Good afternoon, Senators and Assembly Members of the state of New York.

First, thank you for holding this hearing. Given the state of healthcare in this state and

country, we believe it is long overdue to have this public conversation. We extend our

deep appreciation to the Health Committee Chairs for their lead&ship on this issue.

My name is Katie Robbins, and I am the Director of the Campaign for New York Health

(CNYH), an organization founded to advocate for the right to healthcare in New York

State. We firmly believe that a universal, publicly-financed system, or single-payer

Medicare-for-All, is the best way to achieve that goal.

Today we are releasing a report titled, “From Coverage to Care, A People’s Report on

Healthcare in NYS.” Over the last two years, volunteers and partner organizations

surveyed over 2,400 New Yorkers from across the state, aiming for a sample

representative of the state’s population in regards to gender, age, race, and

geographic distribution.

Our findings were clear. 50% of respondents reported delaying or skipping basic

care entirely because of cost. Even though most people had insurance coverage,

they simply couldn’t afford it. One third went on to develop more serious complications

from not receiving timely care. When health issues aren’t dealt with promptly it can

lead to worse outcomes, and more costly care.

Our survey with people across the state went further to capture the stress, fear, and

reduction in quality of life so many people experience when navigating the healthcare

system. That is why we included testimonials from many different New Yorkers who

have lived to tell the tale, speaking about their personal experiences with the system:

“Not being able to afford regular dental care cost me my teeth.” -- Becca from Elmira

1

“1 didn’t have insurance for short periods during my three pregnancies, and the medicaldebt still follows me today” — Sara from Buffalo

“1 stayed at a job that was emotionally and physically exhausting to keep my healthinsurance.” — Frances from Brooklyn

“As a registered nurse who performs bedside care in the hospita4 I have seen patients

delay or refuse healthcare because of cosL “ - David from Orange Co.

Today, you will hear testimony from powerful and wealthy people and institutions,

including the hospital, pharmaceutical, and insurance industries who vehemently

oppose the New York Health Act. Unfortunately, these interests are often incompatible

with healthcare.

In our study, the vast majority of respondents do not view the current healthcare

system favorably. 64% of people felt they do not have a say in decisions about our

healthcare system. Overwhelmingly, people believe that believe that healthcare is a

human right, and most people support a universal, publicly financed, single-payer

system. Frankly, if we didn’t have a crisis in our democratic process, we would very

likely have such a universal system of guaranteed care in place.

Finally, I am including in my testimony a chart of dates recording when countries

around the world implemented their universal healthcare systems. (Yes, we

understand that not every country with universal healthcare has the single-payer

system we advocate for, which is most similar to Canada, Taiwan, or South Korea. But

what all the systems have in common is strong government regulation of the

healthcare industry -- otherwise you’re left with a system like ours that prioritizes profits

over the collective health of the citizenry). Most of these healthcare systems were

established throughout the middle of the last century. The second chart shows the date

universal healthcare systems around the world ended, failed, or were dismantled. If we

believe the talking points of our opponents about the dangers of a single-payer system

this should surely be an interesting timeline. But in fact you’ll see the second chart is

2

completely blank. No country has ever dismantled their universal healthcare system

once it has been established. In fact, these programs prove wildly popular with their

citizenry, making it very difficult to dismantle once they are in place.

We ask that lawmakers recognize the extraordinary price we are paying to maintain the

status quo, not just in dollars and cents, but the human costs paid in worsening health,

quality of life, and too many tragically unnecessary deaths. The legacy of bringing truly

universal healthcare to a state like New York is on the table. It’s time to pass the New

York Health Act.

Thank you.

County Start Daft County Start Dote

• AustralIa 2.975 ItaJyAustria 1967 JapanBahnTn 1957 KuwaItBelgium 1945 Luxembourg •

Snrnd 1958 Neth.dandsCanada 1966 NnZeaIand -

* Cyp 1980 Norway‘, Denmark 1973 Portugal

FInland 1972 SIngapore 1993Franc, 1974 Slovenla 1972

_________

Germany 1941 South Korea 1988 A

Greece 1983 SpaIn 1986

fl Hang Kong 1993 Sweden 1955[, Eceland 1990 SwIfterfand 1994

Ireland 1977 UnIted Arab EmIrates 19Th1995 UnIted KIngdom 1948

_______

UNIVERSAL HEALTHCARESTART DATES

UNIVERSAL HEALTHCAREEND DATES

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gran

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care

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me,

whe

rehe

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until

age

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get

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gg

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nd

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than

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som

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ter

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NY

HA

will

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som

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ilies

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est

ate.

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fam

ily’s

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rien

cesh

ows,

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ing

good

care

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exte

ndth

ele

ngth

and

qual

ityof

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life.

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pite

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erN

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mbu

lanc

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won

’tle

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oken

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clin

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ost-

surg

ery

care

will

decr

ease

suff

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gan

dhe

lphe

al.

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all

Bus

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sO

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r:N

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oS

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heal

thy

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erac

cide

nts.

10.

Dua

l—In

com

e.G

ood

Insu

ranc

e.L

ost

jobs

.L

ost

Eve

ryth

ing

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erN

YH

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ard-

wor

king

NY

ers

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cepe

nury

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en’s

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thne

eds

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befu

llyco

vere

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ploy

er-B

ased

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ranc

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hrea

tens

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Son

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nder

NY

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“Con

tinu

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will

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eno

rm,

not

the

drea

m.

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hang

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jobs

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urch

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life.

12.

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ive.

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lthy.

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rug

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ers

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Net

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NY

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ital

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soar

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eir

doct

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)We

won

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gne

eded

pres

crip

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eLT

CK

ept

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Gra

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ther

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eL

onge

r

zo

oW

e’ll

age

atho

me,

wit

hdi

gnit

y.

I ama

24-year-oldm

edicaistudent

in1.Y

C.M

yoverw

helming

deere

isto

healpeople,

particularlythose

who

arem

ostvulnerable

Our

complex

‘nealshcaresystem

oftenfails

showw

honeed

itm

ost.A

sboth

apatient

anda

fusuiephys:cian

I’veseen

that.even

forthose

wish

healthinsuiance,

accessand

Cots

remain

problemasrc.

We

actuallyhave

separatebuildings

forpallenss

with

private(for

profit)and

publicM

edraid

andM

edicare)health

insurancea,

theN

YC

Teaching

hospitalw

hereI w

ork.Faca!ty

mem

berssee

patientsw

ithp

ivaleinsurance,

titlea

rotatingcast

ofresidents

Idoctoisin

traininglsee

shoaew

ishpublic

assurance.T

hosew

ithouthealth

insurancearen’t

teenat

all—

unlessthey

goto

thesrudens-m

nclinic,

where

medical

studentspractice

onand

treatthem

.

evenfor

those

with

healthinsurance,

accessand

costrem

ainpro

blem

atic

My

hospitalclaim

sthat

patientson

publicand

privateinsurance

receivecom

parablecare

but,as

historyhas

shown

us,T

heparasebut

equal”is

unequal.Pasienss

atshe

publicclinic

wait

longer(or

appointments,

andshetr

doctorschange

continuallyas

residentsgraduate

andnew

doctorsin

trainingtake

over.

Patientsw

hoconsistently

seethe

same

do

no

rhave

adistinct

advantageover

thosew

hodon’t,

thosew

hosee

anew

rotationof

physicianseach

time

theyare

treatedor

hospilalized.C

onstantrelation

preventspatients

fromgening

shecontinuity

ofcate

requitedfor

qualityinterjenijor.s.

Inconsistencyincreates

theodds

thatlong-standing

conditionsare

overlookedor

ynored,often

thedifference

between

lifeand

deathM

edicinerelies

onresident

laboras

ateaching

tool,hut

thissegregated

systemskew

sthe

dstributionof

resourcesby

income,

Data

demonstrates

thissystem

createsde

factoracial

segregation.In

NY

C.

over80%

ofpatients

onM

edicaididentify

atB

lackor

Latino,

while

only30%

ofprivately

insuredpatients

do.In

practice,this

means

I canguess

whether

apatient

will

receivethe

higherlevel

ofcare

asthe

privateclinic

lustby

lookingas

thecolor

ofhislner

skin.

Sadly,such

dispansiesextend

tonearly

everyaspect

ofour

hospitaland

medical

school.O

nthe

08/

GY

Nservice,

patientsw

ithpublic

inturanceare

teenon

adifferent

floorw

iihfew

eram

enitiesthan

shephvately’inaured

patientsN

ewborns

atthe

hospisalare

separatedaccording

toInsurance

status,ensuring

that

thesehealthcare

inequitiesam

presentfrom

ea&baoy’s

firstbreash.

At

them

edicalschool,

it’sw

e]know

nthat

arotation

atthe

pabl:ccity

hosditalm

eansgett:ng

todo

more

andhav.ng

more

autonomy

when

practctngon

patients1en

I triedso

make

apoontrnenta

form

yow

ncare,

Ihada

hardtim

efinding

physiciansasm

yhospital

who

acceptM

edicaid.

these

health

careinequities

arep

resent

fromeach

baby’sfirst

breath

Being

aM

edicaidpatient

meant

rece’.vi nglow

erqual.iy

ofcare

where

Iwork,

solsought

careat

aclinic

thatsarvet

everyone,regardless

olinsurance

stalus.tam

fortunateto

hen

goodhealth

endto

havethe

tootsand

resourcesto

make

informed

dectsionsabout

my

own

healthcare;fly

most

vulnerablepatients

donot.

Thisunequal

systempenalizes

low-incom

epatients

anddelivers

substandardcare

topeople

who

desperatelyneed

qualitym

edicalattention

fromskilled

diagnosticians.W

orse,this

segregationis

entirelylegal.

Because

itis

bated

onhealth

insurancestatus,

notrace,

hospitalsthroughout

shecity

segregatepatients.

While

thissystem

hasdubious

financialbenefits,

ithas

veryreal

healthconsequences.

Our

medical

schoolleaches

usto

valueevery

human

life,In

treatall

patientsas

equals,care

forthem

with

dignity,com

passion,and

shehighest

clinicaltiandardt,

butthis

systemrens

contraryto

everythingw

e’vebeen

taughl,underm

iningit.

Our

med

icalsch

ool

teaches

us

to

valu

eev

eryhum

anlife

but

this

system

runs

contrary

toev

eryth

ing

we’v

eb

eentau

ght,

underm

inin

git

Thism

ulti.t,ered.incom

e-basedsystem

isn’tfair.

It’snot

fairso

patients—

orto

med;cal

students,w

honeen

healshcareto

become

doctorsand

who

needquality

superv:uonto

doright

bythe,r

current(and

future)patients.

.dit’s

notfair

todoctors

who

tryso

giveeach

patienttheir

fullattention

andbest

care—

regardlessof

havingtheir

feesdeterm

inedby

theirpatients’

,ncome.

We

needto

levelthe

playingfield

onhealthcare

—for

patientsand

forproviders.

NYH

ealihw

illm

akea

difference.

SerenaC

a,uileis

am

edicalstudentas

am

ajorN

eivYork

teachinghospital.

We’ll

dismantle

“separate

but

NO

Tequal”

healthcare.

•‘ h

in

I1

?rn

1cn

rm

iliinviIcun

;mP

ir.f’lI

I15.

Authorizations:

Designed

toK

eepP

rovidersFrom

Patients,

Patients

FromC

are

Under

NY

HA

:Y

ourprovider

andyou

chooseyour

care.N

oinsurer

denials.

•A

llfinancial

obstaclesto

care:elim

inated.

16.B

adM

igraine.Scary

Prognosis.

InsuranceT

raps.S

carierD

ebt

Under

NY

HA

:

•N

ohassles:

allinsurance

trapselim

inated.

oIf

youneed

thecare,

it’5covered.

Rationing

basedon

income

will

end.

17.H

ealthcareC

ostsD

estroyD

reams.

Discourage

Entrepreneurs

Under

NY

HA

:

0E

ntrep

reneu

rsW

illflourish,

creating

200

000

newjobs.

oSm

allbusinesses

will

havehealthcare

risksresolved.

18.S

uddenIllness.

Great

Insurance.M

onthsof

Stress

Over

Paperw

orkand

Bills

Under

NY

HA

:o

No

hassleson

bills,ev

er—th

erearen’t

any.

•N

etwork

issues,questions

abouttests,

confusingpaperw

ork—

allgone.

19.M

edS

tudent.E

xperiences“S

eparatebut

Equal”

Healthcare

inN

YC

Under

NY

HA

•E

liminating

tieredservices

will

begindism

antling“separate

butN

OT

equal.

0D

octo

rsan

dhosp

italsw

on’tbe

paidless

fortreating

lower-incom

epatients.

20.S

enatorB

iaggi:C

onstantF

ormulary

Changes

Worry

My

Parents:

Long

Term

Care

Kept

My

Grandfather

atH

ome

andA

liveL

onger

Under

NY

HA

:o

We

won’t

faceobstacles

togetting

theprescriptions

we

need.

•M

ostof

usw

illbe

ableto

ageat

home

—m

uchlonger,

andw

ithdignity.

Online

versionsof

thesestones

—and

more

—are

availableat

tfsisistlsebronx.info/sveekday.magazine’healthcare’in’arnerica

(Author’s

Nam

e)

19

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rupt

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eI

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.B

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elt

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elst

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and

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ally

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and

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life

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ver

and

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alte

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activ

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psw

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we

help

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gate

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mal

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ndtr

uths

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rst,

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owis

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inst

ant,

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ver

and

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tera

bly

chan

ged.

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nd.

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take

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atly

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otio

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ysic

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ried

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ssan

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e.

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elve

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But

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ake

me.

my

eyes

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wor

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orld

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ustr

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than

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itas

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Heaithcare

Costs:

Destroy

Dream

s.D

iscourageE

ntrepreneurs‘reg

nan

cyC

omplications.

Three

Lives

atR

iskI

I vividlyrem

ember

thataw

fulday.A

ugust4th

2014.t.o

riand

Ihadbean

married

lessthan

ayear.

Shehad

recentlyquit

hercorporate

financejob,

goneback

toschool

andstarted

herow

nbusiness.

Thai

daythe

woke

up,turned

tom

e,and

said,“I

can’tfeel

my

arms

andlegs.”

Shew

as28

yearsold.

There

isno

adequatew

ayto

descriheshe

fear,the

piercingdread,

thatw

ashesthrough

youw

henthe

wom

anyou

lovesays

something

likethat,

gatheredher

upand

droveto

shehospital

ER. After

admitting

hero

nan

outpatientbasis,

theyw

heeledher

tothe

radiologydepartm

entfor

anM

Rl.T

heydirected

me

tothe

billingdepanm

ent.W

ethought

we

hadgreat

inaeraece,just

likew

ethought

we

were

youngand

healthy,but

theyw

anted$5,000.

On

thespot.

Inthe

mom

entw

ew

erem

ostvulnerable,

inshe

mom

entm

yw

ife’shealth

was

moss

unclear,she

systemrequired

$5,000.Im

mediately.

Part

ofm

ew

ondered

maybe

we

weren’t

worthy

otcare

ifw

ecouldn’t

pay.Ican

stillfeel

sliatpanic

Ithoughtthere

must

besom

em

istake.N

aively,I

thoughtthey

must

nothave

runthe

insurancecard

correctly.R

unit

again,I urged.

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no,they

were

right—

ourdeductible

was

$5,000.Ihad

two

creditcards

inm

yw

allet.T

heanxiety

I feltunnerved

me,

Panof

me

was

surethey

would

providecare

evenif

bothcards

were

denied.Pan

ofm

ew

onderedm

aybew

ew

eren’tw

orthyof

careifw

ecouldn’t

pay.Ican

stillFeel

thatpanic.

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thisw

asdespite

knowing

we

hadinsurance.

Good

insurance,

Looking

back,I know

we

wem

lucky.Ihad

two

creditcards,

andboth

were

paidup.

But

when

“luckyin

Am

enca”m

eansyou

havethe

capacityto

accruepotentially

vastm

edicaldebt,

we

inA

merica

havea

seriousproblem

.Tw

oyears

ofstruggle

followed

thisinitial

hospitalvisit.

