NEW YORK, NY February 19, 2007 —As Governor Spitzer takes aim at cuts in Medicaid (finding himself right in step with similar proposals from President Bush), hospitals around New York are bracing themselves for the fallout. Especially vulnerable are preventative programs, services for the uninsured, and teaching hospitals, all of which rely to some degree on state or federal support. WNYC’s Fred Mogul has the story.

HUANG: Since the last time I saw you, how’s your breathing?

AHMED: Breathing’s okay.

HUANG: How far can you walk?

REPORTER: At Elmhurst Hospital in Queens, Dr. Huajun Huang is examining a patient named Monsur Ahmed. The 65-year-old Bangladeshi immigrant, widower and newsstand cashier has diabetes and several other conditions.

HUANG: How’s the chest pain?

AHMED: Nothing, nothing . . .

REPORTER: The Health and Hospitals Corporation, the city’s network of public hospitals and clinics, has established an electronic diabetes registry. This program coordinates appointments, drug prescriptions and other aspects of treatment for about 50,000 diabetics. Dr. Huang says the program has helped Ahmed get an integrated regimen.

HUANG: Overall, he was cared by different doctors, different specialties, cardiology, vascular surgery, dietitian, education – like teamwork.

REPORTER: This program is the sort of primary, preventive care for which HHC gets little or no reimbursement from Medicaid. The diabetes registry is well established. It’s is not directly threatened by a potential 350-million-dollar annual cut from Washington. That’s the good news. President Alan Aviles says HHC can’t trim things like Emergency Room, Intensive Care and other truly indispensable services. That means a lot of preventive programs could be scaled back, and new ones put on hold.

AVILES: A lot of what we’re doing for heart disease, a lot of what we’re doing in cancer screening -- all of that would be on the chopping block if we don’t have this funding.

REPORTER: Monsur Ahmed is one of the roughly 400,000 uninsured patients who come to HHC each year – about one third of the total. He does pay a little out of pocket, on a sliding scale, covering a small percentage of his treatment. Aviles says the irony is that investing in Ahmed not only loses money in the short run, it doesn’t really lead to savings for the hospital in the long run. Take asthma, he says. Preventive programs have reduced asthma visits to the E.R. and hospital admissions by 25-30 percent over the last two years, but Medicaid doesn’t cover the cost for that, and it doesn’t reward the hospital for the savings.

AVILES: Really, we’re reimbursing principally for ‘sick-care.’ So, to the extent we promote health, and to the extent that we keep children who have asthma out of our ER departments and our hospital beds, we lose all the revenue that would be associated with having those admissions and those visits.

REPORTER: Aviles is focused on proposed cuts in funds designated for the uninsured. Those come from the federal government. But at Montefiore Medical Center in the Bronx, President Dr. Spencer Foreman is concerned about both state and federal cuts, because both come down hard on teaching hospitals.

FOREMAN: In New York State, for instance, we train 15 percent of all America’s physicians . .

REPORTER: Montefiore is the third largest teaching hospital in the country. And teaching hospitals are costly. They frequently order more tests, do more advanced procedures, and rely on more cutting-edge technology to than other hospitals. They also frequently have high salaries for executives and top physicians. According to Montefiore’s 2004 tax release, the most recent one available, Foreman made close to 2 million dollars in total compensation – almost 8 times more than HHC President Aviles, but in the same salary range as other large hospitals. Foreman says his earnings are small compared to a projected $68-million shortfall if state and federal cuts go through. That could lead to laying off a thousand staff members and reducing the number of residents being trained.

FOREMAN: we now have a national understanding that we are short of both general physicians and specialty physicians for the future, so – if you don’t want to have first-class doctors in 20 years, shut down the teaching hospitals.

REPORTER: There’s strong and widespread opposition to the proposals by President Bush and Governor Spitzer, and hospitals’ very worst-case scenarios aren’t likely to occur. Spitzer, in particular, has made Medicaid reform perhaps his single greatest priority, setting up what could be the fiercest fight in an already contentious political season.