A Healthcare Plan for New York City

When I was six years old, I was diagnosed with Type 1 Diabetes. I remember going to Nassau County Hospital and being told that my body was unable to metabolize sugar on its own because my pancreas no longer worked properly. Like so many people who have received the same diagnoses, my life changed forever. I had to test my blood sugar up to 10 times per day and give myself numerous injections of insulin in order to stay alive. Through my mother’s union job, we were privileged enough to access the healthcare that provided me with insulin.

For far too many in our district and our city, this is not their reality. Folks constantly face the unconscionable choice between critical medications and putting food on the table. This system was not an accident. Powerful pharmaceutical companies have worked to keep these drugs as expensive as possible, increasing the price of insulin by over 1100% since I was first diagnosed. Like so many Americans, I have always been one step away from losing access to the medication I need to survive.

I have always been driven by my first-hand experience with our broken healthcare system. I have made it my life’s work to level the playing field, expand access to quality healthcare, and make sure no one will ever need to go without the treatments they need. I spent almost a decade in Albany writing healthcare policy and have worked as a legal service attorney in New York’s hospitals since 2016. When the pandemic hit, I was working at Woodhull Hospital running a free legal clinic to help folks access the services they needed and navigate our municipal bureaucracy. Last year I opened a new citywide clinic that successfully fought to get people home care so their families weren’t forced to admit them to dangerous nursing homes. I also worked with COVID patients and their families to access needed health coverage and benefits. From courtrooms and hearing offices, to nursing homes and hospitals, my life’s mission has been to take on the forces that threaten the wellbeing of those in my community.

There is work to be done right here in New York City. This plan is a roadmap towards comprehensive healthcare justice. This systemic change cannot wait.

For New Yorkers unable to imagine what a universal healthcare plan looks like, the city gave them a real life experience of one with the roll out of the vaccine. You could show up, regardless of insurance, and be guaranteed a shot. Imagine if all medication and treatment worked like that.

Every day thousands of New Yorkers have to make the choice between food and life-saving medication. I have lived with type 1 diabetes for my entire life and have seen the price of insulin skyrocket. For anyone living with a chronic illness the threat of medical bankruptcy or the need to ration medicine is always present. We cannot wait for changes in federal regulation to lower drug prices — our next City Council must act. That is why I am proposing the creation of city-run community pharmacies. Using the NYC Health+Hospitals network, we can create satellite institutions that will provide the drugs our neighbors need at prices everyone can afford.

New York City Health+Hospitals currently oversees an $8 billion budget. As NYC’s primary non-profit health care institution, it can wield its economic power and use the federal 340b pharmacy program to negotiate for and provide low cost prescriptions across the city and, for patients unable to afford a prescription, free medication. This should be done through a mixture of opening city run pharmacies in neighborhoods underserved by existing pharmacies. In addition, the 340B program enables partnerships with retail pharmacies. However, the retail pharmacies can charge exorbitant fees on these prescriptions. I will work with partners in Albany to make sure we set caps on these fees, and further reduce the cost of prescription for low-income New Yorkers. When elected I will fight to make sure no New Yorkers go without medication, have to spend hours of their day fighting to get their medication, or risk going bankrupt paying for their medication.

Everyone has a right to live a full free life in their community without being forced into a nursing home. It is so fundamental that the United States Supreme Court in the Olmstead decision found that “institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.” (Olmstead v. L.C. ex rel. Zimring, 527 U.S. at 602)

Yet too often people are denied this right because the city fails to provide adequate funding and support for those in need of home care which is necessary for them to continue to live in the community. During the pandemic we saw how poorly our nursing homes were run, especially those that cared for low-income seniors. The COVID death rate was unfathomable and inexcusable — despite Gov. Cuomo’s attempts to cover it up. I work with families at my legal aid clinic to try and get them home care so their elderly relatives can access the support that they need in their community. Without interventions, many of these families would be overburdened by having to work full-time jobs and provide 24 hour care for their parents. The city can be doing so much more to ensure that our seniors and working families can access quality home care and don’t end up in nursing homes. If elected I will expand the services that ensure seniors get long term home care, and get enough care to provide for their needs, without having to appeal for more hours.

