Columbia Spectator
New York, NY
http://www.columbiaspectator.com/2009/11/05/health-care-reform-hits-home
The low- to middle-income communities in West Harlem and Morningside Heights have a particular stake in the health care reform plans pending in Congress.
The five congressional committees that oversee health care issues have each proposed a distinct bill, which leaders must merge into a single, cohesive piece of legislation that can be sent to the Oval Office for the approval of President Barack Obama. The bills are similar in some areas, proposing more money for Medicaid, the federal health care program for low-income Americans. But paradoxically, such a measure could actually hurt locals here, as New York state is one of the most generous Medicaid providers in the country and might lose money under the formulae drawn up by legislators.
Yet local advocates suggest low- and middle-income New Yorkers may benefit from the subsidies and insurance industry regulations included in the proposed bills. All five bills provide some level of subsidies to middle-class families and create a system of health insurance exchanges, which would theoretically encourage increased competition and lower prices. All but the Senate Finance Committee version contain a government-funded “public option”—which would maintain the private health insurance industry but offer a nationalized option—intended to drive down drug and insurance costs.
Some of New York’s federal representatives have taken leading roles in crafting the public option and defending the controversial proposal from attacks. Senator Charles Schumer and Representative Charles Rangel of Harlem, both Democrats, have emerged as key spokesmen for the public option, which is favored by most of their fellow Congressional Democrats but opposed by some moderates and the majority of Republicans. Schumer sits on the Senate Finance Committee, which drafted a leading bill associated with Finance Committee chairman Max Baucus (D-Mont.), and Rangel chairs the influential House Committee on Ways and Means.
“The public health insurance option would be one of many options in the new Health Insurance Exchange created by the House bill, designed to encourage competition and control costs for families and individuals,” said Rangel, whose district spans all of northern Manhattan, including the Columbia campus, in an e-mail to Spectator. “When insurance plans compete, patients win with better choices and better prices.”
Despite taking a number of moderate and conservative positions in the past, Senator Kirsten Gillibrand—who holds the seat formerly occupied by Secretary of State Hillary Clinton—also supports the public option.
“I am continuing to push for a robust public plan that can compete with private insurance and drive down costs for everyone,” she wrote in an email. “The status quo of unaffordable health care and lack of access is unacceptable, and now is the time for real action. I remain committed to working with the administration and my colleagues on both sides of the aisle to fix our broken health care system.”
Even after five months of heated debate in Washington, the final shape of health care reform has yet to emerge. Glaring contrasts in subsidy amounts, stringency of regulations, and the public option remain among the five committee bills. And while the White House has called health care reform its number-one legislative priority for 2009, Obama has yet to express support for one proposal over the others, leading some to question his decisiveness and commitment to those left behind by the current health care system. Yet the nature of the legislative process means the nature of the final product may not be wholly in his hands.
Medicaid matters
One reform measure that has garnered near-universal support is expanding Medicaid, a 45-year-old federal program that provides health coverage for Americans at or below the poverty line. While lawmakers have traditionally targeted Medicaid when seeking to pare federal and state budgets, lowering the eligibility requirements could reduce the estimated 47 million uninsured Americans.
All five proposed bills would extend Medicaid to families whose total incomes are at or below 133 percent of the poverty line. This could have a big impact on Harlem, where in 2008 The New York Times reported the average income for a family of four was $30,000—136 percent of the $22,050 poverty line.
Medicaid is heavily used in West Harlem and Morningside Heights. According to Jeff Jacomowitz, spokesman for St. Luke’s, nearly a quarter of the patients at St. Luke’s Hospital in the past 12 months paid for their treatments with Medicaid, and an additional 15 percent were covered by a Medicaid health maintenance organization (HMO). Fewer than 20 percent of patients were covered by private insurance plans.
Across Amsterdam Avenue at Town Drug Pharmacy, located on the corner of West 113th Street, manager Julia Abramson estimated that 95 percent of daily customers are Medicaid recipients.
But the reform proposals in Washington will not “change Medicaid or Medicare as they currently exist,” according to Bob Cohen, policy director for Citizen Action of New York, an advocacy group affiliated with the national organization Health Care for America Now. Medicare is the equivalent federal health care program for senior citizens.
Cohen added that because the bills would provide additional funds to states commensurate to the number of newly eligible Medicaid recipients, New York would not benefit significantly from reform. While some states’ Medicaid programs only insure families with incomes up to 67 percent of the poverty line, New York’s standard—ranging from 100 to 133 percent—is already more generous.
Follow the subsidies
One area in which reform could have a real impact for New Yorkers is in middle-income subsidies. Kathleen Stoll, director of health policy for pro-reform advocacy group Families USA, lauded the subsidies proposed in the House and Senate bills.
“We’ve got improved subsidies on the Senate side,” Stoll said. “Families will really be protected from spending so much on health care.”
Under the Senate Finance Committee bill, families with incomes up to 400 percent of the poverty line would have to spend no more than 12 percent of their annual income on health insurance.
“There will also be additional protections for low-income people, especially in terms of caps on out-of-pocket costs,” Stoll said. She added that the House bills contain slightly more generous subsidies than the Senate proposals, but Cohen countered, “The House bills—the most expansive, best bills from our perspective—do not provide enough subsidies.”
Some groups unequivocally back one vision of reform over another. Francesca Mueller, a spokesperson for Community Service Society New York, said her organization supports the House proposals, all of which include the public option.
“We are looking at the affordability scales that they propose, and the issues of what subsidies people would get,” Mueller said. “The House committees’ bills are much more generous.”
CSSNY’s ideal vision of health care reform would involve a “single-payer” system, in which the government would become the sole insurance provider, ending the private health insurance industry. Mueller conceded, though, that a single-payer proposal is not politically realistic this year, and said the current proposals are “a start to work towards that.” She added that New York politicians have been receptive to the group’s concerns.
“We want policymakers to look long and hard at affordability, and bring down premium and out-of-pocket costs,” she said. “Schumer’s been pretty interested in what we’ve shown with respect to affordability scales. Some of the officials—like Anthony Weiner (D-Queens) and Rangel—have been listening and receptive to our concerns about how this will affect New York specifically. Is there a true champion? That would be harder to say.”
