NYC: We’ll Pay Health Bills

Terry H. Schwadron

Jan. 9, 2019

For my mind, the speech of the day yesterday was not that of President Trump and his uneven pitch for a Wall. Rather it was from New York City Mayor Bill de Blasio, who announced that the city would start this summer to pay the health bills of any uninsured city resident who cannot qualify for insurance coverage,including undocumented immigrants.

Rather than offering the services through an alternative public health insurance program, NYC Cares will simply pay the bills for physical and mental health services for 600,000 uninsured residents.

It is estimated that the program will cost at least $100 million, money that the city is paying to balance the books of municipal hospitals, who cannot turn away patients for lack of insurance. The idea is that paying more for wellness than hospital treatment makes financial sense.

In so doing, just hours before President Trump was to make a national televised address to fan warning fires about what he sees as a crisis on the Southern border leaking people, drugs, terrorism and disease into the country, de Blasio is putting himself and the progressive movement directly into the national, contentious immigration debate.

“Everyone is guaranteed the right to health care, everyone,” de Blasio said during a news conference in the Bronx. “We are saying the word guarantee because we can make it happen.”

Clearly de Blasio pushes himself as a champion of progressive ideas. He and Trump have bumped visions often.

As immigration talk goes, think about it. Trump wants a Wall and lots of policy changes specifically meant to punish illegal immigration; de Blasio’s proposal approached the whole issue of immigration by embracing those who are here and offering a hand (and simultaneously addresses deficits in city hospitals). The contrast couldn’t be more stark.

The plan is short on detail, but it will start this summer in the Bronx and by 2021 have moved into the other boroughs. The mayor’s office was quick to say that its plan would not be a substitute for any universal health care at the state level or a national single-payer plan. But it is something the city could do immediately and on its own, and not require approval from the State Legislature, which is weighing some form of universal health insurance for New York State.

The city already has the foundation for such aplan — a public health insurance option that helps get direct care to undocumented residents.

As outlined, NYC Care would be a mix of insurance and direct spending, and de Blasio said it would take about two years to get up and running. The city already has an insurance plan run by city hospitals and known as MetroPlus. NYC Care plan would improve that coverage, which already insures some 516,000 people, and aim to reach more of those who are eligible, such as the young and uninsured, and others who qualify but have not applied.

Those who can afford to pay will pay for services on a sliding scale, while those who can’t will receive free coverage. People will be able to simply call 311 for initial help. There will be no tax hikes to fund it, the mayor said. De Blasio said they were already increasing the capacity of public clinics and hospitals, to make sure people who need health care won’t have to wait for it.

It would also spend money directly, up to city $100 million per year when fully implemented, on those without insurance, including undocumented immigrants, who already can receive care at the emergency rooms of city-run hospitals.

Eventually, de Blasio said that eventually New Yorkers will be able to call a dedicated hotline and be connected to a primary care physician who would be their doctor. “They will have a card that will empower them to go to that doctor whenever they need,” he said.

There was no immediate word on outline how much the hotline would cost. It would operate like a “membership card” to the city’s hospitals.

At the same time, the mayor’s office is having a hard time starting a reduced-fare Metrocard transit program for 800,000 residents whose income is below the federal poverty line. He has been widely criticized for the delays in starting that program. By contrast, the medical program seems far more complicated.

“This is the city paying for direct comprehensive care (not just E.R.s) for people who can’t afford it, or can’t get comprehensive Medicaid — including 300,000 undocumented New Yorkers,” the mayor’s spokesman, Eric Phillips, tweeted.

The city’s hospital system has been under severe financial strain and running deficits for years. Part of the idea NYC Care, aides to the mayor told The Times, was to ease that burden while providing better health care to New Yorkers. The current financial plan for city hospitals projects budget shortfalls of over $156 million in 2018, increasing to $1.8 billion in 2022, according to the city’s Independent Budget Office.

What if the program could be expanded nationally?

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