Supreme Court’s Final Nod to the Affordable Care Act (Hopefully)

Could three times be the charm for the fate of the Affordable Care Act?

One week after the presidential election, the Supreme Court began hearing arguments about the constitutionality of the Affordable Care Act (ACA).  This is the third time the high court is considering an aspect of the law’s legality.  Each time the court ponders the law, millions of Americans enter panic mode, as they fear they could lose their affordable health insurance if the law is struck down.  Likewise, hospitals and other health providers worry about the clinical implications and expensive complications that could arise when individuals without insurance forego accessing healthcare.  The ACA is credited with helping New York State cut its uninsured rate in half – from about 10 percent to five percent.

First Case

The first challenge to the law occurred in 2012 when the National Federation of Independent Business argued that the individual mandate was unconstitutional, questioning Congress’ scope of taxing and spending power.  The court ultimately ruled that the individual mandate to buy health insurance was constitutionally within Congress’ taxing power.  However, the court also ruled that the law’s requirement that a state expand its Medicaid program in order to continue receipt of its existing federal subsidy match was an over-extension of Congress’ spending powers. The individual mandate remained law, but Medicaid expansion became voluntary.  The current Supreme Court case is taking a look once again at the constitutionality of the individual mandate as a result of 2017 tax reform legislation that eliminated the tax penalty for not having insurance. 

Second Case

The second challenge to the ACA occurred in 2015.  Plaintiffs in this case based their argument on four words in the law – “established by the state” – to mark a distinction between states that opted to develop their own insurance exchanges (such as New York) and those that did not, leaving their residents to purchase insurance from the federal exchange.  The plaintiffs maintained that only individuals in state-operated exchanges were eligible for tax credits. The court ruled otherwise and the tax credits to this day are available to eligible individuals regardless if the insurance is purchased from a state or federal exchange.

Current Case

The current challenge to the ACA questions the Supreme Court’s decision in 2012 that ruled the individual mandate is constitutional. A handful of Republican governors and attorney generals assert that because the tax penalty was eliminated through the 2017 tax reform law, thereby rendering the individual mandate moot, so the entire ACA should be invalidated.  Recall that the 2012 decision said the tax penalty for not purchasing insurance was valid under Congress’ taxing powers.  Does removing this tax take away Congress’ power of intent for the entire law?  This is the question of severability that the justices will deliberate. 

Like previous challenges, the current case has wound its way through the U.S. court system and has been years in the making.  A federal appeals court decision rendered in December 2019 ruled that the ACA individual mandate is unconstitutional but does not invalidate the entire ACA.  The case moved on to the federal 5th Circuit Court of Appeals, which sent the case back to the original district court in Texas to decide if any of the other provisions of the ACA could exist without the mandate.  That Texas Court had originally ruled the entire law invalid in 2018.  This brings us to the current deliberations by the Supreme Court.  The Kaiser Family Foundation website has a good summary and timeline of the case now before the court.

What’s at Stake?

According to the New York State Department of Health, the loss of the ACA would directly impact about 2.1 million people added through the Medicaid expansion and more than 1.1 million people who enrolled in coverage through the state’s New York State of Health marketplace.  Many marketplace insurance purchasers receive federal subsidies, which are based on income levels.  Nationwide, 24 million people could lose their health insurance.  Hospitals’ uncompensated care costs would increase exponentially, particularly stressing those hospitals that already care for high numbers of uninsured and underinsured patients.

The Supreme Court is expected to rule on the case in June 2021.

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

Pre-empt Fall Season “twindemic” Get a Flu Vaccine Now

Getting a flu vaccine has never been more necessary than it is this year.  COVID-19 cases are rising at alarming rates throughout the country and here, in the metropolitan area, “hot spot” clusters have popped up.  As we move into the colder months, there is a good chance that more clusters of COVID-19 cases will emerge – the second wave that health professionals have warned us about.  That happening alongside flu cases is a problem.  We are facing a possible “twindemic,” and flu vaccination remains the first defense against this harrowing possibility.

By now you have heard the many pleas from public health professionals and medical experts to get a flu shot sooner rather than later.  Let me add my organization’s voice to that plea.  The Suburban Hospital Alliance of New York State (SHANYS) has teamed up with the New York State Association of County Health Officials (NYSACHO) and launched a campaign to raise awareness about the “twindemic” possibility and the importance of getting a flu vaccine now.  The campaign’s messages are reaching residents in Westchester, Rockland, Orange, Putnam, Sullivan, Dutchess, Ulster, Suffolk, and Nassau counties. 

