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How New York Must Build Back a Better Primary Care System


 

Mayor Adams gets health care (photo: Michael Appleton/Mayoral Photography Office)


If you spotted a nickel on the ground, would you stop to pick it up? Probably not—it seems too small, too insignificant. Why bother?

But that small amount is how we value primary care within the context of our whole health care system. It is estimated that only 5–7 cents of every dollar spent on health care is devoted to primary care, despite the fact that primary care is proven to have the best return on investment of all health care services.

Primary care is a cornerstone of vibrant, thriving communities; it helps keep families healthy, children ready to learn, and adults able to pursue education and participate in the workforce. People who have access to primary care are significantly more likely to get preventive care like cancer screenings, flu shots, and counseling related to eating well, exercising, and quitting smoking. They’re also better able to manage chronic conditions like diabetes and asthma. Primary care also saves money; when more people have access to primary care, we see fewer hospital visits, fewer emergency department visits, and fewer surgeries.

It’s a rare “win-win” in health care—better health as well as lower costs.

Investing in primary care is also key to improving racial health equity. Predominantly Black and Latino communities have lower-quality health care facilities and fewer primary care providers than communities that are mostly white. 

This isn’t a problem to be solved simply by throwing more money at the health system; New York’s health care spending is already 20% higher than the national average. Yet our rates of cardiovascular diseases, low birth weight, diabetes, preventable hospitalizations, drug-related deaths, and excessive drinking compare poorly with many other states’.

We don’t need to spend more in total, but we need to spend differently and smarter. We need to rebalance our health care dollars by allocating a greater percentage of our existing spending to primary care.

New York can learn from the dozen or so states that have already introduced or enacted policies to invest more of their health care dollars in primary care. For example, when Rhode Island increased the share of its commercial insurers’ primary care expenditures by 5%, the state’s total health care expenditures fell by 14%.

Increasing the share of health care dollars that support primary care could also help ease the strain on New York’s health care workforce, which has only become more challenging since the onset of the COVID-19 pandemic. One reason for a shrinking primary care workforce is the differences in payment between primary care and specialty care. Both Rhode Island and Oregon were able to increase their supply of primary care providers after they began reporting and increasing primary care spending.

As we look ahead to the COVID-19 pandemic loosening its grip, we must improve our health system, because the old way wasn’t good enough. Let’s bring stakeholders together, analyze the data to determine where resources are currently going, and then shift some of those resources toward primary care best practices and policies that increase health equity and improve community health.

And we should agree on a definition of primary care because there isn’t a standard one in New York or at the national level. That definition should include any location primary care is provided, and any type of provider delivering care, including doctors, nurse practitioners, or physician assistants. It shouldn’t matter where or by whom the care is provided—what matters is the care received by the patient.

With an agreed-upon definition in hand, we can create a baseline measurement of primary care spending. Then we can decide the best ways to increase the proportion of health care dollars that goes to primary care services, set targets for enhanced investments in primary care, and test out pilot programs to identify the most promising models.

The pandemic disrupted everything, but now we have a chance to build back a better health system. By emphasizing primary and preventive care, we can both improve health outcomes and save money—without increasing overall spending. If we seize the moment, New York will be a healthier place for all.

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David Sandman is President and CEO of the New York Health Foundation. Louise Cohen is Chief Executive Officer of the Primary Care Development Corporation.

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Closing the Pipeline that Feeds the Disaster of Rikers


Mayor Adams makes a youth employment announcement (photo: Ed Reed/Mayoral Photography Office)


As people who are deeply involved in our communities, we are the first to understand the value of safety and peace. We have lost loved ones to gun violence and crime, and have lived through the failed policies of over-policing. We acknowledge the rapid increase of both of these since May 2020, two months after the lockdowns that shut down our flourishing communities. The lockdowns have caused a documented increase in addiction, suicide, mental health distress, learning loss, and economic turmoil, all of which must be acknowledged as drivers of the recent increase in violence.  

History shows that we cannot arrest and incarcerate our way to public safety. We can no longer tolerate a city budget that reflects this false notion. With the release of the mayor’s executive budget proposal, it is clear that we have work to do before this year’s budget deadline to move in the right direction.   

Mayor Adams has frequently noted the need to invest in upstream solutions to community safety, and his executive budget shows progress toward that goal. For example, we applaud Mayor Adams’ efforts to address dyslexia among New York City students and support alternative forms of violence intervention through the city’s Crisis Management System. However, the budget also shows an increase in the Department of Correction uniformed headcount of 578 in the year ahead, increasing DOC’s budget to $2.74 billion.  

The Department of Correction has historically been a wildly bloated and inefficient institution and is now the nation's most expensive and richly-staffed jail system, while failing to keep people in its custody alive. The distressed correctional system existed long before the current administration took office, but Mayor Adams has a unique opportunity to address its shortcomings and increase investments in transformative solutions that have proven to uplift communities. A budget increase for DOC is also out of step with the overall trend in the jail population. New York City’s average daily jail population fell 61% from 2011 to 2021, but instead of the DOC budget being reduced by the same amount, it grew by 20%.       