Government programs aimed at healthcare access currently do not do enough for those needing home care. For example, Medicare does not cover long term care services, including home care. Medicaid does cover home care benefits, but the Medicaid eligibility income level is $884 a month — meaning seniors earning above $884 can buy into Medicaid if they are willing to pay any income above $884 to the Medicaid program. As the average social security retirement benefit is $1,543 or $18,516 a year, a senior earning $18,516 would have to pay about $8,000 of that to Medicaid in order to get home care benefits. Without home care, they are forced into nursing homes. Through a Pooled Income Trust, seniors can qualify for Medicaid, and therefore home care benefits. Instead of paying Medicaid the money and it disappearing, they pay it into a trust which then uses their money to pay for their needs, like rent, utilities, and other bills. In essence it enables low-income New Yorkers whose income is above the Medicaid limit to continue to live in the community and get needed benefits. While expanding access to pooled income trusts could improve the lives of countless seniors, the Human Resources Administration (HRA) maintains seemingly insurmountable barriers to those who need it most — from arduous applications and financial parameters, to routine denials due to subjective clerical errors.

I propose a twofold solution to ease the process of getting this reform through the Human Resources Administration (HRA). Firstly, we must lessen bureaucratic barriers so HRA is a facilitator of pool trusts, and not an impediment to their creation. Secondly, the city must set up a pool trust program administered by Health+Hospitals to patients, free of charge. Such a program would expand eligibility for home care to thousands of seniors across the city and thus, reduce the strain on families and the institutionalization of the elderly.

However, Even with robust home care, some seniors may still require full-time nursing home assistance. It is our moral duty after seeing through the pandemic how poorly run these nursing homes are, to make sure they are providing the best service and care possible for our seniors. In order to do this we need to mandate nursing homes have enough staff to provide care and oversight of all their patients. Too often seniors get sick and are hospitalized because of nursing home neglect, which is not the fault of the staff, but rather, the lack of sufficient numbers of staff. In addition, we need to require fair pay for all nursing home workers.

New York City Health + Hospitals serves as the backbone of our public health system. With an $8 billion annual budget, 11 hospitals, and numerous other care centers, it supports over 1.1 million individuals every year — 70% of whom are insured by medicaid or have no coverage at all. The system ensures that our city’s most vulnerable have access to care. However, threats from Albany and the Governor’s office have put this institution in jeopardy.. Over the last decade we have seen the reduction in reimbursements for services provided at community hospitals and the subsequent underfunding of their programs. This year alone, Governor Cuomo has attempted to slash $600 billion in health care spending, including a 1% reduction in medicaid and the reduction of subsidies for safety-net hospitals. This misses the broader point of community hospitals: Their success should not be determined by profitability, but rather whether or not they meet the needs of the community.. The attempted closure of Kingsbrook Hospital is just the latest in attempts to bull health care safety nets out from under those who need them most.

In addition to saving community hospitals from closure, I will expand and support NYC Care. As it exists, NYC Care is a program administered by NYC Health+Hospitals that guarantees low-cost services to those who cannot afford or are ineligible for health insurance. It is one of the largest programs in the nation focused on providing healthcare to all who need it. Currently NYC Care is not an insurance program. In most cases, it is used as a last resort. The next City Council has the chance to broaden its mandate. I will transform NYC Care into a comprehensive health coverage plan for all New York City residents, including undocumented immigrants and people who would be charged unaffordable premiums for underinsured plans under the NY State of Health. Utilizing the existing infrastructure, we have a chance to expand healthcare access to every New Yorker. If this year has shown us anything, it’s that we must prioritize comprehensive health access across our city and commit to making systemic change.

As a type 1 diabetic, I know the fear and anxiety of seeing astronomically high medication prices. My own medication, insulin, has increased 1200% in the past 20 years, even though the medication is exactly the same as it was 20 years ago. It used to cost a few hundred a year for my medication and now it’s tens of thousands of dollars. The pharmaceutical industry’s price gouging has cost lives and financial distress to millions of people. These medications, commonly created through tax payer funded research, are then sold back to New Yorkers and public and private health insurance at egregiously high prices. That’s why I will fight to begin laying the groundwork for our city to produce medication right here at home.

