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Q&A
Council Member Restler questions Dr. Katz on potential Medicaid cuts and impact on NYC Health + Hospitals
1:20:33
·
6 min
Council Member Lincoln Restler engages in a discussion with Dr. Mitchell Katz about the potential impacts of federal Medicaid cuts on NYC Health + Hospitals (H+H). They explore the possible consequences on specialty services, the effect on immigrant populations, and how these cuts might impact both H+H and private hospitals in New York City.
- Dr. Katz explains that specialty services might be curtailed first if cuts occur, as emergency and primary care are essential
- It's revealed that 60-70% of H+H's patient population is foreign-born, highlighting the potential impact of Medicaid restrictions on documented immigrants
- The discussion touches on how private hospitals have increased their Medicaid patient load due to EMTALA, but still lack outpatient care for Medicaid patients
Lincoln Restler
1:20:33
Can I ask two more questions?
1:20:34
Yeah, thank you.
Mitchell Katz
1:20:35
I'm sorry.
1:20:35
So we will keep, so again, so if you take my assumptions, then it says that what you have to do is you have to curtail services.
1:20:47
And probably the services you would want to curtail are probably specialty services.
1:20:52
So, because you probably, you have to maintain emergency, right, because life and limb, and you want to maintain primary care because that's the most cost effective.
Lincoln Restler
1:21:05
But aren't some of those specialty services revenue generating?
Mitchell Katz
1:21:08
It turns out that because they are so much more expensive to do, I would say, again, if you had to cut something.
1:21:18
Yeah, no, I'm not that's where because you just pay more for specialty services.
1:21:25
And again, if if you're trying to make a horrible system a horrible change work, you gotta say what do you prioritize?
1:21:34
And I don't see how you say there's gonna be less emergency services because that's where people be to I I I think you wanna say less primary care.
Lincoln Restler
1:21:43
Absolutely not.
Mitchell Katz
1:21:44
I know that's your primary care.
1:21:45
Those two things, then
Mercedes Narcisse
1:21:47
What's left?
Lincoln Restler
1:21:48
Ambulatory care, outpatient care.
Mitchell Katz
1:21:50
Specialty care.
1:21:51
Specialty care.
1:21:51
You know?
1:21:52
So does the person just again, because you asked, you know, see a cardiologist.
1:21:59
Does everybody see a cardiologist in the world?
1:22:02
No.
1:22:02
If you're poor, you see your primary care doctor.
1:22:05
If your primary care doctor as good as a cardiologist if you have a cardiac problem?
1:22:10
No.
1:22:11
Will he or she do okay?
1:22:14
You know, that's the kind of thing that I imagine is that we're saying, yes, we have a primary care slot.
1:22:22
You want to see a specialist?
1:22:24
I understand that.
1:22:25
I'm sorry, I don't have a specialist for you to see.
Lincoln Restler
1:22:27
So before I get in trouble with the chairs, I just want to try to briefly touch on a couple things.
1:22:33
I do appreciate that answer.
1:22:34
I do hope that you'd be open to planning and conversation with the hospitals committee and the finance committee and other interested council members to understand the impacts in advance so that we can try to make sure that New Yorkers know what's coming if this horrible bill comes to fruition in the community, of course.
1:22:50
We we represent the community as the city council very proudly.
1:22:53
The other two things I just wanted to touch on.
1:22:57
One, I'm frightened by the restrictions on Medicaid access for documented green card holding immigrants.
1:23:09
Could you speak to what percentage of the H and H patient population is foreign born?
Mitchell Katz
1:23:14
Oh, is foreign born very high.
1:23:17
I don't I don't know that you know, of course, we don't
Lincoln Restler
1:23:20
You don't track immigration status, thankfully.
1:23:22
But I wondered if you could track just who's an immigrant.
Mitchell Katz
1:23:27
Would think that we're at 6070%.
Lincoln Restler
1:23:29
Sixty to 70%?
1:23:30
Yeah.
1:23:30
Right?
1:23:30
And that's not to say that every immigrant isn't a citizen, it's just to say disproportionately when we're unable to provide Medicaid to documented green card holding immigrants, it will have a catastrophic consequence on H and H and the need to reduce even more of those specialty services.
1:23:48
Second and last is, could you just help me my understanding or my rep is that over the last ten plus years, we've seen a shift at the wealthier voluntary hospitals where they serve more Medicaid patients than they used to.
1:24:02
And I I won't ask you to explain why that's happened, but could you just help me understand?
1:24:10
Wouldn't doesn't this mean that the voluntary's have just as much skin in this game as safety net hospitals, that this would be devastating?
1:24:18
Not maybe not just as much, that's probably too far, but that have significant skin in this game and that this should be a existential threat to their business model if these cuts come to fruition for New York City voluntary hospitals as well?
Mitchell Katz
1:24:31
Yes.
1:24:31
Well, it's easy to explain why.
1:24:33
The reason why is because of EMTALA.
1:24:36
EMTALA means that an emergency room cannot deny you care in an emergency.
1:24:41
And the city's ambulances go generally to the nearest hospital.
1:24:46
So if you are somebody on Medicaid, right, and you have an emergency, you're gonna go to the nearest hospital.
1:24:53
More people have Medicaid than ever before and so the other private non profits are doing more Medicaid.
1:25:00
The big difference, and this was brought home to me by one of my own patients, she called me to say that she had had an accident.
1:25:08
She was cared for by one of the great private hospitals of New York City.
1:25:13
She has Medicaid.
1:25:14
And they gave her as her discharge instructions, they said please follow-up with an orthopedist.
1:25:19
They gave her three names.
1:25:21
She called me to say I called all three practices, but they said they wouldn't see me.
1:25:25
I don't understand it.
1:25:27
The emergency department told me that I had to be seen in a week and they gave me these three names.
Mercedes Narcisse
1:25:31
Right.
Mitchell Katz
1:25:32
Right?
1:25:32
And the story perfectly explains the situation.
1:25:36
There's no outpatient care for Medicaid.
1:25:39
Right.
1:25:40
The outpatient care is all with us.
Lincoln Restler
1:25:42
But with the emergency rooms and inpatient in the
Mitchell Katz
1:25:44
emergency room and then in the hospital if people need to be medicated.
Lincoln Restler
1:25:50
To increase their occupancy rates they've served more Medicaid patients.
1:25:53
Right.
1:25:53
And they
Mitchell Katz
1:25:54
will, those patients will still come to the private hospitals.
John Ulberg
1:25:58
Right.
Mitchell Katz
1:25:59
And they will still have to serve them under EMTALA.
1:26:02
And so they will have quite large losses now because they will not get paid.
Lincoln Restler
1:26:07
Well, we all know about the stories of the voluntary hospitals that send people down the block to the H and H facilities when they don't want to serve the people that lack insurance.
1:26:17
And, you know, we are hurtling toward a reality where hundreds of thousands, if not a million more New Yorkers are going be in exactly that situation.
1:26:25
And it's going to be on your doorstep to find a way to provide care to all of these people, and we might again be in a situation where H and H becomes a big vulnerability for the city budget because of these dramatic cuts that we've seen in Iowa I'm done.
1:26:39
I'm done.
1:26:40
I'm sorry.
1:26:40
Thank you for the time.