From the New York State Assembly
Health Committee    July, 2001

Sheldon Silver, Speaker    Richard N. Gottfried, Chair

Key Health Bills Stalled in Albany

Dear Friend:

Key health issues with broad support continue to be stalled in Albany. All the bills in this Health Update have passed the Assembly with overwhelming bipartisan votes. But as this Health Update goes to press (early July), there has been no response from the Governor or the State Senate — no talks, no negotiations, no counterproposals.

It’s as if we didn’t have over 3 million uninsured, no staffing crisis, no need for managed care reform. The Governor and the Senate need to be in touch with the health concerns of New Yorkers.

Sincerely,

Richard N. Gottfried
Chair, Assembly Health Committee

Simplifying Access to Health Care
Coverage for Low-Income New Yorkers

The Assembly has passed legislation to cut red tape that blocks people from getting Child Health Plus, Medicaid or Family Health Plus.

Over one million uninsured New Yorkers are currently eligible for Child Health Plus or Medicaid but don’t have that coverage because of needless bureaucratic obstacles that make it difficult to sign up. People eligible for Family Health Plus will face similar hurdles.

We can do more than any other state to reduce the number of uninsured without creating any new program if we overcome the bureaucratic obstacles to getting Medicaid, Child Health Plus and Family Health Plus.

The bill would simplify enrollment and recertification under Child Health Plus, Medicaid and Family Health Plus by reducing documentation requirements, simplifying applications, eliminating the need for personal interviews and allowing mail-in applications. The bill would set consistent eligibility procedures for all three programs.

The bill also expands income eligibility for Child Health Plus, the Prenatal Care Assistance Program, and family planning services under Medicaid.

The bill is strongly supported by New York City Mayor Rudolph Giuliani, whose city administers and pays for a large part of the Medicaid program; State Attorney General Eliot Spitzer, who is in charge of investigating and prosecuting Medicaid fraud; and a broad coalition of consumer advocates, health care providers and managed care plans.

The Simplification bill (A.7909) is sponsored by Assembly Health Committee Chair Richard N. Gottfried, Assembly Insurance Committee Chair Pete Grannis, Assembly Social Services Chair Deborah Glick and 60 additional Assembly Members.

Family Health Plus for Immigrants

The Assembly has passed a bill to extend health care coverage under Medicaid and Family Health Plus to legal immigrants.

The recent Court of Appeals Aliessa v. Novello decision extends coverage under Medicaid. But the Governor has hesitated to apply this decision to Family Health Plus, even though that program is part of Medicaid. The bill would also clean up the statute to reflect the court decision and clarify coverage for certain services where there is an explicit Federal financial participation requirement.

Denying health care coverage to low-income working legal immigrants has a devastating impact on their health, the public health, and our health care delivery system. Hospitals and community health centers are overburdened by the growing number of uninsured. Lack of access to primary and preventive care also means individuals are unlikely to get routine health screenings and treatment for communicable diseases.

Under the 1996 Federal welfare changes, the Federal government no longer pays for Medicaid for many legal immigrants (except for emergency care). Specifically, most legal immigrants who entered the country after August 1996 are ineligible for Federally subsidized Medicaid coverage for five years after their arrival. New York State adopted the same limits.

A number of states, including New York’s neighboring states of Connecticut, Massachusetts, New Jersey and Pennsylvania have chosen to provide Medicaid for these legal immigrants using state funds. New York does cover immigrant children under Child Health Plus.

Immigrants contribute to New York’s economy and population growth. Studies show that immigrants pay 15.2% of the State’s income taxes and 17.4% of residential property taxes.

The bill provides that the State will cover the full cost of expanding coverage, without any additional local share requirements.

The Medicaid-Family Health Plus Immigrants bill (A.7774) is sponsored by Assembly Members Perry, Espaillat, Gottfried, Glick, Grannis, Colman, Jacobs, P. Rivera, Rhodd-Cummings, Silver and Tokasz. The bill is sponsored in the Senate (S.5223) by Senator Roy Goodman.

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.

The Assembly has passed a bill to restore prenatal care to uninsured low-income women, regardless of their immigration status.

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 in future health care costs.

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. A recent study in California estimates that every dollar spent on prenatal care avoids $3.33 in the cost of postnatal care and $4.63 for 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. Under the bill, eligibility for PCAP would be based only on income, not immigration status.

The net cost would be about $5 million a year – but would save an estimated $50 million from improved birth outcomes.

In the Federal court case, Lewis v. Grinker, Gov. Pataki and Mayor Giuliani joined the Legal Aid Society, the March of Dimes, the medical profession and others, to support payment for prenatal care. The recent New York State Court of Appeals decision in Aliessa v. Novello, that needy legal immigrants are entitled to Medicaid coverage on the same basis as citizens, did not involve undocumented immigrants. This bill would cover them.

The PCAP Immigrants bill (A.8953) is sponsored by Assembly Member Gottfried and 46 additional Assembly Members.