Two

yearsof

doctorvisits,

latenight

callsto

insurers,everyday

battlesto

demand

thatthe

carem

yw

ileneeded

anddeserved

was

thecare

shegot

—and

two

yearsof

debtthat

almost

buriedus

financially,alm

ostcost

ourfam

ilyall

we

had,

We

leftN

ewY

orkfor

New

Ham

pshireand

moved

inw

ithm

yA

unt,W

ew

eregrateful

forher

help:w

ecouldn’t

affordm

edicalbills

pluscredit

cardbills

plusrent

ontop.

Our

strugglew

asn’tunique

then.It’s

notunique

now,

Healthcare

inA

merica

isbroken.

It’sa

systemthat

demands

peopleem

ptytheir

wallets

andstress

theircredit

—w

henthey

arecom

pletelyvulnerable,

paralyzedw

ithfear,

andgrievously

worried

aboutthe

fateof

someone

theylove,

Our

lawm

akersm

ustlisten

tothose

who

votefor

them,

ratherthan

shethousands

oflobbyists

spendingm

illionsof

dollarsto

keepthe

statusquo.

Healthcare

istoo

expensive.Its

costis

destroyingtoo

many

Am

encanfam

ilies.Y

es,of

course,it’s

am

oralissue.

But

it’salso

afiscal

issue.M

dan

economic

issue—

forindividuals,

families,

comm

unities,states,

andour

country,

When

we

investin

healthcare,w

eare

investingin

Am

erica...

bigthinkers

andsm

allbusiness

owners

Families

who

arestm

gglingevery

dayto

payfor

foodand

rentend

medical

billsare

tootired

andw

ordedto

work

ontheir

dreams.

How

canm

eexpect

themto

beinventive?

Entrepreneurial?

Tostart

theirow

nbusinesses?

When

we

investin

healshcare,w

eare

investingin

Am

erica—

invetsingin

anA

merica

thatrew

ardsbig

thinkersand

small

businessow

ners,people

who

starttheir

own

business,create

newjobs,

andbuild

valuefor

ourcom

munities.

People

who

fearlosing

theirhealth

coverage,w

hoknow

thattheir

currentjob,s

theonly

way

theycan

afford

insurance,those

peopledon’t

leavejobs

evenifthey

hatethem

,even

if thehealth

insurancekeeps

theirw

ageslow

,even

ifthey

yearnto

transformtheir

bigidea

intoa

business.

People

who

fearlosing

theirhealth

coveragedon’t

leavejobs

—even

ifthey

hatethem

,even

ifhealth

insurancekeeps

theirw

ageslow

TtseR

andC

orporationrecently

analyzedthe

NYH

ealthA

ct,and

concludeditw

ouldcover

everyNY

residentfor

lessthan

what

NY

iscurrensly

paying—

andthat

savingsw

ouldstim

ulatethe

NYeconom

y,m

akeN

Ybusinesses

more

competitive,

unleashentrepreneurship,

raisew

ages,and

crease200,000

more

jobs.O

urgovem

ment

needsshe

fiscalprudence

ofsingle’payer

healthcare.Fam

iliesneed

besterand

more

affordablehealthcare,

Law

makers

needto

hearconstituent

voicesthat

understandthe

issuesfacing

ordinaryA

mericans,

small

businessow

ners,and

families.

I’veseen

firsthand

abroken

systemthat

failsfam

iliesw

hoare

experiencingthe

scariestweeks

andm

onthsof

theirlives.

It’stim

eour

representativesrepresent

ourvoices

andour

future.

Oeagtan

McE

achernm

oved(m

mN

Yback

tofam

ilyin

NH

afterruinous

medicalbills;he

works

inrechnotogy

andnow

adrocareafor

unirersal haalthcam.

rat’sI:

My

lifeexplodes

intohealthcaro

nightmare

Diagnosed

with

preeclampsia

andsevere

ante’nataldepression.

Prescription:total

bedrest.

Here

Iwas,

ina

high’riskpregnancy

shascan

leadto

HEI.LP

syndrome,

aIife.threatening

complication

thathad

almost

killeda

goodfriend.

The

ideaof

leavingm

yth

reeold

erchildren

mo

therless

terrifiedm

e

I knewA

merican

wom

encan

anddo

diefrom

this;it’s

partof

why

theUS

isshe

onlycountry

with

risingm

aternalm

ortality.Iknew

Ineededm

edicalcare

tosave

my

baby—

andso

savem

yow

nlife.

The

ideaof

leavingm

ythree

olderchildren

motherless

terrifiedm

e.R

atherthan

givingm

em

edicalleave,

my

schoolterm

inatedm

e—

which

terminated

my

healshinsurance,

andthe

healthinsurance

ofm

ychildren.

Iwasn’t

eI:giblefor

unemploym

entbecause

Icouldn’tlock

foia

job:com

pletebed

rest

•Iw

asn’teligible

forIperm

anenildisability

becausehigh’risk

pregnancyis

temporary

lehennot

lethal)•

Iwasn’t

eligiblefor

COBRA

,sincem

yem

ployerdidn’t

processm

yterm

inationas

Iasked

•Iwas

scared,and

notjust

form

e

Yes,

Iwas

inthe

moss

dangeroustrim

esterof

ahigh’

riskpregnancy,

butm

yrw

een,recently

diagnosedw

ithsevere

emotional

disabilityand

suicidaldepression,

hadjust

beenaccepted

intoan

inp

atient

program.

When

Ilostm

yhealth

insurance,she

was

terminated

fromher

program.

Her

needsw

ereserious,

andIhad

now

ayto

helpher.

I’dlike

every

local,state

and

natio

nal

represen

tative

tosp

end

afew

day

sw

aiting

among

those

need

ing

ben

efits

My

desperationfor

my

kidsovercam

eshe

profoundsham

edeepening

my

depression:I decided

toapply

forM

edicaid.Itw

asm

ean.spirited,B

yzantine:

Youm

ustapply

inperson

ata

localSocial

ServicesO

ffice.They

openata

00am

,giveyou

anum

beras

youenter,

andthen

youw

ait.

Thetine

outsideform

slong

befom800a.m

.because

youneed

tobe

atthehead

ofshequeue

toget

alow

number.

Irushedto

leavem

ykids

atschool

eadyto

anisebefore

8.00am

,and

nevergot

alow

numher

Because

Ihadto

pickup

my

kidsafter

school,Ih

adto

leaveat 3:00

pmso

Ilostm

yplace.They

lockthe

doomat

3:00or

330,

soyou

can’tcom

eback,

Ifyouleave,you

haseto

returnagain

thenest

morning.

‘Who

made

thesem

les?D

on’sallm

oms

haveto

carefor

kids?People

who

needSocial

Servicesfor

urgent,scary,

Iife.threaseningreasons

havecom

plicatedlives.

Isit

likethis

sodiscourage

people?

I’dlike

everylocal,

stateand

nationalrepresensative

tospend

afew

daysnailing

among

thoseneeding

benefits:every

oneof

ushad

assory,

some

farw

orsethan

mine.

Ifinallygot

my

Medicaid

cardat

38w

eeks.

Who

made

these

rules?D

on’tall

mom

shave

tocare

forkids?

People

who

needSociel

Services

for..,

life•threateningreasons

havecom

plicatedlives

We

mere

allincredibly

fortunatethat

Ididn’tfall

intosuch

adebilitating

depressionthat

Icouldn’tleave

my

bed,although

Icame

close.In

short,as

anguishinglyhorrible

asit w

as,w

eall

survived.

rertII:

The

nightmare

subsidesinto

HC

limbo

Bus,

jutslike

life,m

ystory

continues—

notyet

asgood

asitw

asbefore

thepreeclam

pssa,but

som

uchbetter

thenthose

threem

onths.Ilive

ina

stateof

uncertaintyabout

boshem

ployment

andhealthcare,

Tom

akem

yselfeven

more

attractive—

Iamgaining

additionalcertification

som

yschool

canuse

me

ina

greatervariety

ofsub1ecrs

with

agreater

varietyof

students.I

likethis

school,and

Iloveteaching.

With

NY

HA

my

termination

would

nothave

sodesperately

worried

me

aboutleaving

my

childrenorphans.

And

my

daughtercould

havecontinu

edthe

excellentprogram

she’dentered

ratherthan

interruptingitto

returnto

afam

ilyin

crisisw

itha

mother

who

was

almost

asdepressed

asshe

was,

Under

NY

Health,

I wouldn’t

todaybe

soconsum

edw

ithpatching

togethercontinuing

coveragew

ithas

fewgaps

aspossible.

Instead,I could

focuson

doingthe

bessoh

Icanfor

my

studentsand

colleagues.U

nderN

YH

ealthI’llbe

happyto

paym

orew

henm

yincom

erises.

Carm

enLyre

isa

rpeoaleducation

teacherand

them

oiharof fourchildren,

Entrepreneurs

will

flourish,creatIng

200,000new

jobs.17

Your

childrenw

illalw

ayshave

healthcare.So

willyou.

ERD

oc:

For-

Prof

itIn

sura

nce

Isn’

tG

ood

Eno

ugh

Mig

rain

e.S

cary

Pro

gnosi

s.S

cari

erD

ebt

The

Cas

tof

Hea

rtac

he

Sto

pr

brou

ght

life-

savi

ngpr

epto

ade

adha

lt.

Aw

oman

inhe

rSO

sla

yon

agu

rney

inth

eER

whe

reI

aman

atse

ndin

gph

ysio

an.

Imet

her

EKG

befo

rem

ethe

r,no

ting

the

omin

ous

tom

bsto

nex

patt

ern.

wen

tto

med

ical

scho

olto

heal

peo

ple

,not

tohav

efi

nanc

ial

dis

cuss

ions

about

indic

ated

care

The

wom

anw

aspa

le,

swea

ty,

hold

ing

her

ches

t,co

mpl

aini

ngof

crus

hing

pain

,an

dIt

old

her

she

was

‘hav

ing

ahe

art

atta

ck’

—a

diag

nosi

sIh

ave

mad

eov

er10

0tim

es.

We

calle

dfo

ra

STE

Ml

Ale

rt”

whi

chm

obili

zes

ate

amto

perf

orm

aca

rdia

cca

thet

erpr

oced

ure

—sa

ying

“STA

T”is

redu

ndan

t.

sMie

nan

EKG

show

sa

hear

tat

tack

inp’

ogre

ss,

we

live

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em

antz

a‘F

me

isM

uscl

e.”

Ope

ning

tnat

clog

ged

arte

ryin

her

hear

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.thin

90m

inut

esof

the

pati

ent

ente

ring

the

ERis

the

geld

stan

dard

.ii

’e

90m

inut

esm

ayso

und

like

fore

ver,

prep

ping

isno

tsi

mpl

e:th

ere

are

nom

inut

esto

spar

e.W

est

ripp

edhe

rcl

othe

s,ch

ecke

dvi

tals

,in

sert

edlV

s,dr

ewbl

ood,

atta

ched

mon

itor

s.

..

Like

api

tne

wat

ara

cetr

ack.

asw

arm

ofdocs

or,

nurs

es,

and

tech

nici

ans

tryto

beat

she

dock

.T

hesc

ene

may

look

chao

tic,

bus

ever

ype

rson

isfo

cuse

dan

dfa

ston

anes

sent

ial

job

—to

keep

the

patie

nt’s

hear

tm

uscl

eal

ive,

tosa

vehe

rlif

e.

And

then

cam

eth

esc

ream

that

stop

ped

ever

ythi

ng,

the

entir

eER

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ked

byou

rem

erge

ncy

card

iac

pati

ent

shou

ting

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topl

Stop

l”‘I

need

my

phon

e.In

eed

my

insu

ranc

eca

rd,

Are

you

inm

yne

twor

k?l”

The

team

froz

e.Iw

alke

dto

the

head

ofth

egu

rney

.A

sw

em

ade

eye

cont

act,

she

blur

ted,

“Iha

vein

sura

nce,

but

it’s

ahi

ghde

duct

ible

plan

.M

ysp

ouse

pass

edaw

ay.

Ihav

ea

teen

aged

daug

iste

r.Id

on’t

know

ifIc

anaf

ford

this

.”

Inw

hat

was

likel

yth

em

ost

vuln

erab

lem

omen

tin

her

lile

from

ahe

alth

care

pers

pect

iee.

she

was

NO

Tfn

ghte

ned

byw

hat

was

happ

en;n

gin

her

body

orth

at,

with

out

emer

genc

ytr

eatm

ent,

she

mig

htdi

e—

that

min

utes

ofde

lay

coul

dca

use

al,f

etim

eof

disa

bilit

y.H

erfo

cus

was

onth

eco

st,

abou

tbe

ing

the

only

supp

ort

for

her

teen

aged

daug

htec

The

team

look

edba

ckat

me,

anxi

ousl

yey

eing

the

cloc

k.Ic

an’t

adeq

uate

lyde

scri

beho

wth

issi

tuat

ion

mak

esm

efe

el.

V,’h

enpa

tien

tsbr

,ng

upco

st,

espe

cial

lyin

such

anun

com

prom

isin

gly

emer

gent

cond

itio

n,w

here

the

med

ical

deos

ion

iscr

ysta

lcl

ear.

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dm

ysel

ffe

elin

ga

dee

ppi

tof

ange

r,di

sgus

t,an

dpa

inin

my

own

hear

t.Si

nce

Ifirs

tst

arte

dm

edic

alsc

hool

in20

01,

I’ve

know

nm

edic

albi

llsar

eth

ele

adin

gca

use

ofpe

rson

alba

nkru

ptcy

inA

mer

ica,

mos

tw

ish

priv

ate

insu

ranc

e.It

wor

nes

me

that

the

care

Idel

iver

—an

dev

enth

efiv

esw

esa

ee—

too

ofte

nal

sode

liver

scr

ippl

ing

cost

s.

love

putt

ing

my

year

sof

trai

ning

and

clin

ical

expe

rien

ceto

wor

k—

but

whe

nla

mfo

cuse

don

savi

nga

patie

nt’s

futu

rehe

alth

,Ih

ave

noad

diti

onal

men

tal

band

wid

th.

Itol

dhe

rw

ew

ante

dto

keep

her

aliv

e,th

athe

rfif

ew

asw

orth

savi

ng,

that

not

trea

ting

her

now

coul

dki

llhe

ror

leav

ehe

rdi

sabl

ed.

I tol

dhe

rth

ere

was

now

ay,

inth

isli

fe-t

hrea

teni

ngst

uati

on,

whe

rese

cond

sm

atte

r,th

atI c

ould

figu

reou

tco

sts

4r,d

I ass

ured

her

the

hosp

ital

wou

ldw

ork

w,th

her

and

her

insu

rer

She

let

uspm

ceed

.T

hela

bin

sene

da

sten

t.

Med

ical

lysa

vin

gli

ves

can

fina

ncia

lly

ruin

tfse

m

Icen

tto

med

ical

scho

olto

heal

peop

le,

not

toha

vefi

nanc

ial

d,sc

uss,

ons

abou

tin

dica

ted

care

,B

utth

ecu

rren

tst

ate

ofA

nsei

ican

heal

shca

refi

nanc

ing

has

crea

ted

ado

uble

-edg

edsw

ord:

Med

catly

savi

ngliv

esca

nfi

nanc

ially

ruin

them

Ou

rcu

rren

tIs

ealt

hca

resy

stem

has

tota

lly

cois

spro

mis

edth

edoct

or.

pat

ient

rela

tio

nsh

ip.

It’s

hea

rt-b

reak

ing.

And

frust

rati

ng

Isup

port

the

NY

Hea

lthA

ct,

sing

le.p

ayer

heal

thca

m—

whi

chw

illco

vera

lles

sent

ial

care

for

all

NY

resi

dent

s—

with

nopa

ymen

tat

poin

tof

serv

ice.

Mos

tdo

ctor

sag

ree

onth

is,

Inee

dsi

ngle

’pay

erhe

alth

care

soth

atI

can

final

lyte

llm

ypa

tien

ts,

and

may

beev

enyo

uw

hoar

ere

adin

gth

isan

dm

ight

one

day

bem

ypa

tien

t:“D

on’t

wor

ryab

out

the

cost

s.T

hey’

reco

vere

d.Y

oune

edth

istr

eatm

ent

.n

ow

.”B

us

Ican

’t.

