NYS Health Foundation Releases Positive Report on Health Reform

“Health Reform Works: How the Affordable Care Act Is Already Making a Difference for New Yorkers”

By creating new options for health coverage and building on existing sources of public and private health coverage, the Affordable Care Act (ACA) will give many people an opportunity to access affordable and comprehensive coverage. Important provisions of the health reform law have already taken effect, benefiting millions of New Yorkers as a result.

A new NYSHealth-funded publication by Health Care for All New York and the Community Service Society shares the personal stories of families, small business entrepreneurs, senior citizens, and students across New York who have already been helped by the ACA. The report offers a window into the impact that the new law has had on New Yorkers and shows how changes to the health insurance system can improve the lives of those dependent upon it.

ACCESS the report.

Montefiore Nurses Win New Contract, January Strike Averted

2,300 Bronx nurses make gains on staffing, wages, affordable health care

BRONX, Dec. 30, 2011 – The New York State Nurses Association has successfully negotiated a new, four-year contract with Montefiore Medical Center in the Bronx.

The 2,300 professional registered nurses who work in the hospital made important advances in safer patient staffing, affordable health care, and fair wages, comparable to their colleagues at other New York City unionized hospitals. The nurses had given the hospital a strike notice for Jan. 10, 2012, because of their staffing concerns.

“Our members at Montefiore stood together to get a contract that’s good for our patients, our nurses and our families,” said Judy Sheridan-Gonzalez, RN, president of the Montefiore’s Moses Division bargaining unit. “The nurses give their very best every day to patients, and deserve a contract that treats them and their work with dignity and respect.”

The contract will provide about 125 new RN positions, salary increases of 7.5 percent over four years, a $750 lump sum payment on ratification and affordable prescription benefits.

The strike notice for Tuesday, Jan. 10, has been withdrawn.

The nurses will vote on the proposed contract in January.

The New York State Nurses Association is the voice for nursing in the Empire State. With more than 37,000 members, it is New York’s largest professional association and union for registered nurses. The association represents registered nurses, and some all-professional bargaining units, in New York and New Jersey. It supports nurses and nursing practice through education, research, legislative advocacy, and collective bargaining.

Flushing Hospital Threatens to Terminate Nurses’ Health and Pension Plans

RNs to protest with informational picketing on Jan. 5

FLUSHING – Upset that management plans to stop payments to their health and pension plans, registered nurses at Flushing Hospital Medical Center are planning a protest for next week.

The RNs are currently negotiating a new contract with management and are seeking to improve their working conditions. But hospital CEO Robert Levin has refused to sign interim agreements that continue the benefit plans.

To show management they won’t be intimidated, the nurses will conduct an informational picket from 11:30 a.m. to 1 p.m. Thursday, Jan. 5, in front of the hospital at 4500 Parsons Blvd.

The current contract for the 350 nurses, who are represented by the New York State Nurses Association, will expire on Dec. 31, 2011. The interim agreements would guarantee continuation of both for six months after contract expiration while the parties continue to negotiate. Health benefits continue 90 days after expiration whether the interim agreement is signed or not. But their pension plan would end on Jan. 1, 2012.

The RNs say that comprehensive health and pension coverage is necessary because RNs are likely to suffer from health problems developed while on the job – such as neck and back injuries, high stress, and risk of exposure to contagious disease – and often cannot continue working until the average retirement age of 65.

Quality health coverage is also a key element in encouraging RNs to come to Flushing Hospital and convincing experienced nurses to stay. Improving recruitment and retention, in turn, is crucial to improving RN-to-patient staffing. Studies have shown that hospitals with better staffing have better patient outcomes.

CEO Levin has also put proposals on the table that would cost each nurse $150,000 in lost lifetime pension benefits, while offering no wage increase for three years.

