State of the State: Health Hits and Misses

Earlier this week, Governor Kathy Hochul delivered her State of the State address as the first woman to be elected Governor of New York. That is worth celebrating. But as the Governor herself has said, “I’m not here to make history, I’m here to make a difference.”

The State of the State serves as the Governor’s roadmap for the year, highlighting her priorities for attention, funding, and other resources. Public safety and affordable housing were the big themes of her address. She also announced a welcome $1 billion investment in mental health, among other health issues.

Here are some of the things I’m most excited about in Governor Hochul’s priorities for the year — and a few items that should’ve been on the list:

Medical debt relief: Medical debt has rightly been called “a uniquely American injustice,” and New York has been making important strides to address it. Last year, Governor Hochul signed into law measures to (1) prohibit the extreme billing practice of placing liens on patients’ homes and garnishing wages and (2) ban hospital facility fees for preventive care and require advance notice to consumers for instances in which fees will be charged. Now, she is laying out a broader plan to address medical debt, including new requirements to standardize hospital financial assistance applications, enhanced price transparency measures, and educational campaigns aimed at both consumers and industry leaders.

Enhanced access to primary care: Primary care is among the best bangs for the buck in health care; it is associated with better health and it saves money. The Governor proposes to strengthen the primary care workforce by providing sustainable reimbursement for community health workers, or CHWs, through Medicaid. New York State’s 7,000 or so CHWs are frontline public health workers who are trusted members of their communities; more than half of CHWs are people of color. CHWs are associated with improving access to care and health outcomes, addressing social determinants of health like housing and food access, and lowering health care costs. Increasing support for CHWs is one thing that could expand access to primary care.

But what we really need is to rebalance our health care spending to emphasize primary care. Despite its proven value, we chronically underinvest in primary care; only about a nickel of every health care dollar is devoted to primary care. New York should join the growing number of states that have increased their investment in primary care without increasing total spending on health care. In fact, Rhode Island increased the share of its commercial insurers’ primary care expenditures by 5% and their total health care expenditures fell by 14%.

Last year, both houses of the New York Legislature passed bills to jumpstart the process of increasing primary care investment and test out programs to identify the most promising models. 2023 should be the year that such an effort gets going.

Healthy food: I’ve written before about the urgency of addressing hunger in New York State, as well as the important role that school meals play in students’ ability to learn, grow, and be healthy. Several of the Governor’s proposals would increase access to healthy food, including in schools. New York City has undertaken an ambitious effort to transform school meals from frozen and pre-prepared items to high-quality, appealing, freshly cooked meals. Governor Hochul has now laid out a statewide plan to facilitate cooking from scratch and the use of fresh New York State farm products in school meal preparation. Other proposals include the expansion of community gardens and a grants program to cover start-up costs for farmers markets, supermarkets, and food cooperatives to increase access to healthy food in communities throughout New York State.

Those are great ideas; another opportunity, universal free school meals, could further increase healthy food access. This school year, California, Maine, Massachusetts, Nevada, and Vermont are all providing free school meals to all students. Albany, New York City, Rochester, and Yonkers already provide universal free school meals to public school students regardless of income, but approximately 30% of all public school students elsewhere in the State don’t have the same access. Feeding those students would be a smart investment given the benefits associated with free school meals for all: better physical health, mental wellbeing, and academic performance; reduced stigma and shame associated with eating the school lunch; and lower costs per meal as schools can realize larger bulk discounts with more participation.

Investments in veterans’ health: Veterans are twice as likely as their civilian counterparts to experience food insecurity. Particularly since the onset of the pandemic, New York has developed creative ideas to address veteran food insecurity, including programs to deliver free meal kits to veterans and their families across the State. Now, Governor Hochul has announced plans to expand the FreshConnect program, which provides checks for veterans experiencing food insecurity to get fresh produce and other food items from farmers markets. That’s another great initiative.

Yet perhaps the most critical issue facing New York’s veteran community, veteran suicide, wasn’t addressed in the State of the State. Suicide rates among veterans are twice as high as among the civilian population. And although the rate of veteran suicide in New York State appears to have stabilized in recent years, warning signs suggest that progress is fragile: rising drug overdose deaths, firearm use in suicides, and nationwide increases in suicide deaths overall indicate that veteran suicides could again be on the rise. Ongoing efforts like the Governor’s Challenge to Prevent Suicide Among Veterans and New York State’s Suicide Prevention Task Force are focusing energy, attention, and financial resources to address the problem; community-based organizations are also doing important work to prevent veteran suicide. Now is not the time to take our foot off the gas; instead, this is the moment to redouble efforts to produce a genuine and sustained decline in veteran suicide rates.

In addition to substance, this year’s address had the traditional pomp and circumstance surrounding it. Whether you like pageantry or not, it was another sign of normalcy as we approach the three-year anniversary of COVID-19. Now it is time to keep COVID in check, and to address health issues beyond the pandemic. The Governor has laid out a compelling set of priorities and missed a few opportunities. There are a lot of good ideas worthy of support and more ideas that should be on the table. As this year unfolds, we’re all ready to work together to make a difference.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on January 12, 2023

Giving Thanks in Challenging Times

I’m not a Pollyanna; I know there’s plenty in our health system that needs fixing. But there are also reasons for hope and encouragement. Embrace them and be inspired to keep working to make things better.

