Richard N. Gottfried Chair, Assembly Health Committee

The process to enact the new health care package was certainly not good civics. In January, Gov. Pataki demanded that the Legislature agree to enact a health care package without knowing what was in it. The Assembly refused.

Even before this package became an issue, the Assembly Health, Insurance, and Ways and Means committees had already held public hearings and meetings on most of the key issues that were on the table, including the need for increased funding for the health care workforce; the conversion of Empire Blue Cross to a for-profit company; cutting red tape for enrolling in Medicaid, Child Health Plus and Family Health Plus; funding "excess" medical malpractice coverage; and the Governor’s proposals to cut Medicaid, EPIC, and Early Intervention. We got the input of those who would be affected by the package by reaching out to a broad range of health care advocates and providers.

As chair of the Assembly Health Committee, I worked with Speaker Sheldon Silver, Ways and Means chair Herman D. Farrell and Insurance chair Pete Grannis to re-write the package.

The news coverage focused on the election-year politics of the package. Our concern was the substance, and we took effective advantage of the situation. The result: we got the health care workforce funding we had been fighting for, eliminated cuts the Governor wanted, and added major parts of our health policy program to the package that became law.

First, over 1.5 million uninsured low-income working people and their families are eligible for Medicaid, Child Health Plus or Family Health Plus, but are not getting the coverage because of senseless bureaucratic obstacles and paperwork requirements. I have been fighting for legislation to cut the red tape. We got much of that legislation included in the new health package. This will help hundreds of thousands of people get the health coverage to which they are entitled.

Second, we demanded and won an expansion of Medicaid for people with disabilities who are able to work. Previously, if they got a job, their income could be high enough that they would lose the Medicaid services that enable them to be self-supporting (such as home care). Now they will be able to keep Medicaid, with a sliding fee scale.

The core of the package is increased funding to enable the health care system to pay health care workers a living wage and avert a major financial and workforce crisis. I have fought for this funding for a long time. The Assembly got the package expanded to include funding for community health centers, family planning clinics and others – the first time they have been treated on a par with hospitals.

We also defeated Gov. Pataki’s effort to cut Medicaid reimbursements for pharmacies, and reduced the cut for EPIC prescriptions. (Drug manufacturers should get less money, not drug stores.) We stopped his effort to force low-income families of children with disabilities to pay towards the Early Intervention services they now receive free.

The package also includes the expansion of Medicaid authorized by Congress to cover women with breast or cervical cancer who are diagnosed through the Federally-subsidized screening program.

But there are two major disappointments in the package.

First, the package takes 95% of the money that will come from the conversion of Empire Blue Cross and uses it to help pay for the package. Assembly Insurance chair Pete Grannis and I fought to use that money to endow a foundation that would support innovative health programs for decades to come, as was done in California. Instead, almost the entire fund will be used up in three years to subsidize the state budget. That’s not how this important asset ought to be used.

Gov. Pataki wanted all the Empire money to go into the budget, and to enact that as the rule for any future conversions of non-profit health plans. We blocked that, and got 5% of the money for a foundation. If there are future conversions, we will fight to have this foundation receive the proceeds.

Second, while the workforce funding covers some home care workers – those who do what is called personal care – it does not apply to all home care workers. The Assembly fought to have it cover all of home care, but Gov. Pataki refused to budge. We will continue that fight.

The package commits $3.5 billion to cover $1.8 billion in spending over three years. So it looks like the package has a surplus. But about half that revenue is an increase in what we think Washington should pay us for Medicaid, which we may well not get. And the Empire money will run out. We will have to confront these issues in the near future.

Bioterrorism? Epidemic?
Are We Ready?

The September 11 attack, anthrax, and West Nile virus have raised concerns about whether we are prepared for a serious health emergency.

Do we have the necessary resources – emergency personnel, health facilities, testing laboratories? Is there effective State and local planning? Does the government have the right legal tools to deal effectively with a serious health emergency? Would the government need to take charge of hospitals? Quarantine areas? Compel people to be immunized or treated? What protections are needed for people’s individual rights and privacy?

For decades, New York State and New York City have had laws that give public health authorities extraordinary sweeping powers, with few procedural safeguards. Over the years, court decisions have added some limitations. These laws need to be reviewed and modernized.

