By THOMAS K. DUANE
The stakes for federal health care reform are high. I am a strong believer that we must rethink the way we provide health insurance so that it is available and affordable for all Americans. As the House and Senate continue to resolve differences between their bills, here are three issues of paramount concern to New York:
Federal Medicaid Assistance Percentage: The Senate approach limits new federal Medicaid money to New York because we have already expanded our public programs. In this area, the House bill is better and rewards all states -- regardless of previous coverage levels -- for expanding public insurance coverage. It is only right that, while not losing sight of the importance of achieving a health reform bill, we fight hard for deserved resources for New York.
Disproportionate Share Hospital Funding: This funding is one of the ways that we reimburse hospitals that care for people who do not have insurance. This source of funding is crucial for New York City's public hospital system, the Health and Hospitals Corp., as well as public and safety net hospitals such as NuHealth (Nassau University Medical Center), Westchester Medical Center and Erie County Medical Center.
Both the Senate and the House versions cut this money under the rationale that reform will lead to greater numbers of people with health insurance, and therefore smaller numbers of uninsured. However, the Senate bill implements the cuts more quickly than the House bill. In addition, the House bill is potentially more favorable to New York because of a stipulation that the money cannot be cut until a study has been done that determines the effectiveness of federal reform in reducing the number of uninsured.
Further, neither the House nor the Senate bill provides federal subsidies for undocumented immigrants and the Senate bill prevents them from even purchasing insurance on their own through newly created health exchanges. Regrettably, this is a battle for another day. However, people get sick regardless of immigration status, and whether this occurs in New York or anywhere else, we all pay for the care of those who are uninsured and undocumented.
Consumer protections: We need to be sure that new federal requirements for private health insurance coverage, available through the exchanges, do not lead to erosion in benefits and protections currently available. New York has made substantial progress on requiring comprehensive health insurance benefits. We have some of the strongest consumer protections in the nation, and our public programs have significant limits on out-of-pocket costs.
If national insurance companies are allowed to market plans in New York that are not subject to our state insurance protections and mandates, regional insurers could find themselves priced out of the market entirely.
The Senate version of the bill includes a provision that would allow states to opt out of allowing national plans to sell coverage policies in New York. If this provision is removed, as some are seeking, the insurance protections in New York would become meaningless.
So where does this leave New York?
The good news is that there is still time to improve the final bill now under negotiation and even when reforms are enacted, none of the provisions of health care reform begin immediately. From a policy standpoint, federal health reform discussions have highlighted the importance of primary and preventative care -- a cornerstone of our health care agenda in New York.
Without question, national health reform presents a huge challenge for New York. It will take all our best efforts to get it right at the federal level and make it right for New York.
State Sen. Thomas K. Duane, D-Manhattan, is chairman of the Senate Health Committee.