Just as important, an increase in the DOC budget is out of alignment with what our communities really need to foster public safety, and what was envisioned by the Commission on Community Reinvestment and the Closure of Rikers, established by City Council’s Local Law 193 in 2019.   

The tragedy of investing in incarceration versus real solutions is especially vivid when we look at how young people in marginalized communities are served by the city budget. As of May 1, there were 1,258 young people ages 18-25 incarcerated in New York City jails. At an astronomical annual cost per incarcerated person of $556,539, New York City will spend approximately $700 million to jail these young people at Rikers for one year, while exposing them to violence and trauma that will increase rather than decrease their likelihood of future arrest.  

Let’s consider what $700 million could do to support small businesses, increase employment rates, comprehensively address staggering literacy deficiencies, and provide weekend and evening community recreational programming so that our communities can begin recovering from the effects of the last two pandemic years. Notably, the mayor’s budget did not include funding requested by the City Council to further expand summer youth employment, the Saturday Night Lights Program, or the housing for runaway and homeless youth, and the budget for the Department of Youth and Community Development is set to shrink by $86.9 million overall.   

Our own experiences illustrate how much more impactful alternatives to arrest and incarceration can be.  As a young person, I, Darren, had experience with potential gun violence. Walking home from junior high school with two of my classmates one day, we were jumped by a group of older teenagers. I was scared, confused, and angry. Due to my personal horrible experience with the police, calling them for protection was not an option for me. The next two days, I carried a gun to school with me.    

Luckily, I neither saw the older teens nor was I stopped by the police. Yes, my arrest would have removed that weapon from the streets. But it would not have solved the underlying conflict and cycles of aggression, protection, and retaliation I was getting caught up in. Even incarcerating all the young people involved would not solve the problem, since conflicts in the streets often carry into jail and prison. And in a horrible cycle, conflicts in jails and prisons carry back into the communities we aim to keep safe.   

The good news is that there are alternatives. A credible messenger acting as a mediator could have ultimately resolved that issue and deterred me from causing more harm in a way that law enforcement could not have. Again we applaud the City’s increased investments in credible messenger models, but more funding is needed to support these programs’ expansion into more areas, including schools, and to give their practitioners adequate salaries to reflect the difficult and round-the-clock work these skilled professionals are engaging in.   

The effectiveness of this model has been proven by organizations like BronxConnect, which I, Wendy, have the honor of leading. Since its inception, BronxConnect has understood the need for credible messengers to bridge the gap for youth in danger of incarceration or rearrest.

We have recruited staff and mentors from the community whose backgrounds mirror participants' life experiences. Over 25% of BronxConnect staff are incarceration survivors, which allows them to develop rapport with justice- and violence-impacted populations. Over 90% of youth in our alternative-to-detention programs have remained free from arrest and remand, while 97% of successful graduates of the alternative-to-incarceration (ATI) program were felony conviction-free for at least three years.

Over BronxConnect’s time as a funded Cure Violence provider, we have seen a 52% reduction in shootings and no homicides in our catchment area. Our work has shown that safety and justice are not two mutually-exclusive outcomes. We can achieve both. The answer to gun violence in our communities cannot just be more police. If we want to advance public safety in our communities then we need to invest in our youth and the programs that help them succeed, and we need to commit to addressing the root causes of violence.     

A budget is a moral document — it shows who and what we value. New York City, the greatest city in the world, needs a budget that reflects our investment in communities, small businesses, and the potential of all young people. This will produce true community safety. Everyone wants and deserves to live in a safe community.  

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Darren Mack is the Co-Director of Freedom Agenda and Co-Chair of the Youth SubCommittee of the Commission on Community Reinvestment and the Closure of Rikers. Reverend Wendy Calderon-Payne is the Executive Director of BronxConnect. Freedom Agenda and BronxConnect are among those leading the Campaign to Close Rikers. On Twitter @iamdarrenmack & @BronxConnect.

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New York Can Make History by Shutting Down the Puppy Mill Pipeline


Edie Falco, animal welfare advocates & NY lawmakers support Puppy Mill Pipeline Bill (ASPCA)


Last year, the ASPCA helped rescue over 500 dogs who were living in horrific conditions at multiple properties across Iowa that were operated by Daniel Gingerich, a USDA-licensed breeder. Despite documenting more than 200 violations of the federal Animal Welfare Act (AWA) at Gingerich’s properties – including dogs he allowed to die without being treated by a veterinarian, and dogs he failed to provide with adequate food and water, or to house them in safe and sanitary facilities – Gingerich continued to operate for months and likely bought and sold thousands of dogs during that time.

Based on documents filed with the state, more than one-third of New York’s puppy-selling pet stores – including stores in the Bronx, Queens, Brooklyn, Westchester, and Long Island – imported puppies from Gingerich to be sold to unsuspecting New Yorkers. 

Gingerich was licensed by the USDA in October 2019 to commercially breed dogs and sell puppies wholesale to pet stores across the U.S. and he is not the first to profit from this irreparably broken system. Thousands have gone before him, permitted to operate despite documented – and undocumented – violations of the law.

