Transcript: Mayor de Blasio Unveils NYC Care Card, Details Progress Toward Launch of Guaranteed Health Care

May 7, 2019

Mayor Bill de Blasio: Alicia, you just said it all. That was beautiful. That was beautiful and I want to thank you – you said 22 years? Let's thank Alicia for 22 years serving the people who needed health care in this city. Thank you.

[Applause]

And to everyone here, can I just offer my thanks for all you do for the people of this city, it makes such a huge difference. Do me a favor, give your neighbor a round of applause.

[Applause]

Alicia just told us what she experienced way too often – people making life and death decisions simply because of how much money they had available, not being able to afford the health care they needed, not being able to afford the medicine they needed, hesitating, waiting, not going because they thought it would be too expensive, not going for the health care at the time when they actually needed it because they thought it wasn't for them. And that's really what we're talking about. Some people knowing that health care is always available for them and so many people, hundreds of thousands of people in this city, millions and millions of people in the city who worry about how they're going to pay for their health care. And if you think about it, this country has tens of millions of people, and how wrong that is that health care is being decided by the ZIP code that people live in or how much money's in their wallet.

Health care is a human right. It's as simple as that. It's a human right. It's a universal right. And we need, in this city, to prove that things can be done differently. We don't accept the status quo. We don't believe that what was left to us was any way to live. The notion that some people just went without health care, families went without health care – we don't accept that. And today is a big moment because today is about making a change. Today is about doing things differently. Today is about being bold. Today I am so excited to announce the next big step in our plan to guarantee health care for all New Yorkers – guarantee.

[Applause]

And in my hand, I hold the key. This is the new NYC Care card and this card will unlock health care for hundreds of thousands of people who don't have it now.

[Applause]

You have never seen a card like this before. You've seen insurance cards and all the challenges and hassles that go with them, and you've seen a lot of people, as Alicia said, who don't even have the insurance card. This is a health care card. This is a card that gets you directly to health care. This is the card that gets you a primary care doctor. You get assigned a doctor, a human being with a name who's going to take care of you. This card gets you and your family what you need. And for so many people right now who have no coverage and no idea where to turn other than the emergency room., this card is going to change people's lives. We're very proud of this today.

[Applause]

I want to emphasize health care is a human right. Everyone – everyone should have the right to quality, affordable health care, including mental health services and addiction services. That needs to be the way we move forward. We can't keep saying some get health care, others don't. We can't keep saying, well, you got physical health care, but you don't get mental health care or God forbid you have in an addiction, there's nothing for you. We have to ensure that quality health care is there for everybody. And you're going to hear from our First Lady about how important it is that it truly be comprehensive.

Now everyone knows to guarantee health care for every New Yorker that will cost some money to ensure that everybody in every neighborhood, in every workplace and every school that everybody has health care when they need it. That will cost some money. And you will hear some critics who say it costs too much money, we shouldn't do it. You'll hear some critics who say, we can't afford to give everyone health care. I have a simple answer. It's not a problem of money, from my point of view, there's plenty of money in this world. There's plenty of money in this country, it's just in the wrong hands. It needs to be where the people are. The money needs to be applied where people need help.

So the notion that with actually a reasonable investment, we can make sure that every single person who lives in this city knows where to turn when they need health care. We can end the day where the emergency room is the doctor of last resort. By the way, to anyone who's concerned about the budget, the worst thing in the world is when tens of thousands of people, hundreds of thousands of people, only can turn to the emergency room. That's their only doctor.

That's the most expensive backwards way for people to get health care. We want people have primary care. We want people to know where to go the first time they feel sick, not when it's already too late. We don't want to see people hospitalized who could have been helped early on, but waited and waited and waited because they didn't know where to turn. So that's why this card matters, because it's not just a guarantee of health care, it’s not just that you get that primary care doctor, it says to you what you need is available and it's easy and don't hesitate, don't wait, don't feel like you don't deserve it. It's here for you. That's the change we are making.

[Applause]

And when I tell you it's important, that'd be easy to use, and that it makes sense to people – let's look at what's happening in this city. Let's look what's happening all over the country. People are working harder and harder, longer and longer hours. If it's hard to access health care, people won't do it. If it's complicated, people won't do it. We need to make it easy so we can all be healthier. That's the idea here.

Now it's also real important to remember what can happen if people don't have coverage, they don't have a place to turn. The bills can mount and they can mount and they can mount and they can become astronomical and they can literally ruin a family. It's not just about people not getting health care when they need it, it can destroy a family, and that's happening every day because until now there hasn't been an easy place to turn to actually get what you need. We have 600,000 people in this city who have no insurance at all. 600,000 people, bigger than some of the most important cities in this country. But starting on August 1st, in the borough of the Bronx, you will be able to get that NYC Care card and get the health care you need, right here in the Bronx.

[Applause]

And we know that this is a very human reality. This is not just about statistics. When you hear 600,000 people, let's talk about in human terms. Think about a pregnant woman who needs a prenatal checkup, wouldn't have known where to turn, wouldn't have known how to get it. Now this card makes it easy. Think about a senior citizen with diabetes and they need help managing their diabetes. This card makes it easy. Think about a woman who needs a mammogram – this card makes it easy. Again, this has never existed anywhere else in this country – fully comprehensive, guaranteed health care. That's what this means. A little card that has a big mission. And I got to tell you, this is going to bring a lot of peace of mind. It's going to make people know that there's something in life that's actually guaranteed to them, something they can depend on in a very, very complicated world.

Peace of mind is another thing the NYC Care card will bring. Now to make all this work, we needed a leader who will be able to hit the ground running, knows how to make things happen, and understands New York City. You're going to meet her in a moment and hear from her, but she is a native New Yorker. She has a long impressive record in the health care sector. Most notably played a major role in the expansion of Medicaid through Obamacare all over this country. And so I am pleased to announce the new Executive Director for NYC Care, Marielle Kress – welcome Marielle.

[Applause]

Now she is one of the people who made sure that a record number of Americans have health insurance. That was a profoundly important step forward, but we know there's farther to go. We know that Washington, D.C. has let us down time and time again. In fact, there are some in Washington trying to take away health care from people in this country. We know that we have not seen the commitment in Washington to finish the mission started by President Obama and actually ensure that health care becomes a universal right. Someday I truly believe there will be Medicare for all in this country and we should fight for Medicare for all, but until that time, we're not waiting. We're New Yorkers, we're doing it ourselves. NYC Care.

[Applause]

A few words in Spanish –

[Mayor de Blasio speaks in Spanish]

With that, I'm going to turn to my favorite advocate for universal health care and she's my favorite for a lot of reasons, but one of them is that I don't know anyone in this city, this state, this nation who has done more to spread the idea that mental health care is just as important as physical health care, that we have to respect the needs of those who have a mental health care challenge and give them full access to the care they need. If we are going to move forward, we have to get rid of that stigma once and for all and treat people with love and respect they deserve. No one's done more to move that forward then our First Lady, Chirlane McCray.

[Applause]

First Lady Chirlane McCray: Good afternoon, everyone.

Audience: Good afternoon.

