By Sabina Mollot
Bellevue Hospital, along with all the other facilities that are part of the city’s public NYC Health + Hospitals network, are bracing for the impact of an expected loss in federal funding in the next couple of years.
The cuts have loomed on the horizon since the Affordable Care Act was enacted in 2010. Hospitals including H+H had been receiving Disproportionate Share Hospital or DSH funding for uninsured and Medicaid patients, but when the ACA went into effect, the thinking in Washington was that hospitals wouldn’t continue to need it due to more people being covered.
However, as Bridgette Ingraham-Roberts, associate vice president for government and community relations and planning for H+H, told hospital staff and supporters on Friday, 1.1 million New Yorkers are still uninsured and H+H serves around 415,000 uninsured patients. (Together, there are about 700,000 uninsured and Medicaid recipients in the health system.)
For the past eight years, the country’s largest public hospital network has been able to breathe somewhat easy due to efforts of local Congress members to delay the cuts. But the fight is still ongoing, including a push for emergency backup funding that’s in the governor’s proposed executive budget.
The subject of compensation for care for the hospitals’ uninsured and in many cases undocumented patients was discussed at length at a legislative breakfast event at Bellevue on Friday.
At the event, organized by the Bellevue Community Advisory Board, local elected officials as well as hospital brass discussed what’s expected to happen with regards to health care budgeting.
This fiscal year, hospitals across the nation have dodged $2 billion in cuts. H+H alone would have lost $329 million had those cuts gone into effect. Over two years, the delay will translate to over $600 million in savings, $100 million of which will go to Bellevue Hospital. However, by fiscal year 2020, the expected cuts, if not delayed again, will total $4 billion across the nation. From fiscal years 2021-2025, the expected cuts are $8 billion per year.
“We still need to continue to push to make sure that it is delayed,” said Ingraham-Roberts. “The president revealed his budget over three weeks ago and we anticipate that this will be an ongoing negotiation between the administration and Congress.” She added that she thought it was unlikely planned federal cuts would advance through Congress, but if they do, at the state level, the governor has proposed a “safety net.”
The additional annual safety-net funding began in the 2017-2018 State fiscal year, but funds for that year have not been distributed yet. Of that pool, H+H anticipates receiving $4 million annually.
There has also been talk in Albany of changing the way DSH cuts are distributed, which H+H is in favor of.
A spokesperson for the hospital network later told Town & Village that under the current system, “A decrease in DSH funding affects us first. Had the DSH cuts not been delayed, we would have borne the brunt of nearly the entire state’s reduction. Updating the formula so that cuts are shared more fairly and so that safety-net providers are protected better would be a meaningful change.”
Assembly Member Richard Gottfried, who chairs the State Assembly’s Health Committee meanwhile cautioned the people in the room that public hospitals are not yet out of the water.
First, he pointed out, there was still a chance the governor’s safety net funding of $1 billion wouldn’t go to the hospitals because that money hasn’t yet materialized. It would have to come from the sale of the nonprofit Fidelis health plan, but, he added, there are legal issues yet to be worked out and it’s also not certain what that revenue would be spent on.
He added that he does support changing the way the DSH funds are distributed and money from the state’s Indigent Care Pool (ICP) based on the actual need of Medicaid and uninsured patients. The Assembly’s proposed budget calls for a working group to issue a report on this due by the end of the year.
Gottfried also spoke about how inflation hasn’t been taken into consideration for Medicaid reimbursements and how the Assembly supports funding for an inflation-based increase.
However, “It would cost hundreds of millions to do that,” he acknowledged.
State Senator Brad Hoylman, another speaker at the Friday event, said while he supports compensation taking inflation into account, he doesn’t believe the measure will pass in his own chamber.
“The Republicans control it and the chair of the finance committee, Cathy Young, lives closer to Cincinnati than she does to Manhattan, so they have a skewed perspective,” he said.
Gottfried added that the legislature is under more pressure this year time-wise as the budget is expected to be done a few days earlier than usual due to Easter and Passover both falling on April 1. But, he added, “The substance is a lot more important than the timing.”
The event’s keynote speaker was City Council Member Carlina Rivera, who used to serve as a Bellevue CAB member and was born at the hospital. She now chairs the Council’s hospitals committee.
Also in attendance at the legislative breakfast was City Council Member Keith Powers, Assembly candidate Harvey Epstein and members of the Bellevue CAB, chaired by Louise Dankberg.
Correction: The article originally incorrectly stated the amount H+H and Bellevue saved due to delays of the DSH cuts and the number of uninsured patients.