Federal Cuts Would Be Major Blow to New York City’s Public Hospitals, Comptroller Says

 

Lincoln Medical and Mental Health Center in the Bronx is among the hospitals most affected by the burden of caring for uninsured immigrants. Credit Nicole Bengiveno/The New York Times 

 

 

New York City’s public hospital system is looking at a major cash squeeze within four years if federal cuts to hospitals serving large numbers of poor and uninsured patients take place as scheduled, according to a report by the city comptroller, Scott M. Stringer, to be released on Monday.

Beginning in 2017, the federal government will begin cutting subsidies to those hospitals, based on the theory that since the passage of the Affordable Care Act, which has insured millions of Americans, hospitals will no longer need the same level of subsidies for uncompensated care.

But Mr. Stringer’s report says that the city’s hospital system will not benefit as much as expected from the Affordable Care Act insurance plans because the system continues to serve a high proportion of undocumented immigrants, who are not eligible for coverage under the act.

In the health law’s first year, the number of uninsured patients the system treated dropped by only 1.3 percent, the report said; another decrease of 7.2 percent is projected by 2019.

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Comptroller Scott M. Stringer released a report on Monday calling on the federal government to delay the cuts until their impact can be better assessed. Credit Fred R. Conrad/The New York Times

More strikingly, the city’s hospital system has not attracted enough newly insured patients to give it the revenue increase it would need to make up for the loss of federal funds, the report says.

“We have a solemn commitment to fund H.H.C. so that it can serve everyone who walks through the door, regardless of their immigration status or ability to pay,” Mr. Stringer said in a statement, referring to the Health and Hospitals Corporation, which runs the public hospitals. “That’s why we need to find a real cure for these cuts, not just apply a Band-Aid.”

The 11-hospital system expects to face a deficit of more than $1 billion in fiscal year 2017, which will grow in subsequent years, the report said. The city’s taxpayers are ultimately responsible for filling that gap.

The report projects that the system’s cash on hand, an indicator of financial stability, will drop to $44 million, from $1 billion, by 2019-2020, largely because of the projected $827 million loss in federal “disproportionate share” subsidies.

Dr. Ram Raju, president of the hospitals corporation, said he was working with the city to mitigate the cuts. He said he was also trying to persuade the state to change its methodology for financing charity care, which he said put the corporation “last on the line.”

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Woodhull Medical and Mental Center in Brooklyn is also heavily burdened. Credit Andrew Renneisen/The New York Times

He agreed that undocumented immigrant care was a problem. “The Affordable Care Act did not bring in everybody,” Dr. Raju said. “It left behind a group of people. They have no way of getting insurance, and most of them are served by our system.”

The three hospitals most affected by the burden of caring for uninsured immigrants are Lincoln Medical and Mental Health Center in the Bronx, Elmhurst Hospital Center in Queens and Woodhull Medical and Mental Health Center in Brooklyn, the report said.

City officials have long predicted that the cuts would hurt New York City more than other parts of the country because of its large number of immigrants.

But the report raises another surprising factor: the failure of the hospitals corporation’s entry into the state’s Affordable Care Act exchange to produce as much revenue as expected.

The hospital system was counting on its MetroPlus insurance plan, newly sold on the state exchange, to attract young people of modest means to city hospitals, despite their image as a last resort for the poor. But MetroPlus has not been as successful as expected, with about a third of the 45,000 new subscribers dropping out within the first year, the report said, adding that the decline was because members failed to pay their premiums, among other reasons.

Mr. Stringer said that revenue from new enrollment in MetroPlus was expected to offset only about 28 percent of the federal cuts.

The report calls on the federal government to delay the cuts until their impact can be better assessed, and for the state government to explore the feasibility of using its own funds to cover undocumented immigrants.

http://www.nytimes.com  

Ebola declared dead in Liberia

Elizabeth Cohen, CNN Senior Medical Correspondent

  After losing more than 4,000 people to Ebola, Liberia has now been declared free of the disease by the World Health Organization (WHO).

I wish I were there to hug the wonderful people I met when I visited at the height of the epidemic in September, when any contact, even shaking hands, was forbidden.

