We're in seriously troubled water." With that sobering preface, Greater New York Hospital Association President Kenneth Raske last week described the multiple financial fronts on which New York City's healthcare system is being attacked.
With billions of dollars in federal, state and commercial money at stake, the 175-member GNYHA is pulling out all the stops. The association is focusing on five specific areas:
* Repealing Medicare cuts mandated by the 1997 federal Balanced Budget Act.
* Staving off state Medicaid cuts.
* Sustaining state subsidies for public goods, such as charity care and uncompensated care.
* Reducing the state's ballooning uninsured population.
* Closing loopholes in the state's prompt-payment legislation.
Raske's no-nonsense oratory capped the business portion of the GNYHA's annual meeting in New York City last week. GNYHA members include a number of major healthcare institutions with enough clout to make a dent.
"Now I know many of you are readying layoffs as early as next week," Raske said, without naming names. "Let's not chronicle the pain but talk about what we're going to do."
The GNYHA has estimated that New York City hospitals will lose $3 billion through 2002 under the 1997 balanced-budget law. Healthcare system leaders are forming a group with representatives from Boston, Chicago, Houston, Los Angeles and Philadelphia. The group's mission will be "to stop the pain" of the law, Raske said. The group also plans to work with the American Hospital Association and the Association of American Medical Colleges, he said.
The New York Times will soon publish an ad appealing to President Clinton to stop the cuts, Raske said. The ad is signed by Raske and Dennis Rivera, president of Local 1199 of the National Health and Human Services Employees Union.
At the state level, the GNYHA has joined Rivera and other advocacy organizations to counter an estimated $2.1 billion in state Medicaid reductions. That's the annualized loss to hospitals, nursing homes and home health providers under Gov. George Pataki's proposed budget for the current fiscal year.
Although the state's fiscal year began April 1, legislators have yet to enact a budget. The GNYHA and the Healthcare Association of New York State are prepared to sue if state budget talks stall, "and important weekly (Medicaid) checks are missed," he said.
Behind the scenes, the GNYHA is lobbying business leaders to help preserve $1.9 billion in federal, state and private-sector subsidies that are paid through healthcare premiums to support graduate medical education, charity care and other public goods. The law that created those subsidies expires at year-end.
The association also won New York Attorney General Elliott Spitzer's support on broadening coverage for the uninsured. Spitzer, who delivered the keynote address at last week's meeting, said state proceeds from the national settlement with tobacco companies "should be used to provide coverage for the uninsured."