Lawmakers concerned with health care spending are heading into state budget negotiations with a cloud over their heads as federal cuts to Medicaid and other health funding streams loom under the Republican governing trifecta in Washington.
Although it’s unclear when the cuts will come, how much they will be and what programs could be affected, Gov. Kathy Hochul last week unveiled a $252 billion executive budget proposal that raises Medicaid spending 14% to $35.4 billion. And while the state was given permission to reap an expected $3.7 billion from a tax loophole on health insurers known as managed care organizations during the waning days of the Biden administration, that funding is one-time, which means lawmakers will have to return cup-in-hand to a much less sympathetic administration or find other ways to pay for existing services in the coming years.
Crain’s spoke with state Senator Gustavo Rivera, a Bronx Democrat and chair of the powerful Health Committee, about some of the critical questions at the outset of the legislative session.
This interview has been edited for length and clarity.
Federal approval for the managed care organization tax is a one-time payment that could lead to a fiscal cliff down the road to pay for existing services. Do you have a game plan for plugging that hole in the outyears?
Certainly I’m glad, first of all, that it was approved before this administration started, because we knew that we were not able to get it under this one…It is great that we got it, but I think that there’s other things that we need to explore. We need to not only explore it, but think about where those expenses are going to be, because ultimately we’ll want them to be as investments, not just expenditures.
What are some possible avenues to explore?
Let’s tax the wealthy. That’s something I’ve been pretty consistent on. I think that we need more revenue overall, particularly to make up for what will be cutbacks from the federal government. The depth of these, the extent of them, or the timing of them are still up in the air, but we know they’re coming. They’ve made it very clear…I know that we’re not going to be able to make up everything that the federal government gives us. Now, I recognize that, however, we need more revenue so that we can have a conversation about what we can cover.
You introduced a bill in September that would stop the transition to a single [Consumer Directed Personal Assistance Program] broker and allow more fiscal intermediaries to participate. Since then the state has awarded a contract to Georgia-based Public Partnerships LLC and people are enrolling in the new system. What exactly can change between now and the April 1 deadline to complete the transition?
The entire thing can change. We actually can pass a bill that basically restructures the program. It gives a different timeline. It restructures the program oversight, the types of things the Department of Health can do to make sure that they crack down on bad actors. I still think that it’s actually something that needs to happen, because I do not believe that this is a transition that’s possible by April 1. I just don’t think that that’s the case.
What would this mean for the PPL contract? Would it have to be nullified?
Certainly, PPL could be one of the fiscal intermediaries, but not the single one. They would probably have to put another proposal forward.
The contract has been granted. What can be done to change that, legally speaking?
I’ve not looked at the contract in detail, but I know that it exists because of statute, and we could change statute. I’m sure there are ways for the contract to be terminated by either party. It’s the way the contracts work.
The president issued an order repealing a policy that limited immigration enforcement in hospitals and other so-called “sensitive locations.” Is there anything the legislature can do to protect patients and loved ones from immigration raids while they are seeking medical care?
Absolutely, not only medical settings but across the board. There’s a bill that my colleague, Andrew Gounardes, carries, which would make it so that there’s no cooperation between state agencies [and federal law enforcement]…I believe that we need to defend New Yorkers. We know most poor, working class folks, particularly many, many undocumented folks, people who might be at risk of these dragnets by the federal government, are in the city of New York and get served by public institutions.
What about in private hospitals?
I haven’t spoken with every single one, but I’ve not gotten any indication from any of these folks that they’re not on the same page as I am.
But is there anything that statutorily can be done to affect that one way or the other?
I couldn’t tell you at this moment.
Democrats have increasingly embraced Gov. Kathy Hochul’s push to expand involuntary psychiatric commitment and treatment for New Yorkers with severe mental illness. Where do you stand on that? Do you think there needs to be more flexibility to allow for these types of involuntary or court-ordered treatments?
I think that the real conversation needs to be about making sure that we actually have somewhere for these folks to receive services. Just arresting someone, regardless of whether they are homeless, whether they have a mental health issue, whether they have a substance use issue, doesn’t solve anything. Arresting somebody does not solve anything. Because if we put someone through a system and we don’t actually have services for them, if we don’t have a bed in a psych ward, in an institution, if we don’t have that, then it doesn’t matter…some of my colleagues, particularly some of my more conservative colleagues, could give a shit about where these people wind up as long as they’re not in the streets, as they say.
