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PEP April 2016
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Public Employee Press


Other Voices
Public hospitals struggle with insufficient funding


By JUDY WESSLER


Providing health-care services for low income people who don’t have insurance coverage is expensive.

Federal and state programs that provide funding to help offset the costs. But NYC Health + Hospitals does not get its fair share of state and federal funding. That’s one of the reasons the system faces a neverending crisis.

NYC Health + Hospitals (until recently known as the NYC Health and Hospitals Corporation) was changed from a city agency to a public corporation in 1970. About 18,000 DC 37 members work at NYC H+H.

Despite the change in structure and leadership, the mission of the public health system has remained the same — providing health care to all who need it, regardless of race, ethnicity, language spoken, disability, or the ability to pay. The city’s public health care system does not turn anyone away for lack of money, health insurance, or citizenship.

This means the system’s hospitals, health centers, long term care facilities and other services play a major role in maintaining the health of the city. Of the 1.2 million patients receiving health care services in the city, more than 500,000 have no health insurance coverage. They are either not eligible to apply for insurance or believe they cannot afford to pay for coverage.

If a person is not eligible for Medicaid, NYC H+H staff puts that person on a sliding fee scale called HHC Options. Everyone agrees this fee scale is best for patients able to get needed care and not go broke paying for it.

So, the city’s public health-care system has an enormous responsibility. But it doesn’t receive sufficient support to be able to carry out its mission.

There is a $1 billion-plus “charity care” pool of state and federal dollars funds that is meant to follow indigent patients, pay for the cost of the uninsured, and help the hospitals with highest numbers of Medicaid patients.

For purely political reasons, the public hospitals are limited in how much money they receive from this pool.

As it currently stands, only $139 million is available for public hospitals and of that, only $96 million goes to NYC Health + Hospitals.

Making matters worse, the amount of federal funds to help pay for the charity care pool will be cut in 2017, with New York State standing to lose hundreds of millions of dollars if it does not follow the targeted patients as required.

Paradoxically, there are large private hospitals with huge surpluses that are still funded by the charity care pool.

Adding insult to injury, yet another state funding source meant to help “safety net” facilities specifically excludes NYC H+H. This is pure outright discrimination against New York City’s public health-care system and the patients who are treated by it. This hurts patient care and threatens the loss of jobs held by the dedicated work force employed by NYC H+H.

The message needs to be clear: Let’s change the current definition of “safety net” hospitals in order to ensure proper funding for the health-care facilities that provide the most treatment to low-income populations.

This isn’t a complicated concept: Charity care funds should go to the facilities providing the most charity. And in New York, NYC Health + Hospitals is the largest single provider of care for the uninsured.


Judy Wessler is the retired director of the Commission on the Public’s Health System, a citywide community-based health advocacy group. She currently serves as the Assembly representative on the federal Medicaid waiver, DSRIP, Project Advisory and Oversight Panel.








 
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