Federal Health Budget Proposals Promise Miracle, Deliver Mirage

Remarks by Alan D. Aviles
President, New York City Health and Hospitals Corporation
Press conference with US Senators Clinton and Schumer in response to proposed federal funding cuts to city's public hospitals

We are standing in the beautiful, new ambulatory care pavilion of Bellevue Hospital, the oldest public hospital in the nation. Bellevue first began serving New Yorkers in 1736 and it has continuously operated as a public hospital for the last 270 years.

We are deeply grateful for the strong support and the presence today of both of New York's Senators. Thank you, Senator Clinton and Senator Schumer for taking the time to stand with us today and for your consistent advocacy on behalf of public hospitals here and across the nation.

Bellevue is one of eleven public hospitals, which together with four skilled nursing homes, and more than 80 community health centers, comprise the New York City Health and Hospitals Corporation, the largest public hospital system in the country.

Each year, we serve nearly 1.3 m predominantly low-income New Yorkers, including roughly 400,000 uninsured patients. Every day in our public hospitals and community health centers, we provide pre-natal care to low-income women that helps ensure healthy deliveries and helps to lower the infant mortality rates in our diverse communities.

Every day we provide immunizations to hundreds of children to protect them from serious childhood diseases. Every day we effectively care for the tens of thousands of asthmatic and diabetic patients who for lack of that care would wind up in our emergency departments and our hospital beds. And every day we care for the elderly poor who disproportionately suffer from serious chronic disease like congestive heart failure; elderly patients who without that care would likely wind up in one of our intensive care units.

We do all of that and more every day, even as we operate eleven of this City's emergency departments and six of its trauma centers, where we stand ready 24 hours a day and 7 days a week as a safety net for all New Yorkers.

Public hospitals across this nation provide a similar safety net for their communities, with the common mission of serving patients without regard to their ability to pay or their immigration status.

In a series of actions and announcements over the last month, the executive administration in Washington has threatened to yank the public hospital safety net out from under the millions of people who depend on it.

First, in early January, the administration issued a proposed federal regulation that would decrease Medicaid funding to public hospitals by billions of dollars. That regulation, if implemented, would cause NYC's public hospitals to lose roughly $350 million in annual funding.

A few days later, in his State of the Union address, the President proposed diverting still more of the Medicaid funding that supports care in public hospitals, suggesting that those funds could be better used to partly subsidize private insurance coverage for the relatively more affluent among the uninsured.

In its budget proposal released today, the administration makes clear that it would take tens of billions of dollars from safety net providers, like Bellevue Hospital, that serve a disproportionate number of poor Medicaid and Medicare patients and use that money to supposedly broaden access through private insurance companies.

Frankly, it is remarkable that these proposed cuts are cloaked in rhetoric about expanding coverage for the uninsured when, if implemented, the very opposite will occur.

It is deeply disingenuous for the administration to profess concern about the crisis of the uninsured even as it proposes to strip nearly $4 billion dollars in supplemental Medicaid funding from public hospitals through its proposed CMS regulation.

How can the administration claim a commitment to reducing the legions of uninsured while actively seeking to divert tens of billions of dollars in safety net funding that is expressly intended to afford healthcare access to the poorest and most vulnerable among us?

Those of us who work in our public hospitals strongly favor expanding coverage for the uninsured. But, at best, the administration's proposal to shift billions of dollars away from our public hospitals would simply sacrifice access for the many to provide insurance coverage for the few. The net result will not increase access for the uninsured.

Expanding access to healthcare comes at a cost that must be honestly confronted, not curtly dismissed with magical thinking. The administration is promising a miracle, but they will be delivering a mirage.