New York City can save money, and even generate revenue, by manufacturing generic drugs like insulin, EpiPens, inhalers and other essential medicines. Our public hospital and public health system, Medicaid program, and public employee health insurance pay incredibly high prices for medications. With the skill and know-how in NYC it’s not a matter of technical ability, but the will of politicians to invest in the creation and manufacturing of these life-saving medications. This model has worked before and could work here. It’s time for NYC to step up and start taking drastic action to protect our citizens.

The next City Council must form a commission of experts to study NYC making its own essential medications and issuing a plan to make this a reality. Through partnerships with municipal and state governments, non-profits, and academic institutions, we could lead the way as a city committed to creating medication for those who live here — life-saving medicine for New Yorkers, by New Yorkers.

While we fight for healthcare justice in our city, we must not lose sight of universal access everywhere. New York is the largest city in the United States, with increasingly progressive representation at the statewide and national levels. Our City Council must utilize its platform and influence in the political space to advocate for reforms that improve the lives of both New Yorkers and Americans.

I have fought for single-payer healthcare for over two decades. Since its inception, I have been a supporter of the New York Health Act. As a member of City Council, I will work alongside our allies in Albany to pass this groundbreaking legislation and provide healthcare for all New Yorkers. Under the NYHA, all residents and full-time workers in New York State would be completely covered and access to medication would be expanded.The passage of the New York Health Act would reframe healthcare as a public good and ensure everyone in New York has access to quality, comprehensive care.

In addition, when we do get the NY Health Act passed, I will make sure that it is implemented in a way that serves the people of my district. Passage is just the first step in extending care to everyone. We will also need to continue to fight for quality healthcare and for timely healthcare. As someone who has spent his career helping folks navigate our healthcare system, I will ensure that my office provides assistance to every constituent to make sure they get the care they need. The next City Council must make a commitment to helping folks navigate the complexities of our healthcare system and ensure people are getting the care they need.

I will also fight to send a congressional caucus to Washington DC that is committed to universal healthcare. While the New York congressional delegation is becoming increasingly more progressive, they must be held accountable to the promise of universal healthcare. I commit to working with activists and advocates to ensure our representatives in Washington make health justice a priority. My office will become a hub and haven for any who are willing to organize towards universal health care access, and I will actively support all efforts to elect those who will stand by that goal.

One of the greatest mistakes made during the pandemic was an over reliance on internet based public health interventions to the detriment of community public health assistance. We cannot fall into the trap of equating what is new with what is best. As a legal assistance attorney who regularly helps New Yorkers navigate the benefit system, I’ve seen the creation of digital portals to manage public benefits that erect numerous barriers of entry to those without internet access or technical fluency. The most egregious example of this was the cities test and trace system and the roll out of the vaccine program.

An overly complex online booking system made accessing the vaccination program difficult for those that needed it the most. Elderly folks — especially those over 80 — were the first to become eligible for vaccination. Those without access to technology and those who were not technologically literate had an especially difficult time accessing these services.

As a public health expert, I’m acutely aware of the need for community based approaches in order to roll out any successful public health intervention. We must work with community based organizations and community leaders in addressing public health problems. Too often money is wasted on mass media campaigns and expensive internet portals, instead of meeting folks where they are. Internet based services consistently deny benefits when someone gives an answer that doesn’t fit neatly into the portal’s algorithm. We must invest in expanding public health services, as well as in IT departments.

The past year has laid bare our broken healthcare system. Our next city council must do everything in its power to ensure people can access quality healthcare, affordable prescriptions, and comprehensive mental health care when they need it. Until the elected officials in Albany and Washington fix these problems, it falls to us. I have spent my life working to get folks the care they need. This is a fight I will take with me every day representing District 33.

Learn more at Stu2021.com

Candidate for NY City Council (District 33) — https://stu2021.com/

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