New York Mayor Bill de Blasio says he’s turning the city into a model for how the nation can provide health care to all, including the poor, the uninsured and undocumented immigrants.
In doing so, he boasts he’s saved the city’s public hospitals from bankruptcy and can provide universal care for just $100 million by steering New Yorkers away from emergency rooms and into managed-care clinics. Yet he may have promised more than he can deliver
The system of 11 hospitals — which already provide free care to the uninsured — costs taxpayers more than $2 billion a year, while scheduled federal Medicaid cuts threaten another $1 billion or more in the next year. Those pressures may far outstrip the savings he expects to reap from his proposal, according to private and government analysts familiar with the agency known as NYC Health + Hospitals.
“It may show a positive cash flow compared with last year, but it certainly doesn’t have surplus,” said Stephen Berger, a private equity investor who supervised New York’s budget during its 1970s fiscal crisis and in 2006 led a state health care commission. “Its underused hospitals should be shut down but that’s not going to happen. Whether it can achieve financial stability remains to be seen.”
The mayor’s health care plan is his latest effort to become a leading figure among progressive Democrats. He has made it a goal to influence the 2020 presidential campaign, and he hasn’t ruled out running himself.
Although he cast his program as unprecedented, New York’s hospitals have been open to all for more than a century. What’s new is his proposal to spend $100 million to hire physicians, nurses and assistants and to divert people from emergency rooms to less costly outpatient clinics focused on preventing illness before it requires expensive hospitalization.
De Blasio and other administration officials have declined to discuss the hospital system’s finances ahead of his fiscal 2020 budget proposal next month. Since 2013, when de Blasio took office, the city’s total funding for the hospital system has grown to about $2.1 billion from $1.3 billion, and is projected to reach $2.2 billion by 2020.
Its finances could also be worsened by an economic downturn reducing New York’s tax revenue, said Charles Brecher, research director at the Citizens Budget Commission, a business-supported fiscal watchdog. “Society has a stake in this not just because we are humane, but because this safety net is crucial to our public health,” he said.