Why? Because the USDA does not provide meaningful oversight of breeders or any assurance that dogs whose safety and well-being rest under its authority are kept in humane conditions. Daniel Gingerich and scores of other commercial breeders continue to operate despite known chronic violations of the law showing the long-term suffering of animals in their care.

It is up to New York to do more to prevent this cruelty from flourishing within our state. Daniel Gingerich and others like him exist because the retail sale of puppies is still legal in many states – including ours – providing an outlet for puppy mills to continue selling dogs kept or raised in unspeakable conditions, far from the public eye.

The Puppy Mill Pipeline Bill (A.4283/S.1130) – legislation introduced by Senate Deputy Majority Leader Michael Gianaris of Queens and Assemblymember Linda Rosenthal of Manhattan – would stop these cruel businesses from profiting off New Yorkers by ending the retail sale of dogs, cats, and rabbits in pet stores across the state.

The pet industry would like you to believe that it’s unfair to restrict the handful of pet stores that still sell puppies, kittens, and rabbits from buying from “legal” licensed mills. But federal laws intended to protect these animals are so poorly enforced that a licensed facility can violate the law over and over again with virtually zero risk that the USDA will shut them down, so there is no way to assure New Yorkers that the puppies sold in stores were raised humanely.

Of the 1,000 pet businesses in New York State, fewer than 75 still sell puppies. Instead, the overwhelming majority of these stores sell food and other products, offering services such as grooming and boarding, or partnering with local shelters or rescues to host adoption events to drive consumers to their stores. The success of these businesses illustrates that stores can make money without capitalizing on cruelty.

With just a few days left before the New York State Legislature adjourns, time is running out to protect our state’s consumers, public health, and animal welfare. The Senate recently approved the Puppy Mill Pipeline Bill by a wide margin with strong bipartisan support, and we urge the Assembly to swiftly follow suit by passing this legislation to finally end the retail sale of puppies in pet stores.

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Bill Ketzer is senior director of government relations for the ASPCA. On Twitter @ASPCA.

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Lessons from the Frontlines of Successful Movement Building in 2022


A labor rally (photo: Kevin P. Coughlin/Office of the Governor)


Throughout the pandemic, our nation’s essential workers risked their lives and that of their families to fuel our economy and keep us safe. Yet, as they did so, they received inadequate pay and were often left out of the process of crafting policies supposedly intended to protect them. All the while, , and executive compensation skyrocket. It’s no wonder record numbers of workers are rising up, taking action, and demanding change. 

Every day we are inspired by stories of working people using organized bargaining power to establish true economic democracy. What we’ve witnessed from millions of workers is a recognition that if they want to achieve a better path, they can create change through collective actions and demand a seat at the table. No longer must they passively wait on politicians to change the laws or craft the perfect strategies. People are organizing, speaking out on their shared experiences and struggles, and despite the odds, winning basic protections and benefits in the workplace all across America in 2022, from Amazon to Starbucks to REI and The New York Times.

It is especially gratifying to see a whole new generation of women and workers of color and others for whom the COVID-19 era has been disproportionately painful leading the way. Undoubtedly, Black, Latino, and other workers of color bring a novel perspective to building worker power and what labor organizing could look like in the future. They’re also suggesting ways to evolve collective bargaining to match the needs of modern people — not only changing their wages and working conditions but also addressing discrimination and improving the health of our democracy. 

For far too long, America’s labor movement and workers’ rights have fallen victim to relentless attacks and successful divide-and-conquer strategies from corporations, right-wing politicians, and other powerful institutions, including the media, which have largely concealed what was happening. The result has been extreme income inequality, with Americans working longer hours than ever before in unsafe conditions and feeling little social mobility.

It’s no wonder working people are angry — they’re tired of waiting for a better future that may never arrive, especially after sacrificing so much during the pandemic over the past two years. Also noteworthy is that workers’ increased activism and high-profile victories come amid record-low unemployment and public support for labor unions, reaching 68%, the highest level in more than five decades. Not that any of this translates to corporations – like Amazon, Starbucks, Target, Google, and Apple – suddenly respecting workers’ rights to organize, negotiating in good faith, and improving working conditions. 

For as long as we can remember, institutions have trained working people and communities of color, in particular, to think we have no future to believe in, so why even try. The recently leaked U.S. Supreme Court draft opinion on abortion rights offers a glimpse into the future that our opposition has in store. Overturning Roe v. Wade would be the most egregious assault on women’s rights and equality, access to health care, and right to privacy in modern history – erasing decades of economic gains. Such a ruling would be especially devastating for poor and working-class women, a disproportionate number of whom are Black, Latino, and Asian.

This is not what democracy looks like.

After being bombarded for so long with so much bad news, it’s a wonder any of us get out of bed in the morning. But action is the oxygen that fuels social movements, and we descend from those who knew that “only when it’s dark enough can you see the stars.”

Amazon Labor Union leaders Chris Smalls, Michelle Valentin Nieves, and Angelika Maldonado didn’t just give up amid arrests and the onslaught of attacks from the company. They organized a union and won. Jennifer Bates, Isaiah Thomas,  and other bullied Amazon workers in Bessemer, Alabama – whose activism and bravery inspired so many others to take action – didn’t give up after the company undermined democracy in their union election. They came back and won more votes in a race that remains “too close to call.” The women leading the drive to successfully unionize Starbucks across the country (at 40 stores and counting) didn’t give up, and neither will we.

