A Wish List for 2019

December is a time for reflecting on the past year and looking ahead to a fresh start. At this time of year, I always think about what I want to see happen in the New Year.

I’ll spare you the traditional resolutions of “eat better, exercise more, and be sure to get a flu shot” and instead share my wish list for 2019 when it comes to ensuring that all New Yorkers are as healthy as they can be.

1. Healthy, affordable food at farmers markets for all SNAP recipients.The Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of the nation’s nutrition assistance safety net. Known long ago as food stamps, SNAP helps low-income households purchase food. It is the single most important tool to combat food insecurity.

Fresh, local food became more widely available to people of all incomes when farmers markets began accepting SNAP payments. Customers access their SNAP benefits using an Electronic Benefit Transfer (EBT) card. Across New York State, 439 farmers markets and farm stands now accept SNAP. An estimated 60,000 New York households use SNAP at farmers markets; they redeemed more than $3.5 million in SNAP benefits at markets in 2017. Layered on top of SNAP, a variety of food incentive programs help make healthy foods even more affordable and encourage healthy eating.

I wrote this summer about the impending crisis facing SNAP recipients at farmers markets, when the leading provider of the technology for processing SNAP payments and related incentives at farmers markets, known as Mobile Market+ (MMP), announced it would abruptly withdraw because of insufficient revenues. Governor Cuomo stepped in with short-term funding to keep the program going through February 2019, but a long-term solution is needed. If SNAP recipients lose their ability to use those benefits, it would be a major step backward in healthy food access for low-income people.

I’m happy to report that a long-term, sustainable fix appears to be in the works through a public-private partnership. My first wish, of course, is that such a solution comes to pass. But having an agreement on paper isn’t sufficient. There needs to be a seamless transition of MMP, with no interruption in service. Existing MMP retailers need to roll over automatically to prevent attrition, and a robust marketing and outreach plan should expand the customer base to ensure that even more people can use their SNAP benefits and take advantage of healthy food incentives at farmers markets. Retailers should receive top-notch customer support, including technical assistance, training, and service to ensure an excellent customer experience.

2. Affordable health insurance for every New Yorker. For the last two years, the Affordable Care Act (ACA) has been on life support. An outright repeal by Congress seems off the table for now, given the results of the midterm elections. But a federal judge’s ruling last week that the ACA is unconstitutional makes the law’s future — and millions of Americans’ health insurance coverage — uncertain. Full preservation of the ACA had already been on shaky ground; the current administration has been chipping away at the coverage gains and protections that millions of Americans saw through the ACA. Short-term plans, association health plans, the repeal of the individual mandate, a lack of marketing and promotion during open enrollment…the list of ways that the ACA is being undermined goes on and on.

Fortunately, New York State has stood up against these threats. Outreach and support to enroll eligible New Yorkers in health insurance is robust; in fact, enrollment in 2019 coverage is outpacing last year’s sign-ups. The State’s Department of Financial Services has said that short-term and association health plans — which could erode consumer protections, destabilize insurance markets, promote adverse selection, and raise prices — will not be permitted in New York State.

With 1 million people still uninsured in New York State, more work needs to be done. There are lots of ideas being shared at the State level to expand health insurance coverage. From finding ways to cover undocumented immigrants, to implementing a State-level mandate, to providing State subsidies to make coverage more affordable, to establishing a single-payer system, multiple proposals are on the table. They all warrant careful consideration.

3. Access to a Veterans Treatment Court (VTC) for every New York State veteran. Most veterans return home and adjust well to civilian life, but some face challenges as they reintegrate into their homes and communities. For those veterans who do have difficulty transitioning, behavioral health and substance use issues are associated with various related problems such as homelessness, unemployment, and strained relationships. Sometimes these challenges lead to involvement with the criminal justice system.

Veterans treatment courts (VTCs) are a type of specialty court that provide an alternative to incarceration for veterans who have committed low-level crimes and have mental health or substance use issues. Veterans who choose to use treatment courts are offered mental health and/or substance use counseling and can be connected to various veteran-specific community-based services and agencies. VTCs have been associated with reduced recidivism, lower alcohol and drug use, more stable housing, more opportunities for employment, improved relationships with friends and family, and improved mental health.

It’s a point of pride that the very first VTC in the nation was established in Buffalo, New York. Today, the State is home to 33 veterans treatment courts in 25 counties. About two-thirds of New York veterans have access to a VTC if they need one. That’s good — but not good enough.

At the New York Health Foundation, we’ve spent the last several months convening a working group to develop a consensus plan to ensure that every veteran in New York has access to a high-quality VTC. Led by the national organization Justice For Vets, the working group includes representatives of the New York State Unified Court System, district attorneys, state officials, law enforcement, veterans themselves, and other important stakeholders. The most efficient and effective path to universal access to VTCs is a transfer policy, so that veterans facing criminal charges in a jurisdiction without a VTC can be transferred to a county that does have one and get the care and services they need. My wish is for New York State to adopt such a policy in 2019.