A Wish List for 2020

As we prepare to turn the page on 2019, I’m reflecting on this past year and thinking how 2020 can be even better.

I’ve made some personal resolutions and I want to see the NY Mets win the World Series. Professionally, I want New Yorkers to be as healthy as they can be. If I had just three wishes to make that happen in 2020, here’s what I’d focus on:

1. Protect and expand access to healthy food. We all think about food a lot during the holiday season; it’s a central part of our culture. Food is also one of our most basic human needs. Yet more than 10% of New York households — more than 87,000 families — were “food insecure” in 2018, meaning they didn’t have “enough food for an active, healthy life for all household members.” People should not be hungry in one of the world’s richest nations.

In a year with its share of depressing headlines, some of the worst have been truly devastating proposals that will leave hundreds of thousands more New Yorkers hungry and without access to affordable healthy food. It was just announced last week that the Trump administration will move forward with a rule that will drastically shrink eligibility for Supplemental Nutrition Assistance Program (SNAP) benefits. More than 100,000 New Yorkers are now slated to lose their SNAP benefits as of April 1. As I said in public comments denouncing the proposed policy (mine were among nearly 150,000 comments, most of them critical, and largely ignored), the new rule will “cut food benefits for struggling people, take food out of hungry Americans’ mouths, and cause harm to our communities and economy.”

Additional federal rules are in the works that could restrict access even further. We should be better than this, and we can be better than this. No family should go hungry in New York State in 2020. We need to expand access to healthy and affordable food, not restrict it.

2. Ensure universal access to veterans treatment courts (VTCs). This wish is a repeat from last year’s list. We still haven’t quite achieved it, so I’ll say it again.

VTCs offer an alternative to incarceration for veterans with mental health and/or substance use issues. They provide treatment and services instead of jail time, and they work: VTCs have been associated with improvements related to recidivism, alcohol and substance use, mental health, housing, employment, and interpersonal relationships. The very first veterans treatment court in the nation was established in Buffalo, and about half of New York’s counties now have a VTC. That’s good, but not good enough.

The next step is to make sure that every New York veteran who needs one has access to a high-quality veterans treatment court. The New York Health Foundation brought together a diverse group of stakeholders — including judges, prosecutors, law enforcement, State officials, and veterans themselves — to develop a plan that would establish a transfer policy between counties. Today, a veteran who has an opioid addiction and is charged in Niagara County, which lacks a VTC, is out of luck. Under this plan, that same veteran could go through a VTC in adjacent Erie County and get his life back on track. Even better? The plan won’t cost a penny.

We’ve seen momentum for universal access to VTCs this past year. Both houses of the New York State legislature are considering bills that would allow for a transfer policy between counties. Governor Cuomo has expressed support for VTCs and a transfer policy. 2020 is the year to ensure that New York has the biggest and best VTC program in the nation.

3. Simplify medical bills for patients. Patients pay out of pocket for growing shares of their health care expenses as they enroll in high-deductible and consumer-directed health plans. But it’s hard for them to get reliable information ahead of time about what they can expect to pay for health care services. A majority of New Yorkers say they want information about health care prices and quality to make more informed decisions, but they also overwhelmingly say that this information isn’t widely available. A number of recent federal proposals have aimed to increase health care price transparency, and these are steps in the right direction. But more needs to be done to make this information widely available, patient-friendly, easily comparable across providers, and available in languages other than English.

Especially because patients often don’t know ahead of time what they’re on the hook for, medical bills can be especially stressful. (Look no further than Elisabeth Rosenthal’s latest piece in The New York Times for examples.) Even for the most sophisticated consumers, they are often inscrutable. Patients may get bills long after they’ve seen a health care provider. They may receive multiple bills for one episode of care if they’ve seen a range of different specialists or received services across departments. It’s often hard to figure out what’s paid or pending payment by insurance versus what the patient owes, and it’s not always clear who to call with questions to sort it all out.

It’s complicated and confusing, and it’s especially difficult to navigate when you’re dealing with a chronic illness or if you’re struggling to scrape together money to pay the bills. There’s got to be a better way to provide a simple, timely, consolidated health care bill for a single episode of care. Doing so would benefit patients, providers, and payers.

I know that these three wishes combined are a tall order. And I know they won’t come true just by magic. Making them a reality will require hard work, strategy, collaboration, and persistence. New Yorkers are good at all of those things, and I’m optimistic that we can make our State stronger and healthier in 2020.

One last wish: a happy and healthy new year to you and your families.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on December 12, 2019