New York City’s safety net hospitals need help
When I joined the state Senate in 2019, I committed to fight for health equity. The simple fact is that the community I represent suffers from significant health-care disparities correlated with race and income. In New York City, Black women are eight times more likely than white women to die from a pregnancy-related cause and, in my home borough of Brooklyn, low-income parents disproportionately face the risks of infant mortality, low birthweight, preterm birth and other health risks.
Of course, the pandemic has crystallized these disparities and further exacerbated them. The safety net hospitals that serve my district have worked valiantly to save the lives of those who face enormous barriers to accessing quality health care. But it is unjust that New Yorkers have been subjected to a two-tier health-care system that disadvantages vulnerable populations and perpetuates racial inequality because community hospitals that serve low-income neighborhoods are paid a fraction of what facilities that serve more affluent communities get for providing an identical service. This is why I am calling on my colleagues and the governor to do the right thing and support essential funding and payment reforms for safety net hospitals.
Safety net hospitals — both public and non-profit — serve the vast majority of Medicaid and uninsured patients and are situated in some of our city’s most historically disadvantaged communities. They have the laudable mission of ensuring that no one goes without quality care because they cannot afford it. More than 80% of my constituents are people of color, and we are served by five safety net hospitals. These institutions include SUNY-Downstate, which provided excellent care to me during a severe bout of COVID-19; Kings County Hospital, where I got vaccinated against COVID; Interfaith Hospital, where I was born; and close to my district, Maimonides Medical Center, which has cared for many members of my family. All are struggling financially due to a funding system that perpetuates health inequities.
Medicaid reimbursement rates have remained frozen for more than a decade, despite inflation, the soaring costs of medical care, and an increased number of people reliant on federally sponsored health plans. Currently, the state only reimburses hospitals 61 cents for every dollar of care provided, resulting in extremely low, and sometimes negative, operating margins, preventing safety nets from making essential long-term infrastructure, recruiting needed staff and specialists and technology investments, often leaving doctors and nurses to make the best of limited resources daily.
At a time when we are facing a “tripledemic” of surging COVID, flu, and RSV cases, it is unacceptable that our most critical hospitals are left with only a few days of cash on hand to sustain operations. Meanwhile, hospitals in wealthier zip codes can cross-subsidize Medicaid rates by treating high numbers of top-paying commercially insured patients.
It is easy to argue that these hospitals should “trim the fat,” but those critics don’t understand the policy history that has driven safety nets into the untenable fiscal position they consistently find themselves in. That rhetoric isn’t constructive and frankly only distracts from the substantive engagement needed to find sustainable solutions for these hospitals.
Failure to adequately fund New York’s safety-net hospitals will unequivocally have a direct impact on many of our underserved communities and will reinforce longstanding structural inequalities. These communities have suffered from high rates of COVID hospitalizations and deaths and are disproportionately affected by several chronic diseases. In my district, where more than 50% of the community is Black, the population suffers from elevated rates of heart disease, cancer, stroke, diabetes and HIV/AIDS. Moreover, if safety net hospitals are not adequately funded, New Yorkers will have to travel great distances just to access health care and may decide to forgo it altogether if they find transportation to the hospitals too onerous and difficult.
One of the pandemic’s most painful lessons learned is that our public health system is not nearly as strong as it should be. And given the critical role safety net hospitals play in our health-care ecosystem, we would be remiss not to address that weakness in the 2023 state budget by providing the necessary sustainable funding they need to stabilize themselves and continue delivering top-quality care to vulnerable New Yorkers for many more years. We must also commit to long-term structural reimbursement reform, working with safety net hospitals to find a sustainable solution to reimbursement disparities in the Medicaid program.
If we fail to act now, some of these hospitals may have to close their doors, which will surely compound existing health-care inequities in my community. When we return to Albany, I look forward to advocating for adequate funding and a sustainable payment structure for safety net hospitals that allows them, their patients and their communities to have healthy and well resourced health-care institutions.