The New York State Nurses Association is the voice for nursing in the Empire State. With more than 37,000 members, it is New York’s largest professional association and union for registered nurses. The association represents registered nurses, and some all-professional bargaining units, in New York and New Jersey. It supports nurses and nursing practice through education, research, legislative advocacy, and collective bargaining.

NYSNA, St. Luke’s-Roosevelt Reach Agreement-Strike Notice Withdrawn Pending Ratification

MANHATTAN – The New York State Nurses Association, which represents the 1,300 registered professional nurses at St.Luke’s-Roosevelt Hospital Center in Manhattan, has reached a tentative agreement with hospital management.

Members will vote on the proposed four-year contract on Wednesday, Jan. 4, 2012.

The tentative agreement addresses the nurses’ principal concerns throughout the negotiations – affordable health care, relief for members with high prescription costs, safe staffing levels for patients and nurses, and fair wages.

With this tentative agreement, negotiations continue at two remaining major New York City hospitals – Mount Sinai Hospital in Manhattan and Montefiore Medical Center in the Bronx.

An agreement was ratified by the nurses at New York-Presbyterian Hospital earlier this month.

The New York State Nurses Association is the voice for nursing in the Empire State. With more than 37,000 members, it is New York’s largest professional association and union for registered nurses. The association represents registered nurses, and some all-professional bargaining units, in New York and New Jersey. It supports nurses and nursing practice through education, research, legislative advocacy, and collective bargaining.

St. Luke’s-Roosevelt Nurses to Strike on January 3, 2012

St. Luke’s-Roosevelt Nurses to Strike on January 3, 2012

Fighting for Affordable Health Care and Fair Pay

MANHATTAN – Early Thursday morning, the registered nurses of St. Luke’s-Roosevelt Hospital Center in Manhattan filed notice with hospital representatives that they will strike at 7.30 a.m. on Tuesday, January 3, 2012.

The 1,300 nurses – members of the New York State Nurses Association – have been working without a contract since December, 2010, and have had 25 bargaining sessions trying to reach a new agreement.

The strike notice was given during a marathon 18-hour bargaining session that ended at 4:00 a.m.

“The hospital’s response to our concerns about affordable health care did not meet our members’ needs. We are now mobilizing in the hospital for the January 3 strike,” said Nancy Kaleda, NYSNA’s bargaining director. “While we made some progress on staffing issues in the talks, the healthcare issue carries huge weight for our members and their families.”

Two other major New York City hospitals are also in the middle of intense contract bargaining — Mount Sinai and Montefiore. The Mount Sinai negotiations continue today, Montefiore talks resume next Tuesday. Those NYSNA members have also authorized strikes, but the union has not presented the strike notice yet.

The New York State Nurses Association is the voice for nursing in the Empire State. With more than 37,000 members, it is New York’s largest professional association and union for registered nurses. The association represents registered nurses, and some all-professional bargaining units, in New York and New Jersey. It supports nurses and nursing practice through education, research, legislative advocacy, and collective bargaining.

- 30 -

Key Lawmakers Urge Cuomo To Include Health Exchanges In Budget Proposal

By Laura Nahmias

Several key lawmakers hope Gov. Andrew Cuomo will re-start the process of creating health insurance exchanges in New York next month by including the stalled plan in his budget proposal.

The exchanges were a priority of Cuomo’s first legislative session, but failed in the Republican-led Senate amid lawmakers’ concerns that voting to create the exchange – part of President Barack Obama’s health care reform – could become a political liability in the 2012 elections.

The Supreme Court is scheduled to hear a challenge to health care reform in the spring, but Sen. Jim Seward and Assemblyman Joseph Morelle, chairs of the insurance committees in their respective chambers, said they hoped the governor would not wait until then before passing the bill. The closer the state gets to presidential elections, they warned, the more politically charged the issue becomes.

“I think it’s been so identified with the president and the politics of the presidency, that they’ve avoided or not really focused on the real benefits this provides, not only in terms of benefits to small businesses, but quality of care, improving patient outcomes,” Morelle said Friday at a City & State forum on health insurance exchanges sponsored by HealthPass New York.

