President and CEO of Westchester County Health Care Corp. Dr. David Lubarsky said trouble is brewing in Washington D.C., and he isn’t afraid to share his concerns.
Potential Medicaid cuts are looming, tariffs are driving up supply costs and programs supporting disadvantaged patients are under scrutiny — all of which are raising concerns among health care providers. However, Republicans say changes are necessary to save taxpayer dollars and make the federal government more efficient.
Lubarsky has a different vantage point on these issues, given his new role at Valhalla, New York-based Westchester. The health system operates nine hospitals, with about 40% of its patient population covered by Medicaid. Lubarsky said he is part of a turnaround effort to shore up the system’s finances and reestablish its Hudson Valley presence among competitors including New York-Presbyterian, Mount Sinai and, soon, Northwell Health.
Lubarsky in an interview shared his thoughts about potential federal health policy changes and discussed his growth plans for Westchester. His answers have been edited for length and clarity.
Do you have concerns about the Trump administration’s plans for Medicaid?
Trump isn’t going to directly cut Medicaid because he doesn’t have to, right? He’s going to cut how much money the Medicaid program is spending by eliminating waste, fraud and abuse and insisting on proof of work. It’s been shown several times that most of the people disenrolled from Medicaid because of work requirements weren’t disenrolled because they didn’t qualify. They couldn’t figure out how to file the paperwork.
Have you ever tried to navigate a government website when you have limited education and maybe haven’t even graduated high school? Or maybe English isn’t your primary language? These people will be disenrolled, not because they don’t deserve our help, but because we’re being mean spirited about it. We’re not helping them get the assistance they have earned, and that they need, and that this country can afford. We were affording it just fine just two months ago.
I don’t want Dr. Trump’s solution to the disease. I don’t want a tax cut. I want us to be a kinder society and take care of people who need to be taken care of.
Why aren’t more health officials speaking up?
They’re afraid. I’m a doctor. They’re not. I am not confused at all about what the role of health care professionals is supposed to be, and it is not to cave in to bad decisions. That includes not supporting Health Secretary Robert F. Kennedy Jr., who is pushing against my entire lifetime of scientific inquiry. Why are we not more vocal about that? I’m shocked that we’ve been so silent. I’m dismayed that we’ve been so silent.
Could there be some pressure for a more robust conversation around different ideas? Sure. Does that mean we should threaten and browbeat the universities to death? No. Does that mean we should cut out scientific funding and derail the cure of diseases? No. There are proportionate responses and ways to achieve what you want to achieve.
Are you seeing any effects from tariffs?
We’re looking at probably a 4% to 6% increase in supply costs, which is not insignificant. I mean, we don’t have a margin. Where’s that going to come from? We won’t be able to do all the things that we want to do that improve health care. We want to get an Ion robot to do bronchoscopies. I won’t be able to purchase something like that.
You can’t make money doing anything if you don’t have the right payer mix. If they cut Medicaid reimbursement and add supply costs, there’s no solution. There’s no way to deal with that. You just keep cutting services and providing worse health care. That’s not a good spiral.
If everything you’re talking about comes to pass, many public hospitals are not going to be financially viable.
What is Westchester’s financial situation?
The system had been struggling before my arrival. One of the reasons I think I was brought in is to help with a turnaround. COVID-19 rocked a couple of the outlying hospitals. The main hospital, which is Westchester Medical Center, it’s always been more or less fine. It gets all those transfers. It does a lot of complicated work.
There was a fair amount of debt to make up, which we’re working on. I am happy to say the organization achieved its first positive operating income in March. It’s not about firing anybody. You never cut your way to greatness. It’s about growing the opportunities that were already there and tightening up operations around what we’re doing, how we’re staffing and how we’re optimizing things like 340B that we weren’t taking full advantage of.
What are your thoughts on potential cuts to the 340B program?
How many support struts can you cut out of a bridge before it absolutely collapses? It’s basically just a tax on the excessive profits of pharmaceutical companies that flow back to organizations that treat more Medicaid patients.
I think the barrier to entry should be an exponential curve. But it’s like an on-off switch — if you have 12% Medicaid, you get to file for 340B discounts. Why is that? A lot of hospitals have just enough Medicaid patients to qualify, versus those like Westchester Medical Center that has 40% Medicaid. Why aren’t we getting the lion’s share of the 340B benefits, so we can continue to serve those populations?
How do you intend to grow Westchester’s market share?
No. 1, you have to be attractive. No. 2, convenient. We’re going through a major overhaul of our access to health care. The way that we deliver care will be changed.
We’ve set up patient promises. We’re going to see you within 30 minutes when you come to our emergency departments. We’re going to see you the next day if you need a cardiology appointment. We’re going to see you within three days if you need an ambulatory oncology appointment. We’re investing in the ability to meet the service needs of everybody, and we have not done a very good job with meeting those needs.
We also need to branch out. We don’t have very much primary care. The organization thought of itself as just the backstop, and it did a great job doing that, but it wasn’t really counting on the fact that everybody was going to come in and start skimming up the profitable work in the last five years. I think we need to do a little catch up. We’re going out to the communities we currently serve and to new communities, the ones that maybe have some commercial insurance.
