We advocate for better health care policy

Hospitals and health systems are achieving what was asked of them by the first MRT — reductions in preventable admissions and readmissions, improvements in quality and patient access, and investments in their communities and social determinants of health, all of which contribute to lower Medicaid costs — while operating on restrained reimbursements. The work of the 2020 MRT should be focused on those segments of healthcare that have failed to bend the cost curve, not hospitals.

We also urge that the Medicaid global cap be adjusted to accommodate policy decisions the Governor and Legislature have made in the past decade. Increased enrollment in Medicaid under the Affordable Care Act, increased minimum wage, additional home-based care options and efforts to better manage the care of aged and disabled populations are all worthy initiatives, but they all increase Medicaid expenditures. The global cap should accurately reflect programmatic changes that have occurred since the global cap was initiated.

$2.5 billion in cuts will be painful, whatever the outcome of the MRT’s deliberations. This pain should be shared, not disproportionally targeted at certain regions of the state. Last year’s Executive Budget proposal essentially eliminated indigent care pool funding for a very specific group of downstate hospitals, many of them on Long Island and in the Hudson Valley. While the proposal was not included in the final budget agreement, it set a dangerous precedent that we are concerned may be revisited this year. Hospitals in the suburban regions face the same burden of caring for Medicaid, uninsured and underinsured patients as do more rural and urban areas of the state — in fact, 28 percent of all visits to Suburban Hospital Alliance member institutions are paid by Medicaid.

The state has made great progress in recent years in transitioning from volume to value. Much of this work has been funded with federal dollars, the future of which is now uncertain. We urge the MRT and the Legislature to consider a transition plan for these initiatives in the 2020-21 budget, to ensure that the progress made in the last five years is sustained. Continued investments in facility modernization, community-based care, social determinants of health interventions, behavioral health and substance abuse treatment, and the healthcare workforce will pay off in more efficient, effective and convenient care in the future. Reasonable market rules for health plans and continued regulatory flexibility also contribute to a stable glide path.

The Suburban Hospital Alliance strongly opposes the New York Health Act, which would replace the current system with state-administered coverage for all New Yorkers, including for those currently covered by Medicare and employer-provided insurance.

The Suburban Hospital Alliance opposes the “Safe Staffing for Quality Care Act,” which would legislate mandatory staffing levels that every provider would be required to maintain without any flexibility to account for the severity of their patients’ illnesses or the skill set and experience levels of their workforce. Appropriate staffing levels should be determined by nurse leaders in consultation with their nursing workforce, not by legislators.

Emergency rooms are crowded with patients in crisis for whom insufficient resources are available in the community to address their needs. The Suburban Hospital Alliance urges legislators to increase Medicaid reimbursement, allowing institutions to invest in increased inpatient capacity, promote the growth of community-based care providers and increase the behavioral health workforce. We also encourage increased regulatory flexibility to establish new models of care.

The Suburban Hospital Alliance urges strong oversight of the stability of New York’s health plans and their market conduct and supports the establishment of a health insurance guaranty fund to ensure providers and patients are not harmed if a health plan fails.

The Suburban Hospital Alliance urges the Legislature to restore fairness to New York’s malpractice laws. Medical liability laws should balance patients’ rights to fair compensation for genuine injuries against the need for rational procedures and limitations to make malpractice premiums affordable.

The Suburban Hospital Alliance successfully advocated against funding cuts that would drastically impact hospitals in the suburban regions.

The amended 2019-2020 state budget proposal disproportionately targeted health care providers for funding cuts, rolling back a promised 2% Medicaid rate increase and reducing reimbursement across-the-board by an additional 0.8%.

The final state budget reinstated the promised 2% rate increase and rejected the 0.8% across-the-board cut.

The governor’s amended budget included a $285 million cut to Indigent Care Pool funding targeted expressly at downstate hospitals. Instead of introducing a new statewide formula for the program or proposing equitable cuts, the executive budget called for an artificial cap of $10,000 for certain hospitals located on Long Island, in the Hudson Valley and in New York City. Of these hospitals, 18 are located in the suburban regions and provided more than $1 billion in uncompensated care and other community benefits last year.

The final budget extended the current distribution methodology another year and did not include the targeted cut to downstate hospitals.

The governor’s proposed budget called for the elimination of the Population Health Improvement Program, which was established by the Legislature in the 2014 budget to engage community partners in addressing social determinants of health. The Nassau-Suffolk Hospital Council’s PHIP has convened more than 100 community stakeholders, including all of the hospitals and the two county governments, all aligned in their efforts to reduce obesity and chronic disease incidence.

The final budget rejected the elimination of the PHIP.