NEW YORK STATE PARTNERSHIP FOR COVERAGE HEARING
Good morning Secretary Baker, Commissioners Daines and Dinallo. I am Arthur Gianelli, the President and Chief Executive Officer of the Nassau Health Care Corporation which is headquartered in East Meadow, Long Island, about 30 minutes east of Manhattan.
A profile of the New York State Uninsured recently released by the New York State Department of Health identified 121,000 Nassau adults and an additional 26,300 Nassau children as “uninsured”. The profile identified an additional 165,900 Suffolk adults and children as uninsured. We all find it quite shocking that more than 18 percent of Long Islanders, lacking health insurance, have very serious barriers to the Island’s excellent health care system.
After decades of unsuccessful attempts to create national universal health care access, I am here to add our voice in support of the Governor that the time has come to address the national problem of “access to health care” regionally. We applaud and support the Governor’s recent proposals
Expand health insurance coverage to all 400,000 of New York’s uninsured children by raising the eligibility threshold for Child Health Plus to 400% of the federal poverty level;
Streamline Medicaid enrollment to ensure that those already eligible for health coverage receive and maintain coverage;
Restructure Medicaid spending to follow the patient rather than simply subsidizing healthcare institutions;
These are the most important avenues to improving access to health care and improving health care outcomes. However, our long experience in serving populations of under and uninsured persons encourage us to pose these additional recommendations:
Expand the community based facilitated enrollment efforts. It is our experience that thousands of eligible families, for a variety of reasons, are unaware of these benefits or because of embarrassment or fear, fail to enroll their children or themselves in these important State health benefits . they often avoid preventive care leading to more expensive interventions.
Initiate and underwrite Public Outreach Campaigns. History has demonstrated that outreach efforts work when regularly and persistently undertaken. Enrollment programs should include sufficient fiscal resources to underwrite this most important component
The State should partner directly with providers- in particular its safety net facilities – to create insurance products for the uninsured. Such products should be subsidized through a combination of funds presently made available for charity care and additional State funding to effectively transition to a full insurance model. The safety net facilities can be the sponsors of such products, as they are the facilities who work with the uninsured the most, and are committed to dealing in particular with health care disparities. This proposal re crafts the role of safety net facilities in the context of full health insurance. In this context I would provide the San Francisco example as well as more modestly our catchment area proposal.
Private Health Plans should be required to participate in community health reinvestment programs. Private insurance companies are extracting far too much in financial resources from an already beleaguered health care system. This concept is modeled after similar efforts made in the banking and community development industries. Reinvestment of profits into the “health care” of the community including technology, patient safety and quality of care.
The Nassau University Medical Center is a primary provider of health services to Nassau populations without access to sufficient financial resources. Based upon our experiences in providing these services I would take this opportunity to express our concerns about moving forward.
Expansion of insurance coverage should not come at the expense of funds made available for charity care, as these funds are presently inadequate to cover losses incurred by providers. Over time, one would hope that improved health care outcomes would lead to lower costs, but this is not a short term proposition.
For such a structure to be useful, there needs to be a reworking of reimbursement to properly cover the cost of outpatient services, since the expansion of insurance coverage should be connected to a wellness / medical home model.
Finally, recently released data about financing long term care reveal that more than 70 percent of the Medicaid expenditures are for 20 percent of the users. we believe that any discussion of universal coverage is incomplete without addressing the largest, most pressing financial problem affecting health care in this nation: long term care.
We strongly urge the State to expand Medicaid managed long term care plans. Small regional efforts at supporting older and disabled persons in their homes is not only cost effective but also humane.
However, changes in the approach need to be undertaken to ensure that this effort simply does not become an extension of the already fractured system of health insurance. Rates for these managed care plans need to be regional, rather than a plan-specific. The recent failed history of the Long island based Health Partners underscores the importance of this recommendation. We also need to eliminate incentives to cherry-pick, and to appropriately reimburse plans whose patients reflect greater complexity.
We also believe that lacking a national solution to the financing of long term care that the State should update and expand The New York State Partnership for Long-Term Care. Presently, only a relatively small number of New Yorkers participate in this important program that is a unique combination of long-term care insurance and Medicaid Extended Coverage. Similar to the community based facilitated enrollment projects that are essential for the success of Child and Family Health Plus, we believe that similar efforts need to be undertaken to expand participation in the New York State Partnership. While only a short term solution to the Long Term Care financing effort, it can hopefully defer at least a portion of the enormous expenses associated with this benefit.
I would conclude with a general admonition that the State will undermine its sincere reform efforts by connecting reform to the short-term reduction in Medicaid funding through the same tired means (trend factor, etc). If this is what occurs in the budget, it is easy to forecast that the debate will be forged between the Governor and the Providers about cuts, not about fixing the system. If this happens, all of these great plans will collapse.