Our

cure

ent

heal

thca

msy

stem

has

lota

9yco

mpr

omis

edth

edo

ctor

-pat

ient

rela

tions

hip.

It’s

frus

trat

ing.

And

hear

tbre

akin

g.

Dc

Dan

iel

Lega

ssy

can

ERphys’c

:an

at

3N

YC

hosp

itals

arid

abo

ard

mee

ter,

rtiy

srda

nsfo

r aN

ario

natH

ealth

Pmcr

nn,

NY

Met

roC

hapt

er.

pes’

wny

mef

mor

g.n

jf’catp

eg

nO

’g

At

age

29,

win

abl

ood

clot

atth

ebat

eof

my

brai

n,Iw

asho

sp;t

aliz

edfo

rth

ree

days

in20

15.1

had

tobe

cons

tant

lym

onit

ored

for

stro

kes

orse

izur

esso

.du

ero

ala

ckof

avai

labl

eho

spit

albe

ds,

Iwas

inth

eIC

Ufo

rth

ree

stra

ight

days

.

‘ini

tially

wen

tto

the

ERw

ithw

hat

Itho

ught

was

anet

cept

iona

lly

awfu

l,m

ulti-

day

mig

rain

e.W

hen

the

ERdo

ctor

ran

into

my

curt

aine

doH

area

toas

kfl

had

hit

my

head

(Iha

dn’t

)be

caus

eth

eC

Tsc

ande

mon

stra

ted

blee

ding

,Iw

aste

rrif

ied.

Ihad

tobe

tran

spor

ted

byam

bula

nce

toa

larg

erho

spita

lw

here

anM

RIco

uld

bedo

neon

Satu

rday

afte

rnoo

n.

Iwas

terr

ifie

d,..

nei

ther

ofus

—in

our

pani

c—

thoug

ht

toca

llm

yin

sura

nce

com

pany

Not

hing

like

Ui

5ha

dev

erha

ppen

edto

me

orm

ynu

sbar

tdbe

fore

,so

neit

her

olus

—in

our

pani

c—th

ough

tto

call

my

insu

ranc

eco

mpa

nyto

obta

inpr

e-au

thor

izat

ion

for

all

ofsh

em

edic

alse

rvic

es‘w

ould

need

.W

e&

dn’t

know

how

muc

hw

ould

bene

eded

until

itw

asha

ppen

ingl

Sinc

ew

edi

dro

tca

ll,an

dsi

nce

Ihad

aB

lue

Cro

ssB

lue

Shie

ldhi

gh’d

educ

tibl

epl

an,

man

yaM

,oon

alco

sts

fell

tom

e,an

d‘o

wed

far

mor

eth

anm

yal

read

yhi

ghde

ckic

tible

of$6

,000

.A

lter

leas

ing

the

hosp

ital

,ha

dto

cont

inue

tota

keex

pens

ive

med

icat

ions

sohe

lpbr

eak

dow

nth

ecl

ot.

Tho

ugh

Iwas

dire

cted

tost

art

this

trea

tmen

tth

eda

yIw

asdi

scha

rged

,th

eho

spita

lha

dno

tye

tsu

bmit

ted

itsbi

llsto

BC

BS

with

out

thes

e,as

far

asth

ein

sure

rw

asco

ncer

ned,

I had

not

yet

met

my

dedu

ctib

le,

Iwas

left

with

noch

oice

abou

tpa

ying

hund

reds

ofout

of’p

ocke

tdo

llars

for

my

med

icat

ions

,on

lop

ofm

yho

spita

lbi

lls,

Iwas

left

wit

hno

choi

ceab

out

payi

nghundre

ds

ofou

t-of

-poc

ket

doll

ars

for

med

icat

tons

,on

top

ofm

yho

spit

albi

lls

Ihav

eno

tye

tbe

enab

leto

pay

the

hosp

ital

infu

ll,w

ell

over

two

year

sla

ter.

‘fee

llu

cky

the

hosp

ital

put

me

onan

exte

nded

paym

ent

plan

,an

dIa

mfin

ally

clos

eto

payi

ngof

fm

yor

igin

alho

spita

lbi

lls.

Inde

term

inin

gth

eca

use

ofsh

ebl

ood

clot

,ho

wev

er,

my

doct

ors

foun

da

num

ber

ofun

derl

yng

fact

ors

and

pos&

bte

resi

dual

effe

cts

that

requ

ire

med

ical

atte

nti

on

and

mo

nit

ori

ng

.

Cou

nt’e

ssm

edic

alap

poin

tmen

ts,

anad

diti

onal

hosp

ital

stac

and

anER

visi

tla

te’,

my

med

ical

debt

cont

inue

sto

grow

.

lam

anat

torn

eyin

apu

blic

inle

test

fiel

d(d

isab

ility

righ

tsan

dad

voca

cyl.

Tho

ugh

Iwor

kha

rdan

dlo

vew

hat

I do,

dono

tm

ake

wha

tpe

ople

assu

me

anat

torn

eyw

ould

.It’

sha

rden

ough

tosl

ayaf

loat

fina

ncia

llyw

ithou

tth

ead

diti

onal

med

ical

expe

nses

.T

houg

h‘n

owha

vebe

tter

heal

lhca

reco

vera

ge,

Istil

lha

vesi

gnif

ican

t co’

pays

and

co-i

nsur

ance

.

Cou

ntle

ssm

edic

alap

poin

tmen

ts,

anad

diti

onal

hosp

ital

stay

,an

dan

ERvi

sit

late

r,m

ym

edic

aldeb

tco

ntin

ues

togr

ow

Iwo’

ryth

atth

ere

peal

olth

eA

ffor

dabl

eC

are

Act

’snd

vjdu

alm

anda

tein

the

new

fede

tal

tax

bill

will

leav

em

ew

ithfe

wer

heal

thin

sura

nce

opti

ons

—an

dhi

gh,e

rm

edic

albi

lls.

Like

me.

man

yof

usar

ebu

rden

edw

ithvi

gnif

:can

tliv

ing

expe

nses

and

reti

oact

ive

b:lls

for

our

stud

ent

loan

s.

As

adi

sabi

lity-

righ

tsat

torn

ey,

and

asa

pers

onw

hono

what

spr

e.ex

!stin

gco

nditi

on,

I see

firs

than

dho

wris

ela

ckof

affo

rdab

le,

qual

itym

edic

alca

reaf

fect

spe

ople

ofal

lw

alks

oflif

e,ev

ery

day.

Asi

ngle

.pay

ersy

stem

isne

cess

ary

tom

ake

sum

all

New

Yor

kers

are

able

toco

ntin

ueto

lead

heal

thy,

prod

ucti

veliv

es:

anyo

neco

uld

have

am

edic

alem

erge

ncy

atan

ym

omen

t,an

dno

one

dese

rves

togo

deep

into

debt

beca

use

ofit.

Laur

enG

race

isa

disa

bilit

yrig

hts

atto

rney

and

advo

cate

.Sh

epr

actic

esin

Nei

rYo

rkC

iry

Pat

ient

sfa

cing

deat

hw

on’t

focu

son

thei

rw

alle

ts.

316

All

insu

rer

trap

sel

imin

ated

.

I

‘if

Prior

Authorizations:

Designed

toK

eepP

atientsFrom

Care

re-Existin

gC

onditions.Insidiously

Curtailing

Careers

iiIam

aregistered

nursew

orkingin

adoctor’s

officeat

am

ajorN

YC

medical

center

my

woik

with

patientssuffers

fromhaving

tochase

priorauthorizations.

amtrained

totreat

patientsand

certifiedto

doprocedures

onpatients.

Butwhenever

thebest

courseof

treatment

isnot

onthe

‘formulary”

ofan

insurer(w

hichw

orksw

ithstiff

anothercom

panyto

manage

itsm

edicationapprovals),

Ispendhours

deafingw

itha

convofutedsystem

.

Iamnot

atall

surehealth

insuranceis

about

health

Letm

egive

anexam

pleof

what

was

recentlyrequired

toget

apatient

thebest

carepostibfe.

Thispatient

cannotsake

thegeneric

ofa

specificm

edication.It

makes

herill.

Shepays

ajot

ofm

oneyfor

hersupplem

entalinsurance

andneeds

herinsurer

toauthorize

payment,

sinceshe

cannotafford

tobuy

them

edicine.The

sagabegins,

asitoften

does,w

henher

onginalprescription

was

deniedat

thepharm

acy.

amnot

sureevery

doctot’soffice

putsas

much

effortinto

thisas

oursdoes,

feedingm

eto

believethat

insurancecom

paniespuiposefuffy

handletheir

prtorauthorization

processin

thisw

ay.A

syou

readthrough

thesteps

fittedbelow

,keep

inm

indthat

the“benefits”

emptoyees

f deafw

ithhave

nom

edicalknow

ledge,read

scriptedquestions,

haveno

managem

entavailable

attheir

caffcenters

fforappeafing

decisions),and

haveno

connectionbetw

eentheir

company

(which

manages

prtorauthorizations)

andthe

insurancecom

pany.

alengthy

[appealsiprocess

canlead

toex

acerbatio

nof

illness—

andeven

hospitalization..

almost

always

more

expensivethan

medication

Priorauthorizationsate

themselves

obstades,but

havingthe

processbe

soB

yzantineand

time-consum

ingexhausts

thedoctors

officesand

causesm

ostdoctors

togive

up.1en

doctorsoffices

giveup,

patientsusuaffy

dosom

ethingsub-optim

aforjust

gow

ithout.

Rem

ember

thatw

hifew

epursue

thisprocess,

thepatient

goesw

ithouttreatm

ent,aed

afengthy

processcan

leadto

exacerbationof

ilfnest—

andeven

hospitalization.T

hoseare

afmost

afways

more

expensivethan

them

edication.T

heshortsightedness

ofpre-authorization

isastounding.

21S

tepsG

ettingO

neP

atiantN

eeded

Medication:

1.f called

forprior

authorization.2-

That,nitialcalf

was

denied.

I was

thentold

thedenial

was

‘anaccid

ent’

andthat

everyshingw

asok.

No

progress.

4.Iw

aslater

toldIn

eeded

aleo

erof

‘wed

icalnecessity”

which

Icrafted,

detailingthe

reasonsthe

patientn

eeded

the

wedicatioe

andcouldn’t

Lakethe

generic.T

hedocto

rsigned.

5.T

heprior

authorizat,oew

asdenied.

6.fw

astold

theC

ola

code

(classificationof

condiiicnlw

asincorrect;

itw

asn’t.

7.T

hecom

panyth

ensaid

fneed

edan

appeal

a.tfased

theappeal:

Ihave

areceipt

thatit

went

through.

9.W

eheard

nothing:the

secondarycow

panysaid

we

need

edto

callthe

firstieserance

company.

10.T

heinsurance

company

saidthey

didn’tknow

what

thesecondary

company

answered.

11.They

askedm

eto

fatthew

again.

12.fdid.

13.They

didn’tim

mediately

seethe

laxand

toldthe

patientlw

hocalled)

thaithey

didn’thare

anything.14.

Thew

holeprocess

tooksix

weeks.

15Sy

thetiw

efcalled,

theyhad

foundthe

appeal.

16.treq

uested

thatthey

eaped

tethe

appeal.

‘7.They

saidno.

18.1requested

tofire

acow

pfaint.They

said“no”;only

thepatient

cantie

acom

plaint.19.1

requestedthat

thecom

panycalf

thepatient

with

theresult.

20.A

manager

said‘no’;

theycannot

fagthe

syitemin

thatw

ay.

21.Finally,

thepatientw

asable

roget

theprescnption.

Alice

Lovehas

beena

registerednurse

for22yaars.

jsta

flnuw

sr.saR

a4sT

.4ov1D

O’J

My

Dream

tD

erailed

‘Pre’esisting

condition”:heafthcare

lingofor

anillness

youhave

priorto

applyingfor

healthinsurance.

According

nothe

Kaiser

Family

Foundation,

over25%

ofN

ewY

orkersunder

age65

havepre-exittieg

conditions—

suchas

diabetes,cancer

(evenif

cured,cut

out,or

inrem

ission),high

bloodpressure,

depression,allergies,

oranylh:ng

aninsurer

chooses.

You

may

noteven

knowthat

youhave

sucha

condition.Icertainly

hadno

idea.M

ysenior

yearin

college,t w

ona

Fuibrightfellow

shipto

studyLa

Mone

d’Arthur

inE

ngland,C

ertificationrequired

am

edicalexam

.Tom

ysurprise

anddism

ay,the

doctorrefused

tocertify

me:

‘Iabsolutely

cannotlet

yougo

abroad:you

havea

heartm

urmur’

(specifically,a

‘mitral

valveprolapse’).

Ina

highlycom

petitivefield,

universitiesw

erechary

ofhiring

someone

who

might

haveA

IDS

Sothe

deathof

Arthur

became

thedeath

ofa

lifelongdream

tostudy

with

thefam

ousM

aloryscholar.

Disappointed,

Ipursuedless.specialized

graduatestudy.

Over

my

longacadem

iccareer,

Ineveragain

faceda

physicalexam

forany

job:F

ortunate,because

costcalculations

canfuel

agedescrim

ination.

In20)4,

longretired

andon

Medicare,

them

urmur

became

decidedlypronounced.

Open

heartsurgery

repared

thevalve.

Because

IhadM

edicareand

aprivate

policyto

paygaps

inM

edicarecoverage,

Ihadno

additionalcosts.

Another’s

Dream

sD

erailed

Inthe

80s,w

henIw

asD

epartment

Chair

ata

small

college,the

academic

jobm

arketw

asglutted.

Many

veryqualified

peoplew

ithadvanced

degreescobbled

togethercareers

asitinerant

professors,traveling

among

severalcolleges,teaching

oneor

two

coursesat

each,having

nohealth

benefits.T

heyhoped

forcontinued

goodhealth

(andno

carcrashes).

One

day,an

extraordinarycandidate

appliedfor

asudden

pan-time

opening.H

isdissertation

hadw

ona

prizeat

ankq

League

university.H

ehad

publishedarticles

inseveral

first-ratejournals.

He

hada

contractfor

anearly

finishedbook,

Hit

dossierof

recomm

endationspraised

hisw

orkso

theskies,

exceptfor

onetroubling

sentence.A

recognizedscholar

fina

similar

field)spoke

highlyof

thecandidate’s

work,

thenadding:

‘AC

anadiancitizen,

Candidate

Xm

akesfrequent

tripshom

ew

herehe

seeshis

doctorand’s

occasionallyhospitalized.”

How

was

th:srelevant

tohis

schotarshipor

teaching?I felt

adilem

ma:

ShouldIviolate

theconfidentiality

ofthe

writer?

Candidates

were

notsupposed

tosee

theseletters.

But

thisnon’eelevancy

suggestedthe

writer

borehim

some

secretanim

us.In

ahighly

competitive

field,universities

were

charyof

hiringsom

eonew

hom

ighthave

AID

S.

cost

calculatio

ns

canfuel

age

discrim

inatio

n

Isookthe

youngscholar

outto

fundsand

askedhim

aboutthe

professorin

question,“O

hyes,’

hesaid,

“we

write

aboutthe

same

things.”W

ithoutrevealing

anythingof

substance,Isuggested

heask

hisuniversity

Placement

Office

torem

ovethat

letter.The

nextyear,

inan

eventighter

jobm

arket,m

yexcellent

hirereceived

nofew

erthan

3tenure-Irack

offersfrom

major

universities.M

yhunch

hadbeen

correct.

Young

peopletoday

continueso

make

careerdecisions

basedon

whether

(andw

hatquality

oOhealthcare

comes

with

theem

ployment

package.

ElseFisher

isa

(mainly)

retiredprofessor

ofShakespeare.

Your

pro

vid

erand

youchoose

yo

ur

care.15

IH

ealthcarecosts

won’t

discouragehiring.

Cau

seof

Dea

th:

For

-Pro

fit

Insu

ranc

e.F

ortu

ne10

0F

ires

liti

gat

or

The

Hos

pita

lis

“In

Net

wor

k.’

Sur

pris

e!T

heD

octo

rIs

Not

Cur

able

Can

cer

Kill

s

I mis

sm

ybr

othe

r.A

brill

iant

trial

lavq

er,

wor

king

inth

eG

ener

alC

ouns

els

offi

ceof

aFo

rtun

e10

0co

mpa

ny,

John

nyw

asab

rupt

lyfi

red

fuss

befo

rehe

turn

edsi

xty.