During the 2018 – 2019 flu season, vaccination prevented 105,000 hospitalizations and 6,300 flu-related deaths, according to the Centers for Disease Control and Prevention (CDC).  It’s important to remember that the flu can cause serious complications and be deadly.  Those who are immune-compromised are much more vulnerable to poor outcomes from the flu, as are individuals with chronic diseases. 

Slow the Surge

Imagine now what would happen at hospitals this season if there is not widespread flu vaccination.  We saw how stressed our hospitals were this past spring when COVID-19 hit its peak.  We want to avoid a similar situation, which could be compounded by the flu virus, as we move into the colder months.  No one has suffered from the flu and COVID simultaneously and, from a clinical perspective, we are not sure how the two diseases would manifest themselves in a patient.  If we can remove flu from the equation, all the better.

So far, the flu season in the southern hemisphere, which runs from April to September and is considered a predictor of our upcoming flu season, has been mild.  But there are no guarantees and why take a chance with the coronavirus still highly prevalent.

My colleague at NYSACHO says everyone should talk with their health care provider now and put together a plan that gives them the best chance to stay healthy through the fall and winter. There are options.  The flu vaccine is available via injection and nasal spray. 

Vaccine’s Effectiveness

Even so, there are individuals who question the effectiveness of the flu vaccine and still others who believe they will contract the flu from the vaccine.  The CDC is clear on both of these issues.  The influenza virus continually changes, but some measure of protection always accrues because the vaccine addresses the different strains circulating during any given flu season.  Some seasons the vaccine is more effective than others.  But some protection is better than no protection and severity of the virus is diminished even if you catch it.  According to the CDC, recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine.  As far as catching the flu from the vaccine, the CDC says that is a flat out “no.”   This is because vaccines are made with either an inactivated virus or a single protein from the virus, meaning there are parts missing.

Hospitals and county health departments are more challenged this season in holding flu shot clinics because of COVID-19 social distancing requirements.  Still, there are facilities holding drive-through vaccination sites and others that schedule vaccination via appointment.  Contact your local hospital, county health department, or health provider to see what is available and check our flu vaccine campaign site often. We update it with the latest information about vaccination and flu prevention tips. 

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

COVID-19 Dashes Hopeful Sign of Decline in Depression Found in 2019 Analysis

Overall, 40 Percent of Americans Are Struggling with Mental Health Issues 

Healthcare workers, essential workers, minorities suffering disproportionately

A new Centers for Disease Control and Prevention (CDC) study finds that 40 percent of Americans are struggling with mental health issues related to the pandemic.  Healthcare and other essential workers are disproportionately affected, as are minorities, according to the report.

The longer COVID-19 lingers, the greater the incidence of mental health issues, infers the report. Unfortunately, this makes sense.  The stress and strain wrought by the uncertainty of the pandemic in every facet of people’s lives contributes to increasing anxiety.  Mental health experts note that disasters, such as a pandemic, cause anxiety, depression, and overall feelings of hopelessness among many individuals.

Interestingly, the Long Island Health Collaborative (LIHC), a coalition of hospitals, county health departments, dozens of community-based health and social service organizations, physician groups, schools and libraries, and some businesses, looked at the topic of depression just before the pandemic hit.  The LIHC and its partners work to reduce the incidence of chronic diseases and to enhance prevention and treatment of mental illnesses and substance abuse.

Hopeful News

The group’s pre-pandemic analysis found some hopeful signs.  In 2016, 11.8 percent of adults in New York reported having a depressive disorder while 7.5 percent of adults in Nassau County and 10.2 percent of adults in Suffolk County reported having a depressive disorder.  Self-report data from the Behavioral Risk Factor Surveillance System (BRFSS) was examined.

The analysis further found that depressive disorders are increasing among children and teens.  This was not a surprising result, say the LIHC partners, as mental health experts have been watching an increase in mental health issues in recent years among this population.

Six-months Later, Different Story

Now, six months into the pandemic, the situation has only gotten worse for all populations.

A Pew Research Center analysis of adult responses to questions about anxiety, depression, and sleeplessness experienced during select weeks in March and April found that one-third of Americans have experienced high levels of psychological distress.  A forthcoming analysis from the National Center for Health Statistics’ Household Pulse Survey that began data collection about the frequency of anxiety and depression related to the pandemic on April 23, 2020 and concluded July 23, 2020 will no doubt corroborate the Pew analysis and similar studies.

