NYS must bring equity to Indigent Care Pool 1

The New York State Legislature is currently deliberating on a common-sense bill that would address fundamental inequities in how our state finances safety net hospitals. Namely, companion bills S5954 and A6883 prioritize funding for those hospitals that take care of uninsured, under-insured, and Medicaid-insured patients. These hospitals provide essential care for the poor, in rural and urban communities throughout our state. At present, substantial portions of our tax dollars earmarked for caring for the poor — known as the Indigent Care Pool — are diverted to large hospital systems, many of whose executives and physicians are millionaires.

We have borne witness during the COVID-19 pandemic to how failure to finance safety net hospitals kills. We would not have needed a naval hospital or the Javits Center had we not relentlessly gutted the NY safety net over the last two decades.

I cared for COVID-19 patients at NYC Health + Hospitals/Elmhurst, which suffered an enormous burden and faced a true humanitarian crisis during the first surge of the COVID pandemic last spring. The preventable death toll, disproportionately levied against black and brown people, was unfathomable and like nothing I had previously witnessed in my career as a physician.

The root cause of this crisis included nearby hospital closures like Mary Immaculate and St. John’s hospitals. Queens has fewer than two hospital beds per 1,000 residents, compared to over six per 1,000 for Manhattan. As a public hospital, Elmhurst is also the only place in Queens where my uninsured neighbors can access healthcare. This dire scenario is playing out throughout the rural reaches of our large state.

The proposed legislation would take steps to rectify a long-standing practice in New York state whereby hospitals receive public funding from the Indigent Care Pool even if they do not care for a high proportion of poor or uninsured patients. The safety net hospital bill’s purpose is to “Redistribute Indigent Care Pool funding to better target support to safety net hospitals which provide services to persons who are uninsured or insured by Medicaid.” It does this simply by clarifying the definition of safety net hospitals and how government funds designated for the care of the poor are to be allocated.

With supermajorities of Democrats in both chambers, and a broad societal reckoning on racial injustice, the time is now to pass this commonsense bill that better targets our tax dollars to serve the poor. Leading advocacy organizations like Medicaid Matters and the Commission on the Public’s Health System back it. Students from major medical schools are behind the legislation. Most healthcare unions support the reforms vocally. The nation’s largest public hospital system, NYC H+H, has signed on. So why wouldn’t this simple measure to correct inequities in health financing pass?

It is the healthcare lobby, led by the Greater New York Hospital Association, looking out for their own financial interests, as many hospital systems who do not need the ICP support for care of the uninsured are receiving millions of misallocated tax dollars each year. Academic medical centers, like my employer, the Mount Sinai Health System, and other private hospital systems need to support this legislation to address racial injustice and improve our pandemic resilience.

I am an academic physician proud to serve on the faculty of Mount Sinai, alongside extraordinary colleagues, staff, students and trainees. I am proud of the Mount Sinai Health System’s work in COVID-19 response. I am proud of the way our medical students and trainees, who refuse to tolerate racial and social injustices that is killing our patients, have been pushing us to reform. But, academic medical centers are on the wrong side of history in addressing the root causes of this pandemic’s toll on the poor and on marginalized communities.

Our academic medical centers absolutely need public investment. At the same time, we need to do a better job to hold ourselves accountable to the public’s demand for health equity. Many of our executives and some of our physicians make millions of dollars a year even as they advocate for more funding for themselves away from the safety net. Even with a temporary and largely symbolic 50 percent pay cut in some NYC institutions, they made more in a single year of the pandemic than the lifetime earning of most of their employees. These disgusting salaries also reward the predatory buying up of individual physician practices, driving consolidation which leads to lower quality and higher costs for patients.

So my message to our academic institutions is clear in this time of pandemic and racial reckoning: Our safety net hospitals, from rural counties to the boroughs, need much more support. Let’s reform our own costs in academic health centers, starting with exorbitant salaries of some of our leading physicians. And let us stand up loud and clear in favor of Indigent Care Pool reform and ensure passage of S5954 and A6883.

Dr. Duncan Maru is a physician who lives in Jackson Heights; his views do not represent those of the institutions with which he is affiliated.

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