First Lady McCray: Thank you, Bill and thank you, Alicia. I want to thank you especially because of all you've done with your skills, your training, but you can't do the work that you do without a certain generosity of the heart. So I appreciate you, I appreciate all of you for what you do for all of us. You know, Bill said that mental health is just as important as physical health. While I'd say it's more important because there is, as my father used to say, if you don't have your health, you don't have anything, you can't do anything but if you don't have mental health, you can't take care of the body. So there's something that we really need to give some more thought to as we move forward.

We are here today because as New Yorkers we believe, we know that health care is necessary for everyone regardless of income, housing, or immigration status. And mental health care is necessary. As I just said, there is no physical health without mental health.

[First Lady McCray speaks in Spanish]

Every day in neighborhoods in every borough ThriveNYC is connecting more New Yorkers to behavioral health services in our schools, family shelters, senior centers, police precincts, and community-based organizations. Even with this progress, there are many barriers to care. The stigma around mental illness is powerful. It's difficult, sometimes not even possible for many people to even ask for help, and for the approximately 600,000 people without health insurance mental health care is an unattainable luxury.

That's our reality and that's a dangerous reality. Think about it. No one goes to an emergency room to ask for counseling, to help them quit drinking alcohol, or develop safer drinking habits. Yet our city's emergency rooms have seen as many as 116,000 alcohol-related visits in a single year. Think about that – 116,000. When we don't invest in wellness and prevention, we always pay for it in dollars spent and lives damaged.

[First Lady McCray speaks in Spanish]

That's why New York City is pioneering a better, more inclusive approach with ThriveNYC and now with NYC Care.

Pull it out here.

[Applause]

This NYC Care card will be a key to all of our behavioral health services offered at our public hospitals and clinics. Primary care doctors will assess the whole person and work with patients to determine the best course of treatment. New Yorkers who are struggling with opioid addiction can get buprenorphine treatment. Someone who is experiencing anxiety or depression can get connected to therapy or other psychiatric care. They will pay what they can afford. No one will be turned away. Now, no other city or state provides that level of behavioral health care to all residents and we will work hard to make sure every New Yorker has the holistic care they need when and where they need it. Thank you.

[Applause]

Mayor: So, every time we have an event about health care, we seem to end up in the Bronx and it's because our Deputy Mayor plans all the events and –

[Laughter]

She's a very proud Bronxite. It just seems like a coincidence. So, Deputy Mayor for Health and Human Services, Dr. Herminia Palacio –

[Applause]

Deputy Mayor Herminia Palacio, Health and Human Services: Good afternoon.

Audience: Good afternoon.

Deputy Mayor Palacio: Thank you, Mr. Mayor, for your clarion call to make guaranteed health care a reality for all New Yorkers, for all of us who call this amazing city home. As your Deputy Mayor for Health and Human Services, one of my first tasks was to help bring financial stability and transformation to the largest public health care delivery system in the nation, to bring all of the assets like Lincoln Hospital into the 21st century landscape. And on the achievements made over the past three years when the Mayor announced this push for guaranteed health care, Health + Hospitals under the expert guidance of my colleague and friend, Dr. Katz, the mastermind behind so much of this initiative, we were ready to answer the call and so we rolled up our sleeves and we got to work.

We intensified our health insurance enrollment efforts. GetCovered has enrolled over 19,000 New Yorkers in health insurance in the first quarter of 2019 – a nearly 19 percent increase from the same period last year. MetroPlus, the City's public insurance option, expanded partnerships and outreach under the executive order of Mayor de Blasio. MetroPlus continues to enhance its efforts to let all New Yorkers know that affordable health care coverage is available to everyone. You can see our new campaign displayed here today. And we have made significant progress towards readying Health + Hospitals for the launch in August of NYC Care. We have been hiring new doctors and building new system capacities, so we'll be ready to serve the estimated 10,000 new members expected to enroll in the Bronx in the first six months.

We've been developing a 24/7 customer service line so we'll be ready to connect members to a real person that can answer real questions in real time. And we've been designing a model to expand access to our pharmacies. The NYC Care card is your key to the city's health care. Your card will have the name of your primary care doctor. Your card will have the copays clearly printed so that there'll be no hidden fees or unexpected costs of the kind the Mayor described. Your card will make it easier for you to get affordable prescription medications. Your card unlocks the access to get the care you need when you need it.

This card is a key to the city's health care and New York City has your back. So I am incredibly proud to be part of this effort.

[Applause]

[Deputy Mayor Palacio speaks in Spanish]

[Applause]

Mayor: Well, we always like it when a New Yorker comes home and I'm about to bring up Marielle – and I don't think you need the step here. I don't think you do. But I want to first just take a moment to acknowledge because Herminia mentioned the extraordinary work of everyone at Health + Hospitals. And I have to say Dr. Mitch Katz, your legend preceded you and you lived up to your legend. So let's thank Mitch Katz for all he has done.

[Applause]

I also want to welcome a new member of the team who is going to play an important role in the outreach to help people know that this NYC Care card is there for them and all that comes with it – the new Director of Public Engagement Unit, Omar Khan – welcome. Thank you.

[Applause]

And I mentioned the folks behind me before, but I want to just mention the organizations represented, all of which had been in the forefront of fighting to ensure that health care truly becomes a universal right. Let's thank Local 420 DC 37 AFSCME.

[Applause]

Let's thank the Doctors Council SIEU.

[Applause]

Let’s thank UNITE HERE!.

[Applause]

Of course, we cannot forget the New York State Nurses Association.

[Applause]

Always loud and righteous. And all the advocates, all the folks who have fought for opportunities for folks to get the health care they need. Thank you to all the advocates here as well. So, and I said, Marielle from New York City – has done so much to help people get health care. Was, until very recently, living in Washington, D.C. And I said to her when we spoke the other day, I said, that is not a place to be right now. Come on home. We're making change here. This is where it's happening. My pleasure to introduce our new Director, Marielle Kress.

[Applause]

Executive Director Marielle Kress, NYC Care: Thank you, Mayor de Blasio and First Lady, Dr. Palacio and Dr. Katz for your vision to guarantee health care to all residents on such an extraordinary scale and your leadership in creating this program. Thank you.

I am so proud to be the new Executive Director of NYC Care and so honored to join the great team at New York City Health + Hospitals. As a native New Yorker and the proud daughter of a New York City public school principal, serving my city is a dream come true. I spent a decade in Washington, D.C., as the Mayor mentioned, fighting for universal access to health care in the Obama administration and in the halls of Congress, and I could not be prouder of the work we did in expanding Medicaid in states all across the country. But I couldn't be happier to be back in my hometown to help ensure that access to health care is a basic right for all New Yorkers, no matter who they are.

This is the next frontier. New York City is doing something no other city, no other state has attempted. This is a true blueprint for guaranteed access to health care, a wider range of services than anywhere else provides, regardless of income, regardless of immigration status. Universal health care is the cause of my career and I can't express what it means to me to be able to implement it in the city that I love.

From my time in local government in Washington, to my work expanding and enhancing the Medicaid program during the Obama administration, and to fighting for Congress to protect children and families’ access to care, my North Star has always been the same. Healthcare is a basic right that should be available to all.

