State still pushing on with universal health care study

PHOTOGRAPHER: Sara Foss

Faced with an enormous fiscal crisis, Gov. David Paterson has announced plans to cut almost every area of state spending. But the state is still moving forward with efforts to study and possibly recommend a plan for providing all New Yorkers with health coverage, and advocates for universal health care say they do not expect that process to come to a halt.

“It sounds very counter-intuitive, but crisis brings opportunity,” said James Tallon, president of the United Hospital Fund, a New York City-based think tank. “This is emerging, because of the crisis, as a mainstream, middle-class issue.”

Tallon suggested that the economic situation in the United States has gotten so bad that New York is likely to get additional support for its health insurance programs from the federal government. The change in the White House, he said, should help, as President-elect Barack Obama is likely to provide New York with health care subsidies and monies that the Bush administration had withheld. He predicted that Congress would also pass an additional economic stimulus that would include funding for health insurance programs.

“The economy is so bad we’re going to get additional help,” Tallon said.

Others said they thought the state’s budgetary problems might hinder the process of studying and recommending a plan for providing universal coverage in New York.

“This probably slows it down,” said Mark Dunlea, executive director of the Hunger Action Network of New York State. “I would not be surprised if it comes to a halt in January or February.”

But he said the fact that money is tight actually makes this a good time to consider a single-payer health care system, which is HANNYS’s preferred health care model.

“A single-payer system would cut the state’s expenses for health care,” he said.

Obama optimism

“I’ve heard the governor say that everything is on the table [in terms of budget cuts],” said John Rugge, chief medical officer for Hudson Headwaters Health Network, a nonprofit system of community health centers that serves the Lake George-Glens Falls area. At the same time, he sees Obama as a “willing partner” who will help the state achieve its goal of providing universal coverage.

“It’s such an important thing to do, in terms of justice and humanity, but it’s also important in reducing the costs of providing care,” he said. “We’re already paying for the uninsured. Strangely enough, cost-effective generally means quality effective. It means getting people out of emergency rooms. It means more primary care, more ambulatory care.”

Overall, Rugge is positive about the chances for universal coverage.

“I’m optimistic about the new administration, and I’m quite certain things can’t go on this way,” he said. “It’s like the housing bubble.”

Tallon, who advised former Gov. Eliot Spitzer on health care, echoed some of Rugge’s comments.

“We always understood that health care expansion was going to require a federal partner,” he said. Obama, he said, is likely to be “very supportive” of New York’s efforts.

“Clearly the Obama administration is up against a very tough financial environment, but we’ve always needed a federal partner, and it appears that we’re getting a partner who is very interested in the subject.”

Moving forward

Earlier this year, the state awarded the Washington-based Urban Institute a contract to develop three models for providing universal health coverage and analyze the cost and coverage implications for each proposal. The organization’s report is expected by the end of the year, according to the state Department of Health.

In 2007, the state sponsored a series of public hearings on universal coverage in Glens Falls, Buffalo, Manhattan, Syracuse, Rochester and Old Westbury.

An incremental expansion of the state’s existing health insurance programs is already under way.

This year’s budget provided access to health coverage for the estimated 400,000 uninsured children in New York by increasing eligibility for Child Health Plus, New York’s health insurance plan for kids, which covers children in families that earn too much to qualify for Medicaid. Child Health Plus now covers children in families at or below 400 percent of the federal poverty level; previously, the program covered children in families with income at or below 250 percent of the federal poverty level.

The state had expected the federal government to pay half of the cost of the $37 million initiative, but President Bush vetoed bills passed by Congress that would have provided New York with matching funds.

“The feds resisted,” Tallon said. “But now, I think we’ll get enhancements from the feds.”

Businesses and families can now buy into Family Health Plus, a public health insurance program for state residents, and the Department of Health has been trying to streamline the Medicaid process and get more eligible adults on the rolls.

Dunlea said the state prefers an incremental approach to health care and is particularly interested in the Massachusetts model, which mandates that every resident in the state must have health insurance and provides subsidized health care for residents with earnings at the poverty level or below and partially subsidized health care for those earning up to 300 percent of the poverty level. He said this model is more expensive than it needs to be because of the heavy involvement of health insurance companies. But he acknowledged that this plan has become “the mainstream Democratic plan.”

Economy’s impact

Tallon said the number of people enrolled in the state’s health insurance programs is going to grow because the country is in a recession. Last week, it was reported that the state is starting to see its first increase in Medicaid cases in years. But he said Paterson and the Legislature would make maintaining the state’s health programs a priority.

“I don’t believe anyone is proposing cutting back on the current commitments,” he said.

The state is unlikely to see drastic change in the next six months, but “in a year or two, you’re going to have more people covered and movement toward a more comprehensive program,” Tallon said.

In the short term, the economic collapse could make it more difficult to provide care for people who don’t have health insurance.

Bill Spolyar, executive director of the Schenectady Free Health Clinic, which provides health care for people with no health insurance, is waiting to see whether the state will cut the clinic’s $350,000 grant as part of sweeping cost-cutting measures aimed at reducing the deficit. The clinic survived a round of deep cuts during the summer — an initial cut of 50 percent was later reduced to 6 percent — but isn’t sure what will happen now.

“Obviously with the economy, be it local or national, the demand for health care is going to increase more and more,” Spolyar said.

Recently, there’s been movement on the federal level as well.

Last week, Sen. Max Baucus, D-Mont., unveiled a sweeping health care plan that like the Massachusetts system requires everyone to buy health insurance. The 86-page plan has some similarities to the health care proposal Obama presented on the campaign trail, with one key difference: Obama’s plan did not include an individual mandate.