Archives of Rudolph W. Giuliani

Announcement of HealthStat Initiative

Wednesday, June 14th, 2000

As Delivered

Speaker Vallone, Comptroller Hevesi, Public Advocate Green, all of the members of the administration, members of the City Council, and others.

The reason that I asked all of you to come together today is because we want to use all of the resources that you have available in order to cover the maximum number of people that we can cover in the City of New York with health insurance.

We are modeling this very much on the Compstat program that has been so successful for the Police Department. That may sound a little odd, but if you bear with me, you'll see why it - or the similar program that appears in the corrections department to reduce violence in our jails and prisons, where the success has been astronomical - actually works.

It's the kind of success that brings great credit to the City, because people from all over the country come to look at the Police Department to figure out how they can reduce crime by fifty to sixty percent and homicide by seventy percent. Or they come to the Corrections Department to figure out how to reduce violence in our jails eighty percent in a four to five year period. Or they come to see a similar program in the Human Resources Administration (HRA) where we use the Compstat model to reduce the number of people on welfare - now reduced by 560,000, while the City is setting records for new employment. If this computer driven, pin-mapping accountability system can work in all three of those areas, it can work to cover the maximum number of people who need health insurance in the City of New York.

There are probably about 1.8 million people who do not have health insurance in the City. About 1.5 million of them don't have it because they can't afford it. They are our target, those 1.5 million people.

The reason that you are all here is that Compstat may be the program - in this case we're going to call it HealthStat - but it is your agencies that give us the outreach in order to reach the maximum number of those people, and give them the form that they need in order to be covered under Child Health Plus, or Medicaid, or with a private insurance company. The idea of the HealthStat initiative is a citywide campaign to enroll every eligible person that is out there - and it could be a million people, maybe more, maybe a little less, of the 1.5 million that don't have enough money to afford health insurance - who literally could have health insurance today if they knew about it and we knew about them, and we got them to fill out the correct form and got them covered. There is no reason that it shouldn't be done other than the fact that this hasn't been organized in the right way.

The first priority in dealing with the universe of people who are not enrolled in health insurance is to enroll as many children as possible. All city agencies are going to be mobilized. The City Council has agreed to use their offices, as has the Board of Education, and the Mayoral agencies - obviously HRA and The Health and Hospitals Corporation (HHC) - all of whom have outreach to all the communities in the City, as well as our Police Headquarters, our Police Precincts, and our Fire Headquarters. Every way in which we have outreach in the community, we are going to have people available to give out forms, and give them the information they need in order to fill out the forms that have to be filled out and get covered. All City agencies will be involved. We hope to involve some private groups in order to help us to do the same thing - including churches, private schools, and parochial schools - anyway in which we can have outreach to people.

Here is the breakdown of the numbers that we are talking about. Obviously, this is an estimate. There are 1.5 million low-income uninsured people in the City, and altogether, 1.8 million uninsured. About 800,000 are below the poverty level, about 700,000 are within 100 to 300 percent of the poverty level, and about 300,000 people are 300 percent above the federal poverty level. This all becomes important because of eligibility for Medicaid, Child Health Plus, and eventually Family Health Plus, which will go into effect on January 1st of next year.

About two-thirds of the people who aren't covered are working, full-time or part-time. Fully one-quarter of the people not covered are children, most of whom can be covered right now under Child Health Plus if they and their parents, guardian, or caregiver, would just fill out the form.

Right now we have more than one million children enrolled in current public programs, and 966,000 adults. There are 325,000 children who could be enrolled today if we could reach them, and about 200,000 adults who are eligible to be enrolled if we got the form to them, they filled it out, and we got it back.

Starting on the first of next year, a new program, Family Health Plus, goes into effect. There will be another 375,000 people who can be enrolled in Family Health Plus once that starts. We might as well get a head start on organizing that. So there is a number of about 900,000 that we can set as a goal in terms of trying to get people covered. It may be overly optimistic, it may not be, but that is the best breakdown that we can do right now of what can be accomplished.

Let's talk about Child Health Plus first because that is the priority, that is where we are going to start. Also, if you enroll the children, then you are going to get more information about the family, and then we can figure out who from the family can also be enrolled in the government programs, and the private programs that are available.

Child Health Plus is a new program, passed by the State Legislature and signed into law by Governor Pataki. We congratulate them for doing it; this is a wonderful thing they did, along with Family Health Plus. Children with a family income within 250 percent of the federal poverty level, which roughly works out to $35,400 for a family of three, who are too far above the federal poverty level to be eligible for Medicaid, are eligible for Child Health Plus. And there is an interesting exception to all of the rest of these programs; immigration status is not a criterion. So an immigrant who arrived too late to be eligible for the other programs, even an illegal or undocumented immigrant child, is eligible for this program. So we could have a situation where two or three children of the parents of undocumented immigrants, who could be covered, and should be covered, under the program.