[Applause]

So as you've heard today, the groundwork is being laid and we are laser focused on a successful launch in August that will change lives. We have an enormous amount of work to do and that's ahead of us. Mr. Mayor, thank you again for the opportunity to make a difference in the lives of hundreds of thousands of New Yorkers. We have a big job ahead of us and I'm ready to get to work. Thank you so much.

[Applause]

Mayor: I want you to hear from one more speaker and he really understands what it means to reach people who don't have health care, who have felt that health care is not for them, who have felt the challenge of a language barrier or so many other barriers in the way, and to help make a difference so that people could finally get to the health care they deserve. I want to welcome the Deputy Director of Make the Road New York, Theo Oshiro.

[Applause]

[...]

Mayor: Okay, we are taking questions on NYC Care, yes?

Question: Mr. Mayor, you have many polls from undocumented viewers that [inaudible] to, that have gone through the situation that they find themselves without any care because they require a transplant, an organ transplant and what we understand is that you can only aspire to one, if you have Medicare, and if you don’t basically you’re not going to be able to get the care, we have a young boy who’s 16 going through that situation, and of course you have to prove that you have a healthier path in the future, but you need to have some sort of medical coverage. So, would this plan include that?

Mayor: So, let me say, thank you for raising the really painful situation that this young man is going through and we want to see how we can help him right away. In terms of what this would mean for someone with very severe challenges like that going forward who happens to be undocumented if Dr. Katz or Dr. Palacio.

President & CEO Dr. Mitchell Katz, NYC Health and Hospitals: We’ll absolutely –

Mayor: Come on up, there is a microphone.

President Katz: Thank you – Dr. Mitch Katz. So, yes, I’ve worked on this issue both in LA and here. One of the things that most upsets me is that low income people turn out to be major organ donors, but then have trouble getting when someone in our group actually needs an organ, right. And that is very unfair. It requires individual attention but I’ve worked individual cases, and we will under this program work any individual case. Someone who needs a transplant, we will work with a transplant center to get them on the list and to provide the guarantee of the on-going care that they’ll need.

[Applause]

Mayor: Very good, thank you, Doctor. And will you please make sure to follow up with Dr. Katz afterwards on the specific case of this young man. Yes?

Question: Can you talk a little bit about the cards. I am looking at the co-pay section, and in the press release you had mentioned that it’s individual for each individual. When it’s listed for the co-pays, are you listing like this is the co-pay for primary care visits, it’s a flat rate that every person who gets the card has, and then depending on their specific needs, it becomes sliding scale, and they’re going to pay less? Or is this like you have administrators at H + H who’s going to go through every person’s, you know, eligibility to say this is exactly what you’re going to be paying?

President Katz: Correct, we want everybody to know exactly what they’ll be paying for their sliding scale, so each card will be individualized.

Question: And so how much of the cost for the $25 million for the Bronx is going toward the administrative cost then of having people sit down, and say okay we’re going to evaluate each individual coming through the program, here’s their income, this is what the payment is going to look like for you as a person.

President Katz:  We would have already done that, that work as part of eligiblizng anyone who came to Health + Hospital’s. The difference is that with the card, they’re going to know that they’re entitled to care and what they have to pay and in most cases they’re going to discover that that zero or $10 for a visit.

Question: So this is part of the signup fee, where if I am somebody is coming in, I want to get my card, I come in, I give them any sort of documents I have, saying this is my salary, this is you know –

President Katz: Correct, all of which we would have done anyway.

Question: Okay.

President Katz: But what is here is different is now you’re getting the card, and you’re told that this is what, what you’re going to pay, and you have evidence so that if later on you have a specific need, and you think ‘oh, well I understood that it was okay to go to the clinic, but now I need to go to the hospital that’ll bankrupt me. You can look at the card, and see no it will not bankrupt you.

Question: Just a quick follow-up question. On this side you have the primary care provider. What is the criteria for determining which individual is going to get which primary care provider, and how does that work out?

President Katz: Sure, well, we always try to match people. First match is where people want to go for their care. So, obviously if someone chooses a center that’s near them the choice is among the doctors or nurse practitioners at that center. But then we also ask people other questions like if they some people would prefer to be seen by a woman doctor, a man doctor, we’ll do our best to match that.

Question: And language is part of that as well?

President Katz: Language is a part of it, but we always have translation for anyone who needs it.

Mayor: Okay, Anna?

Question: I am just curious, is the coverage going to be retroactive to January? Because the prototype says effective January 21st which is a little confusing –

President Katz: No, the coverage will start on the day the person gets the coverage.

Question: Okay, and in terms of you know, people physically getting these cards. How long will it take after they sign up, and also I understand that emergency care visits are obviously more expensive for the public hospital system. Is there any figure for how much this will actually save the City in addition to you know, the cost of running the program?

President Katz: In terms of your first question, people will come in, they’ll be given a primary care appointment right at that time, and they’ll receive through the mail their card within a couple of weeks. If they don’t have an address then we’ll arrange for them to come back and pick up the card at the center where they are seen. We don’t have a specific dollar figure attached to the emergency department savings, but we know that people come to the emergency department and Lincoln is actually one of those places – fourth busiest emergency room and you can ask all of the emergency room doctors behind me, many of the people are coming for conditions that could be cared for in primary care.

Mayor: Let me just speak to that. The fourth busiest that come back out – fourth busiest?

President Katz: Fourth busiest emergency department in the entire U.S.

Mayor: In the entire country. Well done, everybody, well done.

[Applause]

So now I’ll come in. So, OMB is in fact doing that bigger analysis, and it will take time as this all emerges. But the point is unquestionably to the point that Dr. Katz made. We know that there is a huge number visits that would not happen if people had a primary care doctor. We know there are hospitalizations that would not be necessary if people had their conditions treated early, instead of when it’s too late. So we think there’s substantial savings. Yes?

Question: Can you clarify how this is different from the MetroPlus health plan. Does it cover more people? Does it cover more services? Or –

Deputy Mayor Palacio: So, MetroPlus is a health insurance plan as our other health insurance plans. But it is a publically funded, public option health insurance plan. So it is just like any other insurance card. The NYC Care program really is a care membership. It is eligible for a number of services that you can receive at Health + Hospitals. It is different in that unlike an insurance plan you will not be able to get primary care in another city. This is really for New Yorkers at New York institutions. But I really defines for a population that’s been left with very little guidance about what services they’re eligible for, very little access to good primary care and preventative care, not access to sort of the kind of high quality pharmacy services that we would expect. This actually makes all New Yorkers have access to high quality affordable care when they need it, based with a primary care physician.

Mayor: Yes?

Question: Mr. Mayor, we’ve had two numbers thrown around – a 600,000 and a 300,000. Can you explain the difference between those two?
Mayor: Sure, and these are obviously broad numbers but 600,000 is the total universe of uninsured New Yorkers. Again, vast, vast number of people with no health care coverage at all. The 300,000 is the broad universe of folks, so there’s two of them really. There’s 300,000 that’s folks who are eligible for health insurance and don’t have it. And there are several reason for that. One of the reasons is cost. And again, we are very, very appreciative about the presence of the Affordable Care Act but even the Affordable Care Act in its construction acknowledges there are some people who just can’t even afford the plans available on the exchange. So those folks are not getting – either eligible officially but they can’t afford it, so this will be an option for them. There are other folks who are eligible and potentially could and we think are not accessing health care because of the difficulty navigating the health care sign up system. We’re trying to make it easier but also that public option MetroPlus is going to be very much more user friendly. It’s going to have you know, the availability of urgent care and a lot of other things that we think 24 hour helpline and things that we think will encourage people to take advantage of it. So 600,000 folks with no health insurance, 300,000 of whom are eligible, some subset of whom still can’t access it because of cost.