We urge elected officials and anyone else hand-wringing about the upcoming elections to follow workers’ lead, mobilizing like never before to protect our sacred freedoms up and down the ballot. Instead of succumbing to fear of a world where right-wing extremists control Congress and every statehouse and governorship in America, let’s put our energy toward creating a future where our democracy can thrive.

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Erica Smiley is Executive Director of Jobs With Justice. Micaela Fernandez Allen is Director of U.S. Advocacy, Open Society Foundation. On Twitter @SmileyJWJ and @MJFernandez2.

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Alarming Workforce Shortage Facing Youth Mental Health Care Workers


NYC Youth (photo: Michael Appleton/Mayoral Photography Office)


Many industries are struggling with their workforce since the pandemic, and the children’s mental health workforce is no different. Capacity and workforce retention have always been a challenge in the human services field, with providers expected to do more with less and families facing increasingly longer backlogs and wait times for appointments.  

Statistics show that 1 in 6 U.S. youth experience a mental health condition each year, but only half get treatment. In addition, 59.6% of youth with major depression do not receive any treatment. In the Bronx, where our organization does much of its work, the three top diagnoses for program participants ages 8 to 17 are attention deficit hyperactivity disorder (ADHD), depressive disorder, and disruptive/oppositional disorder. These three make up over 60% of the overall primary diagnoses for those youth in the borough.   

At Astor Services for Children & Families, over 50% of Bronx program participants identify as Hispanic. This means that besides the need for enhanced salaries to retain and attract competent staff, we also need to provide culturally and linguistically sensitive services.    

Agencies like ours are working miracles to recruit and retain talented employees but are having a tough time competing with city agencies like the Department of Education and for-profit competitors (some even located outside NY), that in some cases can offer twice the salary and benefits. Remote employment, COVID-19 health concerns and other unprecedented back-to-work factors are further complicating matters of employee retention and satisfaction. Astor and local agencies cannot compete at this level. 

To turn around this current trend in underemployment, public investments must be made. We also need to allow employers sustainable reimbursement rates to be able to compete with larger entities and providers.

Expanding funding and reimbursements for outpatient and school-based health clinics will enable us to reach more clients and families and allow us to partner with and integrate mental health within school buildings through a hybrid format (both in-person and tele-health) as needed by clients and staff. We must increase the rates for residential treatment facilities and raise tuition rates for non-public schools that serve children with disabilities to create parity within the industry and across sectors. 

Considering the underserved and underrepresented populations that we provide services to, Astor is seeking to expand and reinvest in its bilingual Spanish workforce that will enable the organization to hire Spanish-speaking clinicians and non-clinical staff, but also to provide the right professional development opportunities to our current staff so that we can create an internal language bank to provide the best service and support possible.  

I remain optimistic that with public awareness, we can secure increased funding to continue to further develop a multicultural mental health workforce that will provide the vital services for our most vulnerable children and families. It should be everyone’s imperative. 

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Yvette Bairan is CEO of Astor Services for Children & Families a nonprofit organization that provides children’s mental health services, child welfare services and early childhood development services in the Bronx and Hudson Valley, New York. On Twitter @AstorServices.

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It’s Time to Deliver Our Neighborhoods from Illegal Commercial Truck Parking


 

Illegal truck parking in Queens (photo: Daniel Sparrow, Council Member Linda Lee's office)


No matter where you look in Eastern Queens, it seems like there’s a commercial truck illegally parked. Whether it’s along a highway or in a quiet residential neighborhood, these four-ton vehicles are hard to miss. Now, it seems like this long-standing problem is reaching a crisis level citywide. Fines and enforcement alone won’t solve this problem -- we need a comprehensive solution that involves government agencies, elected officials, and the private sector to solve this problem for the long-term.

Around 90% of the goods shipped within New York City are carried by truck. Nearly 9 million New Yorkers rely on these trucks and their drivers for our food, medicine, building materials, and just about everything else that makes our daily life possible. On top of servicing New Yorkers’ needs, trucks also support JFK and LaGuardia airports, two of the busiest in the country and both located in Queens, as well as the Port of New York and New Jersey, the third busiest in the country.

As a result, trucks transport approximately 890,000 tons of freight within New York City each day, with many trucks requiring a berth in which to park each night. That number is expected to grow by nearly 70% by 2045, a trend driven by the rise of e-commerce and home delivery that has only increased during the pandemic.

While trucking across New York City has increased dramatically and will only continue to do so for the foreseeable future, the infrastructure to support these fleets has not kept pace. Currently, there are only two commercial truck parking lots in Queens, at JFK and in Long Island City, both of which are usually at capacity and maintain waitlists for truckers looking for a spot to park. Despite the expected continued rise in commercial trucking in the city, there are no current plans to create new space to park these trucks.