Hospital discharge data reveals a similar story.  According to SPARCS data, discharges related to or including depression in both counties have decreased during the past eight years for all ages, with the exception of Suffolk County that saw a slight increase in children and teen discharges.  Mental health treatment specialists agree that depression, especially among teens, is rising.  The Substance Abuse and Mental Health Services Administration’s 2018 survey on drug use and health reports that 14 percent of teens reported depression in the previous year compared to eight percent reporting experiencing depression in the 2006 report.

The LIHC’s Community Health Assessment Survey (CHAS) January through December 2019 results reveal that when asked: “What is most needed to improve the health of the community,” 14 percent of Suffolk County respondents and 10 percent of Nassau County respondents said mental health services. The CHAS is a primary data collection tool that examines individuals and communities’ perceptions about health and barriers to health care on an ongoing basis. The CHAS survey is available online and paper-based. Anyone over the age of 18 is encouraged to complete the survey.

The data reports produced by the Long Island Health Collaborative are used by hospitals, county health departments, community-based organizations, and other social and health services providers to offer programs that best meet the needs of local communities.  The LIHC is an initiative of the Suburban Hospital Alliance of New York State’s Long Island-based division – the Nassau-Suffolk Hospital Council.

 If you or a loved one is experiencing a mental health crisis, please reach out to the National Suicide Prevention Lifeline  at 1-800-273-8255.  These calls are routed to 170 crisis centers closest to the caller. 

Local hospitals and local health departments also offer mental health assistance and can direct individuals to the appropriate care in the community. 

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

 

Education, Communication: Public Health’s COVID-19 Defense Tools

Guest blogger Dr. Monica Diamond-Caravella, Assistant Professor and Academic Coordinator, Farmingdale State College, Department of Nursing, says public health nurses and health communicators understand the root causes of structural inequities, and they are adept at addressing them.

COVID-19 exposed the glaring health and racial inequities that exist in our society.  These have always existed, and we have reams of research and data to prove that.

The daunting challenge is how do we erase these inequities?

Education

Identifying and discussing the multiple complex root causes driving health inequities in this country should start in programs/schools of nursing, schools of medicine and programs in the other allied health professions. If we can expose our students early on in their careers to evidence-based concepts and policies related to health disparities and inequities, the potential for structural change in our health care system can be real.

First, we must get to the root causes of the issue.  There’s no better place to start the conversation about root causes for health inequities than in a classroom, whether it be face-to-face or remotely. The passion for this topic becomes quickly apparent. Health inequities are so ubiquitous; every student has a story.

Those teaching in public health have been incorporating these concepts about health and racial disparities, and the associated social determinants of health (SDoH) framework, into curricula for the past decade or more. What’s new and unfortunate today – as we navigate the COVID-19 pandemic – is that we can emphatically say to our students, “This is what health disparity and inequity look like.”  They are experiencing disparities in real time and close to home.

The learning experience for public health students becomes inherently authentic and resonant because of COVID-19. We can formally embed social and structural determinants of health into population-health frameworks, and expose students to these concepts within the context of their lived experiences with the COVID-19 pandemic. (Abuelezam, 2020). This is the framework of Applied Learning. It is all about knowledge and skills learned in the classroom and applied in a hands-on, real-world environment. Farmingdale State College utilizes such an approach in teaching core public-health concepts, as well as in courses across the campus.

Public Health Nursing

Public-health nurses who are knowledgeable about SDOH framework play an especially important role in the current pandemic, as they do with any natural and man-made disaster in this country. They are there on the frontlines, always.

The journal, Public Health Nursing, just released its May/June issue, with the key editorial, A Call to Action for Public Health Nurses During the COVID-19 Pandemic Public-health nurses are working countless hours serving our local health departments, investigating case-contacts; providing timely education on self-isolation and quarantine through hotlines and home visits; and interpreting data and guidance for the public from the Centers for Disease Control and Prevention (CDC).

The Trust for America’s Health recently issued a report about the severe underfunding of the United States public-health infrastructure.  It notes that less than three percent of the $3.6 trillion the U.S. spends annually on healthcare is directed toward public health and prevention.  Public-health nursing positions have been grossly underfunded, eliminated or replaced over the past three decades. Yet, today’s pandemic speaks volumes of the invaluable and critical role that the public-health nurse serves during times of disaster. There has never been a better time to start a dialog about investing in a strong public-health infrastructure to weather the next few months, and for the future of the nation’s health. And that investment begins with educating the next generation of public-health practitioners.

Public-health nursing has always been grounded in the concepts of health equity, health parity, social justice, nondiscrimination, epidemiology, health promotion and risk reduction. Foundational to this nursing specialty is the understanding and appreciation of the very concepts filling the headlines of social media –systemic and structural racism.