Question: But then the other 300,000 are eligible?

Mayor: The other 300,000 are folks who are ineligible because they’re undocumented, so again you’re going to see with NYC Care, some folks using it who can’t afford any existing insurance options, other folks using it who are undocumented. Yes?

Question: Just on the sign ups in the first quarter, the 19,000 plus. Were those only for MetroPlus? And also do we know how many people left the  insurance – dropped their insurance during that time?

Deputy Mayor Palacio: Sure, that 19,000 is the Get Covered initiative which includes more than MetroPlus and we can get you more details on the more specifics about who gained and who dropped.

Mayor: Yes.

Question: [Inaudible] roll out, I guess by the end 2020 all the boroughs are going to have it?

Mayor: Correct, the point is this– look, our goal is that we have this in place fully operational by the end of 2020 in every borough and that then in course of between now and the end of 2021 we’re reaching literally everyone. Now I want to affirm some people may be given the opportunity multiple times and decide not to take it. So we understand it’s a matter of choice. Some people may be eligible for insurance and we show them every conceivable option, and match what they can afford, and everything and still might not want it. Some people may be reached by all sorts of outreach efforts and – now hear what an NYC Care card is and how it’s going to help them and they still don’t want it or some people no matter how hard we try and reach them, we might not reach. But our goal is to be able to reach into every borough by the end of 2020, by the end of 2021 to have reached everyone who needs it and give everyone a chance to decide. And I think overwhelmingly people who hear about it will take it up. Okay, I just want to make sure we’re dong media questions, and who has not gone? Grace.

Question: So before this program was rolled out, my understanding was someone who didn’t have health insurance could come to a public hospital and make an appointment with a doctor, and see a doctor and not necessarily have to pay.

Mayor: Let me start, and then my colleagues will go into it. What we know has happened historically is that the health care system is cumbersome and that people don’t take up the opportunity to come to every public hospital or public clinic. And what we know is that a huge number of people thought and felt that the only option they had was the emergency room, and that’s how they lived. This – the idea here is to make it as user friendly as it possibility can be to say we’re not going to ask you to go struggle and find your way through, and it’s not like something where you have to wonder. We’re saying, come get this card, we’re going to assign you a doctor, we’re going to show you all the services you can get with this. It’s as straight forward as it can be. And we’re encouraging you to get health care anytime you need it. You never have to wonder where your health care is coming from.

So, they’ll tell you about the existing reality, but I want to say, that 600,000 number should make all of our blood run cold. Again, that’s more people than there are in Miami or I think in Boston. It’s a huge, huge number of people, and what it means for those people is they are getting either no health care or very limited health care or very occasional health care. That’s bad for everyone. We think if the message is – and I want to liken it to Universal Pre-K, because I actually think there’s an important parallel here. Once upon a time, just a few years ago you had to struggle to get pre-K. Before this administration it was you know, a crapshoot, whether you could get pre-K. You would go around applying to different places, maybe you get it, maybe you’re not, maybe it will be full day, maybe it would be half day. People, there was a culture of scarcity. So from a parent point of you, and I can attest, and Chirlane can attest to this. You’re preparing all sorts of options, you don’t know what’s going to happen, and you know a lot of people who get a no, and then they’re scrambling to figure out an alternative, versus when you say this is 100 percent universal, it is guaranteed to you, you do not have to wonder anymore. It encourages people to participate. It makes it easy for people to take advantage of the opportunity. So there’s a lot going on in what we think will change people’s lives and opportunities because they’ll know it’s there for them. Yeah?

Question: I mean unlike Pre-K there weren’t enough seats, public seats for everyone to get one. But my understanding is that HHC was not turning people away –

Mayor: I’m going to say one more thing and then Dr. Palacio. Again I’m telling you about the reality as it’s been lived, which is a vast number of people never chose to or where able to or understood that they could access – this is about both commitment to a wide range of services, but also presenting it as universality and teaching this entire city as universal and available and making more services available then people ever imagined they could get. Even if someone though oh I can go in and deal with an immediate problem, they didn’t necessarily know they could get a mammogram, they could get diabetes treatment, whatever it might people. This is about teaching people that they are going to have access to a full range of health care services. Go ahead.

Deputy Mayor Palacio: So I just want to expand on that. So yes people could walk into the emergency room and nobody was going to be turned away by ability to pay. But to do this, to actually operationalize this important vision means hiring new physicians and new nurses so that we can actually serve the 300,000 people who would be eligible for NYC Care, it means building new ambulatory care clinics, it means expanding hours, it means expanding hours of pharmacies, it means having a 24/7 call number where people can call, actually speak to a person, not just about hey, what’s the address of the clinic, but I want to figure out how to make an appointment with my doctor or it’s after hours and I haven’t been able to fill my prescription so can you please help me figure out where the 24 hour pharmacy is in my neighborhood. It means setting up retail pharmacies. It is real structural capacity building changes to provide a different kind of care then just, yes if you happen to come in so sick into the emergency room, of course we are not going to turn you away but we didn’t have the capacity to have people get primary care docs with a short turn around right? We want you to get an appointment not six months from now, we want to be able to schedule your appointment with your primary care doc in the next one to two weeks. We want to be able to if your primary care doctor needs to send you to a specialist, it means building a whole new system so that specialists and the primary care physician can talk to each other in real time and figure out what test do you need before you get to that specialist so that that appointment happens soon and it happens with the right laboratory test or x-ray test already done so that we are not wasting peoples’ times. This is real, it is real quality, and it is affordable and it means people know what to expect and they have the comfort that they are going to be treated with dignity, they have the comfort and the peace of mind to know that they can go in and get care the way any of us who are fortunate enough to have good insurance have been able to take for granted.

[Applause]

Question: Are people going to opt into this or are there certain income restrictions and are there monthly premiums that are associated with this?

President Katz: There are no income restrictions; there are no monthly premiums, all the care is on a sliding scale. You do have to live in New York City.

Question: I guess I was asking a similar question which is who is eligible so anybody could pick up one of these cards? I mean I guess it wouldn’t be to the advantage of somebody with full insurance.

Deputy Mayor Palacio: So you have to be either, you have to be uninsured and either ineligible for insurance or you have to be uninsured and not be able to afford the most affordable plans in the New York State Essential Plan.

Question: Who determines that though?

Deputy Mayor Palacio: We are using federal guidance around what constitutes affordability in terms of insurance, a certain percentage of an income; we are going to be using that guidance for a monthly expense to figure out who is eligible for NYC Care versus who will be referred to purchase an insurance plan.

Question: What’s the income cut off, like something that you know already is the income level under which you have to be in order to qualify?

Deputy Mayor Palacio: It’s rough estimate of about 8.5 percent if the plan is going to cost more than 8.5 percent of your monthly income.

Mayor: Ok, who has not gone, anyone who has not gone, media questions okay. Everyone’s gone, good.

