Unions Convince Cuomo To Release $360M In Federal Aid to H+H
Infusion Came as City Hospital System Neared Point of Not Meeting Payroll
· By BOB HENNELLY
SQUEEZE PLAY: Interim H+H President Stanley Brezenoff at a conference of health care professionals said he had been forced to consider rolling back hours of operation and consolidation of services, but union leaders subsequently convinced the Governor to pay $360 million of the $380 million in Federal aid owed to the hospital system in three monthly installments.
· The Chief-Leader/Michel Friang
With the city hospital system nearing a point when its ability to meet its payroll would have been in jeopardy, determined lobbying by key union leaders prompted Governor Cuomo Oct. 13 to agree to release most of the $380 million in Federal aid that NYC Health + Hospitals Interim President Stanley Brezenoff had accused him of improperly withholding.
Under the deal brokered by District Council 37 Executive Director Henry Garrido and State AFL-CIO President Mario Cilento, the state will provide H+H with payments of $120 million in each of the next three months to ease the cash crisis that had been fast approaching.
In a letter regarding the Federal Disproportionate Share Hospital program reimbursing hospitals for uninsured and indigent patients they treat, State Medicaid Director Jason Helgerson informed Mr. Brezenoff, “The state will distribute the $268 million for services rendered in prior years. In addition, the state will distribute $92 million in scheduled DSH funding for a total of $360 million as the remainder of their annual allocation.”
Mr. Garrido, who represents a sizable segment of H+H’s 36,000 unionized workers, was said to have devoted virtually all of his energies the previous two weeks to producing relief at a point when Mr. Brezenoff was raising questions about the system’s ability to meet its payroll beyond this month.
Grateful to Governor
While Governor Cuomo had been the target of the anger expressed by both Mr. Brezenoff and Mayor de Blasio, the DC 37 leader in a joint statement with Mr. Cilento said, “The Governor has been focused on helping the working men and women of this state, and today is yet again a champion of organized labor. We thank him for his urgency in listening and responding to the working women and men of H+H, so they may continue to serve the residents of NYC.”
Mr. de Blasio offered no response other than to say that his administration was still reviewing Mr. Helgerson’s letter, reflecting the continued chill in his relationship with Mr. Cuomo. At the time that the relief was announced, the city Corporation Counsel had been preparing legal papers to sue Mr. Cuomo for holding back payments for the care already rendered, which Mr. Brezenoff maintained should have been disbursed to H+H prior to Federal cuts to health care that took effect Oct. 1.
Mr. Cuomo had questioned that the money was overdue while noting that the Federal DSH cuts earlier this month combined with the failure by Congress to reauthorize the Children’s Health Insurance Program that covers 330,000 children statewide, had created a $2-billion budget hole that he said forced the state to defer any payments until it reviewed its obligations to all safety-net hospitals within its borders.
The DSH cuts had actually been scheduled under the Affordable Care Act, which the Obama Administration had assumed would be tenable as more people gaining health coverage reduced the number of patients who lacked health insurance.
Earlier in the week, Mr. Brezenoff had told reporters he had just two weeks of cash remaining, or enough to make the next biweekly $114-million H+H payroll. Beyond that, he said, he was examining reducing the hours of operation for some facilities and the consolidation of services. Earlier in the month, he had announced that the system would be filling just one of every four positions that became vacant.
“The first step to think through the alternative ways to go was for me to tighten the spigot on hiring, so I am now looking at additional possibilities in the hiring field, because when your expenses are 70- to 80-percent personnel, that’s the first place you look,” he said.
Threat to Its Progress
What was at stake, he said, was all of the progress the public-hospital system had made in pivoting away from an inpatient hospital-centric model to an outpatient primary-care wellness approach, with reductions in health-care costs and improvements in health outcomes a result. He confirmed that making that shift remained critical to helping the system’s MetroPlus health-care plan increase its membership. “We have prided ourselves on expanding our hours, we have prided ourselves on continuity of care, we have prided ourselves on introducing care management,” he said. “All those things that are not basic become at risk.”
