Say Patient Care to Suffer
Unions, HHC Decry Bush's Health Plan

By MEREDITH KOLODNER

President Bush's proposed health-care cuts would have a devastating impact locally, with the head of the union representing city doctors claiming the reductions "could destroy the public hospital system."

BARRY LIEBOWITZ: Cuts 'a tremendous blow.'

Mr. Bush's budget would ax $25.8 billion from Medicaid, which provides a significant amount of public hospital funding nationally, over the next five years. One regulatory change alone would eliminate an estimated $350 million in aid to Health and Hospitals Corporation facilities. The Bush Administration says the cuts are part of a restructuring that would allow 3 million people out of the 47 million currently uninsured to purchase private health coverage.

'Could Destroy Us'

The severity of the cuts has galvanized opposition spurred by fear of declining quality of care and an increasingly over-burdened, downsized workforce within the public health system.

"This is a tremendous blow that could destroy the public hospital system in New York City and throughout the country," said Barry Liebowitz, president of the Doctors Council, which represent doctors in the city's public hospitals. "It will result in less staff, fewer doctors, less drugs, and longer waiting times."

The Chief-Leader/Pat Arnow CARMEN CHARLES: 'Will hurt patient care.'

The President's plan would take money previously designated for hospitals and Medicaid and provide tax cuts it says will help uninsured people purchase private health insurance.

"The 2008 budget improves America's access to affordable health care," said U. S. Office of Management and Budget Director Rob Portman at a Feb. 5 press briefing. "With more transparency and competition, it will also slow the rate of growth of health care costs, all of which will help reduce the number of uninsured Americans."

State Cuts Affect 'Privates'

There is little disagreement about the need for health care reform, both in order to cover the uninsured and to curb rising costs. But how to do it has been the subject of heated debate for more than a decade. Governor Spitzer recently proposed a series of health-care cuts that would take about $32 million from the public hospital system. His plan is provoking strong objections from the city's private hospital management and unions.

ALAN AVILES: Bush 'delivering a mirage.'

Mr. Bush's proposals have united a broad array of city-based groups in opposition.

"I think the health-care system throughout the country needs to be looked at and changes are needed, but do we do it on the backs of poor people?" said Carmen Charles, the president of Local 420 of District Council 37, which represents the non-medical staff in the city's public hospitals. "There is no doubt that this will hurt patient care."

The HHC system includes 11 hospitals, four nursing homes and more than 80 community health centers. It serves roughly 1.3 million predominantly low-income patients each year, including about 400,000 people without health insurance. About 70 percent of HHC's $4.9 billion budget consists of Medicaid funds.

'Hurts Many to Aid Few'

"At best, the administration's proposal to shift billions of dollars away from our public hospitals would simply sacrifice access for the many to provide insurance coverage for the few," said Alan D. Aviles, HHC's President, at a joint press conference Feb. 5 with union leaders and Sens. Charles Schumer and Hillary Clinton.

While the details of Mr. Bush's plan have not been fully unveiled, policy analysts say there are three major hits to the public health-care system. The first would redirect Medicaid and Medicare funds that go to hospitals that serve a disproportionate amount of low-income and uninsured patients. The city is a major recipient of that money, some of which would instead go to tax-breaks for the uninsured to purchase private health plans.

The second modification would be a regulatory change to Medicare that would reduce by billions of dollars the amount providers are reimbursed for services. The third shift would reduce Medicaid spending by lowering reimbursements, cutting drug payments and tightening eligibility screening.

"It's basically shifting more of the costs of Medicaid to the states," said Edwin Park, a senior health policy analyst at the Center on Budget and Policy Priorities. "You would see a cascade effect that eventually would affect the public hospitals."

New Doctors Squeezed

One of the changes would also eliminate Medicaid payments for graduate medical education, which would have an impact on medical interns and residents at the city's public hospitals.

"If they want to fund medical education differently, not through Medicaid," said Cara Metz, a spokeswoman for the Committee of Interns and Residents, "they need to put the money in somewhere else because cutting it isn't an option. We're already spread too thin."

All the affected groups in the city said they would focus on restoring the funding and blocking the administrative changes in the coming weeks as Congress makes it own budget proposals.

"Expanding access to healthcare comes at a cost that must be honestly confronted, not curtly dismissed with magical thinking," said Mr. Aviles. "The administration is promising a miracle, but they will be delivering a mirage."