Question: Just to be clear this is not an insurance card?

Deputy Mayor Palacio: Correct.

Question: What would you guys call it? A coverage card?

Mayor: A health care card.

Deputy Mayor Palacio: It’s a member – it’s a health care, it’s a membership card to Health + Hospitals.

Question: Ok, but I guess I’m just curious about –

Mayor: I want to make, I’m sorry to interrupt a second; I want to make sure you get that distinction. It is – so health insurance is like the middle person right? This is just cutting out the middle person. This is go direct to health care. That’s the point. It’s a health care card, it’s a membership card, it gets you that directly. Go ahead.

Question: So I guess I’m just a little confused why you guys keep saying this is the first time people are guaranteed this when they were guaranteed it before. I mean understand there are certain build outs but –

Mayor: It’s just totally different and again, you have to hear it or not hear it, it’s up to you. It’s totally different. We have 600,000 uninsured people and a huge percentage of those people are getting very sporadic, very insufficient health care. This is a fact. Unless you create and entirely different approach, that’s going to continue to be the reality. So we looked around the country and we said how do we create something that reaches people absolutely consistently, ubiquitously with a whole range of services to give them full health care and to make it something that will work for their lives. That has never existed anywhere on this kind of scale, with this kind of comprehensiveness. That’s why it’s different. Yes.

Question: So you said this is a membership card but don’t we as New Yorkers already have a membership to Health + Hospitals, can’t anyone walk into the hospital and get the care –

Mayor: It’s the same question, it’s a way again, this –

Question: You didn’t explain it –

Mayor: I feel I did, but I’ll have the Doctor take a try as well.

Deputy Mayor Palacio: So I am just going to try to use an example right? So if I have a membership card that ostensibly gets me a primary care doctor but I have to wait six months to get an appointment, I would say that’s not a real membership card right? What we are changing, we are changing the game, this actually means something, we are expanding services. Yes we could guarantee that if you came in with a heart attack in the emergency room we would treat you but there was no guarantee that you could get a primary care doc in a timely fashion. There was no guarantee that you could get, in fact right now you do not have 24/7 access to a pharmacy, that’s something that we are going to need to build out. There was not guarantee that these services were available. There was a guarantee that if you had a heart attack we would take care of you. And there was some access to primary care. There wasn’t the kind of access that we are building out and compelling for people to be able to actually use and access. This isn’t theoretical. This is we are building a system where people can actually come in and see their doctor as in a timely fashion that’s relevant to their actual physical health.

Mayor: Or a therapist.

Deputy Mayor Palacio: Or a therapist.

Question: Mr. Mayor, the big change that we see is that undocumented residents will be included and one question that I have about that is documentation. They want to know how they will get this card, what are the requirements, birth certificate from their country, some of them might not have the documentation, are you working with consulates?

Mayor: So, the team will speak to that for a second. Again we will do a few more questions and then anything we will get into much more detail with the team, anyone who needs more detailed briefing after. But I want to note, yes undocumented folks but again, a substantial number of people who cannot afford insurance on the exchange. Which again was anticipated in the Affordable Care Act and it’s a meaningful number of people with many thousands of people in this town. This is also going to be for them, even if they are officially eligible for insurance, if they can’t access it because of cost, this is going to be the thing that will 100 percent be available to them. On the how you verify –

President Katz: The verification will just be about being in New York, some evidence that you’ve been in New York, a utility bill, right, an NYCID card would work, absolutely.

Question: Mayor, I know you distinguished between the full universe of 600 and then the smaller number of 300 but did you say that 300 was the number that you think will actually qualify? That’s what I’m –

Mayor: Yeah, I’m sorry because the numbers don’t perfectly match. 600,000 broadly is the universe, 300,000 folks who are eligible for health insurance do not have it now and again a substantial subset of that is people who are not getting it because of cost. 300,000 or so undocumented folks, so there is some crossover in terms of the use of the NYC Care card but if you were trying to figure out where does this universe of 600,000 total come from, that’s basically how it splits.

Question: [Inaudible] 600 necessarily meet the 8.5 percent of income?

Mayor: No, no, it’s a lot of people but no it’s not all of it by any stretch. As I said there is some people who they have the money but they don’t feel that they can navigate it. There is some people, we talked about this when we announced it, the quote, unquote young invincibles that we are trying to encourage to get health insurance and we believe MetroPlus being made simpler, more user friendly is going to be a great option that we are going to be able to get a lot more people to pick up on.

Question: Do you have a closer number to the number you think or estimate will meet that 8.5 –

Mayor: We can get that, I don’t have that today. Okay, go ahead.

Question: So I’m a little confused about what subset of people who enroll in NYC Care would then be eligible for MetroPlus, and like if I’m coming in saying like hey I heard about this program and I want to enroll and the person I’m talking to goes actually you are eligible for MetroPlus, let’s enroll you in that but you are still going to get the card –

Mayor: Ok, let me just say that your question and the one in back, let me get the answers to these two and then after I just want the team, anything more that’s detail about the functioning of the program day-to-day, the team can get you.

President Katz: So for the 300,000 people who are eligible for insurance, right so those people will go through MetroPlus and we will urge them to get insurance, we will make it easy for insurance. And if they are eligible but the reason they don’t have it is they can’t afford it because as Dr. Palacio said, insurance would cost more than 8.5 percent of their income, they would then instead be led to NYC Care. For the NYC Care, the 8.5 is not relevant for people who are undocumented, for people who are undocumented, those people are all going to be eligible for NYC Care because they are not eligible for insurance. So they don’t have to make any 8.5 cut off.

Question: And that’s absurd, according to the release that number, the release said it was about 300,000 New Yorkers who theoretically would eligible for NYC Care.

Deputy Mayor Palacio: That’s correct and a rough number as [inaudible] said, it’s about half of the 600,000 are eligible for insurance, half of the 600,000 are not eligible for insurance.

Question: Can you talk about the role out of these new doctors, the nurses, the clinicians, can you talk about how much funds are going to be invested and what’s the hiring look like?

President Katz: We are currently hiring. We’ve hired already a number of primary care doctors, by the time August 1 rolls around we will have enough primary care physicians or nurse practitioners to handle the Bronx and as we march through and make this program available throughout the boroughs we will always ahead of time have enough physicians to guarantee as Dr. Palacio said the two week wait for primary care.

Question: And what’s the estimate for the number I guess –

President Katz: Well generally a primary care physician would have a panel of about 1,600 patients so as – and they don’t all come at once. So basically you hire as you move along.

Mayor: Ok we are going to get – I’m going to stop you there. We are going to get a full technical briefing for anyone briefing for anyone who needs it, because we covered the basics very thoroughly here and we got I know other questions and these good people need to get back to doing their good work so thank you everyone.

[Applause]

[…]

Mayor: Okay, off-topic –

Question: Mr. Mayor, last night, I think all of us, we watched you on NY1 and, of course, Errol –

Mayor: Glad to know I have an audience of at least 12. Go ahead –

Question: Errol asked you the question that, you know, everyone was kind of wondering about this week, and some of us had reported that we expected you to announce that you would be running for president this week, and some even said that it was going to be on Wednesday. You said all of the above is wrong. What happened?