Iam

,of

cour

se,

bias

edab

out

this

trag

ictu

rnof

even

ts:

John

nyha

dar

gued

(and

piev

aile

d)m

ultip

leli

mes

befo

reth

eS

upie

me

Cou

rt(a

ndm

any

US

Cou

rts

olA

ppea

ls)

and

she

com

pany

’sju

dici

alfo

rtun

essu

ffer

edaf

ter

hele

ft,no

tto

men

tion

hs

boss

gett

ing

fire

d,

NY

Cis

too

expe

nsiv

eto

bejo

bles

san

dst

ifl

pay

rent

.N

otw

amti

ngto

die

hom

eles

sin

NY

C

He

took

CO

BR

A.

Itw

asja

w-d

ropp

ingl

yex

pens

ive.

He

look

edfo

ra

new

job.

Age

disc

nmin

atio

nis

real

.P

rosp

ecti

veem

ploy

ers

expl

aine

dth

eyco

uldn

’tpa

yhi

mw

hat

hew

asw

orth

and

they

knew

he’d

ump

ship

ifth

eyof

fere

dw

hat

they

coul

daf

ford

Nev

erm

ind

that

NY

Cis

too

expe

nsiv

eto

bejo

bles

san

dsti

llpa

yre

nt.

Not

wan

ting

0di

eho

mel

ess

inN

YC.

John

nycu

tba

ckon

his

expe

nses

,be

gan

spen

ding

hs

savi

ngs,

took

Soci

alSe

curi

tyea

rly

—an

dth

en,

afte

rge

ttin

ga

phys

ical

,dr

oppe

dhi

she

alth

insu

ranc

e

Aft

erth

eco

lono

scop

y,w

ear

gued

agai

n.T

heG

Ido

ctor

wan

ted

tosc

hedu

leim

med

iate

surg

ery.

“Sur

gery

!H

ell,

not”

tmet

him

afe

wda

ysla

ter

inth

elo

bby

ofN

YPr

esby

teri

an,

‘Sam

!H

ell,

no,’

kept

him

com

pany

for

she

hour

ofpr

e.su

rger

yw

aitin

g,an

dhu

ngou

tin

the

fam

ilylo

unge

—w

onde

ring

why

a45

’min

ute

proc

edur

ew

asta

k’ng

2+ho

urs.

“Cob

rais

eati

ngm

yre

tire

men

tm

oney

!”T

hen

his

surg

eon

arnv

ed,

look

ing

sad,

He’

dre

mov

eda

“mas

sth

es’

reof

ala

rge

lem

on.”

John

nyha

dS

tage

IVco

lon

canc

er.

Mul

tiple

doct

ors

built

ap!

an.

John

nyw

assc

ared

and

said

hew

ould

do“w

hate

ver

itta

kes

:

Six

mon

ths

late

r,af

ter

man

yro

unds

ofch

emo,

whi

chhi

son

colo

gist

kept

sayi

nghe

’d“f

aile

d,’

John

nybe

cam

ede

pres

sed:

itw

ash:

s“f

ault’

hew

asn’

tbe

sser

.Jo

hnny

,w

ho’d

aced

ever

yle

sthe

’dev

erta

ken,

final

lyca

me

toliv

ew

ithm

ebe

caus

ehe

’dfa

iled.

Igot

his

com

pany

and

wit

and

insi

ght,

whi

lehe

got

lood

and

car,r

,g.

Jthnry

d,ed

aye

a’ah

erth

atp

hy

cal,

And

,no

,no

tbe

caus

ehe

’d“f

aile

d.’H

esh

ould

n’t

have

died

.

Had

John

ny’s

canc

erbe

endi

agno

sed

bya

colo

nosc

opy

afS

tage

0or’

,he

mig

htw

ell

beal

ive

toda

y.E

ven

diag

nose

das

Srag

e2

or3,

hem

ight

wel

lbe

aliv

e:S

tage

3Aha

sa

S’ye

arsu

rviv

alra

teof

abou

t90

%,

Imis

sm

ybr

othe

rJo

hnny

,(k

now

hesh

ould

n’t

have

gone

thre

eye

ars

wis

hous

seei

nga

dono

r.Ia

lso

know

hew

ould

n’t

have

been

able

toaf

ford

all

the

trea

tmen

the

got

with

out

heal

thin

sum

nce.

No

one

shou

lddi

ebe

caus

ese

eng

ado

ctor

coul

dle

adto

bank

wot

cy.

FJed

,car

e,ev

enw

ithits

gaps

arid

flaw

s.is

ag

od

srn

dfo

rth

ose

over

65.

We

all

need

“Im

prov

edM

edic

are

for

All

New

Yor

kers

,”NY

Hea

lth,

whi

chw

illsa

veus

mon

ey,

cove

rus

all

—an

dke

epbr

othe

rslik

eJo

hnny

aliv

ean

dsh

rivin

gde

cade

slo

nger

.

Jaha

nna

Bar

dm

oum

iny

she

45,0

00,4

men

cans

who

,fil

mJo

hnny

,di

apr

emat

urel

ybr

caus

eof

rati

oeth

heal

thca

re,

adro

raie

sfo

rN,v

rkH

ealt

han

dSe

a!:h

iust

ice.

Sur

pris

elIt’

sa

hosp

ital

bill!

Ele

ven

p.m

.on

aSa

turd

ayni

ght.

My

wif

ean

dIw

ere

retu

rnin

gho

me

from

ara

reev

enin

gou

t,m

ade

poss

ib!e

byou

rch

ildre

nbe

ing

away

ata

sum

mer

cam

pne

arSi

dney

,NY

.It

had

been

asu

cces

sful

even

ing:

vie

had

disc

over

eda

Mor

occa

n-Is

rael

ica

féon

the

Upp

erW

est

Side

ERdoct

ors

are

eng

aged

bypr

ivat

eco

ntr

act,

the

hosp

ital

told

me

As

soon

atre

ew

alke

d‘n

the

door

,th

ete

leph

one

rang

.It

was

she

russ

ofr

omca

mp

Our

son

was

OK

,se

hurr

ied

inas

sure

us,

but

heha

din

jure

dhi

sfi

nger

and

she

nurs

ew

asas

king

for

our

perm

issi

onto

take

him

toth

eER

ofth

elo

cal

hosp

ital.

Nat

ural

lyw

eag

reed

:Si

dney

is12

5m

iles

and

ath

ree’

hnur

driv

efr

omsh

eB

ronx

,it

wou

ldha

rdly

mak

ese

nse

tobr

ing

our

son

all

the

way

hom

eto

see

ado

ctor

.T

heca

mp

had

our

fam

ilyhe

alth

insu

ranc

ein

form

atio

n,an

dth

eho

spita

lac

cept

edou

rin

sura

nce.

Our

son’

sfi

nger

was

spra

iree

bul

not

brok

en;

isw

asta

ped

and

hew

eet

back

soca

mp.

Mat

ter

clos

edO

rso

isse

emed

,un

tilw

ego

sa

bill

for

$400

from

the

ERd

on

or

(Thi

sw

asin

addi

tion

toth

eco

’pay

men

fto

the

hosp

itaL

!

Itse

ems

the

hosp

.tal

acce

pted

our

insu

ranc

e—

but

she

doct

ordi

dno

t-T

his

isso

met

hing

1co

uld

nor

have

imag

ined

until

Iexp

erie

nced

it,Is

n’t

the

doct

oran

inse

para

ble

pan

ofsh

eho

spit

al?

I ask

edbo

thth

eho

spita

lan

dth

eca

mp

coun

selo

rw

hoac

com

pani

edm

yso

nfo

rde

tail

sof

wha

tsh

edo

ctor

did

tous

tify

this

bilt.

From

wha

tIw

asab

leto

dete

rmin

e,th

edo

ctor

spok

ew

ithm

yso

nbr

iefly

,te

nthi

mfo

ran

x’ra

y,lo

oked

atth

ex’

ray

resu

lts,

and

band

aged

his

fing

er.

At

mos

t,th

edo

ctor

may

have

spen

t5

min

utes

onth

isca

se.

Let’s

see:

5m

inut

esat

£400

—th

at’s

ara

teof

$4,R

00pe

’ho

urN

osba

d;ev

enm

ote

than

a‘s

ir/e

r,It

h:nk

.

Eve

ryon

ew

hoco

mes

into

the

hosp

ital

has

tobe

seen

byth

edoct

or

ondu

ty

Iask

edfh

eho

spita

lw

hy,

ifth

eho

spita

lac

cept

edm

yin

sura

nce,

‘rec

eive

da

bill

rem

the

doct

or.

ERdo

nors

are

enga

ged

bypr

ival

eco

ntra

cf,

the

hosp

ital

told

me,

sepa

rate

from

the

hosp

ilal’

sot

her

care

give

rs.

Ifth

edo

ctor

isno

tpa

rtof

the

hosp

ital,

task

ed,

why

coul

dn’t

my

son

bese

enby

anu

rse?

Aft

eral

l,th

ere

was

noth

ing

abou

thi

sca

sean

RNco

uld

not

take

care

of

The

hosp

ital’

sre

ply:

Eve

ryon

ew

hoco

mes

into

the

hosp

ital

has

tobe

seen

byth

edo

ctor

ondu

ty.

Inot

her

wor

ds,

the

hosp

ital

was

havi

egit

both

way

s-T

hrou

ghfu

rthe

rre

sear

chId

isco

vere

dth

attw

oco

rpor

atio

nsow

nal

mos

taf

Ith

em

edic

alfa

cilit

ies

ina

vast

area

ofce

ntra

lN

ewY

ork

Stat

e.

Sinc

eth

enth

est

ate

pass

eda

law

iequ

idng

hosp

ilal

sto

info

rmpa

tien

tsof

thei

rbi

liing

prac

tice

s,so

paL

en!s

wou

lden

sge

t‘s

urpr

ise’

bills

.

flu!

the

stat

ed’

dro

tou

tlaw

the

prac

tice

ofbi

llir

gse

para

tely

for

the

doct

orSo

Igue

ssw

eca

nco

wst

art

figs

inng

out

how

we’

llpa

yth

ebi

llfo

rou

ri!’

ness

be’o

rew

ear

ecu

red.

Ido

not

keow

ifsh

ela

wre

quir

esho

spita

lem

ploy

ees

toex

plai

nth

eir

billi

ngsy

stem

befo

reth

eyst

art

trea

ting

som

eone

who

com

esin

with

ahe

art

atta

ck,

And

ifth

epa

tien

tis

unco

nsci

ous,

doth

eyha

veto

expl

ain

itri

ght

away

ordo

they

wai

tun

tilth

epa

sien

tha

sre

gain

edco

nsci

ousn

ess?

“Per

vers

e”is

not

too

stro

nga

wor

dto

desc

ribe

this

hea

lthca

re“s

yste

m”

And

ofco

urse

,w

hen

you

have

ase

tiou

sem

erge

ncy

whe

reev

ery

min

ute

coun

ts,

you’

reno

tgo

ing

tooo

toa

hosp

ital

fart

her

away

beca

use

it’s

chea

per,

are

you?

‘Per

vers

e’is

not

too

stro

nga

wor

dto

desc

ribe

th;s

heal

thca

re‘s

yste

m.’

No

one

will

die

wai

ting

for

Med

icar

e.5

14

Ikno

whe

shou

ldn’

tha

vego

neth

ree

year

sw

itho

utse

eing

ado

ctor

He

figu

red

he’d

beon

Med

icar

ew

ithin

3ye

ars.

He

ratio

naliz

edth

athe

’dof

ten

gone

year

sw

ithou

ta

phys

ical

.“N

othi

ngba

dha

ppen

edth

en:

noth

ing

bad

will

happ

enno

w,

And

CO

BR

Ais

eati

ngm

yre

tire

men

tm

oney

!”

He

bega

nha

ving

dige

stio

nis

sues

,bu

tpu

tof

fse

eing

ado

ctor

beca

use

heco

uldn

’taH

ord

anys

h’ng

expe

nsiv

e—

and

“Med

icar

ew

illk,

ckin

soon

,an

dco

ver

wha

teve

rth

eyfi

nd—

and,

mor

elik

ely,

wha

tese

rth

eydo

n’t

find

,do

ing

load

sof

expe

nsiv

ete

sts

“Med

icar

ew

illki

ckin

soon

”

The

nhe

turn

ed65

and

got

his

Med

icar

eca

rd,

His

phys

icia

nha

dre

tired

,so

find

ing

ane

won

eto

oktim

e,H

eca

lled

afte

rth

eap

poin

tmen

tso

com

plai

nth

atth

ene

wgu

yw

asin

sist

ing

ona

colo

nosc

opy.

“whi

chso

unds

nast

y,”

We

argu

ed,

He

mad

eth

eap

poin

tmen

t,

Ron

Weg

sm.n

isa

nonp

rofit

raec

usiv

ean

da

fong

iime

,esi

drnt

ofK

ings

brid

gean

dR

isei

da!e

.

No

surp

rise

bills

,no

cost

sat

po

int

of

serv

ice.

Delays

Updating

Insurance.B

arelyE

scapedB

ankruptcyerrifying

Nightm

ares:“M

yW

ifeW

illB

eH

omelessl”

Thisisa

storyof

howM

argaietalm

ostlost

herlife.

Our

livestogether

areso

intenwined

Icannottell

herstory

without

tellingnine-

Itbegins,

innocentlyenough,

with

Iwo

mistakes.

First,only

oneof

usgot

aflu

shot:m

e.M

argaretIhooght

diedidn’t

needit,

becauseshe

iravelsto

seefam

ilyna

warm

erclim

ate.S

econd. we

hadtrouh’e

updatingour

healthinsurance

becausew

ew

anteda

ointpo:cy

andthen

thoughtw

enad

missed

thew

indowfor

enrollment.

Our

storybegan

lastFebruary

when

my

w.fe

fellterribly

ill.A

fterIposted

aboutit

onF

acebook.as

aw

ayof

keep

ng

myself

saneand

gettingsupport

fromfriends,

apnysicisn

friendIhadn’t

seens:nce

aItS

reunion,20

yearsearlier,

recomm

endedIget

anoxim

eterso

checkM

argaret’sblood

oeygen.H

etold

me

thatifis

fellbelow

90%,

togel

herto

theem

ergencyroom

byam

bulance,

Her

blo

od

oxygen

was

85

%...

73

%39%

...

her

carelikely

cost

over

halfa

million

do

llars

Itw

as85%

.Ihustled

herinto

thecar

toour

localER.

Shew

ashaving

troublew

alkingeven

afew

steps.By

thetim

ethe

ERtniaged

her,her

oxygenw

as73%

—

andthey

hustledto

administer

oxygenin

variousand

successivelym

oreintrusive

ways.

At

3am,

shew

asstill

consciousand

toldm

elo

go

home,

that

the

osy

gen

mask

was

working.

At

lam,

when

I returned,the

ERcoordination

physiciantold

me

sheneeded

lobe

puton

anEC

MO

machine

—w

Inchrem

ovesthe

bloodfrom

anartery

inthe

neck,oxygenates

it,end

returnsitdirectly

sothe

hears.The

ECM

Ois

theH

ailM

arylass

resortfor

breathingissues

thisserious.

Imagine

howI fell,

hearingthat

thism

achinew

asher

onlychance,

thatm

yhospital

didn’thave

onefonly

afew

hospitalsdo),

andthat

thew

asfar

tootick

totravel.

Her

bloodosygen

was

39%.

Our

coordinatingphysician

arrangedfor

Monteliore

Hospital

tosend

ateam

of8

(surgeon,nurses,

technicians),w

hoarrived

within

thehour

andperform

edthe

surgeryw

iththe

machine

theybrought.

The

surgerylook

about90

minutes.

As

sheE

CM

Obegan

tow

ork,she

was

upto

45%,

andthat

was

thebeginning

ofher

longjourney

back.

Margaret

went

throughso

much:

oxygendepivalion

harmed

herheart,

brain,kidneys

andother

organs.She

was

inthe

ICUfor

aw

eek—

beingw

atchedby

two

nurses24/7

—and

ina

coma

fora

month.

