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Opinion

State Leaders Must Head Off Impending Safety-Net Health Care Crisis


Gov. Hochul visits health care providers (photo: Kevin P. Coughlin/Governor's Office)


With her 2023 agenda, it’s clear Governor Kathy Hochul wants to be seen as a champion for New Yorkers who face significant health disparities. But for all she pledges to do, she’s failing to rise to the challenge to address a serious health care crisis coming this April.

On April 1, the state will divert funding away from safety net providers like mine — Alliance for Positive Change — and the New Yorkers we serve from under-resourced communities. This is funding we use to provide not only connection to health care, but the housing, food, behavioral health, and other wrap-around supports people need to stay healthy. 

Hochul’s executive budget maintains what’s known as the Medicaid pharmacy benefit “carve-out,” an ill-conceived leftover policy proposal from the Andrew Cuomo era that will disrupt thousands of people’s lives through service reductions and job cuts. Worse yet, some safety net facilities could even be forced to close completely if the Legislature doesn’t now step in.

More than 1,000 people rely on Alliance for Positive Change for access to their prescriptions, treatment counseling, and other supportive services that help them take their medications. In all, safety net providers care for more than 2 million New Yorkers. They can’t afford for implementation of the “carve-out” to move forward. 

Put simply, safety net providers rely on savings that come through the pharmacy benefit program to fund the myriad supports essential to overall health care for low-income New Yorkers. Under the proposed carve-out, the state will snatch away hundreds of millions of dollars. Rather than listening to providers who have presented a workable solution to her administration, Hochul uses her budget plan to create a convoluted payment mechanism that fails to adequately protect providers and the patients they serve.

This is a complex scheme with profound ramifications for the most vulnerable patients: Personalized, lifesaving care will be, at best, disrupted. At worst, it will disappear completely.

Alliance for Positive Change helps participants take their medications on time, get to their doctor appointments, and navigate systemic inequities to achieve health and well-being. We provide them a safe space where they can access pharmacy services and get structured support, including counseling, nutritional advice, and even MetroCards. They also have the opportunity to engage with a community of New Yorkers who face similar challenges. 

These are low-income New Yorkers living with HIV/AIDS and other difficult-to-manage chronic conditions. Many contend with additional challenges like homelessness. Incredibly, more than 95% of those enrolled in Alliance’s Treatment Adherence Program maintain an undetectable viral load — the amount of HIV in the blood — meaning they cannot sexually transmit HIV to others.

One success story stands out for me. I helped a young man living with HIV get his prescriptions, stick with his treatment regimen, and access food and nutritional services so he could take his medication as directed. As a result of his commitment, and our support, he graduated from our peer training program, is now employed part-time, and has sustained his undetectable viral load. Most striking of all is what he said about our work together: “Before I met you, I was terrified of who I was. Now, I’m not scared. I am open about my status, and I can share my story with people.”

Without the pharmacy benefit savings, I fear that the services for this person — and so many others like him — will disappear. Roughly 20% of Alliance for Positive Change’s budget is built on these savings, but other safety net providers lean on the pharmacy benefit far more. 

The carve-out scheme will devastate the continuum of care for patients, resulting in a reduction in treatment adherence, increased hospitalizations, and higher health care costs. It would worsen already startling health disparities and cost the state tax revenue, as reported in a recent publication by the Wakely Consulting Group — ultimately thwarting our statewide efforts to end the HIV/AIDS epidemic. 

As early as this month, Medicaid recipients will begin receiving notifications of these impending changes, creating confusion and chaos. If the governor and legislative leaders don’t cancel the carve-out as part of the final state budget deal due by April 1, there will not only be significant financial costs associated with poorer health outcomes, but also moral costs of sabotaging the safety net for millions of New Yorkers. 

Addressing health disparities is important work. But creating greater disparities in the process is a zero-sum game.

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Samuel Rodriguez is a Treatment Adherence Manager at Alliance for Positive Change. On Twitter @thealliance_nyc.

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The Future of New York's Middle Class is Built on Investment in Growth and Union Labor


On the construction site (photo: Ed Reed/Mayoral Photography Office)


While it’s no secret that the pandemic and looming recession have taken a toll on all New Yorkers, they have been particularly detrimental to low- and middle-income communities, as they’ve only exacerbated the ongoing shrinking of the middle class and troubling disparities in wealth and income.

However, with the inevitability of hardship comes the longevity of certain sectors that will always serve as catalysts for recovery and reinvigoration of the economy and subsequently, the middle class. One of these crucial industries is unionized construction.

Historically, construction has been an enduring and dependable sector throughout and immediately following difficult times, including the Great Depression, times of war, and the Great Recession of 2008. Since 1940, the construction industry has consistently added jobs, with some of the biggest increases coming immediately after these major events.

Following the onslaught of COVID-19, and throughout talks of recession, this pattern has remained the same. Despite the pandemic paralyzing our economy, construction has been able to valiantly bounce back and return to its upward trajectory.

This is why New York must remain committed to greenlighting large-scale public works and private development projects that are built union. If we’re to fully recover from the pandemic and weather the storm of a possible recession, we’ll need the economic stimulus and job creation that unionized construction uniquely drives forward.

Development is the leading generator of family-sustaining careers in New York's unionized construction industry. By creating reliable and honest work for our tradesmen and tradeswomen, projects that are built union, including clean energy and green infrastructure initiatives, give New Yorkers from a diverse range of backgrounds an opportunity to pursue the middle class and contribute to the betterment of the community around them.