It’s also important to note that truckers have little choice about when to park. Federal regulations limit the number of hours a trucker can drive per day, and they must pull off the road when they hit their hours. Mandatory rests can come in the middle of a shift, or just before reaching the drop-off or pickup point at one of the shipping hubs across the city. As a result, without adequate parking facilities in which to rest, drivers are forced to pull to the side of the road to park overnight, resulting in illegal parking in residential neighborhoods.

The result is a hazard to our neighborhoods, a problem Queens residents are familiar with. Illegal truck parking is more than just an eyesore -- by limiting residential street and highway space, it increases congestion, in turn causing longer travel times, more pollution, and more accidents. Parked trucks contribute to littering and illegal dumping and impair visibility for drivers and pedestrians at intersections. The same neighborhoods where trucks often park lack adequate transportation options and therefore residents primarily use cars to get around. Working-class families in Queens rely on street parking to get to school and work, but often those spots are taken up by trucks parked illegally.

As much as New Yorkers rely on trucks for our daily lives, we’ve also collectively decided that this type of behavior is unacceptable. The New York City Department of Transportation posts “no overnight parking” signs in areas with frequent illegal truck parking, but this limits parking available to neighborhood residents. While the NYPD tickets and cites illegally parked trucks, truckers without anywhere else to park treat these tickets as the cost of doing business.

Senator Leroy Comrie and Assembly Members Clyde Vanel and Alicia Hyndman have authored bills in the New York State Legislature to stiffen penalties for trucks left unattended, and we call for passage of legislation to combat this issue by the end of the state’s legislative session next month.

But this legislation alone won’t fully address the issue until we can offer truckers somewhere else to park besides our neighborhoods. Without that parking, shippers will continue to treat these fines as the cost of doing business, and ultimately pass those costs along to consumers. At a time when inflation is being keenly felt by ordinary New Yorkers, we can’t pretend that an enforcement-only approach doesn’t come with costs.

We cannot approach this problem piecemeal, we need sustainable solutions that address the root cause of the illegal parking problem: the constrained supply of commercial parking. Government and the private sector must work together to develop space that will allow truckers a safe and reliable place to pull over when they have met their maximum hours without causing havoc in residential neighborhoods.

The city Department of Transportation’s Freight Mobility Unit must take the lead in identifying the most commonly used corridors for freight trucks across the city and potential nearby lots that can be used for parking. The city’s Economic Development Corporation can lease city-owned land to a private or not-for-profit entity to develop commercial lots and manage them on behalf of the city. These steps will not only get the trucks off our neighborhood streets, but also generate revenue for the city.

We must also pass state legislation (S3258 and S3259) to raise the fines on illegally parked commercial trucks to provide a real deterrent against continued bad behavior, not the current slap on the wrist that is being ignored. The NYPD must commit to robust enforcement and ticketing, including towing these trucks when necessary to penalize repeat offenders.

The private sector also stands to benefit. For instance, numerous big-box retailers across the city should consider renting out their massive parking lots that sit empty and unused after their stores close each night. Trucking companies would jump at the opportunity to pay for these spots, providing a much-needed shot in the arm to an important economic sector that has struggled greatly in recent years.

The economic trends are clear -- commercial trucks are only going to proliferate across the city in the coming years. Rather than fight against the same drivers and companies that facilitate our daily lives, we must work with them to create the infrastructure they need to avoid negatively impacting our communities.

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City Council Members Linda Lee and Nantasha Williams co-chair the Queens Delegation of the New York City Council, representing Districts 23 and 27 respectively. Council Member Selvena Brooks-Powers chairs the Committee on Transportation and Infrastructure and serves as the Majority Whip to the Council. On Twitter @CMLindaLee & @CMNantashaW & @CMBrooksPowers.

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Winning the Public Health Recovery from Covid


Mayor Adams visits health care workers (photo: Michael Appleton/Mayoral Photography Office)


In its battle against COVID-19, New York City, even under a notably disorganized mayor, arrived at an impressive level of health organization. As may be recalled, Mayor de Blasio switched the lead role in the covid fight to Health + Hospitals, the city’s public hospital system, from the Department of Health and Mental Hygiene (DOHMH), which retained major responsibilities but not its usual lead position in epidemics. It is to the credit of both agencies that, under this forced and rather resented bureaucratic marriage, they managed to develop a level of cooperation that saw the city, for one thing, consistently attain the highest COVID-19 testing rate of any large U.S. city.

 But, beyond that, something else happened. For the first time, the city funded an extensive network of community organizations coordinated in a singular mission — fighting a horrible infectious epidemic. Outreach workers and health educators from these organizations were constantly in the streets when almost no one else would be, promoting COVID-19 testing, prevention, masks, proper quarantine, and, of course, vaccination.

 The community-based organizations (CBOs) also formed a Community Advisory Board providing constant insight to refine city covid programming. Today in New York City, which had the nation’s highest COVID-19 death rate in the first surge, 87% of adults have received at least one vaccination shot, with 78% fully vaccinated, the highest rate of any big U.S. city.

 It is time to use this unprecedented health infrastructure to immediately address our other health crises, especially diabetes and the chronic diseases that fuel both COVID-19 and the city’s disturbing levels of preventable ill health.

