David Robinson

Medical decisions muddied by money

The coming year is poised to fundamentally change American medicine. For many New Yorkers, medical decisions are increasingly muddied by money. Their health care needs are often diminished, postponed or ignored due to cost concerns. The financial crisis fallout spans everything from more patients shouldering medical debt to government budgets overwhelmed by Medicaid spending.

From the national landscape to the local scene in Westchester, Rockland and Dutchess counties, the following is a look at the top health-related issues, the key figures who will drive decisions and milestone dates to watch for during 2020.

On the beat

The rising cost of health care is pushing the U.S. medical system to the breaking point.

Many hospitals in rural and poor communities are losing money and facing service cuts or closure.

State and federal governments are struggling to keep pace with rising demands of paying for Medicare and Medicaid. Patients are drowning in a tsunami of unaffordable drug prices, flawed health plans and counterproductive health system spending.

The Lower Hudson Valley is seeing repercussions in everything from hospitals suing patients over medical debt, like the 99,000 lawsuits in New York challenged by federal regulators, to the planned closure of Montefiore Mount Vernon Hospital.

Patients are caught in the middle of clashes between health plans and hospitals over insurance coverage deals. All the while hospital executive bonuses and payouts keep mounting as New Yorkers spend more on health care expenses than the rest of the country.

Yet hotly debated reforms aiming to fix health care are ready to boil over.

The 2020 election is offering the referendum, headlined by the presidential race.

On one side, President Donald Trump is vowing to drive down patients’ expenses in part by boosting medical industry competition, driving down drug prices and replacing the Affordable Care Act, commonly known as Obamacare. On the other, many Democratic presidential candidates are pushing universal government-run health care, known as single payer or Medicare for All, or plans to shore up and expand Obamacare.

Meanwhile, New York is facing a Medicaid budget crisis that threatens to destabilize its entire health care system.

Nursing homes this year sued the state, claiming it illegally slashed $352 million in Medicaid funding and endangered services for the elderly, as well as tens of thousands of jobs.

And regulators are warning the state budget is facing a $6 billion hole in 2020 thanks largely to Medicaid cost spikes.

Lawmakers are braced for fights over further cuts to the program providing health care to millions of New Yorkers.

What follows are key details about the political, social and economic battles looming over these complex issues during the coming weeks and months. The outcomes touch all aspects of life in the Lower Hudson Valley and beyond.

What to watch for

Affordable Care Act endgame. A federal appeals court on Dec. 18 struck down a key part of the Affordable Care Act, ruling the GOP and Trump administration tax reform effectively eliminated the individual mandate. A lower court must now decide if the law should be wiped out.

If that happens, New York in part would lose key federal subsidies for millions of low-income people getting insured through its state-run Affordable Care Act marketplace, forcing tough state budget decisions. The case could be headed to the U.S. Supreme Court next year.

Medicaid budget war in New York. Funding the government health care program that covers more than 6 million poor and disabled New Yorkers, or about one-third of the state, is expected to drive a state budget gap of $6 billion in the coming year.

Albany-based think tank Empire Center attributed it in part to rising Medicaid enrollment, the minimum wage increase and a budget gimmick used earlier this year by Gov. Andrew Cuomo to delay paying Medicaid costs. Closing the gap in 2020 will likely require major cuts to medical services, or a plan to find enough savings elsewhere in the budget.

Universal government-run health care’s big moment. After years of debate, key federal and state lawmakers are poised for their strongest push yet to pass single-payer health care legislation.

Leading Democratic presidential candidates Elizabeth Warren and Bernie Sanders offer similar Medicare-for-All plans. And in New York, some lawmakers in the Democrat-controlled Legislature are championing the New York Health Act to guarantee health care for all New Yorkers.

Though critics have slammed both plans as unrealistic due to systemic costs, they are expected to be front and center in the 2020 election season.

The cost of curbing the opioid epidemic. A growing chorus across law enforcement, health care and social services suggests American government isn’t spending enough money to stem the historic drug addiction crisis underway.

But high-profile lawsuits accusing drugmakers, distributors and other businesses of creating and fueling the opioid epidemic seek to help fill the void.

The outcome of the cases is expected to determine how billions of dollars in legal settlements and judgements gets spent on anti-addiction efforts.

Marijuana legalization reboot. Leaders of New York’s Legislature are gearing up for another push to legalize marijuana use for adults, after a similar bid this year failed under opposition from educators, doctors and law enforcement. Gov. Cuomo is eyeing a regional plan for recreational marijuana legalization, calling on governors of New Jersey and Connecticut to strike a deal on the issue, as well as ongoing efforts to crack down on the dangers of vaping nicotine and marijuana through devices commonly called e-cigarettes.

