Health and Medicaid Issue Scorecard

KEY PLAYERS

St. Vincent’s Hospital closed in 2010. Photo by Andrew Schwartz

GOVERNMENT
In his first year in office, Gov. Andrew Cuomo appointed three health officials with broad authority to implement his sweeping health-policy vision: Health Commissioner Dr. Nirav Shah, Medicaid Director Jason Helgerson and Deputy Secretary for Health Jim Introne. Cuomo invested Shah with unilateral authority to make cuts where organizations fail, and Helgerson has been charged with coalition-building for cost-cutting ideas in the state’s Medicaid program. Introne serves as a vocal defender of Cuomo’s policies. Assembly Health Committee Chairman Richard Gottfried and Ranking Senate Health Committee member Tom Duane are both advocates for liberal health policy, while Senate Health Committee Chair Kemp Hannon advocates changes in federal reimbursement methodologies. Other important figures include new Medicaid Inspector General James Cox, Department of Financial Services Superintendent Ben Lawsky, Assembly Insurance Committee Chair Joseph Morelle and Senate Insurance Committee Chair Jim Seward.

UNIONS and ASSOCIATIONS
Unions have traditionally played a huge role in the state’s health-care process, with coffers large enough to demand some level of subservience from governors who threaten budget cuts. The most powerful is 1199 SEIU, whose president is George Gresham and political director is Kevin Finnegan. Both Gresham and former SEIU Chair Dennis Rivera serve on Cuomo’s Medicaid Redesign Team. The other important players include the state’s hospital and health-care associations. The most powerful of these are the Greater New York Hospital Association (GNYHA), headed by Ken Raske, and the Healthcare Association of New York State (HANYS), headed by Dan Sisto. Other important association heads include Elizabeth Swain, CEO of the Community Health Care Association of New York State, and New York State Nurses Association CEO Tina Gerardi.

EXECUTIVES AND HEALTH MANAGEMENT
State and city government respect the expertise of hospital and health-management CEOs who combine business management and medical knowledge and serve on advisory boards statewide. Among the most influential are Pamela Brier, CEO of Maimonides Medical Center; Steve Berger, chairman for the Commission on Health Care Facilities in the 21st Century; Michael Dowling, president and CEO of North Shore–Long Island Jewish Health System; Montefiore Hospital President Steven M. Safyer; Continuum Health Partners President Stan Brezenoff and Metropolitan Jewish Health System President Eli Feldman.

THE ISSUES

ECONOMIC DEVELOPMENT
In Cuomo’s second year in office, he has made job creation a focus. One of the fastest-growing sectors of the state’s economy is health care, with massive need projected in areas such as nursing and home-health-care. Additional growth is projected as the state undertakes the effort to digitize health records, an effort doctors say will also improve health outcomes. But the state has also begun to issue competitive economic development grants for the creation of health and biotechnology industries in the western, northern and capital regions of New York. The state plans to monitor the grant recipients to ensure job growth.

HEALTH DELIVERY TRANSITIONS
Following the recommendations the Medicaid Redesign Team made last spring, the state has begun implementing major initiatives to change the way the state delivers health care, including rolling patients from mental-health and long-term-care populations into a system of managed care. Additionally, a special task force is working to consolidate Brooklyn hospitals, giving the state oversight to replace management and also enabling private companies to invest in hospitals. Each of these changes is highly controversial, with vocal supporters and detractors.

FEDERAL HEALTH REFORM
While Cuomo gave nary a mention of President Barack Obama’s federal health-reform law in his State of the State address, health advocates are anxiously awaiting the passage of a bill to set up a key piece of that law in New York—health-insurance exchanges where individuals and small businesses will be able to comparison-shop for insurance. A U.S. Supreme Court hearing on the law known as “Obamacare” is scheduled to begin in March, but more than $27 million has already been doled out in New York to implement the exchange. Other parts of the federal law are already taking effect, including a provision that withholds reimbursements from hospitals that have to readmit patients because of their own errors. Look for federal health reform to serve as a wedge issue between Republicans and Democrats in a presidential election year, and for urban and poorer hospitals’ financial distress to increase under the strain of reimbursement cuts and mandated changes from the federal law.

lnahmias@cityandstateny.com