Health Disparities

Public-health nurses and other public health practitioners are keenly aware of the disproportionate effect the coronavirus has had and continues to have upon minorities.  Part of this inequity stems from the higher rates of chronic disease that communities of color experience.  The data show that chronic disease is a risk factor for COVID-19.  So, from the start, minorities are more vulnerable to the virus.  This, coupled with language and cultural barriers many minorities face, makes them especially susceptible to COVID-19.  Public-health practitioners are aware of this population’s limited health literacy skills, and consider this and other barriers when dispensing care and communicating instructions.

Communication

This is one of the reasons Farmingdale State College developed the Health Promotion and Wellness degree program last year.  Its goal is to graduate individuals who will use leadership, management and collaborative skills within a multidisciplinary approach to forge health promotion and planning interventions for individuals, groups, and local at-risk populations. The Health Promotion and Wellness curriculum is grounded in public-health/community-health concepts, along with emphasis on the pursuit of wellness in all dimensions of life: social, physical, emotional, occupational, intellectual, environmental and spiritual. Graduates learning within this multidimensional approach to wellness will undoubtedly be a critical addition to a workforce that will be challenged with the long-term sequelae of the COVID-19 pandemic.

The Nation’s Health discusses how COVID-19 is reshaping the future of public health in this country. Before the pandemic, the general public did not appreciate nor understand what those in public health do. Now they do.

Dr. Monica Diamond-Caravella is Assistant Professor and Academic Coordinator for Farmingdale State College, Department of Nursing.  You can reach her at monica.diamond-caravella@farmingdale.edu.

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

 

 

 

 

 

 

 

 

Health Insurers Seek Rate Increase

Despite dramatic decrease in claims costs due to the pandemic, health insurers seek rate increase for 2021

Earlier this month, New York’s insurance plans asked the State Department of Financial Services to consider a weighted average rate hike of 11.7 percent in the individual market and a weighted average increase of 11.4 percent in the small group market for 2021. The 2021 average rate increase request is higher than last year’s average request of 8.4 percent in the individual market.  This request perplexes those of us in the healthcare business.

With fewer claims costs because elective procedures were halted for two months during the peak of the coronavirus crisis and fewer individuals venturing out, even now, to access healthcare, shouldn’t there be a decrease in rates?

What’s the Reason?

Some plans cite increased costs due to COVID-19 as the reason for the rate hikes.  Fidelis Care, which requested the second largest increase at 18.8 percent, says it took into account the increased risk and uncertainty caused by the pandemic when calculating its 2021 rate increase request.  Fidelis does business in nearly all of New York’s 62 counties.

New York State requires health insurers to seek pre-approval for premium rate hikes.  Plans must present reasonable justification for their increase requests.  Typically, plans will look at prior year claims costs and activity, medical cost trends, and the medical inflation rate when determining rates for the upcoming year.   The state’s Medical Loss Ratio regulation also comes into play.  It requires plans to spend  82 percent of premium dollars on direct care and quality improvement activities.  If plans exceed this ratio, money is returned to consumers. The New York State Department of Financial Services ultimately decides the percent increase it will allow.  We will know that in August.

The State Acts

While it is true that health plans did not and still do not collect co-pays for COVID testing when an in-network provider is used, the sheer drop in patient claims for routine care and cancelled elective surgeries more than balanced this. The state issued a Circular Letter on April 22, 2020 directing health plans to take a variety of steps to alleviate the financial burden imposed by COVID-19 on hospitals and help them with their cash flow.  Some of these steps included no retrospective reviews, no medical necessity denials, resolution of appeals within 60 days, and a requirement that plans work directly with hospitals and provide some financial assistance, especially to those hospitals that were severely cash-strapped.  Nevertheless, many hospitals report that plans have not acted in good faith to ease the cash crisis, despite the health plans’ ever-growing reserves.  The letter’s directives expired June 18th but an extension is under negotiation.

Predicting Health Costs

PwC’s Health Research Institute recently issued a report that detailed several economic scenarios that could play out next year.  The report projects that the medical cost trend could range from a high of 10 percent to a low of 4 percent.

The surge in telehealth has also driven down costs for health insurers.  These visits are reimbursed at a lower rate.  In the Northeast, telehealth claims increased by 4300 percent, during the peak of the pandemic, according to nonprofit Fair Health’s monthly telehealth tracker .