Nursing Home Staffing

The Assembly has passed a bill that sets minimum staffing ratios for nurses and certified nurse aides in nursing homes.

There is a strong connection between the amount of staffing hours and the quality of care. More important than fingerprinting employees, raising fines or hiring more inspectors, the greatest factor in the quality of care in New York’s nursing homes is direct care staffing levels.

We have an obligation to protect our nursing home residents. We also have an obligation in future budgets to assure that nursing homes have enough funding under Medicaid to comply with this legislation. This legislation would force the Governor and the Legislature to meet our obligation. Without it, the crisis will get worse and worse.

The Assembly Health and Aging Committees held hearings in December and January on nursing home staffing. The Committees found that inadequate staffing levels in nursing homes affect elderly residents who need meals delivered, call bells answered, and help getting to therapy and recreational activities. In addition, a large number of residents need help with daily activities such as bathing, grooming, and eating. The low staffing levels at many nursing homes are lowering the quality of care, jeopardizing patient safety, making work harder and more hazardous for workers, and driving many workers out of the nursing home field.

We have heard testimony of nurse aides having to take care of 10 to 15 people at a time. Workers often injure themselves or suffer from undue emotional stress because their workload is simply too large. The result is a high turnover rate, which disrupts important caregiving relationships between staff and the residents, and an inability to fill staff vacancies. Nurses and nurse aides say, "we just need more people to help."

The staffing ratios would take effect in January 2005. The Health Department could also set higher ratios in particular cases. By January 2003, each nursing home would report to the Department on their anticipated staffing needs and how they plan to comply with the law.

The Nursing Home Staff Ratios bill (A.4171-A) is sponsored by Assembly Member Gottfried and 54 additional Assembly Members.

Prescription Drug Discount Plan

The State Assembly has passed a bill that would create a prescription drug discount program for people who don’t have prescription drug coverage.

Millions of New Yorkers pay too much for prescription drugs. This program gives them a real break.

The prescription drug discount program would maximize the market power of consumers. The State Health Department would negotiate discounts with manufacturers, using the bargaining clout of the large pool of customers represented.

Big insurance companies, HMOs and Medicaid all negotiate discounts with drug companies. But people without drug coverage pay full price. Consumers need state government to bargain for them.

Any individual could sign up for the discount plan covering any prescription drug purchases not covered by insurance. Any health plan, health care provider (e.g. hospital, nursing home, clinic, or health care practitioner) could join as well.

Participating pharmacies would sell at a discounted price to participating consumers, based on a formula taking into account the program discount and a dispensing fee.

The Prescription Discount Plan bill (A.7557-A) is sponsored by Assembly Member Gottfried and 35 additional Assembly Members.

Health Plan Accountability

Increasingly, HMOs and insurance companies control our health care. They can deny care, cancel tests, refuse hospital admission, send patients home before they are ready, and switch drug prescriptions. And when these acts damage a patient’s health, the health plan is above the law.

The Health Plan Accountability bill says that if a health plan delays or denies care that it was obligated to approve, and a patient suffers harm, then they or a family member can sue for damages.

The point is not to encourage lawsuits. It is to get health plans to provide appropriate care and say "no" only when it is medically justified, and to hold them accountable if they break the rules.

The Health Plan Accountability 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 also includes whistleblower protection for health care providers who criticize a plan for providing inadequate medical care or imposing incentives that encourage the provider to delay, fail or refuse to provide adequate care.

The Health Plan Accountability bill (A.8318) is sponsored by Assembly Health Committee Chair Richard N. Gottfried, Insurance Committee Chair Pete Grannis and 57 additional Assembly Members. The bill is sponsored in the Senate (S.4013) by Senators Guy Velella and James Lack.

Protecting Patients
in Office-Based Surgery

More and more, invasive surgical procedures are being done in doctors’ offices instead of hospitals. But they are not subject to Health Department 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 Assembly has passed a bill to expand the Health Department’s incident reporting system, which now applies to hospitals, to cover office-based surgery. Under the proposal, health care practitioners would report to the Commissioner of Health all complications, mortalities, emergencies and emergency transfers to hospitals that arise during office-based surgery.

The Office-Based Surgery Incident Reporting bill (A.5549-A) is sponsored by Assembly Member Gottfried, Assembly Majority Leader Paul Tokasz, and 31 additional Assembly Members. The bill is sponsored in the Senate (S.3458-A) by Senator Roy Goodman.

The Department of Health issued guidelines for office-based surgery in December 2000. However, these guidelines lack the force of law. A related bill, the Office-Based Surgery Standards bill (A.5548-A), would give the Health and Education Departments authority to adopt enforceable regulations governing office-based surgery. The bill is awaiting Assembly action.

For further information, contact:
Assemblyman Richard N. Gottfried, Chair
Assembly Health Committee
822 Legislative Office Building, Albany, New York 12248
Tel: (518) 455-4941 Fax: (518) 455-5939
E-Mail: gottfrr@assembly.state.ny.us