framed as a bipartisan fix to the ACA.

“Despite claims to the contrary, the Cassidy-Graham plan is just another ACA repeal bill and would have the same devastating effects on New York as the previous, failed GOP repeal bills,” said Ron Deutsch, the executive director of the Fiscal Policy Institute. “Like every other ACA repeal bill, it would take coverage from hundreds of thousands of New Yorkers and tens of millions nationwide.”

Of particular concern is the measure would curtail the Medicaid expansion under the ACA and eliminate tax credits that aid low-to-moderate income New Yorkers.

“The public, experts across the political spectrum, and groups representing patients, hospitals, physicians, seniors, people with disabilities and others have forcefully and repeatedly rejected this misguided approach,” said Deutsch. “It’s time to focus on bipartisan solutions that strengthen – rather than weaken—our health care system.”

Amid Rate Increases, NY Points To DC Uncertainty

The uncertainty over repealing and replacing the Affordable Care Act, now giving way to the future of subsidies under the law, has played a factor in growing rates in the individual and small group health insurance markets.

Insurance rates for those in New York’s health care exchange will rise, with individual plans rising more than 14 percent on average, and small group plans increasing by more than 9 percent on average. State officials say the increases are driven in part by the higher cost of care and prescription drugs.

But there’s another factor as well.

“We believe also it is driven by the uncertainty that has come out of Washington,” said Donna Frescatore, the executive director of New York’s health exchange, known as NY State of Health.

That uncertainty has come from President Donald Trump, who has threatened to end subsidies under the Affordable Care Act that keep plans affordable. Ending those subsidies, which include tax credits for those with qualifying incomes, could lead to lower quality care and fewer people being insured.

“Should those cost sharing reductions be eliminated, the price of insurance will go up,” Frescatore said. “That is something we hear from consumers as well as organizations throughout the state.”

Members of Congress say they want to find ways of stabilizing the marketplace after broader efforts to repeal the law have failed. In the meantime, New York’s health care exchange officials say they’re working to reassure policyholders their insurance will remain in place.

“We want people to be certainly aware of what could happen in Washington, but we also want to encourage people to continue shopping for coverage,” Frescatore said.

Since 2011 when the exchange was established, health officials say there’s been a 55 percent reduction in rates for individuals.