NYC Public Hospitals See Number of Uninsured Rise, State Funding Drop
Feb 21, 2010
The New York City Health and Hospitals Corporation announced today that the number of uninsured New Yorkers who sought health care services at HHC hospitals, nursing homes and health centers in 2009 continued to increase for the third year in a row. The number of patients with no health insurance grew to nearly 453,000 – a 14 percent increase from calendar year 2006, when HHC served some 396,000 patients who lacked health insurance coverage.
The higher demand for HHC services comes at a time when the city’s public health care safety net system receives more than $240 million less in annual Medicaid revenue as a result of three successive years of state budget cuts, and faces another cut of $70 million in health care funding in the Governor’s proposed budget beginning in April 2010. The vast majority of HHC’s insured patients are covered by Medicaid, making the public health insurance program the primary source of reimbursement for the city’s public hospital system.
“The economic downturn has increased dramatically the number of uninsured patients seeking our services. While our commitment to provide the best care possible to individuals and families without reliable access to health care remains as strong as ever, rising costs and repeated Medicaid cuts now seriously threaten our capacity to fulfill our mission,” said HHC President Alan D. Aviles.
As the largest municipal health care system in the country, HHC provides care to all regardless of ability to pay or immigration status. During 2009, HHC served more than 20 percent of the estimated total number of uninsured residents in the entire state, and an even higher percentage of the uninsured residents in the state who actually sought health care services. HHC estimates that the annual cost to care for its patients without health insurance is about $850 million.
In addition, the 2010-2011 Executive State Budget provides no assurance that, beyond March 2010, HHC would continue to be granted access to its current level of Disproportionate Share Hospital (DSH) funding to help cover indigent care costs. During the last two state fiscal years, an additional $300 million in DSH funding – consisting only of federal and city dollars – has been made available to HHC facilities. This critically needed funding does not include any state dollars.
“DSH funding is the lifeblood of our public system – it would be virtually impossible to sustain our mission without it,” Aviles said. “As the recent efforts to enact expanded insurance coverage nationally make clear, providing health care services to uninsured patients cannot be done with magical thinking. It comes at a cost and takes significant funding. It is no different here in New York City, where HHC is the next best thing to universal coverage.”
Added to the adverse shifts in funding, HHC has experienced exponential growth in fringe benefit costs for its 38,000 employees. Pension costs have risen from just under $50 million in fiscal year 2004 to a projected $335 million in fiscal year 2011 – a nearly 700 percent increase. HHC has also experienced a near doubling of employee health insurance costs, which has added another $180 million in expenses. As a result of these and other factors, HHC’s projected expenses for the next fiscal year, which begins in July 2010, will exceed its total projected revenue by more than $1 billion. This projected budget deficit amounts to more than 18 percent of the total operating budget for the entire HHC health care delivery system.
Last March, Aviles announced a number of service and workforce reductions, as well as a hiring freeze and operational efficiency measures to begin closing the anticipated budget gap. He also announced plans to restructure operations later this year, which will require additional program closures, service consolidations, and further workforce reductions.
HHC officials are also keeping a close watch on St. Vincent’s Hospital and other struggling voluntary hospitals in the City that serve significant numbers of low-income and uninsured patients. The recent collapse of two voluntary hospitals in Queens- St. John’s and Mary Immaculate – put enormous pressure on the two public hospitals in the borough. Queens Hospital Center and Elmhurst Hospital immediately experienced increased demand for their services and were forced to fill the critical health care access gap created by the hospital closings.
Aviles says that even if stalled federal health care reform efforts are revived and such much needed national reform becomes a reality, the public hospital system will continue to be essential in New York City.
“New York City is a city of immigrants, with nearly 40 percent of its residents who are foreign-born and an estimated 500,000 immigrants without legal documentation. Even if national health care reform becomes a reality, our public hospital system will remain the essential safety net for the vast number of new immigrants in our city, as it has been for generations.”
Contact: Ian Michaels
The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlusHealth, and is the largest municipal healthcare organization in the country. HHC serves 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, five skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission’s John M. Eisenberg Award for Innovation in Patient Safety and Quality. For more information, visit www.nychhc.org/hhc or find us on facebook.com/NYCHealthSystem or twitter.com/NYCHealthSystem.