“My fear is that this gets played out over the next year-and-a-half, and I think that would obviously put New York in a very, very bad position,” he said.

Without a bill authorizing the insurance exchanges, the logistics of running the program, such as renting office space, or hiring staff, have been delayed. Federal law requires the exchanges be functional by Jan. 1, 2014, leaving New York with less time to make decisions. The bill passed the Assembly earlier this year, but remains stalled in the Senate.

Seward said the Republican conference decided to wait to pass the bill – which he considered soundly written – until more details came from the federal government about what services the state would be required to insure.

“In New York, let’s face it, we have a number of mandates in our policies, more than perhaps anywhere else in the country,” Seward said. If the federal government insured fewer services than New York’s broadly mandated services, the state could be liable for the cost, he said.

But that question was settled just hours after the forum, when the U.S. Department of Health and Human Services issued guidelines outlining essential benefits. The state could have its already mandated services covered under the federal plan, which would alleviate concerns about potential hidden costs.

The HHS guidelines set up a system whereby each state could determine its own essential benefits package, avoiding the possibility the federal government could be seen as imposing costly mandates on the states. In New York, it means people will continue to receive the same services they’ve always had, no more and no less, said Ben Geyerhahn, a Hudson TG who studies health care for the Small Business Majority.

“I think it will disappoint some consumer advocates who had hoped for more standards,” he said. “I don’t think, from a policy perspective there’s going to be a lot of change.”

Even if a bill to set up the exchange should pass in the next budget cycle, other key stakeholders voiced concerns about how it would work.

Separate exchanges that only cover small businesses, or ones that cover both small businesses and individuals could be considered under the state’s plan. And what the governor ultimately decides could have enormous financial consequences, because of the expense of covering individuals, said Margaret Moree, director of federal affairs at the Business Council of New York State.

“Everyone understands that the individual market in New York is under incredible stress,” Moree said.

Those considerations offered even more reasons for New York to authorize the exchange sooner rather than later, said Peter Newell, Health Insurance Director at the United Hospital Fund.

“I think my sense of urgency for not having legislation in place yet comes from the fact that you reach a point where … you need to have an exchange that can go out to the health plans and say, what kind of products are you going to offer? Are you going to play or not? What sort of network choices do you have?” Newell said.

“The exchange needs to get a sense of what kind of hand it’s going to be dealing to businesses and individuals who come and shop there,” Newell said, “because at the end of the day, they’re going to have a product to sell, and unless it’s a good product, people won’t buy there.”

Nurses at Mt. Sinai and Montefiore vote to strike

Vote sets the stage for a possible strike by 7,000 NYC nurses

MANHATTAN & BRONX, Dec. 9, 2011 – Registered nurses at Montefiore Medical Center and Mt. Sinai Medical Center have voted to authorize a strike if hospital management does not settle contracts that provide the best possible patient care, affordable health care for nurses and their families, and decent wages. The nurses at Montefiore and Mt. Sinai now join their colleagues at St. Luke’s-Roosevelt Hospital Center, who voted last month to authorize a strike.

The 7,000 registered nurses at the three hospitals, members of the New York State Nurses Association, are working together to win fair contracts at a time when hospital management at some of the city’s most prestigious and most profitable hospitals are using the difficult economic climate as an excuse not to reasonably compensate nurses for their extraordinary, daily contributions to the well-being of their patients and to the success of the hospital.

“Many New York nurses are working with long-expired contracts. A strike is our last resort,” said Judy Sheridan-Gonzalez, bargaining unit president of Montefiore’s Moses division.

“In 2010, 5 NYC hospital CEOs made almost $18 million!” Sheridan-Gonzalez said, quoting numbers from a Nov. 27, 2011 New York Post article. “We are demanding that we be able to protect our patients with safe staffing ratios. We are also standing up to the corporate agenda that has been squeezing workers across the country to pay more for benefits in order to fix years of their own mismanagement.”