Not to mention, as the barriers to education remain and starting salaries for many occupations struggle to keep up with the cost of living, let alone loan repayment, union construction remains an industry accessible for New Yorkers of all backgrounds, including those from diverse and disenfranchised communities.

Pre-apprentice, apprentice, and direct-entry programs have become the crux of the unionized construction industry. They provide entry-level workers with accessible, on-site, and in the classroom craft skills training, as well as safety training, and prepare individuals for careers in the construction industry by providing them with the skills necessary to succeed. These programs ensure that we will have a ready, safe, and productive workforce to build critical infrastructure for years to come and uniquely pave a clear pathway for hardworking New Yorkers to build a sustainable, middle-class career.

While Governor Hochul, Mayor Adams, Majority Leader Schumer, and the Biden administration are seemingly aware of the importance of union construction, and should be applauded for their collective focus on infrastructure, we must continue the progress made on pushing forward or commencing major initiatives like the Penn Station Redevelopment, the Hudson River Tunnel Access project, the new Buffalo Bills stadium, and the NYCFC soccer stadium in Flushing. It will be projects like these that create tens of thousands of middle-class union jobs, bolster and sustain our economy, and foster stimulus for other local businesses and industries, including hospitality, retail, transportation, culinary, real estate, and more.

When it comes to periods of uncertainty, history has undoubtedly repeated itself, and each time, unionized construction has played a role in leading us out of the dark. With our current situation, we must lean into what we know how to do best: innovate, build, and develop by training and mobilizing our dedicated and skilled workforce of union tradesmen and tradeswomen. Not only will this sustain and uplift our middle class, but it will also maintain New York’s place as a leader in modernized infrastructure, fiscal opportunity, and forward-thinking ideas.  

 ***
Gary LaBarbera is the president of the New York City and New York State Building and Construction Trades Council. On Twitter @NYCBldgTrades.

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No More Baby Steps: Commissioner Rosa Must End the Yeshiva-Gate Scandal


Mayor de Blasio in Williamsburg (photo: Michael Appleton/Mayor's Office)


State Education Commissioner Betty Rosa’s demand for June completion of New York City yeshiva investigations is a step in the right direction. But her order will be hollow unless deficiencies are quickly addressed. Every day that ultra-Orthodox yeshivas fail to provide substantially equivalent secular instruction to their students is a day that those children are deprived of their legally guaranteed educational rights.

What The Daily News criticizes as “slow motion” progress is insufficient, demonstrated by the recent case of Yeshiva Mesivta Arugath Habosem (YMAH) in Brooklyn, where after years of delayed investigations and months after Commissioner Rosa finally determined YMAH is violating state education law, no meaningful improvements have occurred.

Last October, after a lengthy legal case, Commissioner Rosa ruled that, contrary to New York City Department of Education findings, YMAH doesn’t provide required secular instruction, such as English Language Arts, science, math, social studies, and other mandated subjects. A corrective plan was ordered by December. Yet the Commissioner’s detailed twelve-page decision was cynically met by YMAH with a mere three-page, widely-spaced response more intent on delay than meeting the educational standards itemized in the decision.

That plan, I said, “could have been written on a napkin during a quick lunch.” It is devoid of even the most basic structure of the school day, daily or weekly hours of instruction in the required subject areas, the scope and sequence of topics in each instructional area, and the specific qualifications needed to teach them. Merely parroting words plucked from the commissioner’s decision and relevant regulations, the napkin plan attaches speculative dates for delivery without explaining the process or sources through which deadlines will be attained, making a mockery of a timeline that extends well into next year prior to implementation and eventual evaluation.

Perhaps most astounding, the plan includes the mystifying passage that “connections to particular lessons in Judaic Studies will be identified to demonstrate how the Judaic Studies curriculum satisfies learning standards” and that “Judaic studies curricular materials will be included,” raising the question of whether YMAH intends a separate secular studies program at all.

Yet, despite its empty substance and extended timelines, Commissioner Rosa still has not ruled on the so-called napkin plan, allowing YMAH to shrug off the legal and ethical duties that the commissioner demanded.

That same scenario is playing out again with the commissioner’s new order for New York City to complete other investigations by June. These have been delayed since a complaint was filed by Yaffed, an advocacy organization, in 2015. The city’s Department of Investigation determined that the de Blasio administration obstructed the task for political purposes, words also used in the state education commissioner’s latest order concerning Mayor Adams’ conduct. Yet, incredibly, the commissioner is still depending on the city to conduct a timely review.

Moreover, the DOE’s previous examination of YMAH gave it a clean bill of health, requiring the state commissioner herself to visit and overturn that decision! Why should the city continue to be trusted with this investigatory function when it has demonstrably failed to hold yeshivas accountable for providing the sound, basic education required by the state constitution?

So, come June, the scenario of questionable city investigations will be repeated with no promise that the State Education Department will adequately review its results. And even if it does, more time will be lost with further letters of demand from the commissioner and more napkin plans submitted for further review and, best case, slow-motion implementation.

This chicanery, robbing children of required instruction in math, reading, history, and science, must end. The public has lost faith in government because of farcical cycles of buck-passing where nothing is accomplished. The commissioner’s “enough is enough” is not good enough. It extends good faith to bad actors at the cost of educational justice and public confidence. That price is too high. State Ed has to send its own independent experts into the yeshivas, make rapid detailed evaluations of any deficiencies, and institute immediate reforms consistent with state law.

Enough is enough.

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David C. Bloomfield is Professor of Education Leadership, Law, and Policy at Brooklyn College and The CUNY Graduate Center. On Twitter @BloomfieldDavid.

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