 New York City is very, very sick.

Between chronic disease, uncountable cases of long covid, and the increasing evidence that those who had covid are at elevated risk for diabetes, the city faces staggering levels of illness. To forestall this disaster, New York must widely assure that thousands of people in neighborhoods overwhelmed by chronic diseases directly learn chronic disease prevention and self-care. With its COVID-19 infrastructure, the city absolutely already has the necessary vehicle to move forward. The neighborhoods and the Black, Latino, and low-income populations most devastated by COVID-19 are, tragically, the neighborhoods also most devastated by chronic disease.

 Yet, the city seems to be letting its COVID-19 infrastructure collapse. Instead of starting to deliver proven health-building services, the first group of some 35 CBOs that the city partnered with to fight covid will be defunded by the city in a few months. In losing these CBOs, the city loses their neighborhood staffs of community health workers, outreach teams, and peer educators — people uniquely able to engage very distressed communities in trying to rebuild health.

For an example of the kind of effective health education these groups could provide, consider the following. A few years ago, with special federal funding, Health People instituted a four-week training course to prepare local Bronx people with diabetes and pre-diabetes to deliver the Diabetes Self-Management Program (DSMP). This six-session course reduces blood sugar -- immediately reducing vulnerability to the worst covid outcomes -- as well as overall complications, and the high rates of co-morbid depression seen in diabetes. It also slashes emergency room visits by 40% or more -- an extraordinary benefit.

The peer educators fanned out to dozens of community sites -- churches, homeless shelters, mental health programs, public housing -- and enrolled almost 2,000 Medicaid recipients with Type 2 diabetes in the DSMP. This was evidently the largest community mobilization for diabetes self-management ever to occur in the United States. And it was defunded just as covid struck and preyed upon those with underlying chronic conditions.

By contrast to its impressive fight against covid, the city has long failed to make any credible effort to control chronic disease. In a city that had a staggering 356% increase in diabetes deaths in the first covid surge, DOHMH doesn’t now -- and never has -- supported a single DSMP group where those with Type 2 diabetes could learn better self-management.

And it’s not just specific diseases. For example, with that same now-ended federal funding, Public Health Solutions worked with NYC Health + Hospitals to form community networks that included 275 diverse community-based partners, which helped 16,000 H+H patients, mainly those just discharged, linking them to vital services -- such as programs to provide nutritious food. This generated approximately $1.4 million in health-care savings through the improved well-being even of very sick people.

If DOHMH and H+H don’t use their large shares of the city’s billions in federal emergency funds to support and coordinate the many health-building services that the CBOs who worked on covid can so clearly provide, New York will have largely won the fight against COVID-19 only to totally and tragically lose the recovery.

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Chris Norwood is Executive Director of Health People. Lisa David is President of Public Health Solutions. On Twitter @HealthPeopleOrg & @wearephsny.

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The Question Isn’t Whether Antonio Delgado is Latino, It’s Whether He’ll Stand Up For Our Community


Antonio Delgado (photo: Mike Groll/Office of Governor Kathy Hochul)


The recent appointment of new Lieutenant Governor Antonio Delgado was marred by a debate about his ethnicity – specifically, whether he is Latino. 

The debate about Mr. Delgado’s ethnicity misses the point. The question that Latino New Yorkers should be asking is not whether he is Latino. As his opponent in the June primary and a Latina myself, if that’s how he identifies himself, I’ll take him at his word.

The more important question is: will he stand up for Latino New Yorkers in office? Sadly, on that question, his record is mixed.

As a member of Congress, Delgado has repeatedly been on the wrong side of key issues affecting Latino and immigrant communities.

Let’s start with immigration. In 2019, when the Trump administration was terrorizing immigrant communities across the country, Rep. Delgado sided with Trump and Congressional Republicans to dramatically increase funding for the same Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) that were tearing children from their parents’ arms at the border and terrorizing immigrants nationwide. Shockingly, the bill also allocated funds to the Pentagon to support troops that Trump sent to the southern border.

The Congressional Hispanic Caucus called the bill “a betrayal of our American values,” and 102 Democrats, including New York Reps. Velazquez, Espaillat, and Ocasio-Cortez, voted no. Many other Latino leaders like me also expressed vocal opposition. Delgado voted yes.

On other key Congressional fights for Latino communities, Delgado was completely absent. Latinos all too often lack access to affordable, quality health care–in fact, we are three times as likely to be uninsured as our white counterparts. We thus stand to gain enormously from a universal health care system. But Delgado refused to co-sponsor Medicare for All legislation.

Latino communities are also often at the front lines of the climate crisis, and we need bold solutions to transition to a clean and renewable energy economy, create jobs, and ensure a just transition. But Delgado refused to co-sponsor the Green New Deal.

His record has also been weak on other issues specific to New York’s Latino communities. Earlier this year, Delgado penned a letter to the Governor opposing giving farmworkers access to overtime pay after 40 hours of work. These workers are largely Latino immigrants and have done back-breaking work before and during the pandemic. They deserve the same wages and protections as anyone else. 