Ebola 1 year later: Where they are now? 32 photos

EXPAND GALLERY

It was a horrible time. Ebola patients stood in line to get into hospitals that didn't have a bed to spare. Thousands of children in West Africa were orphaned. Burial teams roamed the streets carrying victims to crematoriums.

"We went through just a horrific epidemic," said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, who visited the country in August. "It's a searing memory that many of us will carry with us for the rest of our lives."

Something else is seared in my mind, too: the realization that smart people failed to stop this epidemic before it got so terribly out of hand. The outbreak started in March, and when I arrived six months later, the response was still clumsy.

Officials in Monrovia, including ones from the WHO, held an elaborate opening ceremony for an Ebola hospital, but then a few hours later when patients arrived, no one came out to help them. Weakened by the virus, the patients fell out of ambulances onto the ground.

A doctor in a rural county begged authorities for an Ebola hospital, but no help arrived. He was forced to build one himself, where he managed to save many patients.

Dr. Gobee Logan worked around the clock to help fight Ebola in Bomi County, Liberia.

In another part of Liberia, a woman couldn't find space in the hospital for her four Ebola-stricken relatives and was forced to take care of them at home by herself. She had no protective gear, and so suited up in trash bags to keep herself safe. Why was gear unavailable? It was just one of many unanswered questions during my time there.

Fatu cared for four of her family members with Ebola, keeping three alive without infecting herself. Her trash bag method was taught to others in West Africa who couldn't get personal protective equipment.

Larry Gostin, faculty director of the O'Neill Institute for National & Global Health Law at Georgetown University, gives the world an "F" for the initial response to Ebola.

"If the world had mobilized rapidly and decisively, we could have saved 10,000 lives, great human hardship, and enormous health and social costs in three of the poorest countries in the world," he wrote CNN.

Three reasons are often given for this poor initial response: Ebola hit big cities, where people live in close quarters; the West African countries have a dangerous lack of doctors, nurses, laboratories and supplies; and it was difficult to convince people to put a halt to the tradition of washing their dead relatives before burial, which spread the virus.

While all of those are true, there was something else going on.

Frieden describes how back in March of last year, he tried to get his teams into Guinea, where the outbreak started, but he says WHO leaders there wouldn't let them in.

"We got all these crazy questions, like 'We're not sure your team is qualified, send us more CVs,' and 'We're not sure when would be a convenient time for you to come,'" he said.

Frieden Intervened, calling WHO officials in headquarters in Geneva. "That's really unusual, for me, at my level, to have to call and say, 'Let my staff in,'" he said. "There's been maybe one other instance where I had to do that in my six years as director of the CDC."

In July, the CDC was allowed to ramp up the response, sending 50 staffers in just 10 days and 100 total by the end of the month.

"But our team was not particularly welcome there," he said. "It was not a very comfortable situation."

The problem, he says, was that WHO leaders in Africa failed to appreciate the severity of the outbreak and were overconfident they could handle it on their own. "We were surging into the area and the WHO said, 'We don't need you,'" he said.

As those issues resolved in the late summer and fall, the CDC and others could move in and do their jobs. Gostin gives this "late, belated response" an "A."

It eventually worked. Liberia has gone without a new case for 42 days, twice the maximum incubation period, which is why it's now deemed free of Ebola.

"The road to zero has been long and hard," Frieden said.

Guinea and Sierra Leone each had nine new cases last week, a dramatic decline from last fall when each week saw hundreds of new cases.

There's currently an internal and external review of the WHO Ebola response. "What WHO did or did not do will be examined by this commission and the results will be made publicly available for all to see," said WHO spokesman Tarik Jasarevic. "In parallel, we are currently undergoing an independent evaluation of our response chaired by Dame Barbara Stocking."

And the organization is already making reforms to respond more rapidly and effectively to public health emergencies. "We have an extensive program of work to implement these changes and will be reporting to the World Health Assembly later this month," Jasarevic wrote CNN.

But Gostin is concerned WHO won't do enough.

"I believe firmly that the world remains unprepared for the next epidemic," he wrote to CNN. "The next epidemic, moreover, could be far worse than Ebola, and we are not well prepared." 

http://edition.cnn.com/2015/05/09/health/ebola-declared-dead-in-liberia/index.html

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