Nurses have been at the negotiating table for months with the three hospitals and management has consistently refused to adequately address the nurses’ concerns about affordable health care premiums, reasonable wages and patient care issues.

The nurses at New York-Presbyterian Hospital had also authorized a strike in late October, but have now reached a tentative agreement that addresses key staffing concerns and would not increase the nurses’ health insurance benefit costs. A ratification vote for the proposed contract is underway.

“The nurses at Mt. Sinai stand together with our colleagues at St. Luke’s-Roosevelt, Presbyterian and Montefiore,” said Jacklynn Price, bargaining unit president at Mt. Sinai. “Our members give patients excellent care, and they need and deserve quality health benefits for themselves and their families, just as we provide care for all of our patients.”
In addition to preparing for a possible strike, the Nurses Association has launched a new 60-second radio ad on several New York-area stations, in which Karine Raymond, a working nurse from Montefiore, seeks support for the middle-class nurses in their contract fight against the millionaire hospital executives.

The nurses will decide in coming days when they will begin the strike notification process with hospital management.

The New York State Nurses Association is the voice for nursing in the Empire State. With more than 37,000 members, it is New York’s largest professional association and union for registered nurses. The association represents registered nurses, and some all-professional bargaining units, in New York and New Jersey. It supports nurses and nursing practice through education, research, legislative advocacy, and collective bargaining.

Nurses Association contact: Robin Wood (518) 782-9400, ext. 223

Retirees Sue State over Health Insurance Increases

The Retired Public Employees association group representing about 40,000 retired public employees today Thursday filed suit against Gov. Andrew Cuomo’s increased health insurance for the state workforce — which also applies to retirees.

“He didn’t have the right to do this to current retirees,” contended Stan Winter, president of the Retired Public Employees Association. He was referring to the increased share that state retirees, along with current workers, are now paying toward their health insurance premium.

Read the entire article: Health Insurance

Insurance Premium Transparency is Good; Next Stop: Provider Transparency

MVP Health Care CEO Dave Oliker shares his thoughts on a wide range of topics related to health care and health reform on his blog. Dave’s posts reflect his unique perspective based on his more than 30 years of experience in the health care industry.

Here’s his latest post:

Determining health insurance premiums every year is a complicated business. A health plan has to look at what services its covered population used this year, see how close it came to predicting that correctly, try to determine how the population will change, then project how much that population will use next year, and how much that is likely to cost.

And that’s the oversimplified version. There are people who are very good at math—actuaries—who do this job. Then, when the health plan files its premium rates with the state, government actuaries analyze and certify the data.

Starting this year, New York’s Department of Financial Services wants to make all that data and all the calculations for every health plan available to the public. I say, good. Transparency is almost always in the public’s interest.

Of course, the public isn’t composed entirely of actuaries. They may not be able to make sense of the numbers they see. Or they may not care to. Or they may be tempted to take a figure out of context to prove a point.

But that’s the risk we take any time we make information freely available. I’m confident that those who look closely at the data will find something significant there, something they might not have just taken my word for: the fact that rapidly increasing health care costs generally drive increased premiums.

It’s true that sometimes, as I explained in an earlier post, a big increase can come from a change in the coverage pool. If the covered population changes drastically, the change in its health care usage—and therefore its premiums—can be drastic too.

But if health care usage stays the same and premiums go up anyway, the culprit is obvious: rising health care costs. That’s what the data show. And once people understand that, they might even want to see the math behind those costs. Why do hospitals (and doctors and pharmaceutical companies and so on) charge what they charge?

If insurance premium transparency is a public good, shouldn’t we have provider transparency too?

Seeking a Cure for Troubled Hospitals in Brooklyn

by Nina Bernstein

When the pain in his groin was too great to bear, Ralph Hutchins, who works as a mover, headed to the crowded emergency room at the nearest hospital one recent Tuesday, his life at risk. Tanya Boynton, a mother of four who works 12-hour shifts, hobbled into another emergency room from a homeless shelter, afraid illness would end her job.

