New York City Mayoral Candidates Focus on Uninsured, But Overlook Reimbursement, Access Issues, New York Times Reports

The Aug. 20 New York Times analyzes health care proposals from the city's mayoral candidates, who have "homed in" on the city's 1.7 million uninsured and its "troubled" public hospital system. But by "so narrowly focusing their interests and proposals, most of the candidates have overlooked or misinterpreted other key health care questions in the city, such as where people are able to get care once they are placed in a health care plan," the Times reports. Further, almost all the candidates have the "key goal" of expanding public insurance programs, but many of those proposals require state or federal action, the Times reports. For example, "most" of the candidates said they favor extending Medicaid benefits to legal immigrants, who are barred by federal law from receiving such benefits until they have lived in the United States for five years. Also, candidates have proposed prenatal care services for undocumented immigrants, which a federal appeals court recently ruled is not something the federal government must cover under Medicaid. As for expanding public health programs, City Council Speaker Peter Vallone, who is vying for the Democratic nomination, has an "aggressive plan" to increase enrollment in Child Health Plus, the state's CHIP program. Under his proposal, the city would cover premiums at a cost of $108 to $180 annually per child, or a total of $147 million per year. But the Times reports that the "issue of premiums may be the wrong one to focus on" because studies have shown that a "modest" premium does not prevent parents from enrolling their children in public health insurance. Further, premiums "remove the stigma that a free public program carries," the Times reports.

Missing the Big Picture
"There has been a lot of focus on getting kids enrolled. That is very important. But insurance without infrastructure is not access to health care," Dr. Irwin Redlener, president of the Children's Health Fund, said. The Times adds that "few" of the mayoral candidates have discussed the city's "frayed" public hospital system, which has had to deal with "poor" reimbursement rates. Although Democrats Mark Green, the city's public advocate and Fernando Ferrer, the Bronx borough president, have advocated increasing Medicaid reimbursements, managed care reimbursements in particular are "integral" to the city's problems, the Times reports. Managed care rates for primary and pediatric care are "low," which could be a "crucial problem" as the city moves all Medicaid beneficiaries into managed care programs in the next few years. During a three-hour forum on health care last week, none of the candidates mentioned that issue, the Times reports. Dr. Luis Marcos, president of the Health and Hospitals Corporation, said, "[The candidates] are missing the big picture here, which is that if any mayor wants to provide free care they have to think of how funding is going to be arranged" (Steinhauer, New York Times, 8/20). For further information on state health policy in New York, visit State Health Facts Online.