New York State has just enacted a $175.5 billion budget that will affect the lives of State residents in myriad ways.
Some issues dominated the headlines: congestion pricing for Manhattan, a statewide plastic bag ban, and comprehensive reforms to the cash bail system are in, while recreational marijuana is out (for the time being). After some back and forth, $550 million in proposed Medicaid spending cuts were restored. But other items that have largely flown under the radar could also have important implications for the health of New Yorkers, both positive and negative.
On the plus side, here’s what stands out for me:
Shoring up the Affordable Care Act: More than nine years after its passage, the Affordable Care Act (ACA) remains vulnerable to threats at the federal level. The last Congress was unsuccessful in repealing the law in its entirety, but the 2017 tax bill eliminated the penalty for not having health insurance, effectively eliminating the individual mandate. It is also possible that the courts could strike down the ACA, that administrative changes and executive actions could further erode its provisions, or that a future Congress could dismantle the law in part or in its entirety. Despite the ACA’s popularity and success, its future remains uncertain — a frightening prospect for the millions of Americans who depend on it to get the health insurance and health care they need. More than 4.7 million New Yorkers have enrolled in health insurance through the New York State of Health Marketplace. The ACA also includes important consumer protections, such as ensuring that people with pre-existing conditions can’t be charged more for health insurance and requiring that health plans cover a core set of essential benefits.
The latest New York State budget enshrines key ACA provisions at the State level, regardless of federal law. The intent, as written in the enacted budget, is “that the laws of this state provide consumer and market protections at least as robust as those” in the ACA. The budget specifically lays out the essential health benefits that every health insurance policy must cover, from emergency care to mental health and substance use services to chronic disease prevention and management. It also maintains protections for New Yorkers with pre-existing health conditions. And it codifies the New York State of Health Marketplace in State law, replacing the executive order that was issued to create it initially.
Supporting opioid addiction treatment: The opioid epidemic has not spared New York State; opioid overdose deaths nearly tripled between 2010 and 2016. A number of provisions in the enacted budget target improvements in treatment for opioid misuse. These include removing barriers to buprenorphine administration in emergency departments, a new tax on opioid pills, and additional funding for treatment and support in correctional facilities. The budget also includes a number of technical measures to improve access to affordable substance use treatment services by, for example, limiting co-pays and coinsurance for those services.
Expanding diabetes prevention: Diabetes is estimated to cost New York State $21.6 billion annually in medical expenses and loss of productivity. More than 4.5 million New Yorkers have prediabetes, which means that they are at a high risk for developing diabetes. The National Diabetes Prevention Program (DPP) is a lifestyle and behavior change program focusing on diet, exercise, and weight loss strategies that has been shown to help participants lose weight and decrease their risk of developing diabetes by more than 50%. Preventing diabetes can improve health and lower health care costs, and spreading access to the DPP can help limit adverse impacts, including heart attack, blindness, loss of limbs, and shortened lifespan.
The enacted budget expands access to the DPP to New York’s Medicaid beneficiaries, who can participate in the program through community-based organizations like YMCAs. The program is estimated to save the State $900,000 over the next year and reduce the incidence of diabetes among those at highest risk — a classic “win-win” for public health.