Earlier this year, NYC H+H eliminated 10 percent of the hospital system’s 4,000 management jobs. Just before the layoffs, Mr. Brezenoff testified at a City Council hearing that “the stark reality is that we are facing a fiscal cliff. We have a large budget gap—$1.1 billion in FY 18, which is increasing to $1.9 billion by FY 21.” He said the management layoffs were part of a $250 million “restructuring and personal initiative” that “is based on industry best practices, to create a more-efficient and financially sustainable management structure to direct resources where we need them most—at the front line of patient care.”
H+H’s unionized employees including members of the Doctors Council, SEIU 1199, the New York State Nurses Association, and DC 37. Throughout his tenure, Mayor de Blasio has committed to avoid layoffs, even as the public-hospital system faced a rising tide of red ink requiring increased support from the city treasury. Since 2003, 16 hospitals outside of the municipal system have closed in the five boroughs.
Trump Kills Subsidies
Labor’s effort to resolve the local standoff came as President Trump took his most-aggressive unilateral step to dismantle the ACA with an executive order ending Federal subsidies that Washington pays insurance companies to help struggling households cover their co-pays and deductibles. That feature of ACA was scheduled to pay $9 billion in such supports in the coming year, with the subsidy growing to $100 billion over the next several years.
The ACA subsidy had already been legally challenged by Congressional Republicans who maintained it was unconstitutional because the Executive Branch paid out the money without a legislative appropriation. In May 2016, U.S. District Court Judge Rosemary Collyer ruled in their favor. Last week Mr. Trump also took aim at the ACA’s state health exchanges by signing another executive order making it easier for alternative health plans—low-cost “bare-bones” coverage—to organize across state lines. Supporters of the ACA said that move was likely to upend the stability of the local exchanges that were the foundation of Mr. Obama’s signature legislation.
In May, Attorney General Eric Schneiderman and California Attorney General Xavier Becerra, led a coalition of Attorneys General suing to defend the health-care-coverage subsidies in Federal court. They were granted intervenor status in August.
‘A Reckless Assault’
Last Friday, Mr. Schneiderman announced a new multi-state lawsuit filed by 19 Attorneys General to defend the health-care subsidies against Mr. Trump’s executive order wiping them out. “These subsidies make critical health care affordable for our most vulnerable,” he said in a statement. “President Trump’s move to cut these subsidies is a reckless assault on the health care of thousands of New Yorkers and millions of Americans.”
“Unable to move the repeal of the Affordable Care Act in Congress, President Trump is now attempting to administratively dismantle the ACA bit by bit,” said Mr. Cuomo in a statement. New York was joined in the latest legal action by California, Connecticut, Delaware, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia.
The states like New York that chose to expand Medicaid as encouraged by the ACA to increase the number of people covered, find themselves in an untenable bind. They are being hit with the billions in cuts the Obama bill required on aid to charity care while they battle Mr. Trump’s efforts to eliminate the parts of the ACA that were working. The President tipped his hand in a tweet last week when he announced his plan to end the “massive subsidy payments to their (Democrats) pet insurance companies. Dems should call me to fix it.” The tweet was followed up by a similar comment to reporters that it was time for the Democrats to come to the table.
CHIP Collateral Damage?
Health-care experts maintain that in taking aim at the ACA, Mr. Trump and Congressional Republicans have undermined key programs like CHIP that have enjoyed decades of bipartisan support. It now provides health coverage for nine million children nationally, although three states have warned that the failure to re-authorize will mean the end of their programs. Officials in Albany say they have sufficient funds to continue the program to the end of this year.
Judith Arroyo, president of District Council 37’s Public Health Nurses Local 436, said the case for CHIP could not be stronger, and failure to re-authorize it unthinkable. “Having health care for children does improve their health outcome,” she said. “You have less absenteeism. They can concentrate better on their school work…Think about it holistically…If a child learns how to take care of their own diabetes—if they know how to count carbohydrates and do the formula themselves and [are] able to manage their own diabetes, then there are [fewer} emergency-room visits. They can participate more in sports and things like that because now, since they know how to take care of their own condition, they can go out and play basketball and mom or dad or a nurse doesn’t have to be hovering over them. The same thing is true with asthma.”