Mayor: I don’t know. And we, meaning – we never said – all I said was the month of May. We never said a specific day. If we’re ever asked, we’re not going to say, you know, you could – if you wanted to, you could take the whole month of May and say, will it be at this day, this day, this day – we’re not doing that. It will be in the month of May that we make a decision. We’ll announce the decision. We cannot make an announcement until we make a decision. So, it’s as simple as that. 

Question: Just as a follow-up, what do you tell the folks who are looking at you taking your time on this – as some might say, your time is running out – and say, the whole US Attorney’s investigation into you fundraising and the whole DOI investigation – that, that is somehow weighing as to how you might appeal or not appeal to folks in Iowa and New Hampshire. 

Mayor: No, that’s not on my mind, honestly. 

Question: [Inaudible]

Mayor: It’s just not. I’ve said it 1,000 times, but I’ll say it 1,001 – all of that was looked at, everything was closed. I’m very comfortable with the way we handled things. We make our decisions in government based on the merits. We really, very, very intensely, consistently, every single time, make our decisions in government based on the merits. I’ve been telling you guys that a long time – I’ll keep telling you, because it’s the truth, and no one has shown me anything to the otherwise – to the contrary. It is the truth. And all of these things were looked at. And I actually think when a bunch of people look at something and come back with nothing, it makes the case pretty damn clear. So, no, that is not part of the discussion. 

Rich?

Question: Can we get a measles update? We understand the number has gone up, and can you fill us in a little bit on –

Mayor: Yes, and we’ll have the good doctor – Deputy Commissioner of the Health Department – join me. I want to say, look, the count today, 466 – we have said because it takes a while to manifest that we will expect the numbers to grow for a period of time. And obviously, the thing we’re really concerned about was the Passover holiday and vacation, and families being together, and kids being home and seeing how that’s going to manifest. The doctor will explain to you exactly what that kind of timeline is. But it is – I’ll give you the once-over – 43 new cases since last week; grand total now, 84 individual violations have been given, and that will continue in earnest until we are convinced that this is over. And we have seven schools total that were closed at one point. I believe, doctor, they’re all reopen now –

Deputy Commissioner Demetre Daskalakis, Department of Health and Mental Hygiene: That’s correct. 

Mayor: But seven have been closed and only got reopened once they proved that they had the documentation for all of their kids. With that, I’m going to turn it to the Deputy Commissioner. 

Deputy Commissioner Daskalakis: So, as the Mayor said, we have 466 cases reported. Just to be clear about the timeframe in relation to Passover – so, we are seeing – we saw 43 cases last week, but, actually, if you look at our curve, we’re starting to see a slow decrease in newer cases. So, we did not see a large bump related to Passover, although we saw a bit of one. So, the good news is, it’s a bit of a deeper epidemiologic, sort of, observation is that, overall, though we have cases, they’re filling backwards – they’re earlier cases. So, we have fewer newer cases, meaning, that I think we’re starting to see a glimmer – actually, more than a glimmer – a beginning of hope that we’re nearing a decrease in what we’re seeing with new measles cases. We did have that additional piece of news, that we had two children that were diagnosed with measles, who were in the Sunset Park area of Brooklyn. They were students in public schools. But the important piece of news there is that they were not in school at all during their infectious period, which means that we do not expect any transmission related to these two children in public school. So, all in all, I think we have the beginning of a decrease. I am guardedly optimistic. We need to monitor as we have been doing and getting all of our information about these cases and transmission. But, all in all, we’re starting to see things going in the right direction. And I think primarily a lot of that is on the exciting news of our increase in vaccination that we’re seeing in the ZIP codes that are specifically part of our Commissioner’s Order that launched April 9th. We’ve seen over 2,100 vaccinations given to children six months to 18 years of age in Williamsburg in that area alone. 

Mayor: Since the order –

Deputy Commissioner Daskalakis: Since the order, since April 9th – but, overall, since the beginning of the outbreak, over 22,000 vaccines have been given in Williamsburg and Borough Park. So, the community in that area has really stepped up and I think along with the order that has really encouraged more rapid strategies to vaccination, we’re really seeing the beginning – the fruits of our labor in terms of this measles outbreak getting into control. 

Mayor: Any questions on measles? Go ahead –

Question: The State Legislature is kicking around the bill that would end all non-medical exemptions. And the conversation right now is, if the State Legislature doesn’t do it now, it’s probably not going to happen because of this measles outbreak. And I was wondering if you could speak a little bit to what the City is doing to lobby for the State to –

Mayor: I want to start from scratch on this one. And obviously, the good doctors may join in if they have anything to add. We’re going to look at the legislation, but I want to really emphasize our problem here is not religious exemptions – it isn’t. The vast majority of the community leadership in Williamsburg has been supporting vaccination, the vast majority of community institutions have been supporting vaccinations. So, these are the Orthodox leaders of the community strongly supporting vaccination, working hand-in-glove with the Health Department. So, let’s be really clear about what’s happening. In fact, Borough Park is another important example – tremendous cooperation, and it lead to pretty much ending the crisis in Borough Park. What’s happening here is, the anti-vaxxer movement has infiltrated into Williamsburg as a strategic action. We have to understand this, there’s a national anti-vaxxer movement, it is well funded, it made a decision as a movement to go into Williamsburg and try and, as much as possible, move people at the grassroots level. And they have found a small number of people who have been swayed, and now there’s a huge counter-push going on by community leaders, but also by the Department of Health. And I want to thank Dr. Palacio for leading the way in terms of creating a really holistic public outreach effort in English, in Yiddish to counter the absolutely horrible propaganda and misinformation coming from the anti-vaxxer effort. So, we’ll look at the legislation, but I really think the legislation in terms of what we’re experiencing doesn’t speak to our reality. Our reality has nothing to do with religious exemptions. 

Question: But it does kind of intersect with one another where you really have this big outbreak and it’s spreading to 23 states now. There’s around 800 cases reported by the CDC. And so, my question really is, do you support ending non-medical exemptions?

Mayor: Again, we’re going to look at the legislation, but I want to emphasize that that is not the root of our problem. 

Question: [Inaudible] those kids have religious exemptions? Even if it’s maybe a philosophical distinction?

Mayor: Again, I’m arguing strongly that we can have an interpretational discussion, but you have a community where you have a huge number of people who are – the exact same people as their neighbors – are getting the vaccinations. And so, just listen to my logic pattern here – somehow ending the religious exemptions doesn’t address what happened here, where the anti-vaxxers convinced people not to get vaccinations – that’s the root problem. That’s what I’m trying to say. It’s not like there’s some magic bullet here. So, we will look at the legislation, we’ll asses it, but I want people to understand how rarified this situation is. It is not happening in other elements of the City, other areas of the City, other areas of the Orthodox communities in the City. It’s because of a conscious misinformation effort in one neighborhood. 

Question: Mr. Mayor, last month you announced new technology for NYCHA for lead paint detection –

Mayor: Can I just – I’m sorry, I’m coming to you, I just want to see if there’s anything else on measles. 

Question: You had said, I think, 84 individual violations have been given out?

Mayor: Yes.

Question: Have any of those people paid fines? And what is the City doing to – what next steps is the City doing beyond, sort of, issuing these violations?