Long before September 11, the Federal Centers for Disease Control and the Georgetown University Law School, working with several national groups, began drafting a Model State Emergency Health Powers Act. It has just been published.

The Health Committee will be holding a public hearing on the proposal on Thursday, March 14, at 250 Broadway in Manhattan. People who want to testify should contact the Health Committee’s Albany office.

If you would like to see the proposal, it can be found on the web at: www.publichealthlaw.net.

Prenatal Care for Every
New York Baby

For over a decade, New York State and the Federal government have paid for prenatal care for low-income women. In May, a Federal appeals court ruled that under the 1996 Federal welfare changes, Washington would no longer pay for that care for undocumented immigrants. Under New York’s law, the loss of Federal funding ended the State coverage as well.

In February the Assembly again passed a bill (A.8953 by Assembly Health Committee Chair Richard N. Gottfried) to restore prenatal care to uninsured low-income women, regardless of their immigration status. But Gov. Pataki and the State Senate have not yet supported the bill.

Every baby deserves the healthiest start in life possible. Prenatal care for the mother helps prevent complications, low birth weight, premature birth, and long-term disabilities in the baby. Apart from the human need, every dollar spent on prenatal care saves over three dollars.

Every baby born in the United States is a U.S. citizen from birth, even if the mother is an undocumented alien. If the mother is poor, the baby is eligible for Medicaid or Child Health Plus. Denying prenatal care to the mother means increased State-funded expenditures for emergency deliveries, neonatal care, and long-term complications.

New York’s Prenatal Care Assistance Program (PCAP) is a part of Medicaid that provides prenatal, delivery and postpartum care to women whose income is too high for ordinary Medicaid but less than twice the poverty level.

Patient Safety in
Doctors’ Offices

More and more, invasive surgical procedures are being done in doctors’ offices instead of hospitals. But they are not subject to Department of Health (DOH) regulation or oversight. People are stunned when they learn that there are no regulatory standards for office-based surgery, no regular oversight, no reporting of problems. The DOH issued guidelines for office-based surgery in December 2000. However, these guidelines lack the force of law, and they were recently struck down by a court decision. When something goes wrong in a hospital, the state’s nationally-renowned incident reporting system (NYPORTS) requires it to be reported to the Health Department. But there is no reporting when something goes wrong in office-based surgery.

In 2001, the Assembly passed a bill (A.5549, Gottfried) to require incident reporting in office-based surgery. It is expected to pass again this year. The Senate has not acted on this bill.

Making Health Care
Plans Accountable

Managed care companies and other health plans must provide appropriate care and say ‘no’ only when it is medically justified, and should be held accountable if they break the rules.

The Health Plan Accountability bill (A.8313 by Assembly Health Committee Chair Richard N. Gottfried and S.4013 by Senator Guy Vellela) says that if a health plan delays or denies care that it was obligated to approve, and a patient suffers harm, then the patient or a family member can sue for damages.

This bill builds on managed care reforms adopted by the Legislature in prior years including a managed care bill of rights and the right to an independent appeal of a health plan’s denial of coverage.

The bill has passed the Assembly several times, but has never been taken up in the Senate.

Changes Won in
Disaster Relief Medicaid

The Department of Health has announced a transition plan that will extend Medicaid coverage for three hundred thousand New York City residents enrolled in the Disaster Relief Medicaid (DRM) program. The plan is consistent with an Assembly Health Committee report issued in January.

DRM is a temporary program providing four months of Medicaid coverage for any New York City resident earning below the limit set for either Medicaid or FHP. People were allowed to enroll in the program through January 31, 2002. They filled out a one-page form, attested to their income and received Medicaid coverage, usually the same day. They were exempt from the extensive documentation requirements of Medicaid, Child Health Plus and FHP. Governor Pataki created the program in the aftermath of September 11, using existing administrative authority.

In January, the Health Committee released a report calling on Governor Pataki to extend DRM. The report was based on a public hearing held by the Committee on December 3 and prompted by concerns that hundreds of thousands of working New Yorkers would lose their health care coverage unless immediate action was taken.