The participants get to choose from 18 different health plans. Families with incomes greater than $22,600 for a family of three have a co-payment responsibility of nine dollars per month. The program covers medical checkups, dental visits, eye exams, eyeglasses, mental health services, prescription drugs, hospital care, and other services; it is a full medical health insurance program, and a good one. It's a program that is run by the State, and the funding is 65 percent Federal and 35 percent State; unlike Medicaid, which is 50 percent Federal, 25 percent State, and 25 percent City. Obviously, this is a program that the City should take advantage of for the benefit of the children of the City. The first priority will be to get children covered under this program or whatever other program they are eligible for.

Medicaid eligibility is much stricter. It is for very low-income children and adults. $4,300, would roughly be the limit for a single adult, and $12,300 for a family of three. Recent immigrants, meaning those who came to this country after August of 1996 - the effective date of the unfortunate immigration reform bill - are not eligible. But their children are eligible if they fit the guidelines of Child Health Plus. Medicaid, as you know, covers the same things Child Health Plus covers - medical checkups, dental visits, prescriptions drugs, hospital care and other services. HRA has offices all throughout the city to enroll people in Medicaid.
Family Health Plus is a program that is not currently in effect. The effective date is January 1st of 2001. But again, there are a lot of people who are going to be covered under Family Health Plus when it goes into effect, and we are going to have the applications ready to have the adults covered, rather than starting on the first of the year and spending a year trying to figure out who they are. Family Health Plus covers single adults with incomes up to 100 percent of the federal poverty level, roughly $8,400, and parents with incomes of up to150 percent of federal poverty level - that's $21,225 for a family of three. Unfortunately, recent immigrants are not covered under Family Health Plus, although their children will be covered under Child Health Plus. Hopefully, at some point Congress is going to change this, particularly with regard to legal immigrants.

There is a substantial group of people who are not eligible for Medicaid, and their children are not eligible for Child Health Plus, and they would not be eligible for Family Health Plus. They are earning wages that are above those income limits. Very often they are working in businesses that cannot afford health insurance because the business may have only five or ten or fifteen employees. Two years ago we started creating programs that try to cover them by giving the businesses the option to pool together and form a larger group, helping them try to find insurance coverage. We are going to substantially expand that, including the outreach effort, setting up health care purchasing alliances so that small businesses can pool together and purchase insurance as if they were a large business.

When an employer chooses Health Pass, each employer can select from four health plans, twenty benefit options, with prices that right now begin at $182 per individual per month. Of course, the employer will work out with the employee the co-payment, either paying for all, or paying for a portion of it. But it makes sensible and affordable health care programs available to small employers. Health Pass has enrolled 200 companies and more than 2,000 people in just the first couple of months of operation, and we will put a tremendous amount of emphasis on making this available to businesses. We can't force businesses to do it, but we can encourage a business to do it, and we can make it easy for a business to do it. We're therefore probably not going to be able to get the kind of coverage that we're going to get from the government programs, but I think with the right education we can see these numbers go up quite dramatically.

Healthy New York is a State program of subsidized health insurance for small businesses. The small businesses have to fit certain criteria. It doesn't fit all small businesses. If the small businesses have been eligible for twelve months and have at least 30 percent of their employees earning $30,000 per year or less, then they're eligible for the program, and we'll make that available to them also.

I said that we were going to follow the Compstat program. Some of you may be familiar with what I mean by that, some may not be familiar. It's a program that won an award from the Kennedy School of Government three years ago as the most innovative program in government. It tracks crime on a very sophisticated basis, all the way down to the street corner on which a disproportionate number of crimes are taking place, so we can figure out how to deploy the correct police units. It is one of the things that is largely responsible for the big drop in crime in New York City.

We're taking the operating principles of Compstat and applying them to health care by using computer pin-mapping to figure out where the most eligible people are located in the City. This will help us determine where to put the bulk of our resources in order to get hundreds of thousands of people covered in a relatively short period of time.

[Pointing to chart] What we've found is that those red areas of the city which include the South Bronx largely, the Northern part of Manhattan, and the Northern to mid-parts of Brooklyn, on the Brooklyn-Queens border - are the areas in which we have the most children uninsured. Then you'll see that we have analyzed the other areas based upon high levels of uninsured down to the areas where the lowest levels of uninsured exist. The allocation of our resources and outreach are going to be determined by this analysis. Obviously, as we learn more we may have to change it somewhat. With a few exceptions, the same thing is true for the eligible adults. [Pointing to chart] This is an analysis of where we are going to reach out to the most uninsured adults. We determined how to break down the different regions and the emphasis that we are going to put on them using this geographical analysis of the City.

We are going to divide the City into eight regions. Each region is going to have a manager who is going to be responsible for coordinating the efforts of all the agencies that have subdivisions within that region. There will be weekly meetings with the Police Department, the Corrections Department, and HRA to assess the results and to figure out what we can do to improve our outreach efforts. The weekly meetings will be held at the Office of Emergency Management (OEM) to use all of their technological resources. We have already had one preliminary meeting there a week ago. Each of the agencies will be represented at those meetings and they will try and figure out how we can continue to make progress in covering more and more people, and how we can fix the glitches that occur in any program like this. We will probably change it substantially as we move along to make it more effective.