Mayor: So, doctor, help us, because the – I don’t think most of us understand the nuances of OATH, maybe you do. But there is always a period of time, and then there is due process, so just help everyone understand that. 

Deputy Commissioner Daskalakis: So, we are approaching the time where individuals who have received violations will have their cases heard at OATH. And it takes about four to six weeks to get there, so we’re expecting that the first hearings are going to be at the end of May. It’s OATH who hears the violations and ultimately adjudicates whether or not the folks who have received the notices of violation will actually get a fine. So, we continue to do our work identifying unvaccinated individuals in 11205, 11206, 11211, and 11249 – those areas in Brooklyn – and are continuing giving them notices of violation. But like I said, it does take four to six weeks before these cases are heard.

Question: And just to be clear, these were people who were ordered to vaccinate, or vaccinate their children, and refused?

Deputy Commissioner Daskalakis: Yeah, so, we have a Commissioner’s Order that came out on April 9th that focuses on the four zip codes I just stated – 11205, 11206, 11211, and 11249 – and the order was to be vaccinated or know your immune status for measles. In the scenario where someone does not know their immune status or has not been vaccinated, they are subject to a notice of violation and ultimately a hearing at OATH that could result in a $1,000 fine. 

Mayor: Anything else on measles? 

Okay, back to you, Lisa. 

Question: Thank you, Mr. Mayor. Last month you announced new technology to do lead inspection at NYCHA and I wanted to find out about how you feel about the progress on what’s being done.

Mayor: I think it’s working and the first developments that have been looked at are the ones we knew would be the toughest – that was a purposeful choice. They’re developments that we have every reason to believe have a lot of lead in them and we’re confirming what we think is pretty evident. We’re going to be, over time, of course, reaching a huge, huge number – 135,000, I think it is, units. So, I think the first month or two is going to be smaller and not showing us what the larger program is going to indicate. I think when you get down the line a few months, you’re going to start to see bigger numbers and you’re doing to start to see developments where we find a lot of units that, thank God, have no lead and, it will turn, out never had any lead. Then that’s going to allow us to focus much more time and energy on the ones that do have lead and really ensure that we follow up on that very aggressively. So, in terms of people who live in public housing, when this testing is complete, there’s going to be a lot of people in public housing who know their apartment is 100 percent lead-free and that’s going to be an incredible relief for parents. And then the other apartments where we’ve confirmed there’s lead, we can then take a lot more resources, focus on addressing each issue, obviously, with the most important focus being on an apartment with a kid under six years old. 

Question: Samaritan Village is proposing a 165-cot men’s shelter in the Parkchester community. These men will then be sent out into the community once daytime breaks. Samaritan survives drug addicts, criminals, and sex offenders. There are three schools nearby, a pre-K and public library that children use right across the street. Family shelters are being phased out in Parkchester, so why are you, or DHS, putting a men’s shelter where family shelters are needed?

Mayor: Okay, I, respectfully, am not going to say I agree with every characterization you’ve made because I haven’t heard the full composition of that shelter and the approach that’s being taken. What we know is – we devoted, two years ago, in this city to a plan for 90 new shelters so that we could ensure that we could support folks who are homeless and get them back on their feet, get them out of the shelter system, and that they had to be as close to home as possible – which is, I think, a huge mistake of the past sending people all over the city who are homeless.

That means not only having new shelters so we can get out of those expensive hotels, get out of the cluster buildings that were low quality – it also means putting them in places where we haven’t had as much. But we have to treat and support every kind of person. I would argue to you that someone who has a substance misuse problem, which a lot of people in this city and a lot of families – we’re trying to make sure people get well. We’re trying to make sure they get the support they need.

Question: [Inaudible]

Mayor: Again, I don’t know how it’s being handled specifically so I’ll come back to you after I get DHS’s explanation of what’s going on there. But I wanted to put in perspective for you what we’re trying to do. We will get you a formal response from DHS about who is going where and why. Go ahead.

Question: You asked the – or you gave the BOE a list of more than 200 sites for potential early voting. Have you heard back from them?

Mayor: I am going to look over to the team because I have not heard back from the Board of Elections. Has anyone on the team heard back – or heard of their team hearing back? We will confirm that. But to the best of my knowledge, shockingly, we gave them – we’re saying here’s $75 million for 100 sites. We gave them over 200 sites. It should be really easy to do. To the best of my knowledge, we have not heard back but we’ll come back to you on that. Yes?

Question: Mr. Mayor or First Lady – since this is in her wheelhouse and she has graced us with her appearance – yesterday Speaker Corey Johnson said that you rejected transparency measures for the budget including more reporting on cross agency initiatives like Thrive. Is that accurate and if so, why?

Mayor: We’ve been working very closely with the Speaker and his team on the budget process and I’m not – when you say it that way, I don’t even know what you’re referring to honestly. I don’t know what we have rejected. I think we’ve tried to work with them on a lot of things.

Question: He’s saying that you wouldn’t work with him on more transparency for Thrive.

Mayor: We are in the middle of the budget process. We’re discussing a whole range of items. We have at least six weeks or more to go – six to eight weeks. And there was a whole hearing recently to go over a lot of the issues in Thrive including the budget. So, I’m confused by that. Would you like to say something? Ms. McCray –

First Lady McCray: I can’t really add much more. The first time I heard about that was earlier today. As you know, Thrive is reaching huge numbers of people. NYC Well, alone, has received more than half-a-million calls, texts, chats. And we’ve held many briefings on the Thrive budget including the hearing that we held not so long ago. One-on-one meetings – Susan Herman is doing a tremendous job of meeting individually with Council members to make sure that all their questions are being answered. Every dollar can be traced. There’s nothing to hide. And we’re always willing to work with the Council on Thrive. Before we even launched we spoke with every Council member about the program, what we wanted to achieve because at the bottom – the foundation of Thrive is to help people.

And I feel confident that in the end we will come to some agreement about how this very innovative program should be tracked and measured because we all want to help people. That’s what we’re in the business of doing. I’m a full-time volunteer. All I want is for people’s lives to be better because they are getting the important mental health services that they need. And again, I’m sure that we’ll be able to reconcile. Thank you.

Mayor: Who has not gone? Media question – media?

Question: Well, this is with health –

Mayor: Wait, media question, sir? Okay, we got to do media right now. Go ahead.

Question: Mr. Mayor, the Conflicts of Interest Board issues dozens of private warning letters to officials in City government every year. And I’m wondering if in interest of transparency, you would be willing to make public any private warning letters you’ve –

Mayor: We’ve covered this. Everything is about a past issues for an organization that is defunct. I’m just not going into this anymore.

Question: [Inaudible]

Mayor: Again, we’ve covered it.

Question: [Inaudible] you were just talking Thrive, and you had spoken about Thrive in the past tense. And so, I was curious, when you were talking about the past tense of Thrive – is the program going to be eliminated [inaudible] –

Mayor: Okay, now that – that’s a really. Please, please – I respect your attempt to interpret but I have to say I don’t know how on Earth you could see it that way. This is a –

Question: [Inaudible] Thrive was a foundational effort to address a [inaudible] –

Mayor: Again – excuse me, excuse me, excuse me – we talk about it all the time as one of the pillars of what we’re doing in this administration. It’s going to be here for a long time to come. So, sometimes that’s just an English-language construct  – talking about why something was created. Nothing has changed. Anyone else –

Question: Just wanted to follow up – in the talks of downsizing the Mental Health Service Corps program which, you know, had been discussed, I wanted to know what criteria you’re using to determine where those cuts are going to be made for Fiscal Year 2020.