They needed care in the heart of Brooklyn, not far from the world’s richest concentration of premier hospitals. Only a few private hospitals have survived in neighborhoods like Bedford-Stuyvesant, Brownsville and Bushwick to serve poor patients like them. Now all are in such dire financial shape that a small group of veteran health care planners appointed by Gov. Andrew M. Cuomo is debating last-ditch measures to save them.

For decades, the fallback solution in American cities has been to close such hospitals.

But one of the actions being considered by the group may be even more radical: expunge the hospitals’ debt of more than $1 billion, partly at taxpayer expense, and then let large for-profit companies take over the facilities and restructure patients’ care. Experts say what ultimately becomes of the hospitals could make them a model, or a disastrous experiment, in the delivery of health care to the poor.

The proposals are still being drafted but are already generating concern among public health advocates, who worry that the changes would shred a frayed medical safety net and send the poorest and uninsured patients to other overwhelmed hospitals, especially to three public hospitals that are at capacity and facing new budget cuts.

Proponents say this fear is unfounded. But it runs deep in New York State, which added a right to health care to its constitution during the Great Depression, and is the only state that still prevents large companies and their stockholders from owning hospitals.

“If we don’t figure out a way to redesign the system, we’re going to have free-fall bankruptcies not only in Brooklyn, but all over the state,” said Stephen Berger, chairman of Mr. Cuomo’s Brooklyn Work Group. Its recommendations are due this month.

Brooklyn shows the acute stage of a problem that has vexed the nation for years: how to sustain delivery of major medical care to the poor. After the crack and H.I.V. epidemics of the 1980s, either shrinking hospitals with empty beds or letting them fail was seen as a way to make the system more efficient. But as big cities lost more than half their hospitals, closings were concentrated in places like central Brooklyn, where the bed-to-population ratio is now below state and national averages and busy hospitals are struggling financially despite high occupancy rates.

Kings County Hospital Center, Woodhull Medical and Mental Health Center and the State University of New York Downstate Medical Center, the three public hospitals in the area, could shoot up to as much as 130 percent of capacity and face a third more emergency room visits if even one or two of the most vulnerable private hospitals closed, according to a study submitted to the Berger group by the union representing interns and residents at public and private hospitals.

Alan Aviles, the president of New York City’s public hospital system, said it was making contingency plans for such a flood but could not go it alone, particularly since the collapse of the city’s Roman Catholic hospital network.

“We have to make sure that we still have voluntary safety net hospitals that are capable of sharing in that effort,” he said, noting that city hospitals already provided 75 percent of all outpatient care to the uninsured.

To stay healthy, experts say, even nonprofit private hospitals need a 3 percent profit margin. Only two of Brooklyn’s 10 private hospitals are doing that well, and of the five considered endangered — Interfaith Medical Center, Wyckoff Heights Medical Center, Brookdale University Hospital and Medical Center, Kingsbrook Jewish Medical Center and Brooklyn Hospital Center — some are hemorrhaging money.

Questions about mismanagement hang over some of these institutions, but analysts agree on the basic problem: Most of their patients rely on Medicaid, the government insurance program for the needy, which has been repeatedly cut as eligibility expanded.

There is no confidence that the national health care overhaul will help. Indeed, federal cuts expected through 2013 will disproportionately hurt the same hospitals. In neighborhoods with mainly black and Latino residents, in a borough of 2.5 million where more than one in five residents live below the poverty line and two in five receive Medicaid, the five endangered hospitals account for 83,000 admissions, 325,000 emergency room visits and 760,000 clinic visits a year.

The case of Mr. Hutchins, who showed up at Wyckoff, illustrates the strain. It was the third time in two months he sought help, he said. This time, at his insistence, the hospital admitted him.

Surgery revealed a strangulated hernia so far gone that cutting out life-threatening infected tissue left an open wound, he said.