We can’t figure out how COVID-19 imposed undue financial burden on health insurers.  Let’s hope the State Department of Financial Services keeps that fact in mind when it reviews the plans’ rate increase requests for 2021.

About the Suburban Hospital Alliance of New York State 

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

 

Hospital Association Reminds the Public that Hospitals are Responsive, Resilient, Ready

Campaign draws attention to safety, infection control protocols

Delaying care can lead to more acute and complicated health problems

We have come a long way since New York recorded its first coronavirus patient on March 1, 2020.  Thankfully, today, the number of daily coronavirus cases has decreased dramatically.

Now, fears about utilizing hospitals and physician offices for routine, but necessary care could spark another crisis of sorts.  Routine care, screenings, and vaccinations serve to blunt more complex health issues if left unattended.   Delaying care is not the healthiest option.  All hospitals in the suburban regions were recently given the green light to resume elective surgeries and scheduling a procedure sooner rather than later is a wise decision.

NorMet 1NSHC 12

 

 

 

 

 

 

It is understandable that patients are wary of accessing care, and they fear for their safety in such settings.  But throughout this pandemic, hospitals took extraordinary measures with infection control and safety protocols to protect patients and staff.  This continues full force.  Social distancing in waiting areas, temperature checks, and deep sanitization, are some of the measures your healthcare providers are taking to keep you safe during your next visit.

Recent studies and polls show that many consumers are delaying care – some with telltale signs of heart attack or stroke are not going to the emergency department where immediate care and minutes are critical to a positive outcome.  One study shows ischemic stroke patients are arriving at the ER 160 minutes later as compared to a similar timeframe in 2019.

A poll conducted in late April by the American College of Emergency Physicians and Morning Consult found that nearly a third of American adults (29 percent) delayed or avoided care due to fears about contracting the coronavirus.  A Kaiser Health poll conducted several weeks later found that nearly half of the adults surveyed said they or a family member skipped or delayed care due to the coronavirus. But most said they expect to access care within three months.

Responsive, Resilient, Ready – this is the message healthcare providers throughout the Hudson Valley and Long Island regions have for patients.  The world has changed, but their care has not.  Consumers can read about the specific steps that hospitals in their area are taking to keep patients safe during their next in-person visit by visiting the Responsive, Resilient, Ready page maintained by the Suburban Hospital Alliance.

Consumers should also keep in mind that a region’s ability to remain open hinges on a few metrics maintained by hospitals.  Ensuring that timely primary care and other care needs are handled in the community ensures that hospital capacity is not overtaxed with critically patients.  As part of the governor’s New York Forward Plan, hospitals must maintain a 30 percent hospital bed and ICU bed capacity at all times.

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. We engage key lawmakers and regulatory decision makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

Coronavirus Impacts Minority Communities Disproportionately

Chronic diseases, a compromising factor for coronavirus, also run higher in these communities as do social determinant of health inequities

While the Covid-19 pandemic is ravaging all of New York State, from Montauk on Long Island to Mahopac in the Hudson Valley, many minority communities are feeling the effects more than others. Underlying chronic conditions such as hypertension, chronic obstructive pulmonary disease (COPD), and asthma are some of the chronic conditions that also disproportionately affect minorities.  Public health researchers also note that most of these communities endure inferior housing, higher unemployment, and less access to affordable healthy foods – factors known as the social determinants of health.

In early April, the state began to see a trend where communities of color were contracting COVID-19 at a higher rate than their white counterparts.  In response, the governor opened five new testing sites in downstate minority communities and requested state staff to investigate this disheartening trend.  The Centers for Disease Control and Prevention (CDC) is also tracking this COVID-19 incidence disparity.

But health disparities among minority communities are nothing new. The coronavirus pandemic just brought them to light in a more profound way rather quickly.  It is a perverse silver lining to a persistent problem that has plagued healthcare providers, public health practitioners, and researchers for years.

The Numbers on Long Island

In Nassau County, 17 percent of residents who died from coronavirus were black, while they only make up 11.7 percent of the population. In Suffolk County, blacks made up 11 percent of deaths and only eight percent of the county’s population.  Percentages were derived from the New York State Department of Health COVID-19 data posted on April 14, 2020, and the U.S. Census Bureau 2018 American Community Survey.

The Numbers in the Hudson Valley

Some regions of the Hudson Valley are seeing their unfair share of minority communities being disproportionately infected by the coronavirus.  According to state data as of the end of April, in Westchester County age-adjusted deaths from COVID-19 per 100,000 of the population revealed the rate for Hispanics was 96.7 per 100,000 and for blacks 104.5 per 100,000.  The rate for whites was half.  It is a similar story in Orange County and Rockland County.  In Orange, the rate was 66.2 per 100,000 of the population for Hispanics, 89.1 for blacks, and only 32.1 for whites.  The rates in Rockland County were 133.5, 176.4, and 73.3, respectively.

