By Mary T. Bassett and Stanley Brezenoff
If there was any hope that Senate Republicans could bring some sanity into the national discussion around the future of our health care system, such hope completely vanished on Thursday. Like the House's health care bill, the Senate's proposal is nothing less than an all-out attack on public health and our public hospital system, and its consequences will be devastating for New York City and the country.
As the Senate prepares to vote on the bill next week, it's imperative to understand what is at stake if the federal government guts funding for public health insurance — as it is poised to do.
The Senate is proposing to save money by slashing Medicaid, the health insurance program for the poor established in 1965. Under its bill, cuts to Medicaid would be even harsher than those proposed by the House — which axes $880 billion to Medicaid over 10 years. Even worse, these efforts would push millions of Americans to the uninsured rolls.
Adding to this concern is the President's budget, which targets Medicaid with a proposed cut of $610 billion. His budget would also cut $5.8 billion from the Children's Health Insurance Program over two years.
Taken together, these policy proposals threaten a death blow to public hospital systems across the country, including our NYC Health + Hospitals. More profoundly, both the House and the Senate's bills would destroy a national commitment made 52 years ago to provide health care to the elderly and low-income Americans.
By shifting risk and fiscal responsibility to each state, the Republicans want to change what it means to be one country united in protecting all its citizens from the hard times of ill health.
Roughly 40% of residents in New York City are on Medicaid. And many need care; 61% had a pre-existing condition in 2015. If federal Medicaid funding is restricted, costs in billions would shift to Albany, requiring New York State to choose between raising taxes, drastically reducing services, shifting costs to New York City or kicking entire groups of people off the program.
Where will all these people go? New York City's public hospitals and clinics currently serve 1.2 million patients annually, one-third of whom are uninsured. As proposed by Republicans, the cuts would lead NYC Health + Hospitals to absorb as much as $1 billion in losses, without even taking into account further cuts from the President's budget proposal.
And this doesn't count the underinsured, whose care private hospitals often shift to the public sector. As critical as primary care is, the biggest challenge for the under- and uninsured is costly specialty care — cancer treatment, for example. Those with "skinny plans" and the uninsured will land in public hospitals reeling from budget cuts.
The cost won't be measured only in dollars. It will be measured in lives, mostly of the poor and people of color.
Despite its precarious future, the Affordable Care Act helped further the truth that health care is a human right. Now is the time to double down on that right, not double back.
Bassett is the New York City health commissioner. Brezenoff is the interim president and CEO of NYC Health + Hospital.