At the hearing, Health Department officials conceded they had no concrete plans to transition DRM enrollees to Medicaid or FHP or to notify them of the expiration of their DRM coverage.

The Committee report contained several recommendations, including: notification to DRM beneficiaries on how and where to apply for Medicaid or FHP; maintenance of DRM coverage until an individual’s Medicaid or FHP eligibility has been determined; extension of the enrollment period for DRM beyond January 31st and extension of the coverage period beyond four months; notification to health care providers that DRM has been extended; continuation of automatic recertification of Medicaid and CHP beneficiaries in NYC; and streamlining of the Medicaid and FHP application process.

Under the new transition plan, DRM beneficiaries will receive notice of the expiration of their benefits along with an Access NY Health Care application and an appointment date at a NYC Human Resources Administration office. Beneficiaries who submit an application will be kept on DRM until they are accepted or rejected for Medicaid or FHP. Providers will also be notified of the continuation of DRM coverage. In addition, the automatic recertification of Medicaid beneficiaries in NYC will continue until September 2002.

Disaster Relief Medicaid has been a great success. It proves that cutting red tape works. It should be made permanent and statewide.

A full copy of the Health Committee’s report is available from Assembly Member Gottfried’s Albany office at 518-455-4941.

Emergency Contraception

"Emergency contraception" is a special dosage of birth control medication that is used after unprotected intercourse to prevent pregnancy. It has been proven safe and effective. In fact, the American College of Obstetricians and Gynecologists recommends that it should be available without a prescription.

Easier access to emergency contraception is important, because it must be taken within 72 hours. Only the Federal government can eliminate the prescription requirement. But California and Washington have passed laws that allow what is called a "non-patient-specific" prescription for emergency contraception. It does not name a particular patient and can be kept on file at the pharmacy. This makes emergency contraception available without the woman having to go and get a prescription. A bill to make this the law in New York State has been introduced (A.9653 by Assembly Member Amy Paulin) and is currently pending before the Health Committee.

Emergency contraception does not cause an abortion. It prevents pregnancy by preventing a fertilized egg from becoming implanted.

On January 28th, the Assembly also passed a bill (A.2214 by Assembly Member Susan John) to require hospitals to provide information on emergency contraception and, upon request of a rape survivor, emergency contraception to such survivors during emergency treatment.

Telemedicine

Telemedicine — using the internet or other long-distance communication for health care and related services – is rapidly increasing. For example, a specialist half a world away can read an MRI result or consult with a doctor or patient in an underserved area.

The benefits can be extraordinary, but health care professionals, patients, and government have concerns about patient protection and consent, professional licensing, surveillance of quality of care, and insurance.

The Assembly Committee on Health, in conjunction with the Committees on Higher Education and Insurance, will hold a public hearing in 2002 to explore these issues. For details, contact the Health Committee’s Albany office.

Highlights of the Health Package

  $1.8 billion over three years to hospitals, nursing homes, freestanding clinics and personal care providers to support workforce recruitment and retention.

  Extends Medicaid to many low-income uninsured and underinsured women diagnosed with breast or cervical cancer.

  Enacts a Medicaid buy-in program for low-income working disabled persons.

  Finances excess malpractice insurance for physicians.

  Simplifies enrollment and recertification for Medicaid, Child Health Plus and Family Health Plus.

  Authorizes conversion of Empire Blue Cross/Blue Shield to a for-profit corporation; 95% of the proceeds help fund the health care package, and 5% endows a new foundation for health initiatives.

  Increases the tax on cigarettes by 39 cents, from $1.11 to $1.50, with proceeds dedicated to the health package.

  Re-establishes 6% assessment on nursing home revenues. The Assembly fought to have the full 6 percent assessment be reimbursable by Medicaid and to limit the assessment to three years. The Governor had proposed that the 6 percent assessment be permanent, and that only 5.4% be reimbursable.

  To reduce Medicaid costs, mandates the generic substitution of brand name drugs under Medicaid unless physician gets prior approval; exceptions to be allowed.

  Requires private insurers to coordinate benefits covered by EPIC and Early Intervention to reduce program costs.

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NYS Assembly Health Committee
Richard N. Gottfried, Chair
822 Legislative Office Building
Albany, NY 12248

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