The state’s analysis of May data for newly diagnosed COVID-19 patients shows these disparities are continuing in both of these suburban regions.

The NYS-Covid-19 Tracker reports that outside of New York City, blacks make up 17 percent of coronavirus-related fatalities, while Hispanics account for 14 percent of deaths. These are revealing statistics as blacks and Hispanics make up only nine percent and 12 percent of the New York State population, excluding New York City, respectively. The report also shows that 88.5 percent of all fatalities suffered from at least one comorbidity.

Long before the days of coronavirus, communities of color were experiencing disparities related to the social determinants of health (SDOH).  These are the conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These conditions include economic stability, education, social and community context, healthcare, and neighborhood and built environment.

Black and Hispanic families are more likely to live in areas with higher rates of poverty and are less likely to have access to resources such as quality health coverage, access to new treatments, and paid time off from work. The lack of a federal paid leave policy forces low-income workers to choose between staying home from work when sick and not losing wages.  Those who go to work ill are potentially spreading the coronavirus. Many minority workers are also essential workers who do not have a work-from-home choice. These historical health inequities that affect communities of color are also why they are more likely to suffer from chronic diseases such as asthma, hypertension, and diabetes – the underlying, chronic conditions that make them more vulnerable to the coronavirus.

Solutions

The importance of programs combating chronic diseases, especially in high-need communities, is more necessary than ever.  And equally important, are social determinant of health interventions that work in tandem with medical care.  Hospitals offer a variety of programs and services to help patients manage their chronic diseases, including culturally-sensitive outreach programs that connect with minority communities.  There are onsite hospital-based “farmacies” that equip discharged patients, who have a diagnosis tied to a nutritional need, with bags full of vegetables, fruits, and other healthy foods to set them on their way to healing.  Other hospitals provide medical transportation, either fully-covered or subsidized.

Some health plans also fund social determinant of health interventions.  One plan embeds nutritionists in primary care offices.  Another co-locates social workers so patients’ behavioral needs are addressed during a routine visit.

However, we know more needs to be done to eliminate health disparities.  COVID-19 has made that glaringly apparent. The solutions are not easy and they cost money.  Public and private partnerships have made only a small dent in the need.  But if we are to improve mortality and co-morbidities stemming from chronic diseases we have to intensify our efforts now.

Part of those efforts include chronic disease self-care and management – tools to help individuals easily adapt healthier lifestyle changes, which are scientifically proven to improve health.  The Live Better campaign offered by the Long Island Health Collaborative is designed to do just that – raise awareness about better self-care of chronic diseases.  It provides basic education and links to helpful community and hospital-based programs.

If we chip away at the incidence of chronic diseases now then if and when another contagious epidemic strikes we will be more resilient individually and societally.

Learn more about hospital and health policy and regulations at Suburban Hospital Alliance of New York State.

 

 

 

 

 

For Your Own Well Being, Use News Correctly

This month we feature guest blogger Jaci Clement, CEO and Executive Director, The Fair Media Council, a nonprofit organization working to improve the public conversation on the hyperlocal, regional, and national levels.  There is a constant barrage of information related to the COVID-19 pandemic, especially for those of us in the health, social, and human services sectors.  It is daunting to say the least, particularly as we are all overwhelmed with our daily jobs whether those jobs are in direct patient care or behind-the-scenes.  Our guest blogger offers expert advice on how to safely consume news during this stressful time.

You’ve heard it said countless times – when it comes to your health, everything in moderation.  Yet, you’ve probably never thought to apply that same rule to your usage of news coverage.

Today, the concept of a balanced approach to using news is ever more vital, as the 24/7 news cycle brings us severe news and information in relation to the COVID-19 pandemic. The good news is it is quite easy to get your news habit in check.

