New York State
Medicaid cuts jeopardize care for millions who rely on New York’s safety net hospitals
Nonprofit health care systems may have to make difficult choices about which services to keep.
Hospital staff at Brookdale Hospital Medical Center in Brownsville, Brooklyn. One Brooklyn Health
Under fireworks and fanfare, President Donald Trump signed the One Big Beautiful Bill Act into law on the Fourth of July, but health experts warned it would unleash the most sweeping upheaval to America’s health care system in decades. Some of New York’s safety net hospitals are already examining how to adapt to the loss of funds.
The $1 trillion in Medicaid cuts could result in 11.8 million more people becoming uninsured by 2034, according to estimates from the Congressional Budget Office.
“The cuts will have a ripple effect in our communities and in our economy,” said Dr. Sandra Scott, CEO of One Brooklyn Health, a nonprofit health care system with three hospitals in the borough. Scott said while there will be direct impacts to Medicaid patients and the professionals who care for them, the new law will affect the entire health care system. Patients with private health insurance who also rely on safety net hospitals may see their health care options shrink. “ I’m not sure that it’s clear to the average person what this means to them,” Scott said.
Hospitals and community health centers across New York state face $8 billion in Medicaid cuts and 1.5 million New Yorkers will lose their health coverage, according to Gov. Kathy Hochul’s office. The Greater New York Hospital Association and the Health Care Association of New York State estimated that the law will lead to 34,000 lost hospital jobs in New York.
The Health Care Association of New York State said in a written statement that the bill “represents the largest erosion of our health care system in history and will significantly impact New York’s health care system, reducing coverage for millions and straining our hospitals and health systems.”
The GOP bill contained modifications to the premium tax credit eligibility that would reduce revenue for New York’s hospitals by an estimated $1.4 billion per year, according to the Greater New York Hospital Association. The changes affect immigrants, low-income residents who qualify for Affordable Care Act marketplace subsidies and those enrolled in New York’s Essential Plan, the state’s basic health coverage program. The association said the harm will be most acute at safety net hospitals in underserved communities like the three in the One Brooklyn Health network. “I think this is going to create catastrophic changes,” Scott said. As many as 90% of the people who depend on One Brooklyn Health are covered by Medicaid. Scott said there’s no way they’ll be able to avoid a reduction in services, “which means there will be a decrease in access to care, not only for those whose insurance is cut, but also for everyone who uses those services.”
The nonprofit health care system in Central Brooklyn is already exploring which services to keep and which to cut. “ We are in communities that have a 12-to-13-year life expectancy gap compared to communities in Manhattan,” Scott said. “So we have a particular challenge in that the population we’re serving, their health outcomes are already less than what’s desired.”
Scott believes that safety net hospitals will dig in around services that address widespread community health issues, and reduce or eliminate care in specialty areas. “ We know that certain chronic conditions have the highest cost of care. For example, diabetes, hypertension, emphysema, those chronic conditions, if not well managed, are the drivers of the high cost of health care,” Scott said. One way they’re looking at reducing those costs is by focusing on wrap-around services that keep those patients healthy and reduce the likelihood of hospitalization.
Scott said she thinks it’s unrealistic to expect the state to make up for the federal cuts to Medicaid. “ More and more hospitals post-COVID have required subsidies. That’s been a challenge for the state,” Scott said. “Now, these Medicaid cuts are another extreme financial challenge.”
Two weeks before the bill was passed, House Minority Leader Hakeem Jeffries joined hospital leaders at a press conference at Brookdale Hospital Medical Center, which is part of the One Brooklyn Health system. He called the Medicaid cuts unconscionable. “Children will be hurt. Everyday Americans will be hurt. People who rely on Medicaid with disabilities will be hurt. Many older Americans will be hurt,” Jeffries said.