State Experts Offer Advance Prognosis Of Effects Of Federal Legislation
Tue, 17 Nov 2009 11:47:00
On the pavement of 47th Street in midtown Manhattan, below the offices of Sens. Chuck Schumer and Kirsten Gillibrand, toddlers waved balloon animals in the air, signs reading “Senator Schumer, Stand Up for Children’s Health” strapped to their strollers.
“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?”
Federal health care reform legislation goes back to the Senate this week, where it awaits another round of furious debate and will emerge reshaped once more, while in New York, local health experts look on warily as they expect potential massive changes to the state’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. [State Senator Tom Duane, the chair of the Senate Health Committee, has said for months that the state will lose out if the federal government does not provide funding to help support New York’s extensive coverage, a possibility that the Senate may take up.]
Medicare funding is also threatened by proposals to introduce geographic variations in pricing, a system of rewarding areas like the Midwest that spend less, according to William Van Slyke of the Healthcare Association of New York State. He said that punishing New York for its high spending on Medicare did not take the state’s extra costs into account: it has big pockets of poverty, especially in New York City, and prioritizes certain needs that are considered frills in other states, like pre scri ption drugs.
“The whole state will be heavily penalized,” said Van Slyke. “That’ll affect every provider and every hospital, especially in New York, where we have a large aging population.”
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.
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 these hospitals’ funding without looking at demand, in the name of shifting funding to community-based primary care. These cutbacks are largely an urban issue but will also affect some hospitals upstate.
Meanwhile, Paul Howard at the Manhattan Institute has also been tracking how New York will maintain its services, but he argues that universal coverage should be held off or abandoned to prevent the kind of squeeze that experts describe.
“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.”
A final concern was noted by Van Slyke, who said he has watched to see if the legislation would follow up on President Obama’s reference in a speech earlier this year to reforming medical malpractice law. But medical malpractice has not been addressed, which Van Slyke said continues to drive up costs and deter doctors from maintaining private practices in New York.
“They’re really not doing anything,” he said. “We have OB-GYNs who are leaving New York in droves because their medical malpractice insurance is $175,000.”
“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?”
Federal health care reform legislation goes back to the Senate this week, where it awaits another round of furious debate and will emerge reshaped once more, while in New York, local health experts look on warily as they expect potential massive changes to the state’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. [State Senator Tom Duane, the chair of the Senate Health Committee, has said for months that the state will lose out if the federal government does not provide funding to help support New York’s extensive coverage, a possibility that the Senate may take up.]
Medicare funding is also threatened by proposals to introduce geographic variations in pricing, a system of rewarding areas like the Midwest that spend less, according to William Van Slyke of the Healthcare Association of New York State. He said that punishing New York for its high spending on Medicare did not take the state’s extra costs into account: it has big pockets of poverty, especially in New York City, and prioritizes certain needs that are considered frills in other states, like pre scri ption drugs.
“The whole state will be heavily penalized,” said Van Slyke. “That’ll affect every provider and every hospital, especially in New York, where we have a large aging population.”
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.
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 these hospitals’ funding without looking at demand, in the name of shifting funding to community-based primary care. These cutbacks are largely an urban issue but will also affect some hospitals upstate.
Meanwhile, Paul Howard at the Manhattan Institute has also been tracking how New York will maintain its services, but he argues that universal coverage should be held off or abandoned to prevent the kind of squeeze that experts describe.
“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.”
A final concern was noted by Van Slyke, who said he has watched to see if the legislation would follow up on President Obama’s reference in a speech earlier this year to reforming medical malpractice law. But medical malpractice has not been addressed, which Van Slyke said continues to drive up costs and deter doctors from maintaining private practices in New York.
“They’re really not doing anything,” he said. “We have OB-GYNs who are leaving New York in droves because their medical malpractice insurance is $175,000.”
