N.Y. needs Medicaid waiver
Kenneth E. Raske, Times Union
By Kenneth E. Raske and George Gresham, Commentary
Updated 11:09 am, Friday, September 13, 2013
If you Google "Brooklyn hospitals" these days, you'll see plenty about the looming closures of Long Island College Hospital and Interfaith Medical Center, the dire fiscal plight of several other Brooklyn hospitals, and the uncertainty gripping the borough's most vulnerable communities and thousands of health care workers.
But the number of financially reeling hospitals — usually "safety net" facilities serving poor and uninsured patients — extends far beyond Brooklyn. From the Bronx to Buffalo, years of inadequate reimbursement, relentless government funding cuts, huge numbers of uninsured patients, and a still-sluggish economy have left dozens of hospitals in perilous financial condition, with many fighting for their survival.
The numbers tell the story: 14 hospitals have closed across the state in just the last five years. We're fast approaching a tipping point where additional closures will severely harm New York's health care delivery system and threaten access to care — just as baby boomers reach their senior years and the Affordable Care Act is set to extend health coverage to a million currently uninsured New Yorkers.
Despite that grim scenario, a healthier financial future for New York's hospitals is tantalizingly close. Last year, the state submitted a $10 billion Medicaid waiver request to Washington to transform health care delivery in New York from a fragmented system that prioritizes institutional care to an integrated system of highly coordinated care. The waiver funds would target primary care expansion, public health innovations, safety net hospital stabilization and workforce flexibility.
A rapidly shifting health care landscape is forcing hospitals to restructure their business models and care for patients beyond their physical walls. These structural changes vary from hospital to hospital, but they all share the "triple aim" of improving population health, enhancing the patient care and reducing health care costs.
New York's hospitals have embraced this challenge and have already made important strides. Under Gov. Andrew Cuomo's leadership, the state's Medicaid Redesign Team developed a five-year action plan that includes more than 200 recommendations, many of which have already lowered health care costs and improved quality.
Our hospitals need additional resources to continue. They need Washington's help. They need the waiver.
And the waiver is far from a handout — it's funding we've earned. The MRT's initiatives, including a "global cap" on Medicaid spending, have already saved huge sums and are projected to save the federal government $17 billion over the next five years, making the waiver a sensible reinvestment of a portion of those savings. The waiver will enable hospitals to implement new care delivery models and help ensure that New York has the necessary health care workforce for the future.
The waiver has the strong support of Sen. Chuck Schumer, Sen. Kirsten Gillibrand, and the New York Congressional delegation. At a time when consensus rarely crosses party lines, the waiver enjoys near-universal support among New York's elected officials.
Health care in New York is at a crossroads. Numerous Medicaid reforms have helped the state lower its health care costs without compromising quality and access, but as the Brooklyn crisis affirms, too many of our safety net hospitals lack the resources to build on that momentum, transform their delivery models and continue to meet the health care needs of their communities. The waiver would both acknowledge the progress New York has made and deliver the tools to stabilize vital institutions for years to come.
On behalf of the patients our hospitals and health care workers serve, we urge Washington to approve New York's Medicaid waiver.