Although

everso

much

benernow

,she

hasnot

fullyerovered

andtires

easily.M

argaieslost

herob,

andthis

new

pre.ex

issing

tondL

lion

mak

estied

ing

anew

jobch

allengng.

Com

pan

iesare

reluctan

tto

hirean

yo

ne

likelyto

inuw

xse

lhe.r

insu

rance

costs

Bet,

than

ks

toth

atnag

calm

achin

ean

dtruly

ded

:catedd

octo

rsan

dnurxes

fromco

ohosp

itals,m

yw

ifelees.

Marg

are

tlo

st

her

job,

and

this

new

pre

-existin

gconditio

nm

akes

find

ing

anew

job

challe

ngin

g

Now

forthe

insurancepan.

equallyscary

andw

ithan

equallyhappy

ending.A

dono

rto’d

me

hercaie

t.kelycost

overhalf

am

illiondotxrs.

Fee!:ngiN

myself,

Ihadtried

toapoly

onlinefor

ouro.nl

insurancepolicy.

andhad

gonensw

&w

iththe

forms

sincetw

opolicies

hadto

become

one.T

hen,during

theheight

ofher

illness.Iforgot

tofollow

through.Is

tookm

anycalls

iohe

NY

CH

ealthD

epartment

befove,eached

anagent.

who

fcundour

intialapplication

andallow

edus,

first.to

activatethe

loal

policyand,

second,dale

itback

1°m

yinitialapplication.

The

kindagent

toldm

esve

had1

daysto

make

theale

payment

forFebruary

beforeour

coveragew

ouldbe

cancelled.

We

mig

ht

hav

elo

stev

ery

thin

g—

bu

t

for

the

graceof

onevery

kindarid

patie

nt

NY

SH

Dagent

Imade

thepaym

ent—

alarge

sumfor

us—

andw

ew

eresaved. 1

en

I thinkofw

hatm

ighthave

been.A

ftalf.million.dollardebt

would

haveruined

us.We

might

havelost

everything—

butfor

thegm

ceof

onevery

kindand

patientN

I’SH

Dagent

who

tookthe

lime

tofind

ourfile,

understoodour

situarion,and

made

allthe

coveragehappen.

Ifeel verylucky

indeed,

Iamthe

executivedirector

for anagency

thathelps

homeless

people.providing

shelterand

advocatingfor

affordablehousing

forallN

ewY

orkers.Ironically,the

poorand

homeless

inN

ewY

orkreceive

quiteadequate

camfrom

Medcaid,

butcalamity

almost

tookm

yw

ileand

my

futum—

asudden,

unexpectedhealthcam

calamity, from

which

my

belovedand

I barelyescaped.

NYH

ealthw

ouldhave

preventedm

anyofthe

anxiely.causingaftereffects

ofmy

wife’s

illness.

George

Gross

si execmire

directordan

eteda,thagency

thatad

uocales

forthe

homeless

eN

YC

.

No!

Nol”

my

husband’snightm

ares—

vividchim

erasabout

hism

edicalhills

leavingm

ebankrupt,

without

ahouse,

food,or

safely—

spikedhis

heartrate

andblood

pressure,tngge’ed

alerts,caused

medical

staffto

raceto

hisbed

sde.

They

wou’d

findm

etrying

tow

akehim

toreality,

ashe

grippedm

yhands

gatping,‘A

reyou

sureall

thisit

covered?I can’t

havethre

treatment

.fyou

wont

besafe.’

V/hen

fullyaw

ake,M

ichxelknew

hew

aslucky,

with

Cadiilac’

insurance.D

espitetrus,

we

tegulartygot

billedfor

thousandsof

doilarsO

verfive

years,Ioften

made

callso.sputing

bills:he

was

toosick

local1.

My

hu

sban

dw

orried

about

need

ing

tob

orro

wm

oney,ab

out

dyingbefo

red

ispu

tesw

erereso

lved

Som

etimes

I heardm

issing‘prior

suihorirations,’or

hs

cardnum

berhad

beenre,ected

orinsuranre

hadpaid

Xdollars

andhe

stillow

ed35<.T

henIw

ouldcal

‘benefitsand

beput

onbold,

I stento

music,

geltransferred

around,constanliy

askedfor

me

same

numbers

anddates,

Michael

would

listenfrom

hisbed,

whispering

worned

questions.Per

hisinstructions,

Ikept

anotebook

ofevery

phonenum

berand

personI

talkedto,

andeverything

theysaid.

When

I’dfinally

getthrough

toa

benefitsperson

who

couldhandle

hispolicy,

I’dheat

itwas

coveredbut

thedoctor,

thehospital,

thelab

hadfiled

thew

rongpapenvork.T

oom

anytim

esto

count,w

ereceived

lettersfrom

collectionagencies,

threateninglaw

suits,describing

punitivefinance

charges,w

ritingreally

scarythings.

I respondedto

thesein

writing:

“The

billis

indispute.

Return

itto

theprovider

imm

ediately.”

I always

feltterrib

lew

hend

octo

rs(and

nurses)sp

ent

time

defen

din

gm

edicaldecisions

when

they

need

ed(and

wan

ted)

tosp

end

time

with

patien

ts

My

husband,a

faviryer.would

dictateand

signthese

letters,to

heknew

howm

anydisputes

were

inplay

—

endtheir

repercussions.A

ftersending

theletter,

I would

phonew

hoeversent

thebill

tocollection,

andw

asusually

toldit

hadbeen

sent‘in

ecor.”

My

husbandw

orriedabout

needingto

borrowm

oney.about

dyingbefore

disputesw

ereresolved.

When

home,

hew

aseligible

forv,siling

home

healthcare:each

newperson

requireda

new‘intake

form,’

sometim

eslastng

2hours

orm

ore.Som

eof

them,

heanivss!y,required

himto

answer

everyquestion,

becausehe’s

thepatient,

notyou.’

His

insurershad

noqualm

sab

out

over-rulinghis

doctors’d

iagn

oses

andp

rescriptio

ns

Never

mind

thathe

was

drugged,exhausted,

tootick

torem

ember

everym

edicationor

me

name

andphone

number

ofevery

doctorV

.’o,se,aher

everyhospitalization,

thisintake

formhad

tobe

doneanew

—there

was

now

ayso

carryany

information

overbecause

‘thingshave

changed.’N

othey

hadn’t.T

hem

a,orchange

was

always

thedale.

UIt.m

ately,M

ichael’scare

was

‘tree’—

andw

ew

ereso

gladto

getgood

careand

tohate

itcovered—

butit

was

norw

;thoulcost

som

anyletve,t,

notebooks,and

hoers,so

much

effortand

stresshe

couldhave

spenthealing.

His

insurershad

noqualm

sabout

ov

erruling

hisdonors’

diagnosesand

prescriptions.H

isdoctors,

nurses,and

hospitalinsurance

administrators

allspent

hourson

thephone

andcom

puterstrying

toget

approvalsand

permissions,

checkingbilling

codesand

FDA

sites,persuading

bureaucrats.

I always

feltterrible

when

doctorsfand

nurseslspent

lime

defendingm

edicaldecisions

when

theyneeded

(andw

anted)to

spendtim

ew

ithpatients.

The

hasslescaused

byhis

Cadillac

insurancem

adelife

almost

asgm

esome

ashis

illness.B

utIknow

hegot

superbcare

despitefor’pm

fi trnsurance,N

OT

becauseof

it.

All

ofus

needa

simpler,

more

user.friendly,less

costlypaym

entsystem

.It’s

onereason

why

single.payerN

YH

ealthw

illbe

better

Donors

will

diagnoseand

prescribeaccording

toevidence.based

protocolsdefined

bydoctors

—and

getpaid,

promptly.

All

thetim

enow

spentarguing?

New

lyavailable

forpatient

care.A

ndm

ydarling

husband—

andyour

lovedones

—w

on’tw

onyabout

bankruptingtheir

families,

orleaving

themhom

elessbecause

ofunpaid

medical

bills.T

heycan

concentrateon

gettingw

ell.

JudithU

ebenlost

herhusband

after580

days0f

hospiralizaiion.In

hishonor,

sheadrosates

forN

VH

ealth—

toelim

inatefinancial obstacles

tohealthcare

forall

New

Vortem

.

Au

tom

aticen

rollm

ent

inth

ebest

plan,alw

aysth

ere.13

Loved

onescan

focuson

healing,notfearing

homelessness.

Got

Sick

.L

ost

Job.

Los

tIn

sura

nce.

Hag

gled

for

His

Life

Sud

den

Chr

onic

Illn

ess.

For

mul

ary

Hel

l.W

illIS

urvi

ve?

IIa

imos

tti

edel

even

year

sag

o.In

itial

ly,

Ihad

ajo

bw

ithin

sura

nce

but

illne

ssco

stm

em

yjo

b.L

osin

gm

yta

bco

stm

em

yin

sura

nce-

Not

bein

gab

leto

affo

rdhe

alth

care

alm

ost

kille

dm

e.M

yst

ory

isa

vici

ous,

like

-thr

eate

ning

cycl

e.I’v

ele

arne

dth

athu

ndre

dsof

thou

sand

sof

Am

sric

ans

have

sim

ilar

stor

ies.

now

my

job

didn

’tin

clud

ehe

alth

insu

ranc

e.N

otal

ljo

bsdo

,ev

enso

me

that

recr

uit

you

wit

hpr

omis

esof

heal

thin

sura

nce

Afe

wye

ars

earl

ier,

Ihad

my

first

epis

ode

ofbi

liary

du

nob

stru

ctio

nan

ddi

dn’t

gel

sosi

ck.

My

insu

ranc

eco

mpa

nypa

id$1

,500

for

ach

olec

yste

ctom

yan

d,af

ter

wee

ksof

reco

very

,Iw

asal

mos

tba

ckto

norm

al,

livin

gm

yl,t

ean

ddo

ing

my

job,

but

now

my

job

did

nt

incl

ude

heal

thin

sura

nce.

Not

all

jobs

do,

even

som

eth

atre

crui

tyo

uw

ithpr

omis

esof

heal

thin

sura

nce.

Soth

ere

Isva

sel

even

year

sag

o,w

oik:

ngev

ery

day.

The

nI g

otre

ally

sick

—in

tens

ebl

oatin

g,ja

undi

ce,

afa

natic

alitc

h’ng

that

kept

me

from

slee

ping

far

four

mon

ths.

Itw

asco

nsta

ntev

ery

hour

ofev

ery

day.

Nonst

op

.Iw

asin

such

mis

ery.

Ilos

tw

eigh

t.Iw

asha

llow

edojr

.

One

fnen

dsa

idIl

ooke

dlik

ea

“dea

dm

anw

alki

ng.”

The

hosp

ital

told

me

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ould

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e

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the

way

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used

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tryi

ngto

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t,m

uch

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cons

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ply

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All

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lack

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ngto

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good

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Even

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insu

ranc

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gh.d

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duct

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eppe

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any,

like

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ving

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got,

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ent

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ddi

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ove

knan

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care

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job

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ness

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see

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and

get

trea

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not

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ting

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pove

rish

our

fam

ilie

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reg

otr

eatm

ent

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ddi

e

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erhe

arth

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une

edto

find

$20,

000

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or$1

3600

,or

$8,0

00or

even

$1500—

for

aro

usin

epr

oced

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ents

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hen

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have

ajo

b,yo

u’ll

pay

apr

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lose

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You

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ildre

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on’t

lose

met

heal

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beco

vere

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eth

eyre

child

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ram

iles

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out

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e.

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ter

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t ind

ustry

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ever

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ing

prio

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thor

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gas

sidu

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yon

my

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lf—

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turn

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succ

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Bus

let

me

begi

nat

the

begi

nnin

g.

I am

very

activ

e-Ir

un,

wal

k,bi

ke,

doY

oga,

eat

heal

thily

and,

until

Pass

over

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cons

ider

edm

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fen

tirel

yhe

alth

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sm

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san

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test

ify,

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ing

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sm

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ring

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ay,

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denl

ybe

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roll

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ctaf

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cles

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men

tion

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head

ache

and

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emem

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roug

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eigh

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ent

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roll

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rras

smen

tan

dpa

in.

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the

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fam

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enat

tend

ing

Cha

bad

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iver

dale

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Rab

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ave

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ason

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nose

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eaf

ter

serv

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get

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ptom

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ddi

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som

eki

ndof

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test

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ady.

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ally

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rear

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aG

l.I r

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Ala

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edi

agno

sed

me

with

ulce

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litis

fOCI

,an

inlla

mm

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wel

dise

ase

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mai

nly

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cts

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linin

gof

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larg

ein

test

ine

(col

on).

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imm

une

dise

ase

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laps

ing-

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itti

ngco

urse

,w

hich

mea

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e’up

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efo

llow

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ods

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mis

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mill

ion

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ase.

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the

mom

ent,

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e’s

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edic

alcu

refo

ruc

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adic

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rger

yca

uses

othe

rpr

oble

ms.

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day

one,

the

illne

ssw

asdi

ffic

ult

for

me

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appo

intm

ents

look

fore

ver,

the

cost

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yroc

kete

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ctiv

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hedo

ctor

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ver

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edto

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plai

nts

orha

den

ough

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real

lyto

help

me

get

sow

here

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ldbe

.

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ertw

oye

ars,

six

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and

thre

eco

lono

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ies,

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llym

iser

ab’e

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yen

t,re

body

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me

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amed

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kle

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ings

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tim

port

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sura

nce

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cove

rth

ebe

stm

edic

ines

,w

h,ch

are

very

expe

nsiv

e.

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my

sala

ryan

dw

ithfa

m’ly

obli

gati

ons,

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not

affo

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ed,c

atio

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aIm

ight

help

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mor

eth

anth

eon

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mon

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eso

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with

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itio

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ken

both

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ness

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incr

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nanc

ial

buid

en:

avi

ciou

sci

rcle

beca

use

ansi

esy

incr

ease

ssh

esy

mpt

oms.

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heal

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stem

mak

esch

roni

che

alth

diso

rder

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ffic

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eat

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ause

insu

ranc

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ppy

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UC

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depe

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ing

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eto

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loca

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ery

rest

room

inth

eC

ity.

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tem

fied

ifIg

eta

cram

pan

dm

ust

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faci

litie

sin

neig

hbor

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ithno

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ilet.

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aco

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nce

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ase

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ergy

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eat

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caus

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nce

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hose

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cd,

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dw

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urce

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ust

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inue

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ups.

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ches

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rm

irac

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res.

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the

one

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Hep

atiti

sC.

whe

reth

eco

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eatm

ent

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onde

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even

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ere

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cure

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UC

,w

illI

beab

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affo

rdis’

“Lit

tle

mor

eth

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we

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big

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ma

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eric

ans

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illke

epus

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ata

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nal

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eR

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hreatensM

ySon’s

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orkH

ealthA

ct

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yperfectly

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neighborhoodhospital

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anda

halfw

ew

atchedhim

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abilityto

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allow,

focushis

eyes,and

reliablybreathe,

He

was

eventuallydiagnosed

with

anti’NM

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receptorencephalitis.

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my

husbandw

aschanging

lobs,

moving

ourson

toth

enew

policyw

ould

haveth

reatened

hislife

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ou

ttw

om

on

ths

into

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hosp

itat

billingoffice

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oer.of.netw

orkproviders:

ourinsurance

hadcontracts

wish

thehospital,

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doctors.B

utI never

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choiceof

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providerm

yson

was

seenby

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nappenedto

heon

service.

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hadbeen

sentto

collecl:onsfor

nonpayment

thanI

didn’teven

knowab

out

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onths,I had

heldbedside

tigilfor

my

sonas

heteetered

between

lifeand

death.I w

astold

hew

asetig

iefor

nsttut;onslM

edicaid,bun

enmlling

himm

qired

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go:ngto

them

idtown

offices.I refused

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my

son’sbedw

dew

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was

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hatinitial

hosp.talizatontasted

IScontinuous

months,

between

threedifferent

tsospitalseach

with

differentinsurance

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complications.

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ebegan

givinghospital’level

careat

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eachch

ange

createspoten

tialfor

—nnd

has

caused

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istakes

end

disru

ptio

ns,

puttin

ghim

thro

ugh

unnecessary

sufferin

g

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fightto

geteverything

we

needto

keepour

sonalive,

endto

avoidbankruptcy,

isdaily

anddraining.