Mayor: Well, that one was put on the table already –

Question: Right, I wanted to know the criteria in terms of how are you actually evaluating these programs.

Mayor: Well, that’s a very broad question. I’ll give you a very broad answer because it’s a huge, huge endeavor – and obviously jump in if you want to add. That’s what OMB is for, on the one hand, and then each part of the government is constantly looking at its own programs to determine efficacy as well. So, Thrive exists within a whole host of City agencies and so those agencies are looking at it, OMB is looking at it, and then the central Thrive leadership is looking at it determining if the vision is being fulfilled.

And I again I want to – there’s a startup reality here I hope we’ve articulated but maybe we haven’t well enough. This – I remember the earliest meetings on this. This was about something that did not exist. There was no universal mental health care strategy. I remind everyone there is no State health care strategy – mental health care strategy, there is no federal mental health care strategy. This is this really strange reality where 20 percent of the people are affected by something – pretty much every family – and there’s no strategy.

And so, if I had to boil down Thrive and the sort of revelations that occurred in the first year or two of the administration was we had to create, essentially from scratch, a holistic mental health strategy and that became Thrive. But that is start up by its very definition.

So, a  whole lot of ideas were put into play – some of which I think have worked 100 percent clearly well, others of which are still growing and we have to see, and some for sure did not reach their expectations. But it’s a lot of pieces being evaluated by a lot of people. What I want to emphasize is that startup reality. We never thought in 2014 or 2015 everything would be perfect the next year or the year after. We knew we were trying to do something that hadn’t been done before and it would take quite a while to fully develop. But that’s okay if it reaches its ultimate goal. Yes – do you want to add?

First Lady McCray: Yes. Just want to add – I just want to add because I think that the people keep getting left out of this discussion that the corps was started to make sure that mental health services were available in underserved areas. If you look at the various maps that we have available and look at what was before Thrive and what is after Thrive, you will see that service corps members and other Thrive services, you know, are all over these areas that are actually designated as federal – goodness I can’t remember the term – but they’re designated as underserved mental health areas.

So, we’ve done a tremendous job in making sure that we had a creative way to put people where people – put professionals where they are needed. But those sites and people didn’t always match up because we don’t have a health care center – a health care training, medical training, that prepares primary care doctors to work with mental health professionals. We’re strong believers in collaborative care but that’s actually something you have to learn how to do. And what we – one of the things that we have found is we learned many lessons with the Mental Health Service Corp, is that we have to make sure these doctors are prepared and ready to receive corps members. The sites have to be ready.

There are a lot of pieces to this I think that we have done a great job with the concept and now we’re refining it. So, it’s not just about downsizing. It’s about really tinkering with the program to make sure that we’ve got a great fit with the sites, the doctors, the people who are there, that there’s cultural competence with the neighborhoods where people are in, and they’re getting the number of hours that they need to get their licenses where applicable.

Question: [Inaudible] traffic fatalities are up 30 percent from this time last year. The City Council Speaker is pushing for legislation that would make Vision Zero design standard in projects. Is that something that you would support?

Mayor: We’re going to talk to the Council about that for sure because, look, we’ve done a huge expansion in terms of the work with traffic design and intersections all over the city and streets and bike lanes – I mean there’s been a huge, huge investment and it continues to grow. We’re very happy to talk to the Council about the future of that and how much we can build out and how quickly.

But I also want to say two things. One – it has been a tough few months, unquestionably and it’s painful to see and it’s really – these are all human stories of what’s happened here. We don’t want to ever lose a life. But I would also say after five years, we know that Vision Zero works. What we will certainly be doing is any place where we see a problem, we’re going to put a lot more enforcement into play because we can move additional enforcement in very quickly. We also know that now with the help of Albany, we’re going to have a lot more speed cameras around schools and you’re going to see a steady growth of that. And that, I think, is going to be a major new part of the equation.

So, it has been a tough few months but I think you’re going to see real progress going forward. And every year we have seen, so far, five full years by the end of the end fatalities continue to go down. Yes, Anna?

Question: Mr. Mayor, do you think that taxpayers have a right to know how much they are spending on your outside travel [inaudible] security costs with the NYPD?

Mayor: The question is how the NYPD deals with that – and I don’t know how they deal with that.

Question: [Inaudible]

Mayor: Again, I don’t know how they deal with it. So, you have to start with them. I don’t know what their protocols are and what they feel comfortable putting out and not putting out and what it says about security approaches and all that. So, that’s an NYPD question to begin –

Question: [Inaudible] you run the NYPD as Mayor, so you can tell [inaudible] –

Mayor: The NYPD is the security experts and they have to determine what’s the right way to provide security and what is the kind of information that could be available about it. It’s a classic security question. There are some things you put out, there are other things you don’t.

Question: Hello.

Mayor: Hello.

Question: Did you read the letters that the Conflicts of Interest Board sent you raising concerns over your [inaudible] –

Mayor: Again, not going into anything more about what happened years ago.

Question: [Inaudible] years ago. This was a letter that was sent to you last year.

Mayor: Of things that happened years ago. Come on, keep going. Let’s do others.

Question: You said earlier that lots of people looked at these things and they came back with nothing. In fact, they did not come back nothing, they came back with a letter sent directly to you –

Mayor: All – again, I’m just not going over it. Every investigation was closed, no further action was taken, and the entity involved is defunct. Anybody else?

Question: [Inaudible] is defunct?

Mayor: The entity that they were writing about is defunct. Anybody else, anybody?

Question: I do have another question.

Mayor: Please.

Question: Do you think that the Conflicts of Interest Board, which is appointed by you, has sufficient independence to handle cases where concerns are raised about your activities? And do you think that the law should be changed so that issues related to the Mayor that come before the Board should be handled in a different way or –

Mayor: Okay, [inaudible] question. So, the Conflicts of Interest Board of New York City, I think, has been the gold standard. The current way of approaching it – the current way of naming it is consistent with what’s been done for years. I think it’s been an effective approach. I think we have the strongest – strongest everything – strongest ethics monitoring, the strongest campaign finance system. I think we, as a city, have done a lot of different things the right way to get it right. So, I’m comfortable with the way it is now. Yes, sir?

Question: Okay, based on those previous questions – the Mueller investigation, that has proved nothing right now, [inaudible] do you think the President has been vindicated? Yes or no, and why?

Mayor: No, of course he’s not been vindicated because – 

Question: [Inaudible] Conflict Interest Board that’s [inaudible] –

Mayor: No, no, no, wait, whoa – boy, apples and oranges, my friend. Okay, we’ll close on this. My mind has exploded. I’ll try and get it back. Mueller report is something on an entirely different level and I think it’s clearly pointed to a number of areas where there could have been violations of the law and impeachable offenses, and now it’s up to the Congress to take the next step – so, entirely different matter.

Thank you, everyone.