February 16, 2007
HEALTH BUDGET ON THE GRILL
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NYSDOH braintrust faces the Legislature |
New York's new Health Commissioner, Dr. Richard Daines, and top staff from NYSDOH laid out the details of Governor Spitzer's controversial health care proposals for legislators in two long, hard hours of testimony and questioning Tuesday morning in Albany.
Surprisingly, Daines wasn't subjected to particularly hostile or aggressive questioning by lawmakers; given the high-intensity opposition to Spitzer's proposals from big hospital, union, nursing home and HMO interests, we expected more fireworks.
Housing Works joined 46 other groups in providing testimony at the hearing (you can read ours here); unlike in recent years when we were the only AIDS group testifying, we were joined this year by GMHC and the Legal Action Center.
Multi-year effort on reform
The new Commissioner was straightforward and direct in his approach to lawmakers, laying out the general principles of the Spitzer healthcare budget, which he said was the start of a "multi-year effort to reform the system."
The principles:
- "putting patients first" through coverage expansion and quality improvements;
- "Medicaid spending is unsustainable"—costs would be reduced with a one-year freeze on hospital, nursing home & HMO rates and recalculating service intensity rates;
- "Medicaid should be the payer of last resort" resulting in a phase-out of the Medicare Part D wrap for dual-eligibles;
- "Medicaid monies should be concentrated on Medicaid beneficiaries and the institutions that serve them" -workforce training and retention funds would be targeted based on actual service and structural funding will be shifted "away from expensive institutional care towards community-based settings"
- "renewed commitment to public health" with new initiatives on community, children's and family health.
Daines said Spitzer's restructuring proposals are "fair, strategic3dotsessential reforms that are necessary to prepare the system for the future."
He said they achieve "fiscal restraint, not by taking away health care benefits from our most vulnerable, but by asking hospitals and institutions that receive more funding than anywhere else in the nation to become more efficient"—it turns out that the hotly-contested hospital cuts represent less than 1% of the operating budget of the institutions.
Fuel for the fire
Senate Health Committee Chair Kemp Hannon (R-LI) made it clear he won't let restructuring and reform initiatives through the Legislature without implementing language that's agreed-upon by all three sides.
Assembly Health Committee Chair Dick Gottfried (D-Manhattan), while calling Spitzer's budget "the best health care budget I've ever seen," came closest to skewering Daines and Medicaid boss Deborah Bachrach when he asked for a specific rationale for the one-year freeze on hospital and nursing home rates, contrasting it to Spitzer's approach to education funding that would throw more money at underperforming institutions.
Daines admitted there was no policy rationale for the rate freeze other than the need to "take a pause" on new funding while preparing wide-ranging structural reforms.
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Sens. Montgomery (L) and Hannon (R) grill the commish |
Several legislators used their questions to object to recommendations of the Berger Commission (to which the Legislature as a whole gave a tacit 'OK' by allowing them to pass into law last December).
Senator Velmanette Montgomery (D-Brooklyn) invited Daines and his (all-white) aides to her upcoming "Women of the Diaspora" health conference, noting "I don't see any diversity in your staff here, and I hope you will work to enforce that principle in your work going forward."
To join Housing Works clients and staff in budget advocacy, including at this week's Black, Puerto Rican, Hispanic & Asian Legislative Caucus weekend, send an email to Charles Long at long2@housingworks.org.