We

canonly

usethe

preleeedproviders

who

havecontracts

with

ourinsurance

company,

aneverevolving

listthat

changesw

ithcontract

negotiations.

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time

ourinsurer

d,scontnuescontracts

rashproviders,

we

scramble

tofind

newones

endto

restartcom

plcatedprocesses

ofdoctors’

orders,prior

authorizations,and,nsurae

ceapprovals.

en

my

husbandw

aschanging

jobs,m

ovingour

sonto

thenew

policyw

ouldhave

threatenedhe

tile.

We

endedup

usingC

OB

RA

benetitto

keepour

sonon

thepo’icy

we

hadw

henhe

firstgot

sick,and

hiseligib;liry

(orthat

expiresin

thecom

ingyear.

We

stilldo

notknow

howso

ensureour

son’ssafely,

indeedhis

eiabiity,during

thetransit.on

toa

newem

ployment’

basedprim

arypolicy

,itestill

100%dependent

foralt

artivinesof

dailylife,

inthe

sevenyears

sincethe

onsetof

hisillness,

my

sonhas

re!earnedno

walk

with

assistance,he

hasdeveloped

acom

munication

systemusing

vocalizations,eye

gaze,and

hisright

hand,and,

tom

yjoy,

hecan

nowear

bym

outh.H

egoes

toan

amazing

NY

Cpublic

neighborhoodschool

andthrives

inan

inclusiondats.

He

isdeterm

inedand

funny,courageous

andfrustrated,

andoutsm

artseveryone

who

underestimates

himor

hitintelligence

basedon

htsm

edicalcondition

andesutting

limited

motor

control.

My

sonhas

anupcom

ingsutgery.

The

daybefore

Thanksgiving,

Iwas

informed

hem

ightnot

havethe

same

surgicalteam

tnathas

performed

threepnor

sergeneson

h,mat

thehospital

Thathas

managed

hisconsplet

casefor

thetast

sevenyears.

dueso

contractnegotiations

between

shehosptat

andthe

insurancecom

pany.Iw

asterrified

my

son’scare

would

sufferbecause

ofthis.

Itis

gru

eling

.It

issen

seless,It

isd

esign

edto

enhan

ceth

epro

fitsof

insu

rance

com

pan

ies

The

contractnegotiations

ultimately

endedin

anagreem

entand

thisspecific

cnsisw

asaverted,

busw

hatIam

describinghere

5m

addening.ts

isgrueling.

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senseless.It

isdesigned

toenhance

theprofits

ofinsurance

companies

andother

money.m

otieatedm

edicalcoss.inflators.

There

itabsotusely

nosense

inm

yson’s

changingdoctors,

nurses,suppliers,

andhospitals

dueto

contractnegotiations

between

profit’m

otivatedentities,

orchanges

ininsurance

policiesonce

hisC

OB

RA

eligibilityexpires.

Each

changecreales

potentialfor—

.and

hasactually

caused—

mistakes

anddisw

pto

ns

tohis

care,putting

himthrough

unnecessarysuffering

anduitim

ateiynak:ng

hiscare

more

enpensiveto

thesystem

asa

whole.

Likem

anydiseases,

ourson’s

unpredictableillness

couldhappen

toanyone,

atany

time.

SandraJoy

Steinisaw

nrer

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Aperfect

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itedbread

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easthat

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theoven,

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thetrays,

tw.st

around,and

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thecooling

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meat

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murder,

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600pounds

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boxes.I rem

ember

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breaksto

my

foot,leg,

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becausethe

traumat;c

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my

lower

backobliterated

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thought.Ilost

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painas

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tciaticnotch

broke.

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ourhealth

clinicfloor

—no

ambulance

was

called,no

onestayed

with

me.

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particularw

orkplacediffers

fromthe

comm

ercialkitchen

youvelikely

imagined.

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uN

oso

my

Boss:

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insolitary

confinement

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ealthcare:W

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illsC

orrectionalFacility,

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oreyears

thanis

easilyim

agnable.

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that90%

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female

inmates

havebeen

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priorto

incarceration;that

prisonreform

advocatesreoor,

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hokill

theirabusers

have25%

higherconviction

rates—

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get

farharsher

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thanm

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alepartners

orm

enw

hokilt

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personcan

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sentenceof

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earlierparote)—

white

female

DV

vicsims

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thosebadly

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was

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inimat

supplies.C

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unnecessayexpense,

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ofadditional

reports,and

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investigationinto

mishandling

inmates.

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lefton

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floorfor

thenexs

shiftso

dealw

ithbecause

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didn’tw

antto

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echarges.

andshe

guardsdidn’t

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sow

astefam

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eby

wnsing

overtime

repont.

conrieuedon

page9

“Continuity

of

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willbe

the

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.6

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bulancecosts

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‘tleavea

brokenback

ona

clinicfloor.

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NY

courtthat

follows

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guidelines(not

alldo)

couldcharge

me

with

second’degree

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anslaughterand

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sciaticnotch

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okeperhaps

sentenceme

to1.5

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floorfo

ctsin

myra

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that

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iss

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NEW YoRKHEALTH ACT

Savings and Spending Under the New York Health Act FAQ

Introduction: The New York Health Act (NXHA) will generate enormous savings by

replacing the marketing, bureaucracy, and profits of insurance companies with a single

publicly-accountable plan, as well as by negotiating fair prices with drug companies. Data

from the RAND study shows that NYHA, while covering everyone, including long-term care,

and eliminating all deductibles and copays, will save more than $11 billion in 2022 and even

more in ffiture years. By distributing the tax burden fairly based on ability to pay and having

capital gains and other taxable investment income contribute to its cost, 90% of New Yorkers

will see substantial savings in their spending for health care.

How Much Will the Average Person Save and Pay under the NY Health Act?

New Yorkers will save billions of dollars by not paying rising premiums, deductibles,

copays,outtofnehvortchargesrandJong=term2aracosts

(homecarenursinghomecare).

We’ll save tens of billions by cuffing out insurance company bureaucracy and profit,

lowering doctor and hospital administrative costs, and negotiating lower drug prices.

The lower cost of the single payer system will be funded by existing Medicare and

Medicaid and other public funds, along with a progressively graduated tax on payroll and

taxable non-payroll (investment) income. The employer will pay at least 80% of the payroll

tax; the employee no more than 20%. A self-employed person would pay the full payroll tax.

MI New Yorkers, including children, will be covered, whether they are working or not.

The NYHA provides that the first $25,000 of a person’s annual income will not be

taxed. The bill does not specify other income brackets and rates, which would be set shortly

before the plan is ready to be implemented.

We can, with reasonably high accuracy, estimate what the average working New

Yorker will spend under the New York Health Act single payer legislation. Over 80% of

New Yorkers earn less than $100,000 per year. For that significant majority of New Yorkers,

here is what they will pay in New York Health taxes, based on the results of the RAND

report and a Summary’ and Evaluation of that report (see below):

Employee Employer Self-employed__1

Annual Tax Effective Tax Effective Tax Effective

Income rate rate rate

$25,000 $0 0% 50 0% $oj 0%

$50,000 $900 1.8% $3,600 7.2% $4,500 9%

$75,000 $1,800 2.4% $7,200 9.6% $9,000 12%

$100,000 $2,700 2.7% $10,800 10.8% $13,500 13.5%

For any income below $100,000, the maximum tax can be calculated as follows:

1. Subtract $25,000 from the income.

2. For employees/employers/self-employed, multiply the result by 0.036/0.144/0.18.

Higher-income persons will pay proportionately more, as tax rates rise in accord with a

progressively-graduated tax schedule, These taxes will raise the funds described below.

Note: The New York Health tax is a tax on individuals, not households or families.

As an example. the median household income in New York State is $65,000; if that income

is earned by two employed people making $32,500 each, their total New York Health tax

will be less than $540.

Compare all these numbers with what people spend today: The average family health

insurance coverage in New York State costs £21,000, and the average deductible is £3,200.

What Will Overall Savings and Spending be under the New York Health Act?

Getting rid of insurance company bureaucracy and profits will save New Yorkers

over $20 billion. We will save over $16 billion we now pay to doctors, hospitals and other

providers for the adminisfrative costs of fighting with insurance companies. Under NY

Health, we could cut drug prices over $18 billion with the bargaining power of 20 million

consumers. That’s over $55 billion a year. The New York Health Act would use the savings

tQpAyj,pflcalth carej pujjjgp,çyt jkers’ pQclcets.

NY Health would pay health care providers more than Medicare and Medicaid now

pay, because the rates would be required to be related to the cost of delivering the service and

sufficient to assure an adequate supply of the service, and unpaid care would now be paid.

For patients, NY Health would also cover what we now spend on deductibles, co

pays, out-of-network charges, and out-of-pocket spending for long-term care.

Table 1. Savings & Additional spending — in S billions

SavingsReduced insurance company bureaucracy and proflt 20.4

Reduced health care provider adnthilsfrative costs 16.3

Reduced prices for prescription drugs 18.6

TOTAL SAVINGS 55.3

• Additional spendingCovering the uninsured & eliminating deductibles,

17 1copays,_out-of-network_charges

I Improved provider payments 8.8

I Long-tenn care — shifting unpaid care to paid 18.0

TOTAL ADDED SPENDING 1 43.9NET SAVINGS

See also Figure 1. See the RAND study and a Summary and Evaluation

for further details on this table and what follows.’of the RAND Report

wwwnnd.orw’content’darn/rand/oubs/research reports/RR2400/RR2424IRAND RR2424.odf:

www.infoshare.org/main/Summary and Evaluation of the RAND reoort - LRodbern.pdf

What does Long-term Care (Long-term Services and Supports) Add to the

Cost of the New York Health Act?

Today in New York, spending on LTSS is $22 billion by government (primarilyMedicaid) and $11 biffion private spending (insurance plus out-of-pocket) -- totaling $33billion. The RAND study estimates that people in New York provide about $3 I billion inunpaid home care (generally provided by a family member, usually a woman), and assumesthat a portion of current unpaid home care will be replaced by paid home care under NYH,costing $18 billion. Therefore, the new public spending on LTS S under NYH would be $11billion plus $18 billion, totaling $29 billion.

Table 2. Long-term care — in S billionsCurrent government spending for LTSS 22.0Spending shifted to NY Health:Current insurance spending for LTSS 4.0Current out-of-pocket spending for LTS S 7.0Unpaid home care shifted to paid care 18.0TOTAL NY HEALTH SPENDING FOR LTSS 5.29.0

____

How Much Revenue Must be Raised by the NY Health tax?

New York Health will replace current spending by New Yorkers: $131 billion wenow spend on premiums (employer and employee share, individual coverage, Medicare PartB premiums, etc.), $29 billion in out-of-pocket costs (deductibles, co-pays, out-of-networkcharges, paying for long-term care, etc.). It would cover the $8.9 billion cost of the localshare of Medicaid. This current spending totals $169.3 billion. Table 1 shows that NYHealth saves $11.4 billion in current spending. Taking account of these savings, the NYHealth tax will need to raise $157.9 billion. See also Figure 2.

Table 3. Revenue needed from NY Health TaxCurrent spending replaced by NY HealthInsurance premiums (employment-based, P S 131.5

individual,_Medicare_Part_B,_etc.)Out-of-pocket spending 28.9 IMedicaid local share 8.9TOTAL 169.3Net savings from Table 1 -11.4Revenue to be raised by NY Health tax 157.9

3

Pigure 1

Sources of Savings, Added Costs and Net Savings

t$43.9B

Covering Everyone WhileSa’ing Money

Total p,oJactn status quo[__ypendiag In 2Dfl:$3116

In,,r,nrp

almr. rotv

Not:—$11.4 B

Rpd,prd Mu

P. -Ir.piThl

4cinFfl nsT

nio: ftzLciem

(.‘E

‘5.5% Net Savings:

-3.6%

Total Savings —17.7% Thtal Additional Costs: t14.1%

1otI__. _____

— ——

scr,t:JcLmrz.s,3n,::’wLzr;/eyrNcclthjc1. Pttçocr_.4cpi;313

Inni T.&c..Sr—’cr ru £‘&: nj’’w&tVDC.nóñ Lxr:n’.f;’w S’,Aw. a.t20:S.

—$55.1 B

Figure 2 Current Sources of Funding

vs. Funding under the New York llealth Act

iThe NY HuaILh Wx rephct>

& co-artt-Mecicaid cosis

Sa \i I g bi 1111) as

private insuauce. oai-of-pc.cket c,sIs. throuhadailiüstrtive simplification and

CURRENT SOURCES OF;:1% HEALTH CAn FUNDING

Fr,vate

redicedriccs of drjgs andinedical devices

HEALTH CARE FUNDING UNDERruE NEW YORK HCALTh ACT

lnsuran

It%irci Po:,.i

34% rdo,

- — I 0% Slob— Gz.

-

3% ovnly ,. -

I 1., jl,crrund:

Health Tar

0% SuosGovu

Ilt Cuhar

Sour:,,: )odi U... et u An A ustsnuenr 0.’ rt rjy Htc,th 4:; 154s:’ corprxrtloh, AIfL.Sb C18);

teonrndbr;. S.mrs..ycndEv:snnti;th4kPtvp,rcr,—rAsnuw:,r.r{5apIe,nbi.r20I2b.

• How the New York Health Act Works

in Tables and Figures

1. Where New Yorkers Currently Get Their Coverage Today

Source of coverage Population (millions)’

Employment-based private insurance 9.4

Individual (non-group) insurance 1.8

Medicaid, Essential Plan & CHIP 4.3

[Medicare&VA 2.4

Dual Medicaid and Medicare 1.0

Uninsured1.2

Total20.1

‘Data from Jodi Liu eta!, et cii, An Assessment of the J’1Y Health Act (RJ4}D Corporation,

August 2018), 2022 projection.

2. How the Cost of Private-sector Employer-based Health Insurancein New York has Grown

Percent2008 2017

Increase

Average premium

Average employee share of premiumSingle coverage $947 $1,568 65.6%

Family coverage $3,376 $5,878 74.1%

DeductiblePercent of employees with deductibles 46.6% 75.2% 6 1.4%

Average single deductible $732 $1,687 130.5%

Average family deductible $1,524 $3,226 111.7%

Note: General inflation between 2008 and 2017 was 15%.

Source: Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality. DFU-{S.

Washington, DC, 2018

Single_coveragçFamily coverage

$4,638 $7, 30R$12,824 $2 1,317

57.6%66.2%

https:!/rneps.ahrg .ov/rnepsweb!data stats/quick tables search.jsp?cornponent=2&subcornponent=2

3. Savings under the New York Health Act:Comparison with Status Quo Spending on Health Care Services

Expenditures ($2022 Billions)

1R9S1 1Q7 11 R°/

Includes increased utilization (per RAE]) report) and improved provider fees

2NYHA could negotiate lower prices (not included in RAE]) report)

Includes universal long-term care

Medical care

Status PercentNYHA Change

Quo ChangeHealth care services

161Prescription drugs & devices 48.1 36.2 -11.9 -24.7%Nondurable medical products2 6.0 6.0 0.0 0.0%Long-term care (paid) 38.0 56.0 18.0 47.4%Long-term care (unpaid) [31.0] [13.0] [-18.0/ [-58.0%!

Total health care services 255.4 280.7 25.3 9.9%Administration

Health plan administration 28.5 8.3 -20.2 -70.9%Provider administration 26.4 10.1 -16.3 -61.7%State fmancial administration 0.6 0.6 0.0 0.0%Employer health benefit admin 0.2 0.0 -0.2 -100.0%

Total administration 55.7 19.0 -36.7 -65.9%Total health care spending 311.2 299.7 41.4 -3.7%

4. How Health Care Is Paid for Today,

and How It Would Be Paid for under the New York Health Act

Expenditures (S2022 Billions)

Source of Health Care SpendingStatus

NYHA Change

EM±cr, MedicaithACAkc.) 120.5 JP±S_ - 0 —

State & local govt (Medicaid, etc.) 34.1 ! 25.22 -8.9Employer-based private insurance 84.8 -84.8

Individual (non-group private insurance) 10.4 -10.4Other miscellaneous premiums2 27.8 -27.8Medicare Part B premiums3 8.5 -8.5NYHApayrolltax4 102.0 102.0

NYHA non-payroll tax4 55.9 55.9Out-of-pocket payments 33.5 4.6 -28.9

j Total health care spending 319.6 308.2 I 11.4

1Local share of Medicaid removed and paid for by NYHA tax

2lncludes Medigap, Essential Plan, CHIP premiums

3Paid to the Federal government and thus not reflected in Table 2 health care sen’ice spending

‘NY Health tax replaces private insurance premiums, out-of-pocket costs, and other premiums. It pays for

improved provider fees, Medicaid local share, Medicare Pan B premiums, and universal long-term care.

