Medicaid Reform Is a Tough Pill to Swallow

Governor Cuomo’s panel to revamp the state’s health care system held it’s first meeting Thursday, and it featured some stern talk from the panel’s co-chair.

Michael Dowling, a top hospital executive and former health secretary to Governor Mario Cuomo, chaired the meeting. The attendees read like a who’s who of New York’s health care system, including directors of influential hospital lobbying associations, union leaders and key state lawmakers.

Dowling, the CEO of the North Shore Long Island Jewish Health System, told the group that Gov. Andrew Cuomo has not given them much time to come up with some major solutions.

“It’s a short time frame,” said Dowling. “This is tough.”

The panel is to report back on short term cost cutting solutions by March 1.

Dowling urged panel members to take advantage of the “extraordinary opportunity”, and to think beyond their own “special interests” and not to be “self-serving.” And he warned that if they don’t come up with some good ideas for saving money, it may be done for them, in way they won’t like.

“If we don’t figure out how to do it, in all likelihood worse things are going to happen,” Dowling said.

Cuomo’s budget is due by February 1. The state faces a $10 billion budget gap, which will grow to $17 billion in two years if nothing changes -- figures State Budget Director Robert Megna calls “horrendous.”  Medicaid is the largest portion of the state budget, at 26 percent of total spending, and Megna said the ongoing economic crisis means that the Medicaid program will be further squeezed. More people will be seeking government funded health care.

Courtney Burke, director of SUNY’s Rockefeller Institute Health Policy Research Center, said it’s a good idea for the new governor to bring all of the stakeholders together. She said the meetings are likely to generate many more innovative ideas on how to improve health care, and curb costs.

“It actually becomes a competition by those people who are involved to put more ideas on the table,” Burke said. “And then they feel vested in having to implement those ideas.”

Bringing the stakeholders or, as critics call them, the special interests, into the decision-making also changes the power dynamics. The new governor will not be dictating specific cuts to the health care industry, for now, and is instead asking for their participation. It also keeps the interest groups occupied for a time.

In past budget battles, groups including the health care workers Union 1199 and the Greater New York Hospital Association teamed up to fund negative TV advertisements that predicted emergency rooms would close and other disasters would occur if proposed cuts were enacted.

The ads caused the popularity of former Governors George Pataki and Eliot Spitzer to plummet, and both governors ultimately rescinded the cuts.  

Burke said even though the stakeholders are involved, don’t expect them to sit quietly for long if they believe proposals might harm the constituencies -- like hospitals, and nursing homes -- that they represent.

“They are still likely to want to protect their interests,” Burke said. “But it’s less likely that they are going to challenge those cuts from the outset, if they’ve been involved.”

Gov. Cuomo is prepared for resistance from the groups, as well.

The new governor is getting aid from business leaders and the real estate industry, who have been raising money to run counter ads. The group, called the Committee to Save New York, has already begun airing spots, preemptively, that for now focus on the positive and endorse Cuomo’s efforts to fix up the state’s finances.

The other co-chair of the Medicaid redesign panel is Dennis Rivera, former head of the health care workers Union 1199, who was intimately involved in many health care decisions. Rivera, who now has a national post with the union, called the panel “an incredible opportunity” to strengthen the Medicaid program.