Why you should care

Health care is facing drastically divergent paths in the coming year. Almost all of them will change how patients can access and afford medical care.

The ripple effects will be felt across all aspects of American life, as politicians and health industry players fight over the fate of one-fifth of the U.S. economy and overall public well-being.

Key players

Gov. Andrew Cuomo. His handling of New York’s Medicaid budget gap has far-reaching implications for millions of patients and thousands of workers. The governor’s budget plan will also establish the political agenda for a variety of health issues, such as marijuana legalization, opioid addiction and single-payer legislation.

Michael Dowling, president and CEO of Northwell Health, formerly North Shore-LIJ. The Long Island-based health system with 70,000 employees at 23 hospitals, including Northern Westchester in Mount Kisco and Phelps Memorial in Sleepy Hollow, is the largest private employer in New York. Its multibillion-dollar expansion plans have affected medical providers across the region.

Dr. Philip Ozuah, the newly named president and CEO of Montefiore Medicine, the Bronx-based health system with 15 hospitals, including Nyack, Mount Vernon and New Rochelle. Montefiore is a national leader in community-based programs seeking to reduce costs and improve patient outcomes, but its plan to replace Mount Vernon’s hospital with a new $41 million outpatient facility has drawn criticism from some community leaders.

Robert Friedberg, president Nuvance Health, the health network serving 1.5 million patients across the Hudson Valley and Western Connecticut. Nuvance, which includes Vassar Brothers Medical Center in Poughkeepsie, Northern Dutchess Hospital in Rhinebeck and Putnam Hospital in Carmel, was formed earlier this year after the $2.4 billion mega merger of Health Quest Systems of LaGrangeville and Western Connecticut Health Network. Its efforts are expected to reshape health care across the region.

Michael Israel, president and CEO of WMC Health, the Vallhalla-based health system anchored by Westchester Medical Center, the Hudson Valley’s only top-level trauma center that recently had a major overhaul. The 10-hospital system has been expanding its footprint into Rockland, Dutchess and Orange counties.

Key dates

Jan. 20: The high-profile trial in New York of drugmakers and other pharmaceutical industry players accused of creating, feeding and profiting off the opioid epidemic was moved up to early 2020 amid similar court battles in other states. The case is being argued in state Supreme Court in Suffolk County and has implications for dozens of counties and cities statewide that filed similar lawsuits seeking money to combat drug addiction.

April 1: New York budget deadline. The fate of everything from the looming Medicaid budget gap to recreational marijuana legislation is expected to be lumped into the state budget debates.

Nov. 3: Election Day. Health care reform will be a central campaign issue during a volatile battle for control of state and federal governments. Other dates of note in the presidential race include the primary fights throughout February and March for Democrats.

By the numbers

67%: That’s how much medical spending for a typical family of four with employer-sponsored health insurance increased between 2008 and 2018. It reflected spending about $4,700 for premiums and $3,000 for out-of-pocket costs like deductibles and co-payments, according to a Kaiser Family Foundation study. Wages only rose 31% during that same time period and inflation increased 21%.

$88 billion: The amount Americans borrowed in 2018 to pay for health care, according to a Gallup survey funded by a nonpartisan health group. Yet despite all the borrowing, one in four Americans still skipped medical care because of costs.

34: The number of opioid pain pills distributed per person in Ulster County. The tally is part of billions of painkillers that flooded New York, igniting the historic drug-addiction epidemic. In contrast, Dutchess County had 29 pills per person, Rockland County had 22 and Westchester County had 18. Communities hit hardest by the addictive meds are vying for larger portions of the multi-billion-dollar legal settlements being proposed in state and federal courts.

78.6: The average life expectancy in the United States, which continues to be dragged down by rising midlife mortality. Experts contend the trend stems from an American workforce plagued by drug overdoses, suicides and organ-system diseases while grappling with economic stresses. In contrast, the average longevity in similar high-income countries is 82.2 years, with Japan at 84.1, France at 82.4 and Canada at 81.9.

$2.9 billion: That’s the projected deficit in in New York’s $70 billion Medicaid program, and the gap is expected to grow to $3.9 billion by 2023. The shortfall comes amid an otherwise strong economy, underscoring how rising health care costs have reached a tipping point in New York.

© 2020 The Journal News

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The Empire Center is an independent, non-partisan, non-profit think tank located in Albany, New York. Our mission is to make New York a better place to live and work by promoting public policy reforms grounded in free-market principles, personal responsibility, and the ideals of effective and accountable government.