5. Savings and Additional Spendingunder the New York Health Act

Savings -— __S2022RReduced health plan admin costs & profit 20.4Reduced provider admin costs 16.3Reduce prices of drugs & devices 18.6

Total savings1 55.3Additional spending

Covering the uninsured & elimination of cost-sharing 17.1Improved provider fees 8.8Long-term care 18.0

Total additional spending 43.9Net savings 11.4

NYHA could achieve additional savings through reduction in fraud and waste. RAt’4D did notprovide an estimate of potential savings; Friedman estimated at least $5B in savings.

a

6. One Proposed Effective Payroll and Non-payroll Tax Ratesunder the New York Health Act’

NYHAIncome

Effective RateS250U00J0$50,000 6.9%$75,000 10.2%$100,000 12.2%$200,000 16.9%$400,000 20.8%

Note: Average health care spending today at all income levels, including premiums paid byindividuals, out-of-pocket payments (including the cost of long-term care), tax payments supportinghealth care programs, and premiums paid by employers (forgone wages), is over 20% of householdincome. See Jodi Liu, eta!, An Assessment of the MY Health Act (RAND Corporation, August 2018),especially Fig. 5.4 and Appendix B.

1Marginal tax rates: <$25,000: 0%; $25,000-$49,999: 13.8%; S50,000-$74,999: 16.9%;$75,000-$99,999: 18.4%; $lOO,000-$199,999: 21.6%; $200,000 or more: 24.6%. See L. Rodberg,Summaiy and Evaluation ofthe RA]TD Corporation’s Assessment of the AT Health Act (September201 8). Section 9.

Sources of Savings, Added Costs, and Net Savings

Covering Everyone Whileoney

Total:

Total projected status quo

spending In 2022: $3118

Net:

—$1i.A B

Total SavinEs: —17.7%

—$55.1 B

Total Additional Costs: +14.1%

÷$43.9 B

Reduced Reduced MDInsurance & Hospital

Admin Costs: Admin Costs:-6.5% -52%

CoveringEveryone &EliminatingCos: Sha:ing:+5.5%

improvedProvider Fees+2.8%

Reduced Pricesof Drugs &Devices: -6%

termCare+5.8%

Net Savings:-3.6%

Sources: mdi Lit. ci a!.. .1nAssrswieni ofrheNYHethth4c:. RAND CoipomtiomAucust 2018

Leonard Rodbera.Siuimca v and Emluarion ofthe RAND Colporarioii;rAsse.rcnienr of the NYHeahiiAc!, September2015.

Current Sources of Funding

vs. Funding under the New York Health Act

HEALTH CARE FUNDING UNDERTHE NEW YORK HEALTH ACT

Savings 34% Federd

$IIB‘\Govt.

10% StaleGovt

The NY Health tax replaces Saving billioas

private insurance, out-of-pocket costs.& countyMedicaid costs

31% PrivateInsurance

CURRENT SOURCES OFHEALTH CARE FUNDING

through administrative simplification andreduced prices of drngs and medical devices

34% FederalGovt.

-fr

il%OuL20c Pocket

3% CountyGvt ii Olper

— Funds

41% NYRealth Tax 11 % Other

Funds

Sources: Jodi Uu, a of An Assessment of the WV flea/ti, Act (RAND corporation, August 20181;Leonard Radberg, Sun,maryondEva(ustioti of the RAND CorpororianAssessntetir(September 20181.

Progressively Graduated Taxes

under the New York Health Act

-Paying foTNYHIththroughVayroIL&Non-PatU1iTaW

T 80% paid by empIoye 20% paid by employee

-r--1

4 t_TaxBracket

$I

Wages & Salary & Taxable Investment Income

lncome/ Effective Employee Pays Employer Pays Non-Payroll

year Tax (20%)/year (B0%)/year (investor pays)

A 550K 69% 5690 52,760 53,450

B 5100K 12.3% 52,455 59,820 $12,275

C 5175K 16.3% 55,695 523,475 526,475

0 5225K 17.8% $8,005 $32,020 $40,025

E 5400K 20.8% $16,615 $66,460 $83,075

24%

16%

8%

0Ffe

Sourceriodi Uu, cccl, An Ancssmcnt of the NV HeolthAct (R4ND Corporation, August Zeta).

Leonord Rodbcrg,Summorycnd Ev&uotian of the RAND Corporation’s Assenmcnt of the NVHcolch Act (September 2013).

Data Sources

The principal sources for these tables are the following:

Jodi Liu, et ci, An Assessment ofthe AT Health Act (RAND Corporation, August 2018).

www.rand.ora/oubs!research reports!RR2424.htrnl

Leonard Rodberg, Summaiy and Evaluation of the RAND Corporation ‘s Assessment of the NY Health

Act (September 2018). www.infoshare.org/mainJSurnmary and Evaluation of the RAND report -

LRodbera.pdf. This report includes evidence for greater savings than found in the RAND report as well

as estimates of the cost of improved physician fees, covering the local share of Medicaid. covering

Medicare Part B premiums, and providing universal long-tern care.

Gerald Friedman. Economic Analysis of the New York Health Act (April 2015). www.infoshare.or!

maim/Economic .alysis New York Health Act - OFriedman - April 2015.pdf

Additional data sources on long-term care:

Incorporating Long-tern Care into the New York Health Act, PN}IP NY Mefro Working Group, 2016

www.infoshare.org/main/lncorporating Long-term Care nto the New York Health Act,pdf

Reinhard. 5, Feinberg, L, Choula, R. & Houser, A. (2015). Valuing the invaluable: 2015 update. AARP

Public Policy Institute report. Washington, D.C. Available at

hnp:i/www.aam.orIcontentidamIaarnIDpi/2015/valuinathe-inva1uable-2015uodate-new.odf

NEW YORKHEALTH ACT

Federal Waivers FAQ

Q: In order to efficiently integrate federal funds into the new system, the New York Health

program will seek waivers from the federal government that will bypass ordinary federal

reimbursement rules and enable bulk transfer of funds based on global budget projections.

What options are available should such waivers not be forthcoming?

A: Over half the funds that provide and administer health care services in New York comes from

federal and federal-state public programs. These include Medicare, Medicaid, the Children’s

Health Insurance Program (CHIP), and Affordable Care Act (ACA) tax credits.

The New York Health Act (NY Health) explicitly provides that the Commissioner of Health will

seek federal waivers needed to smoothly and efficiently integrate these funds into the NY

Health trust fund (See the bill Introduction and Section 5109).

Medicaid and CHIP

States manage and partially fund the Medicaid and CHIP programs. Matching funds are

provided by the federal government. Currently, federal funding is conditional upon verifying the

eligibility of each Medicaid and CHIP participant and assuring the validity of each individual

service transition. New York would seek a waiver to allow funds to be received, in bulk, based

upon past receipts and estimates of future eligibility and costs, bypassing the need for case-by-

case, fee-by-fee verification. This would be similar to the global funding waiver currently in

effect for Rhode Island’s Medicaid program.

New York already has a number of approved Medicaid waivers that allow New York to provide

services that are not part of original Medicaid including, among others, long-term care services

in the home and community and certain behavioral health and addiction services. These

waivers would be expected to continue, along with others in effect, or under development, that

allow integrative managed care approaches and capitated payment methods that move away

from the less efficient fee-for-service model.

Medicare

The Medicare program does not have state-based “waivers”, but it does have “demonstration

projects” as defined by the 1967 and 1972 amendments to the Social Security Act which can

potentially serve the same purpose. These are intended to promote research that might assist

Congress and the Department of Health and Human Services (HHS) in designing reforms that

would increase the efficiency and cost-effectiveness of the Medicare program, without

1

compromising health care quality. These reforms could include changes in payment

methodology that would allow for seamless articulation of the Medicare program with NY

Health.

Most projects were expected to be proposed initially by Congress and HHS, and managed and

evaluated by the Center for Medicare and Medicaid Services (CMS). The legislation was not

designed to support state-specific operational program reforms, although the research has led

to some innovative technical improvements and a few state-based operational waivers, such as

one that allows Maryland to establish uniform pricing, and, more recently, global budgeting, for

all hospitals. Maryland is now seeking to extend its Medicare pricing policy to physician

reimbursement.

The Maryland waiver shows that significant changes in payment methods in a state are treated

by CMS as aligning with the intent of the original Medicare legislation.

Medicare Advantage may be used if a Medicare waiver is unavailable

Alternative payment mechanisms such as Medicare Advantage (MA) are available if a waiver

were not to be granted. In 1973, Congress codified federal rules for provider collectives that

offered services on a capitated basis, and Medicare was authorized to develop demonstration

projects that would allow such HMOs to manage services for older adults. This became the

basis for the Medicare Part C (Medicare Choice+) legislation in the Balanced Budget Act of 1997

and the Medicare Advantage legislation in 2003. Although nearly all MA organizations have

been private, usually for-profit, the 1973 law refers to “public or private” entities that could be

authorized by the federal government to be providers for such programs.

Over 38% of Medicare recipients were enrolled in MA programs in New York as of 2017. Such

programs typically offer an expanded set of benefits, usually optical, dental, and hearing, along

with a prescription drug component. The MA organizations typically reduce their expenditures

by offering only a narrow network of providers, by requiring substantial co-pays, and

sometimes by requiring a premium add-on.

A public or quasi-public entity serving as an MA plan could ease the way toward integrating

Medicare into NY Health. Medicare recipients in New York State would be considered to be

part of the state’s MA plan. They would, of course, receive the same comprehensive benefits as

everyone else. The federal government already uses capitated payments for such plans,

replacing inefficient fee-for-service reimbursements. This would help to smoothly integrate

federal funds into the NY Health trust fund, if a waiVer (or demonstration project) could not be

negotiated.

Since this would be a new situation, there are issues that might arise. The original Medicare

Advantage amendments were intended to encourage health marketplace competition to drive

down premiums and allow consumers a broader range of health plan choices. A state MA plan

2

would be part of the single-payer plan that eliminates competition for basic comprehensive

health insurance. NY Health will, of course, reduce health care spending and allow for total

freedom of choice of provider. Comprehensive benefits will cover everything covered by MA

plans, and more, with no cost-sharing.

New York’s dual-eligible plan already incorporates Medicare Advantage

The ACA was designed to help states implement innovative health insurance reforms. One

major goal was to find ways to integrate Medicaid and Medicare for so-called “dual-eligible”

patients, including long-term care. In 2008, dual-eligibles constituted only 20 percent of

Medicare beneficiaries nationally but 31 percent of Medicare spending. They constituted 15

percent of Medicaid beneficiaries but 39 percent of Medicaid spending.

Section 2602 of the ACA set up a Federal Coordinated Health Care Office, reporting to the

administrator of CMS. Among the purposes of the office are to more effectively integrate

benefits under Medicare and Medicaid for dual-eligibles, simplify the processing of claims, and

________—

in effect, becomes the waiver vehicle through which Medicare is integrated with Medicaid into

a single payment stream managed by states.

New York is one of 17 states authorized to carry out such a demonstration project. It is called

Fully-Integrated Duals Advantage (ADA) and is part of the state’s Medicaid Redesign Team

reform effort launched in 2012. Although New York already had two small integrated programs,

including the Program for All-inclusive Care for the Elderly, or PACE, the ADA initiative aimed to

eventually include all dual-eligibles and become part of the ongoing effort of New York to

transition Medicaid recipients into managed care and managed long-term care environments

where, in theory, costs can be managed and quality improved.

The new federal office uses the MA program to carry out its integration efforts. New York’s

FIDA initiative was set up as a set of MA plans using private insurance organizations to manage

the demonstration project. Medicare payments are made according to the MA model.

Medicare wrap-around

As a fallback option, a state could set up a Medigap plan, or other plan, that would “wrap

around” traditional Medicare. Such a plan would run parallel to Medicare as it currently exists

and provide any needed extra payments to providers. While such an approach would limit

administrative savings for the state government, since providers would still have to submit bills

to the Medicare program, an efficient electronic claims processing system could minimize the

additional administrative effort by providers.

There are also provisions under Section 1395kk of the Medicare law that allow the federal

government to hire contractors to maintain data and administer benefits under certain

conditions. A state or state-related entity could qualify as such a contractor and thus could

process Medicare claims as well as claims made directly to NY Health.

3

ACA Innovation waivers can bypass ACA requirements

The Affordable Care Act Section 1332 offers innovation waivers that allow a state to opt out of

ACA requirements (for instance, the requirement to create a “marketplace” to offer private

insurance plans) in order to introduce new approaches that could address substantive areas of

health insurance policy and/or technical areas such as data collection and claims processing.

The waiver option was included in the ACA on a bi-partisan basis because it could cover

approaches that were of interest to both conservative and liberal membersof congress. The

discussion leading up to the enactment of the law explicitly included single-payer options, and

the state of Vermont submitted a 1332 waiver request for the single-payer legislation it passed

in 2011 (the request was withdrawn when the governor tabled the plan.).

In order for a 1332 waiver to pass muster, the new system must offer benefits at least as

comprehensive and as affordable as would have been the case without the waiver, and it must

cover at least as many residents. In addition, the state must present a ten-year budget that

demonstrates that the system will not add to the federal deficit. The NY prnfioujd

readily meet these “guardrail” provisions.

At a minimum, an innovation waiver will allow a state to receive ACA premium tax credit funds

directly and in bulk form rather than for each individual service fee. A waiver can also allow a

state to develop uniform pricing and innovative claims processing systems. NY Health will likely

use a single “back office” to manage payments to providers to limit administrative expense.

Sources

Legislation

• Medicare demonstration project waivers

Social Security Act Amendment (1967) Section 402a

https://www.ssa.gov/OP Home/comp2/F090-248.html

Social Security Act Amendment (1972) Section 222a

https://www.ssa.gov/OP Horne/como2/E092-603.html

• Medicare Advantage

Health Maintenance Organization Act of 1973

https://www.govtrack.us/congress/bills/93/hr7974/summary

Balanced Budget Act of 1997 (Creates Medicare Part C) https://greenboolc

waysandmeans.house.eov/siteskreenbook.waysandmeanshouse.gov/files/2011/images/l97-

802 gb.odf

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Creates Medicare

Advantage). https://www.congress.gov/bill/lOSth-congress/house-bill/1

4

• Medicare-Medicaid Integration: Dual-eligibles

Affordable Care Act (2010) Section 2602 httgs://www.cms,gov/Medicare-Medicaid

Coordinatjon/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination

Qffice/Downloads/AffordableCareActSection26o2.pdf

• ACA Innovation Waivers

ACA Section 1332 httns://www.cms.gov/CCIIO/Programs-and-lnitiatives/State-lnnovation

Waivers/Section 1332 State Innovation Waivers-.html

Other sources

Medicare waivers. Review by Kip Piper (consultant)

http://piperreport.com/blog/2008/08/12/rnedicare and medicaid demonstration waivers on

_

_

Medicare administrative contracting Section 1395kk

https://www.ssa.ov/OP Home/ssact/titlels/1874A.htm

Maryland Medicare waiver and proposal to add physicians and other providers in 2019.

http://www.baltimoresun.com/business/bs-bz-medicare-waiver-20170824-storv.html

ACA and New York integrated programs for dual-eligibles. Western New York Law Center

http://www.wnylc.com/health/entry/166/

John McDonough on ACA Innovation waivers (Journal of Health Policy, Politics and Law)

httos://read.dukeupress.edu/jhopl/article/39/S/1099/13650/Wvden-s-Waiver-State-

Innovation-on-Steroids

Rhode Island “Global Waiver”.

http //www.oh hs.ri.gov/med icaid/pdf/WaiverPresentation House8-08.odf

Rhode Island “Global Waiver” renewal.

http://www.nilin.state.nius/sfiscal/Dther%2ODocuments/Medicaid%200verview.odf

D

NEW Y*RKHEALTH ACT

The “EPISA Problem” FAQ

Q: The federal Employee Retirement Income Security Act (ERISA) was passed in 1974 to

provide security and uniformity across the nation for pension, health, and other benefits

provided by employers. ERISA declares that the federal government has priority in

governing such plans, and states cannot establish laws or programs that regulate or

otherwise impact such plans. Does the New York Health Act violate the provisions of

ERISA?