On a personal note: I’m thankful for my family and friends, my health, and rewarding work with great colleagues. I wish a happy holiday to you and your families and tables that overflow with laughter and love. Please comment and share what you are grateful for.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on November 21, 2022

Today’s Problems, Yesterday’s Data

  • COVID-19 data dashboards: Particularly in the early days of the pandemic, tracking COVID case counts, hospitalizations, and deaths on a near real-time basis at the county and community levels was critical for estimating risk, making policy, and targeting limited resources. Publicly available, user-friendly dashboards — like this one from The New York Times — are especially helpful for communicable diseases, where individuals can play a role in protecting themselves and keeping others safe.
  • U.S. Census Bureau Household Surveys: Beginning in April 2020, the Pulse survey began asking people about pandemic-related challenges such as food scarcity, employment, delayed medical care, mental health, and so on. Questions were added and dropped as the landscape changed. Over time, the survey began asking about vaccination status and it has recently added a question about long COVID symptoms. The survey provides real-time, non-clinical data that can be easily viewed using an online interactive tool. Best of all, the data are very current; data are now available through October 17, 2022 — just two weeks ago.
  • Wastewater analysis: Wastewater surveillance has been invaluable to public health officials over the last few years, allowing them to detect everything from COVID-19 (which can show up in wastewater several days before it appears in positive tests or hospitalization) to opioids to polio. New York State has a dashboard showing where COVID-19 has been detected in wastewater across the State, and it’s updated weekly. With the reemergence of polio in New York (I still can’t believe I’m typing that sentence in 2022), officials are working to improve wastewater surveillance for it, and counties are exploring using it to detect flu, Hepatitis, and opioids.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on October 31, 2022

For My Family and Yours: It’s Still About the Prices

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on July 19, 2022

Crises Require Courage: New York’s Overdose Prevention Centers

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on June 15, 2022

Photo: OnPoint NYC staff at an overdose prevention center in East Harlem. Photo by Timothy A. Clary.

Past Due: Easing Medical Debt

Imagine that you’re dealing with cancer and huge medical bills keep piling up.

Or that you are recovering from a hospitalization and you’re now being sued for outstanding bills and dodging debt collectors. Or that you were injured in a car accident and ended up in an ambulance that wasn’t covered by insurance and now you owe large sums of money. Maybe these debts are forcing you to consider selling your home or moving in with relatives to save on rent.

It’s not hard to imagine these scenarios because they happen regularly in the United States.

As RIP Medical Debt (a nonprofit that has helped eliminate more than $6.7 billion of medical debt for more than 3.6 million families yet has barely scratched the surface of the problem) puts it, “Medical debt is a uniquely American injustice.”

It’s true:

  • Medical debt is the most common reason for bankruptcy in the United States.
  • Estimates vary, but a survey found that 41% of working-age Americans have problems with medical bills or are paying off medical debt.
  • A recent analysis found that people in the United States owe approximately $195 billion in medical debt.
  • That same analysis showed that an estimated 23 million Americans — nearly 1 in 10 adults — have “significant medical debt” of more than $250.
  • Americans who have a disability are more than twice as likely to have significant medical debt than those without a disability.
  • The U.S. Census Bureau estimates that 28% of Black households carry medical debt, compared with 17% of non-Hispanic white households.

We are seeing some steps to address medical debt nationally. Starting this summer, the three major credit reporting agencies will expunge medical debt from many consumers’ credit reports — if it’s paid off or if it’s less than a year old. Starting next year, medical collection accounts of less than $500 will also be excluded from credit reports. That’s a good start, but those measures will only affect about 70% of medical debt — meaning that many Americans who are saddled with high medical bills will continue to have ruinous credit scores.

As part of a broader set of measures to “protect consumers and lessen the burden of medical debt on American families,” the White House just announced it will build on those private-sector efforts and eliminate medical debt as a factor for underwriting in all federal agencies’ credit programs. The Biden administration has also pledged to address predatory and aggressive billing and collections practices; make it easier for veterans to get their VA medical debt forgiven; and provide more educational resources to help patients understand their rights.

Here in New York State, medical debt burdens patients. In 2020, 6% of New Yorkers were put into collections over medical bills — with double that rate for people of color in parts of the State (this interactive map from the Urban Institute shows the substantial variation of medical debt across New York State by geography and race). In the most extreme cases, New Yorkers face lawsuits and property liens or wage garnishments because of medical debt. More than 52,000 lawsuits were filed against patients by New York hospitals between 2015 and 2020. Low-income communities and communities of color outside of New York City have been particularly hard hit by unfair billing practices.

Thanks in part to advocacy efforts like the Community Service Society’s End Medical Debt campaign, New York State is taking action to address medical debt. The statute of limitations for medical debt lawsuits was reduced from six years to three years; a loophole in the State’s surprise bill law was closed (although some gaps still remain) to cover emergency services; and interest rates that may be charged on any consumer debt were reduced from 9% to 2%. Legislation that would prevent hospitals from placing liens on patients’ homes or garnish their wages recently passed in the Assembly, but remains pending in the State Senate. More still needs to be done to make it easier for eligible patients to know about and receive hospital financial assistance in New York.

Even in a sharply divided country, easing medical debt is a ripe topic on which to find common ground. It’s not a partisan or ideological issue. I don’t know anyone, regardless of their politics, who believes that getting sick and needing health care should be financially ruinous for patients and their families. It’s an economic and moral stain on our system, and patients deserve more protections for their physical, mental, and financial health.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on April 26, 2022