Meanwhile, while he was writing his own letter to prevent these essential workers from getting overtime pay, he was refusing to sign on to a letter signed by 11 of his congressional colleagues to expand tenant protections and prevent evictions without good cause across the state. Ensuring these protections is a crucial issue for Latino and immigrant tenants who pay enormous rent burdens, often for substandard housing, and have been decimated by displacement from their homes.

All of these positions are worrying enough on their own. But they’re made worse by the fact that Delgado has joined a ticket with Governor Hochul, who herself has a history of anti-immigrant positions. The Governor first rose to prominence as a county clerk demagoguing against immigrants and opposing the restoration of access to drivers’ licenses to undocumented immigrants as county clerk. She didn’t just oppose the measure – she threatened to have undocumented immigrant applicants arrested and put at risk of deportation.  

While Hochul eventually changed her position as lieutenant governor, just this year she led the effort to callously exclude undocumented immigrant children from the expansion of access to childcare in the state budget, while opposing replenishing a fund for excluded workers and blocking legislative efforts to pass Coverage for All, which would have ensured health coverage to low-income New Yorkers regardless of immigration status.

Particularly with a Governor who has proven apathetic at best, and hostile at worst, to the needs of Latino and immigrant New Yorkers, we need a Lieutenant Governor who will be an independent voice of accountability. When the Governor is proving unresponsive to the needs of Latino New Yorkers, we need a Lieutenant Governor who will stand up to her and secure better outcomes, instead of providing cover from policies that continue to exclude our communities. Mr. Delgado’s record leaves little grounds for optimism. 

What does give me hope is that Latino and immigrant New Yorkers are organizing all over the state, and partnering with visionary legislators to win historic victories, like the $2.1 billion Excluded Workers Fund they won last year. Our communities deserve better and will continue to demand better. Our eyes are on the prize of a more just society, not representation in name only. 

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Ana María Archila is a Democratic candidate for Lieutenant Governor of New York. On Twitter @anamariaforny.

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Judicial Selection is Crucial at Every Level


Courtroom (photo: Governor's Office)


As early as primary school, we are taught about the United States Constitution’s system of checks and balances, and that the judicial branch was created to temper the actions of the executive and legislative branches of government. We learn about the importance of an independent judiciary, but beyond that, the vast majority of us don't think about the role and function of judges unless we find ourselves involved in a court case. We need to be more keenly aware, nationally and at home, of the tremendous power the judiciary and judicial selection have in most facets of our everyday lives.

With the leak of the draft majority decision in Dobbs v. Jackson Women's Health Organization written by Justice Samuel Alito, the Supreme Court is suddenly under intense public scrutiny. Dobbs is only the latest development that highlights the immense repercussions of a partisan Supreme Court, and the dire consequences of elections. In Alito’s view, the right to an abortion is not “deeply rooted” in our nation’s history. He writes for the majority that, “Until the latter part of the 20th century, such a right was entirely unknown in American law.”

Perhaps that’s true, but it’s disingenuous and reverses the women’s rights revolution that began in the mid-nineteenth century with the fight for the right to vote. Fifty-three years after the constitutional amendment granting women the right to vote, in Roe, the Supreme Court recognized women’s bodily autonomy — a relatively compact timeline for the enshrinement in law of the rights of a marginalized population. It also proves how potent “deeply rooted” constitutional liberties are when applied to all. The draft majority in Dobbs discards the court’s procedural norms by flouting abortion jurisprudence and the principles of stare decisis. Roe is settled law for 50 years — an independent, non-partisan judiciary would heed precedent. The leaked decision is a wholesale (not even incremental) rejection of precedent.

Here in our home state of New York, the judiciary’s recent decision that this year’s primary elections would be bifurcated and held on two separate dates due to challenges to the redistricting process is also being treated with skepticism.

Primaries for Congressional and New York State Senate offices will be held in August and primaries for all judicial and other offices will be held in June. There is some irony in the fact that despite this irregular electoral schedule being brought about by the judiciary, highly impactful judicial races were by and large left out of the primary date discussions and legal battles, which focused primarily on races for Governor, Congress, State Senate, and State Assembly. The primary bifurcation raises serious questions about what impact the Court’s decision will have on voter turnout, which is already often below 20% during primaries.  

Putting aside whether the judges were correct in bifurcating the New York primary, the public’s immediate mistrust of the process has larger implications. For example, the fact that the public generally doesn't understand the process by which people become judges does not engender deference and trust in the judiciary. Recently, while petitioning over five weeks for signatures to get on the June Democratic primary ballot for Surrogate's Court judge, many people skeptically asked me why there’s rarely a choice in judicial candidates when they vote.

Part of the problem is that judicial candidates get on the ballot through a process that is little known and poorly understood by most people, even voters who are otherwise quite well-informed. 

Judicial candidates for Surrogate's Court like myself need signatures (4,000) from registered Democrats to appear on the primary ballot. Surrogate’s Court, also known as probate court, oversees wills and estates, as well as the appointment of fiduciaries, guardianships, and adoptions. Judicial candidates for Civil Court positions also need signatures (1,500) to appear on the primary ballot.   

