The number of uninsured New Yorkers who sought healthcare services at HHC hospitals and health centers in 2009 continued to increase for the third year in a row to nearly 453,000 - a 14 percent increase from calendar year 2006, when HHC served some 396,000 patients who lacked health insurance coverage.

As the largest municipal healthcare system in the country, HHC provides care to all regardless of ability to pay or immigration status. During 2009, HHC served more than 20 percent of the estimated total number of uninsured residents in the entire state, and doing so cost HHC approximately $850 million.

"The economic downturn has increased dramatically the number of uninsured patients seeking our services. While our commitment to provide safe, effective, efficient and compassionate care to the individuals and families who need it most remains as strong as ever, rising costs and repeated Medicaid cuts now seriously threaten our capacity to fulfill our mission," said HHC President Alan D. Aviles.

The higher demand for HHC services comes at a time when the city's public hospitals and health centers now receive about $240 million less in annual Medicaid revenue as a result of three successive years of state budget Medicaid cuts. To make matters worse, the recent proposed executive budget would cut HHC's Medicaid funding by another $85 million. The vast majority of HHC's insured patients are covered by Medicaid, making the public health insurance program the primary source of reimbursement for the city's public hospital system.

In addition, the proposed state executive budget left unclear whether HHC would continue to be granted access to $300 million in Disproportionate Share Hospital (DSH) funding to help cover indigent care costs. Such funding - which consists only of federal funds matched with city funds and does not involve any state dollars -- has been made available to HHC during the last two state fiscal years.

"DSH funding is the lifeblood of our public system -- it would be virtually impossible to sustain our mission without it," Aviles said. "As the recent efforts to enact expanded insurance coverage nationally make clear, providing health care services to uninsured patients cannot be done with magical thinking. It comes at a cost and takes significant funding. It is no different here in New York City, where HHC is the next best thing to universal coverage."

HHC officials are also keeping a close watch on the recently floundering efforts to achieve federal healthcare reform, and are hopeful legislation will be resurrected and adopted this year.

"The promise of greatly expanded coverage and the end of insurance abuses now suddenly appears to have receded on the horizon - like a mirage," Aviles said. "But we remain hopeful that our Congressional leaders will persevere to finally make affordable access to healthcare a reality for nearly all Americans."

Aviles says that even if federal healthcare reform becomes a reality, the vast majority of New York City's estimated 500,000 undocumented immigrants will remain uninsured. "Our public hospital system will remain the essential safety net for the vast number of new immigrants in our city, just as it has been for generations."

February 2010