These are the regions that have been determined so far based on the analysis that I discussed before. That also is subject to change if it turns out that we were wrong in determining where the bulk of people that are uninsured are located. [Pointing to chart] There are eight regions. Regions 1, 2, and 3 cover Manhattan, Southern Bronx, and Northern Bronx. 4 is in Northern Queens and Far Rockaway. 5 is in Southern Queens. 6 is in the Bushwick, Bedford- Stuyvesant, and Williamsburg areas of Brooklyn. 7 is in Coney Island over to Sheepshead Bay. And one space, 8 is in Bayridge, the whole area of Southern Brooklyn and Staten Island.

So let's take a region, Region 2, to show you what we mean by resources that exist in that area. First of all, for Medicaid the primary resource is HRA. In Region 2 there are 14 HRA offices just in that region, all of which will be available for outreach to people and finding who they are. When you add to that the public schools in that area now you have over 200 sites. HRA's facilities and the public schools together have 200 sites that will have forms available, and everything that is necessary to get people enrolled in Child Health Plus, Medicaid, Family Health Plus when that becomes a program, and even information about the private programs that exist and are available to businesses and to others. When you add the New York City Housing Authority (NYCHA) facilities, you have to 282 facilities that are available. Then when you add the police precincts, the fire houses, and of course the hospitals and the clinics that are in that area, you have 339 sites that will be giving out information, and helping to enroll people, just within Region 2. This is roughly similar to the other seven regions that exist in the City.

In addition to these agencies, the Board of Education is going to be involved. The Chancellor has agreed to substantially use the schools. Obviously, the schools are our best outreach to the children for Child Health Plus. We'll start with the roughly 250,000 summer school students, and the Department of Employment's Summer Youth Employment Program, which has about 50,000 participants. Some percentage of those young people are eligible for Child Health Plus. NYCHA, with their summer camp participants and their residents, and the Department of Health, each have tremendous outreach.

We have uninsured people who come into the hospitals, who are covered under the Bad Debt and Charity Pool, but many of them should be enrolled in Medicaid, Child Health Plus, and the other programs that are available. We just need to pay more attention to that. The Administration for Children Services, the Fire Department, and EMS are all going to be available to do this. As well as HRA, the NYPD, the Department for Housing Preservation and Development (HPD), the Department of Homeless Services (DHS), the Community Assistance Unit (CAU), the Department of Business Services, the Department of Corrections through the released inmate referral, and the Youth Agency, each of which will have trained personnel that are going to reach out to people and make sure that they are eligible for health insurance, and that they understand how to fill out the forms.

This morning I spoke to the Speaker, and all Council Members will have information about this available in their offices. We'll work with every group that has a presence in the different communities in this city. As soon as we get this organized, we'll work with private groups to see if any of them can get organized to accomplish the same goals.

Agencies are going to be expected to submit weekly data, so we can figure out who is covered and how much further we have to go. Also, we will check up on everybody. Whenever you do a new program like this some of the forms are going to be incorrect, some of the forms will be inaccurate, and people will make mistakes. So we are going to have do a lot of follow up to correct them. Let's not be afraid to do that, because the objective here is to get as many people covered as possible. If some mistakes are made along the way, we can correct those mistakes. Weekly reports will generate detailed information by region, by agency, and citywide results, that will allow us to keep changing this program as it goes along so that it works. The Mayor's Office of Operations is going to be responsible for developing the data selection and reporting system that is necessary.

That is largely the idea of this program. This is something that in a city like ours, if we can do this, becomes a model for the rest of this country for how to get people covered on the available health programs that exist before we go around inventing new ones. There are, unfortunately, many available health programs that people just don't know about. And it would be wonderful if the City of New York, in addition to setting the standard for so many other things, sets the standard for getting the overwhelming number of people who are uninsured, insured.

We shouldn't lose sight of this in what we're saying: New York City has universal health care. The city invented it ninety years ago with the public hospital system. So if you are sick and you need help, if you need treatment, you can go to a New York City hospital and you will be treated free of charge. In fact, you can go to a private hospital in New York City or New York State and get treated free of charge and the State, the City, and the federal government will reimburse that. But the system doesn't work the way it was originally envisioned. When that system was developed years ago there wasn't any government health insurance or private health insurance. We've never made the readjustment to the much more intelligent, much better way of providing health insurance, a way that involves a lot more preventive medicine. We never made the readjustment that is necessary, given the society we live in now. And hopefully this is where we can make that adjustment, and get the maximum number of people insurance - private or government - so they can make their own choices.

I want to thank Tony Coles, who has helped to envision this whole program and develop it, and Mike Carpinello, of Operations, who spent a tremendous amount of time putting this together. I really appreciate your involvement. It is going to mean a lot of hard work, and the hard work is going to pay off because this is going to be an enormously successful program for the health of our people.

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