  • First, remember you have total control over how much news you allow into your life. When the news is at its darkest, it’s best to set limits, for your own well being. As a best practice, read newspapers (print or online) in the morning, then use television, radio and the Internet to give you updates on the news throughout the day. The reason is simple. Newspapers provide the most detail and background of a news story, compared to other formats of news, which are designed to sum up a story quickly and provide the latest developments.
  • If you rely heavily on your phone to bring you the news, don’t be alarmed if you are constantly getting updates. That doesn’t mean something horrible has necessarily happened; it just means each news outlet you follow is doing its job. Today’s news is highly repetitive to cater to our shorter attention spans and greater demands on our time. Consider muting some of the voices you follow, even if only temporarily, if you are having difficulty balancing your time and the news.
  • One of the top complaints about news is: Too much opinion, not enough facts. Fair enough. Here’s the answer to that. Prioritize news over commentary, because the commentary is opinion driven.
  • When it comes to television, limit your time watching talk shows. Some people have a hard time distinguishing between a news program and a talk show, so here’s a rule of thumb. If someone is reporting the news, it’s a news program. If someone is talking about what’s in the news, it’s a talk show. You can also check the guide on your television menu to verify a talk show or news program — although not all menus carry this information.
  • Also, keep in mind: the cable news networks don’t report news for 24 hours a day. In fact, a look at the FOX News Channel’s daily lineup showed at least 16 hours of talk shows within a 24-hour span. CNN does news, talk shows and documentaries. Watch whatever you want; just know what you’re watching.
  • Breaking news is what people tend to give too much credence to, and here’s why. On a regular day, breaking news should be taken with a grain of salt, because the speed at which the news is being reported often prevents it from being fact-checked by multiple sources. (To be fair, outlets are slowing things down a bit these days, as credibility comes back into vogue.) Breaking news during a pandemic often changes dramatically from what is originally reported, because the sources — the doctors and authority figures — aren’t sure of the answers. For instance, social distancing started at three feet, then went to six feet, then moved to “at least six feet.” Masks and gloves were not advised for the general public, now they are. Just think of breaking news the way you think of the 1.0 version of any app. You know it will be full of bugs that will be worked out later.
  • One of the biggest changes in news is how it hangs around for a long time, so you shouldn’t have a fear of missing out. The story will be there, if not being repeated during a broadcast then available online. That should give you comfort to know you can tune it out and go about your daily life, then check in to see what’s going on at your convenience. Reach Jaci at: jaci@fairmediacouncil.org

Go to COVID-19 Information Sources:

New York State Department of Health 

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services

Healthcare Association of New York State

Suburban Hospital Alliance of New York State

Medicaid Ensures Access, Especially Vital During Infectious Disease Outbreak

It’s always a good idea to get back to basics when a topic becomes more and more complex as the years move along.  That is the case with New York State’s Medicaid program.  And, during the current coronavirus crisis, it is especially important to understand the necessity of such a public program to ensure everyone has access to healthcare during an infectious disease outbreak.   About one-third of the state’s population of – 19.5 million people – is covered by Medicaid.

The federal government established Medicaid in 1965 to provide health insurance to poor and low income families and individuals and to disabled children and adults.  Each state administers its Medicaid program and receives federal matching dollars.  In New York’s case, that is about 50 percent; many other states receive a higher federal match.

New York has witnessed increasing enrollment in Medicaid, especially since the state expanded its program under provisions of the Affordable Care Act.  According to the United Hospital Fund’s Medicaid Institute, enrollment increased by more than 36 percent between 2009 and 2015, though much of this population was inexpensive to cover.  For example, children account for 37 percent of the Medicaid population, but less than 20 percent of the Medicaid expenditures.  Members who are eligible for both Medicaid and Medicare comprise 13 percent of the total population, but generally represent the most medically complex patients and therefore incur higher costs.   About half of all Medicaid dollars are spent on long-term care, like nursing home and home care services.

Who Are Medicaid Recipients?

The majority of Medicaid recipients are individuals we encounter in our daily lives – grandparents, neighbors, friends, children, and even some co-workers.  Contrary to popular belief, the vast majority of Medicaid enrollees – 87 percent – are children, the elderly, the disabled and working-age adults with jobs. The Kaiser Family Foundation’s website features the stories of Americans who are Medicaid recipients and how this program serves as a lifeline.

New York’s Medicaid program is quite comprehensive compared to other states.  Benefits include regular exams, immunizations, doctor and clinic visits, relevant medical supplies and equipment, lab tests and x-rays, vision, dental, nursing home services, hospital stays, emergencies, and prescriptions.  Costs for long-term care either provided in a nursing home or in a patient’s home are by far a major driver of the program’s escalating price tab in recent years.  Enrollment in and the cost of the state’s managed long-term care program has been growing at about 13 percent per year.

