HHS plans to cut $1 billion in federal funding that underwrites New York State's Basic Health Program, which creates one more challenge for the nation’s largest municipal health system.
If the Trump administration makes good on its plans to cut about $1 billion in funding for New York State's Basic Health Program, then a big share of the burden of doing more with less will fall upon the state's safety net hospitals.
John Jurenko Jr., vice president of government relations at New York City Health and Hospital Corp., says about 73,000 patients at the nation's largest municipal health system rely on the BHP for coverage. If that funding goes away, Jurenko says, NYCHHC will have to find another way to provide the care. NYCHHC already provides approximately $1.4 billion in uncompensated care annually.
"Eliminating this program, which essentially could restrict access to coverage for some people in the state, runs against healthcare policy that you want people to have continuous coordinated care so they stay healthier, they stay out of hospitals, and out of the emergency departments when they come in at the end when they are really sick," he says. "This is very short-sighted for the federal government to do this."
About 700,000 New York state residents are covered under the BHP, which began in 2015 and which is also called the Essential Plan. The funding, created under the Affordable Care Act, targets people who earn between 133% and 200% of the federal poverty level: the working poor who make too much to qualify for Medicaid, but not enough to afford health insurance premiums. While the program was made available to all states, only New York and Minnesota have BHP programs. Minnesota's BHP covers about 100,000 people.
Earlier this week, Minnesota and New York filed a joint lawsuit against the Trump administration and the Department of Health and Human Services, claiming that the funding cut violates the Administrative Procedure Act protocols for making administrative payment decisions. In mid-December, HHS told New York state officials, via email, that they would not receive a payment of $266 million for the first quarter of 2018.
"The Essential Plan is a lifeline for over 700,000 low-income New Yorkers. The abrupt decision to cut these vital funds is a cruel and reckless assault on New York’s families – and we will not allow it," New York Attorney General Eric T. Schneiderman said in prepared remarks. "I won't stand by as the federal government continues to renege on its most basic obligations in a transparent attempt to dismantle the Affordable Care Act. We’re suing to defend these vital funds and the quality, affordable health care they ensure for New Yorkers."
Jurenko says that many of the people on New York’s Essential Plan would be hard pressed to find affordable coverage without help, and would likely have to rely upon charity care.
"If it were to go away, it would make our jobs harder because we would see more and more uninsured folks," he says. "That's bad financially and bad for the patients in terms of the continuity of care, and it seems to run counter to what state and federal policies on the healthcare side had been; where it was to ensure access to coordinated healthcare services where you don't want to have people coming in for episodic care in the emergency department."
It's unlikely that New York can step in to fund the program, he says, because state legislators are already wrestling with a $4 billion shortfall. With few other options on the table, Jurenko says NYCHHC may have to make do with less.
Last year NYCHHC served a patient base of 1.2 million people, about 410,000 of whom were uninsured, Jurenko says. "We would not want to see that number go up. We have been doing everything we can to try to get more and more people who are eligible but not enrolled to get them coverage. This only makes matters worse," he says.
"Our CFO has already lost all his hair, because it's very hard to plan with all this uncertainty," he says. "But our commitment to New Yorkers is unwavering. We will always serve New Yorkers regardless of their ability to pay."
"But, it makes it hard because at the end of the day someone has to pick up the tab for the care," he says. "We will have to pick up any shortfall on the financial side for people who come in and are uninsured. Our staff in our facilities, our hospitals and community health centers, would be working with individuals to see if they're eligible for public health insurance."
"We are not going to eliminate programs. It will make it more financially difficult for us if we have larger numbers of uninsured, but we are still going to provide services to them."
John Commins is the news editor for HealthLeaders.