A—The-New-Y-ork-HealthAct-1%-Hk-does notsegulateemplover-provided-health- -—-- - -

benefits, nor does it direct employers to provide, or not provide, any particular benefits. MI

employers must pay the state-wide taxes that fund and make possible the NY Health

program, but employers are free to maintain, limit, or eliminate their existing programs.

Insurers that provide coverage for employer-based health insurance plans are regulated by state

insurance laws and regulations. However, what plans are offered by employers, and the extent of

coverage they offer, cannot be regulated by states. That is, federal preemption governs in that

case. (Note: Plans offered by employers that self-insure and take on risk themselves are not

considered insurance plans and are not subject to state regulation of any kind. They may bypass

state health care laws, reaulations, and certain direct taxes.).

The federal ERISA law can potentially preempt any state rule such as NYHA that “impacts”

such plans in any way. This would have a significant effect on the new program, since currently,

millions of workers in New York State get their health insurance benefits through employer-

provided plans.

NY Health will be better than any plan provided by an employer. Such plans usually require

significant cost-sharing, that is, they have large deductibles and co-pays. They also typically

have limited networks and benefits that are less comprehensive than those of NY Health.

Companies must also incur expenses managing such plans or contracting with a management

service to oversee them.

Federal law does not prevent a state from taxing businesses and employees, as long as the taxes

are broadly based and not intended to force actions by such employers. These taxes could include

those aiming to improve health care for all state residents. Under NYHA,, all employers will be

paying such a tax on behalf of their New York employees to help fund the NY Health program.

It would be expected, therefore, that most companies would no longer include their New York

resident employees in their health plans, since these employees will automatically qualify for the

new state health insurance program that will be both superior and less costly. However, NYHA

would not require them to stop offering their own program if they so desired.

The federal ERISA law is vaguely worded, and conflicting legal rulings make it unclear what

might be considered an action by the state that would “impact” an employer plan. Some might

argue that the NY Health tax, while itself iegal, would, in effect, be forcing an employer to

abandon its program in the state. Opponents of NY Health might well launch a law suit claiming

that ERISA preempts the new law because of its “impact” on employers.

Following the advice of legal experts on ERISA, the language of the NY Health Act is explicitly

employers, and their employees, for taxes paid on behalf of employees who live out of state but

work in New York [see Section 4(2)(e)(ii)j. Should a challenge still occur, the bill’s sponsors are

confident that, based upon a clear interpretation of legislative intent and past federal rulings, NY

Health will prevail. Should any part of the bill be ruled in violation of EMSA, an

accommodation that would exempt some employers, while inefficient and costly, would still

leave NY Health as a viable program and in the best interest of the vast majority of New

Yorkers.

Sources

Butler, Patricia A. (2009). Basic short guide to ERISA for health policy makers. National

Academy for State Health Policy. Available at https:/!nashp.or!erisa-preemption-prirner!. For

greater detail, see https:!/nashp.orz/erisa-preempti on-manual-state-health-policy-makers!.

Butler, Patricia A. (2014). What we can lean about Federal ERISA law from Maryland’s court

decision. Wisconsin Family Impact Seminars, University of Wisconsin-Madison. Available at

httv:!!wisfamilvimnacLorAvo-content!upIoads/20l4!l0!s wifis24col.odf

Kaminski, Janet L. (2007). ERISA pre-emption and state health care reform. Office of

Legislative Research Report. Connecticut General Assembly. Available at:

https:!!www.caa.ct.cov/2007!rt!2007-R-0 131 .htm

Hsiao. William, et al. (201 1). Act 128 Health System Reform Design: Achieving affordable

universal health care in Vermont. Report commissioned by the Vermont State Legislature.

Available athtft:ftwww.lea.state.vt.us!ifo.lhealthcare!FINAL%2OREPORT%2oHsiao%2OFinal%2OReport%2

0-%2017%20Februarv%20201 1 3.pdf

NEW YORKHEALTH ACT

Wait Times AQ

Q: Canada, the UK, and other countries are often held up as model single-payer health care

systems, yet we persistently hear of long wait times for appointments and services. Is this

what we can expect from a single-payer system?

A: Numerous careful studies have found that the insurance and financing system is not

responsible for long wait times. Excessive wait times can be found in all systems, single-

payer or multi-payer, public, mixed, or private, and can occur within systems by region, state,

province, county, municipality, or even individual medical facility or practice. The most

impGrta11tfatWrflffttiflWaittiflT€ciflZlUdWphSitiiflh&tage5,

funding constraints, and poor patient flow management.

The “wait time issue” is important. No one should have to suffer pain and anxiety while waiting

for diagnosis or treatment, or be forced to remain away from work or school for unnecessarily

long periods. Nor should they be placed at increased risk of death or disability.

The Organization for Economic Cooperation and Development (OECD), a grouping of the major

industrial countries, has undertaken extensive studies of their health care systems, including

variations in wait times. All of these system but that of the US provide universal coverage with

comprehensive financing and rich data sources. In all of them, government has a major role in

the health system, so waiting times for elective procedures have often become a contentious

political issue. In 2001-04, many of them were concerned about waiting times, and OECD began

reviewing policies for reducing waiting times.

A major study completed in 2013, Waiting Time Politics in the Health Sector: What Works?,

evaluated what progress had been made in that period. Not surprisingly, they found that

countries that spend more on health care, had increased their supply of physicians, and had

greater hospital capacity experienced shorter waiting times. In some cases, they had adopted

waiting time guarantees or targets to place pressure on those working in these systems, and

these incentives were effective when they were enforced.

Most important, these studies found that it was these capacity and budget factors, not the

nature of a country’s health care financing system, that determined the existence and length of

any delay for receiving care.

There has recently been great concern about excessive wait times in Veterans Administration

facilities. An independent assessment conducted for the American Legion found that “waft

I

times at the VA for new patient primary and specialty care are shorter than wait times reported

in focused studies of the private sector.” Overall, the report concluded, “VA wait times do not

seem to be substantially worse than non-VA waits.”

Emergency services

With respect to potentially life-threatening emergencies) all advanced countries use specially

designed and tested triage systems to ensure that high priority emergency room (ER)

admissions are treated immediately upon patient arrival in cases needing resuscitation, and in

less than an hour in cases considered of “emergent” or “urgent” acuity. Under most conditions,

high priority wait time targets are met in the vast majority of cases in all advanced countries.

If target times are not met, there are usually external reasons. In rural hospitals it might be due

to travel time for surgical specialists. In heavily-used urban hospitals, delays are often a

function of temporary or, in extreme cases, chronic ER crowding. Recent cutbacks in National

Health Service funding in England, as another example, have affected ER wait times.

true emergency problems. In a 2013 Commonwealth Fund study involving 11 advanced nations,

the US had the largest percentage of such patients, due primarily to inadequate or no

insurance.

The same study showed that the US and Canada had among the largest percentage of non-

urgent ER admissions due to difficulties getting appointments with primary care physicians. Yet

France, Australia, and the UK, all with universal health care systems, single-payer and multi-

payer, had 40-60% fewer such admissions. Germany and The Netherlands, also with

government-regulated universal systems, reported the overall percentage of ER use at only 25-

35% of that of ER5 in Canada and the US

Wait times for emergency services can vary widely among countries, and among regions and

hospitals within countries. There is no correlation based on national financing system. Single-

payer countries are among the best and the worst with respect to ER wait time. After years of

improvement, the National Health Service in England, for example, has experienced a recent

worsening of ER wait times, while the nearly identical program in Northern Ireland recently

reported that 95% of ER patients get a triage assessment within 8 minutes and are seen by a

medical professional within 29 minutes, both excellent results.

Wait times to see a primary care physician when sick

As noted above, a major reason for crowded ERs is a person’s inability to get an appointment

with a primary care physician to treat an acute condition which is not a true emergency. A

2016, 11-nation Commonwealth Fund survey found the following results for adults “able to get

same-day/next-day appointment when sick.”

2

Percent of adults who made a same-day or next day appointment when needed care,

2010

Netherlands

Austrzfla

Comparable County Average I1,I;i. IIflI

Sweden

United VJngdm

UnftetStates

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IIII liii III I I IIIlIllIlIllIll

____

III I II 111111 I_Cenada liii liii Ii • 1—.—-—-

u’te: 2015 ornmonweaah Fund International HealU Poticysuivey’ Get the data • PNC- Petersnti-Rntwr

Health System Tracker

Same-day or next-day access to primary care in Canada and the US is below the 11-nation

average, yet one has a public single-payer health insurance system and the other a private

market-based system. The fully nationalized UK system does better than both. In any case,

there is little difference among these countries having very different financing systems.

Managing patient flow is of critical importance in meeting wait time goals and there are many

aspects to this management Limited physician networks in the private US system are a typical

source of long wait times. Physicians refusing Medicaid patients create long delays in the US

public system as well, affecting wait times for the poor and driving them into emergency rooms.

The single-payer Medicare system in the US, on the other hand, has fewer network restrictions

and better primary care wait time results, on average) than both private and Medicaid patients.

The availability of evening and weekend hours can mitigate wait time problems as can the

availability of urgent care walk-in clinics. Increased use of nurse practitioners and physician

assistants can address wait time problems in areas with physician shortages or long travel

times.

Countries, regions within countries, and individual facilities and practices vary widely in their

ability to manage patient flow. The variation cuts across all modes of health insurance

financing.

3

Wait times for non-urgent care and elective procedures

Many of the complaints involving Canadian, British, and other single-payer or multi-payeruniversal systems relate to care that is not urgent or involves elective procedures. This couldbe first-time visits with a new provider, annual check-ups and screenings, visits to specialists, ornon-urgent or elective surgery such as hip and knee replacement or cataract surgery. Long waittimes in these situations can be a direct product of patient flow management as providers

prioritize care for those with more immediate needs, or can result from physician supplyconstraints due to many of the same factors as described above.

Following years of steadily improving service including reduced wait times, the Canadian

Medicare and English National Health Service systems have experienced substantial increases inwait times for non-urgent services since the recent recession. This has generated publicdiscontent and a barrage of press stories describing some of the worst cases. As a result, publicofficials have prioritized the issue, and both systems have begun using improved patient flow

management systems coupled with penalties or rewards for meeting, or failing to meet, theta?getrMdr im irlytrgaetpewd iwghs1nci’easetiwrEspotrswtopubl itt ternabout the problem.

Here are the data from the 2016 Commonwealth Fund study relating to non-urgent wait times:

Specialists & Surgery

“Waited two months or more for a specialist appointment”

R “Waited four months or more for elective surgery”

h 1k !I Ii h0 I’? f -

pC,

The US fares better in this category than Canada and England and even Norway and Sweden,

and much has been made of this fact, However, the universal social insurance systems ofFrance, Germany, and the Netherlands fare just as well as the US

4

The New York Health Act and wait times

The New York Health Act will remove many of the sources of long wait times in the US. There

will be no limited provider networks, and providers will no longer discriminate against Medicaid

and Medicare patients, since reimbursement rates will be standardized. There will be no

barriers to provider choice, creating a greater range of options, especially in urban areas with

greater concentrations of providers.

With reduced paperwork and administrative burden, providers will have more time to devote

to patient care and the management of patient flow. This will be especially important in the

face of the expected increase in utilization of health care services. Hospitals, too, will be

relieved of an administrative burden and be able to devote more resources to patient services.

In the longer run, NY Health planners will be able to work with the Governor and the

Commissioner of Health to increase the supply of providers in rural areas and to provide the

necessary capital for expanding patient care facilities and diagnostic technology where it is

neededr

- --

—-_____

________

Sources:

“Waiting Time Policies in the Health Sector What Works?,” OECD, Paris. 2013. Available at:

http://dx.doi.orcz/ 10.1787/97892641 79080-en

“Mirror, Mirror, On the Wall: How the Performance of the US Health Care System Compares

Internationally: 2014 Update”, Karen Davis, Kristof Stremikis, David Squires, and Cathy

Schoen, The Commonwealth Fund, June 2014. Available at:

https://www.commonwealthfund.oru/publications/fund-reports!201 4/iun!mirror-rnirror-wail-

201 4-update-how-us-heafth-care-svstem

“Minor. Mirror 2017: International Comparison Rflects Flaws and Opportunities for Better US

Health Care”, Eric C. Schneider, Dana 0. Samak, David Squires,

Amav Shah, and Michelle M. Doty, Commonwealth Fund, Available at:

www.commonwealthfund.org/interactives/2017/july/mirror-rnirror -

“VA Health Care: A System Worth Saving”, Phillip Longman and Suzanne Gordon, prepared for

the American Legion. Available at: https://wwwAegion.org/publications/238801/lonman-

ordon-report-va-hea1thcare-svstem-worth-savinq

Northern Ireland Department of Health. (2017). Emergency care waiting times statistics (Jan

Mar 2017). Available at: https://www.health-ni.gov.uk/news/emergency-care-waitin-time

statistics-january-march-2017

S

Lagasse, Jeffrey. (2017). Hospital wait times longer for Medicaid patients than privately insured,Health Affairs study finds. Heafthcare Finance. Available at:htt://www. healthcarefinancenews,com/news/hospita Is-wa It-times-longer-medicaId-patientsørivately-insured-health-affairs-studv-flnds,

Q’Hara, Mary. (Aug. 25, 2015). Fed up with NHS wait times? It’s even worse in the U.S. TheGuardian. Available at: https://www.theguardian.com/societv/2015/aug/25/go-apoointment-waiting-times-in-us-worse-than-nhs

6

New York Health Act (A 5248, S3577)

Dear Senators and Assembly Members,

The twenty stories collected in this book are typical of the nearly fifty we’ve publishedover the past year for This Is the Bronx.

They tell stories of family members, friends, and neighbors — people representative ofyour constituents who suffer under our current broken healthcare payment system, peoplewho have told pollsters that healthcare continues to be their most urgent election issue.

Most of these stories are about people who thought their job-based insurance would keepthem safe. ft didn’t. It can’t. The current multi-payer private-insurance system has abusiness model that prioritizes profits over patient health, too opaque to manage orimprove. Few New Yorkers have any idea how vulnerable we are.

We are vulnerable because healthcare costs are consuming our economy: about 12% ofGDP 20 years ago; almost 18% today; projected to hit 32% within a decade. In 2000, thecost of family coverage through employment was 13% of the median wage. Today, it is50% of the median wage.

The average family spends more on premium contributions than on food for a year; moreon healthcare premiums plus out-of-pocket health expenses than on housing. Becauseemployers can’t afford it either, they are shifting an increasing share of costs toemployees and reducing the number of covered workers (down 17% since 2000). Bydiscouraging routine medical care, these uncontrolled costs torpedo our public health.

We are volunteers working to pass the New York Health Act, so that all but the wealthiestNew Yorkers will spend less for healthcare and, finally, to control costs by cutting at least17% of wasteful spending that benefits no one’s health, that frustrates physicians, thatreduces their clinical time with patients.

Even more important than monetary savings, however, will be the security of having allfinancial obstacles to care removed — improving public health, increasing productivity,and strengthening families. New Yorkers, like those in these stories, will no longer haveto choose between seeing a doctor and paying rent, filling prescriptions for chronicdisease and buying food, halting an ER doctor’s life-saving treatment for a heart attackand impoverishing their family.

We hope that you — as you read these stories — will hear echoes of people you know.Almost every family has a story similar to these. Enacting NY Health will allow NYS tolead our nation — demonstrating that American exceptionalism doesn’t require poorhealth outcomes at unsustainable prices. Like Tommy Douglas in Saskatchewan, we canlight the way to universal, comprehensive, affordable healthcare.

Thank you for listening to your constituents.- av-bavu

N YHA.Estrin(ö)umail.com NYHA.Estergtiest(1igmail.corn