Funding Is Fragile

Governor Cuomo’s 2020 – 2021 state budget proposes cuts and changes to the Medicaid program in order to close a $6.1 billion budget hole.  His office estimates that about $4 billion of the total deficit is attributable to Medicaid expenses.  The governor formed a Medicaid Redesign Team II  (MRT II) as the venue through which the state will find $2.5 billion in Medicaid savings in the upcoming state fiscal year and will ensure that Medicaid spending in future years stays within the global Medicaid cap.  The cap was a recommendation forwarded by the MRT I when it convened in 2011.  At that time, the state was facing a $10 billion deficit.  The cap, which is tied to the Consumer Price Index, restricted Medicaid spending growth to about four percent annually.  For the most part, it has worked, until recently.  The MRT has a very short window of time in which to present its recommendations for savings to the governor and legislature so the recommendations can be incorporated into the 2020-2021 state budget.

It is difficult to predict, at this time, what the MRT will recommend, but hospitals certainly cannot absorb any more cuts to Medicaid reimbursement.  On January 1, 2020, the state health department instituted an across-the-board one-percent reduction in Medicaid payments to providers through the first quarter – March 31, 2020.  It is a total reduction of $124 million.  Those most affected by continuing Medicaid cuts are the most vulnerable New Yorkers among us.  We hope the governor and state legislators keep the “faces of Medicaid” in mind, as they deliberate the budget and make recommendations for changes to the Medicaid program.  About six million New Yorkers’ access to healthcare hinges on their decisions.

 

Hospitals Ready for Coronavirus

While 2019-nCoV (coronavirus) is new, hospitals have lots of experience handling emerging infectious diseases.  Think of the seasonal flu.  It varies year to year in both its potency and molecular design.  The current flu season officially began September 29, 2019, and was declared prevalent by the New York State Health Commissioner on December 5, 2019.  In terms of reach, this season’s flu is infinitely more widespread in the United States than the coronavirus.  Consider that there are 14 confirmed cases of coronavirus in the U.S. and 121,088 confirmed cases of the flu in New York State this season.  At present, there have been no confirmed cases of coronavirus in New York State.

But that does not mean there is a zero threat from this pathogen.

Hospitals remain vigilant and are prepared to handle any patient who presents with coronavirus.  All facilities follow strict infectious disease protocols that begin with immediately isolating the patient so that staff and the public are kept safe.   Anti-viral drugs and supportive therapies are the best defenses we have to fight this virus.  Once diagnosed with the coronavirus, rest, fluids, and fever reducers are in order.  This is the same treatment plan in place for the seasonal flu.

Hospitals learned many lessons about containing an infectious disease during the Ebola outbreak in 2014.  With one confirmed Ebola case in New York State and only a handful of other cases noted in the United States, the Centers for Disease Control and Prevention (CDC), state health departments, and local county health departments lost no time in preparing for more widespread disease occurrence.  This positioned them well to deal with the current coronavirus and other novel and emerging infectious diseases.  Today, in every hospital emergency department, patients are asked whether they returned from recent travel outside the United States whether or not there is a current pandemic in place.  The New York State Health Department also requires hospitals to hold surprise emergency preparedness drills on a regular basis.

During a pandemic, such as the coronavirus, communication is key.  The World Health Organization  (WHO) deemed the coronavirus outbreak a public health emergency of international concern on January 29, 2020 and the U.S. Department of Health and Human Services (HHS) declared it a public health emergency two days later.  As a result, hospital staff have been in constant communication with the CDC, the state health department, and their local county health departments to ensure they have the most up-to-date information about the spread of the disease and that proper infectious disease control procedures and methods are in place.

At the very local level, hospitals and the broader healthcare community keep in touch.  In the Hudson Valley – MACE – Mutual Aid Coordinating Entity – works cooperatively to keep tabs on regional supplies and personnel resources.  In Suffolk County, that task falls to the Suffolk County ESF 8 Group (Emergency Support Function) and in Nassau County it is the Health and Medical Multi-Agency Coordinating Group (HMMACG).

But back to the coronavirus.  Just what is it, and how do we keep ourselves safe.  Coronaviruses are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Severe Acute Respiratory Syndrome (SARS), which emerged in 2003.  Common signs of infection include fever, cough, shortness of breath, and breathing difficulties.  In more severe cases, infection can cause pneumonia, SARS, kidney failure, and even death.   As the coronavirus is so new, scientists and epidemiologists are working to pinpoint the virus’ transmission process, which appears to be airborne, and other characteristics of this novel infectious agent.  While they make progress, the best defense right now is to frequently wash one’s hands, cough and sneeze into one’s elbow, stay home if any signs of viral infection emerge, and place a call to one’s physician for further instructions.  The same advice public health officials give for combating the flu.