The economic inequality gripping our city affects more than just a family’s paycheck. It also produces deep health disparities.
In neighborhoods where poverty and unemployment are widespread, access to affordable, quality health care is tenuous, while the epidemics of our time — diseases caused by smoking and obesity — take their toll on families. Of the 62 counties in New York State, the Bronx is ranked dead last in health indicators, and Brooklyn fares little better. Parents are forced to forgo preventive check-ups and medication so they can pay their bills instead. More than a million New Yorkers are without health insurance. Hospitals are closing from Jamaica to South Brooklyn and Greenwich Village. All this inequity exists in the same city that boasts the finest doctors and medical institutions in the world.
Yet with the Affordable Care Act taking full effect on the first day the next mayor takes office, New York has the opportunity to remake its health care system to be affordable and accessible to all families. As of 2014, well over $10 billion per year in new federal dollars will be coming into New York State to expand Medicaid, provide subsidies for middle-income families to buy insurance, and support small businesses in buying insurance for their employees. Federal dollars flowing to New York City’s own budget will free up billions of dollars over the next decade to support new initiatives.
New York City needs a renewed commitment to universal coverage and community-based health that delivers quality, affordable care to every family and every neighborhood.
Throughout his career, Bill de Blasio has fought to keep neighborhood hospitals from closing, expand access to reproductive health care for women, bring nurses and mental health professionals back to our schools, and enact a strong public health agenda that fights diseases stemming from smoking and obesity.
No neighborhood should ever face the total loss of the doctors, nurses and services of a community hospital. No New Yorker should ever go without life-saving screenings and preventative health care that can help them live longer, healthier lives. As mayor, Bill de Blasio will pursue an ambitious public health agenda that builds on New York’s status as an innovator and increases accessibility for every family.
Take Advantage of the Affordable Care Act to Expand Coverage
While an estimated 500,000 additional New York City residents will gain coverage under the Affordable Care Act, nearly a million more will still lack coverage. However, since 67 percent of those uninsured are projected to be eligible for but not enrolled in ACA programs, a full-scale campaign mobilizing all city agencies and supporting community-based organizations to do outreach will not only increase coverage for New Yorkers, but increase federal dollars flowing to the city that can help free up resources for other health care initiatives for the remaining uninsured.
The city’s health department has created a detailed outline of ways to coordinate existing resources like ACCESS NYC, NYC Business Express, and other city resources with grants to community-based organizations — especially those in immigrant communities — to create a comprehensive “navigator” program that will supplement state efforts to enroll the uninsured. Bill de Blasio will commit every financial and human resource needed — which will be repaid through the new federal dollars flowing to the city — to enroll 600,000 more New Yorkers in ACA-covered health insurance programs by 2018.
Protect Community Hospitals
The loss of a single hospital can hollow out health care for an entire community. As mayor, Bill de Blasio will help older hospitals that form the safety net in the outer boroughs to thrive again. Instead of gambling on costly outside consultants to turn troubled institutions around, de Blasio will work to partner financially-strained institutions with flagship hospitals here in the city that can help pool resources, share best practices, and improve quality of care. In Albany, de Blasio will champion for community safety-net hospitals by fighting for fair funding, protecting institutions from speculators, and reducing waste that threatens hospitals’ thin margins.
The city’s public hospitals administered by the Health and Hospitals Corporation must also be protected. HHC remains the primary source of health care for the uninsured—and even after the Affordable Care Act is in full effect, HHC will remain critical to serving communities across the city, including more than half a million undocumented persons. De Blasio will also resist any efforts to downsize this vital health network.
Expand Capacity Of and Access to Community Health Centers
Expanding community health centers is a cornerstone of federal and state health reform goals, since they provide an integrated approach to care for patients regardless of their documentation status or ability to pay. Building on new funds for community health centers provided in the ACA, Bill de Blasio will create at least 16 new community health clinics in the communities of highest need — identified by the New York State Health Foundation — and increase the efficiency and capacity of existing clinics by improving productivity, filling staff vacancies, and keeping them open longer hours. City health centers should be serving 500,000 additional patients by 2018.
Fill the Nursing Shortage With Health Care Workers Trained Here in New York City
Health care is one of the fastest-growing parts of our economy, and the expansion of coverage in coming years will just increase the need for health care workers. While there are tremendous opportunities for those with the right skills, right now New York hospitals and health facilities need to recruit abroad to fill 16,000 nursing positions, because too few New Yorkers have the necessary skills. By investing in training programs in our high schools and at the City University of New York, Bill de Blasio will ensure New York City graduates have the skills needed to fill health care positions created in coming years and deliver care to those who need it.
Expand Primary Health Care Clinics at or Adjacent to Worksites to Serve City Employees
Health care costs for the city’s 300,000 municipal workers, their families, and 200,000 retirees are expected to hit $8.3 billion by 2018. To help bring those costs down, Bill de Blasio will work through the city’s Health and Hospitals Corporation (HHC)—which already delivers services to more than a million New Yorkers—to create or contract 20 new primary health care clinics to serve city employees at or close to their workplaces. These convenient clinics would encourage preventative care and take advantage of HHC’s scale to provide services at a lower cost. The city can incentivize workers to use the clinics by waiving co-pays and providing flexible scheduling to use them. This would improve access and the quality of care for the city’s workforce. The city could save $750 million to $2 billion through long-term savings by investing just 2 percent of current health care spending in these clinics over four years.
Expand Affordable Housing Support For Patients With High-Cost Health Needs
One major factor driving up health care costs is that patients with chronic illnesses are often homeless or are precariously housed, leading to inconsistent treatment and higher medical costs. Studies reviewed by the New York State Medicaid Resign Team found that providing supportive housing to chronically ill and disabled homeless patients cut Medicaid treatment costs by thousands of dollars. As mayor, Bill de Blasio will support efforts to fulfill the NY-NY III agreement and invest Medicaid savings in supportive housing development and services. He will also work to create a broader successor agreement that increases the supply of supportive housing for homeless people, including persons living with disabilities, persons living with mental illness, families, unaccompanied youth, young adults, veterans, seniors, survivors of domestic violence, and people exiting correctional facilities.
Support Nursing Home Transition
Bill de Blasio supports New York’s Nursing Home Transition and Diversion program because he believes that it is important to provide seniors and those with disabilities the ability to stay in their own homes, but to do so while maintaining access to vital services.
Ban Use of Condoms as Evidence in Prostitution Cases
Police confiscation of condoms as evidence in prostitution cases creates disincentives for prostitutes to use or even carry prophylactics. This jeopardizes public health by making the spread of sexually transmitted diseases more likely. Bill de Blasio supports state legislation that would prevent prosecutors from using condom possession as proof in court in prostitution cases.
Make Our Schools Centers of Healthy Lifestyles and Supportive Services
As a public school parent, Bill de Blasio values the role our schools can play in helping our children live healthier lives. By funding the biggest expansion of after-school programs in the city’s history, de Blasio will revive athletic programs that have been decimated by years of cuts. He will bring gym classes back to schools that have lost them. To better serve many students with special needs, Bill will accelerate the adoption of “community school models” that partner schools with community-based organizations to provide mental health services on campus. As mayor, de Blasio will end the wasteful and damaging practice of needlessly sending children to the emergency room for mental health issues that should be attended to within a school setting.
Protect HHC’s Ability to Serve Undocumented Immigrants
Federal health care reform excludes undocumented immigrants, who will then come to depend even more on the city’s Health and Hospitals Corporation for health care. As health care reform is implemented, Bill de Blasio will designate high-ranking officials at HHC and the city’s health department to protect immigrant families’ access to health care.