Cost efficiency demanded speedy discharge; last year, Medicaid cut by 31 percent what it would pay for a case like his. But before Mr. Hutchins could be released, the hospital had to get him a portable wound pump.

At hospitals that pay suppliers promptly, administrators say, the device typically gets same-day delivery. At Wyckoff, it took a week.

Wyckoff’s general counsel, David Hoffman, said the hospital was like a homeowner with an underwater mortgage. Its buildings are worth a fraction of the $88 million it owes on a $140 million state loan, used in 1994 to rebuild. Its reserves are gone.

Such hospitals have not benefited from recent gentrification in Brooklyn. Affluent newcomers typically keep ties with their Manhattan doctors, who send them to hospitals there with the prestige to get top dollar from private insurance plans.

In 1980, Brooklyn had 26 hospitals; now it has 15, and 41 percent fewer acute-care beds — 2.3 beds per 1,000 residents, compared with Manhattan’s 4.7, the state’s 3.1 and the nation’s 2.6.

That pattern has played out nationwide, said Alan Sager, a professor of health policy and management at Boston University who has analyzed decades of hospital closings in 52 cities.

Professor Sager found that what best predicted that a hospital would be closed was not inefficiency, but location in a minority neighborhood, and for-profit hospitals were likeliest to close.

Proposals to save the Brooklyn survivors include a federal waiver that could redirect state Medicaid savings to so-called safety net hospitals, and a push for additional mergers. Another idea is making one or more of the hospitals a free-standing emergency department, a concept being tried at the defunct St. Vincent’s Hospital in Greenwich Village.

The proposal requiring the most salesmanship, and possibly a change in law, would leave taxpayers, bondholders and other creditors to absorb the hospitals’ net debt and then invite investors into a reformulated health care network.

Steven Moore, an executive with PricewaterhouseCoopers, the consultants invited by Mr. Berger to sketch out this proposal, likened Brooklyn’s indebted hospitals to banks with toxic assets, and suggested a bailout first. “Our premise is you have to design a system that will attract private capital,” Mr. Moore said. “Private capital is more efficient, it demands productivity, it demands creativity, it demands innovation.”

It also demands profits. Many experts doubted the proposal’s contention that 20 percent to 30 percent waste could be safely carved from Medicaid spending in Brooklyn to yield a reliable return of about 7 percent.

At the Greater New York Hospital Association, the lobbying group for hospitals, board members worried about people without insurance, particularly the city’s many illegal immigrants. Getting rid of toxic assets — hospitals’ debt — would not solve the problem of patient mix and revenue, said Kathleen Shure, an association executive, and “the board fears that it will end up in for-profit entities getting rid of ‘toxic populations.’ ”

Mr. Berger, an investment banker and veteran of health commissions, is impatient with such objections. “Health care is not hospitals,” he said. “Health care is an integrated system, a network,” one that requires new patterns of investment.

By law, hospitals must provide emergency care. But it is unclear what that might mean in a reformulated for-profit system, particularly for people in pain who damage the bottom line, like Ms. Boynton, 40, who limped into Interfaith with what turned out to be an acute attack of gout the same day Mr. Hutchins went to Wyckoff.

She would have preferred the Bronx clinic in her Medicaid managed-care plan, but her family had been evicted from its Bronx apartment after the landlord failed to make repairs required for a housing subsidy. At Interfaith, she got a three-day prescription that put her back on her feet and commuting, from a Brooklyn homeless shelter to her $300-a-week job at a home goods store on the Upper West Side of Manhattan.

Mr. Hutchins, 50, now discharged, is also on the mend. The hospital’s prognosis is more guarded.

“We stay open at the grace and generosity of our vendors,” said Mr. Hoffman, Wyckoff’s general counsel. “They know it will eventually get better, because we have to have hospitals. Otherwise, we’ll have sick and dying people lying in the streets, and nobody wants that.”