For Supreme Court judges, the Constitution of the State of New York created an alternate method to the petitioning process. In place of a primary election, "judicial delegates" (an elected position), vote at a judicial nominating convention for the Democratic Party candidates who will appear on the general election ballot.  

Both the Democratic primary winners and the “nominated” Supreme Court candidates generally aren’t challenged by other party candidates in the general election and that’s why there’s rarely more than one “choice” on the printed ballot. 

Voters need more information about how people become judges and about the candidates themselves. Exacerbating the perceived lack of choice and imposed apathy, even during a contested primary, voters don’t know where to find information about judicial candidates. The New York State Bar Association and The New York State Board of Elections should collaborate on means and methods of disseminating information to the general public about judicial candidates well in advance of elections.

As things stand now, the impression some have about how people become judges in New York is that it's largely dependent on who you know and how much money you have to finance your candidacy. That's not good enough. We need a judiciary that represents our entire expansive mosaic. 

Now more than ever, we must guard against the appearance of backroom deals and patronage in the judiciary and promote impartiality. Lawyers, judges, legal, civic, and community groups all have a role to play in demystifying the judicial electoral and appointment processes and in advocating for the necessary reforms to restore people’s faith in the judiciary‘s independence and, by extension, the rule of law.  

As Roe illustrates, voter participation lies at the very heart of constitutional progress and the full realization of our deeply rooted rights.

***
Elba Rose Galvan is a Surrogate's Court Referee in King's County and candidate for Manhattan Surrogate. She served under Surrogate Margarita Lopes Torrez, and currently serves under Surrogate Rosemarie Montalbano, both considered reformers of the court.

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For the Sake of Voter Turnout and Trust, New York Must Merge the Primaries


Voters at the polls (photo: Michael Appleton/Mayoral Photography Office)


Due to the ongoing challenges to New York's redistricting maps approved by Democratic lawmakers earlier this year, New York voters may be required to vote in two separate primary elections this year, one in June and another in August.

Issues with the new Congressional and State Senate district maps have thrown our upcoming party primaries into disarray and could run the risk of reducing voter turnout statewide. To preserve voter turnout and spare confusion, the Legislature should vote to merge and hold all primaries on August 23.

A state judge set August 23 as primary day for the U.S. House and State Senate party primary elections after the New York Court of Appeals rejected the newly-drawn districts for those chambers as unconstitutional. Primaries for statewide offices like Governor and Lieutenant Governor and for State Assembly remain set for June 28. This is a potentially costly and confusing development for voters and must be addressed rapidly.

In 2018, New York State ended its two primary system, where voters used to vote in federal primaries in June and state primaries in September. New York’s divided primaries caused the state to spend many millions of dollars more while suppressing voter interest. The federal government requested the change to a single primary to provide enough time for military and overseas voters to get absentee ballots for the general election.

Holding a separate primary is costly, given the logistics of running a statewide election. According to the New York State Board of Elections, statewide primaries will cost as much as $30 million, covering ballots, election day materials, inspector pay, poll site rentals, moving costs for voting machines, staff, and mailings. Some lawmakers have called for additional funding for local elections boards to help pay for the two separate votes, which would include not only the two primary days, but the mandatory early voting periods ahead of each.

Consolidating the 2022 primary elections would minimize the impact of the Court’s ruling on voters, candidates, and election officials and provide some stability to the current election cycle. Changing the political calendar requires swift legislative action due to legal deadlines and administrative constraints.

Not voting to consolidate the primaries is wasteful, expensive, and only leads to confusion and lower voter turnout. Historically, the two separate dates caused some hesitancy in voters’ minds about when to vote. While the August date is not ideal given the likelihood of summer vacations, it has been established by the court, and cannot be moved. The June primary can be shifted, and for the sake of all voters, should be.

To reduce voter confusion and maximize turnout, the Legislature should refer to historical precedent and vote to merge the elections for this year, unifying the primaries in August. This would provide the summer to prepare absentee ballots and give some time for a lot of voter outreach and education.

The Legislature should prioritize legislation that unifies the primaries for this cycle in the next few days, providing ample opportunity for voter engagement and familiarity to ensure a sizable turnout at the polls. We must reduce confusion and rebuild trust among voters who may feel disenfranchised, confused, or upset about how redistricting has gone and the issues with the shifting primaries. Elected leaders should provide one date that guarantees New Yorkers will vote in all races on the ballot this year where there are primaries.

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Christian Amato is an organizer and Democratic candidate for State Senate in New York’s 36th District. On Twitter @amatoforny.

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We’re Assembly Members, Healthcare Experts, Women of Color, Mothers, and Fed Up: It’s Time to Pass the New York Health Act


"Healthcare is a right" (photo: Ed Reed/Mayoral Photography Office)


The fact is, New York’s profit-driven health-care system continues to fail marginalized communities like those we represent in the State Legislature. As a matter of racial and gender justice, we must finally pass single-payer health care this state legislative session.

Before we were elected to office, we each worked in or around New York’s health-care system – Assemblymember Reyes as an oncology nurse, Assemblymember Forrest as a maternal-child health nurse, and Assemblymember González-Rojas as a reproductive healthcare advocate.

Through our work and our own lived experiences as Afro-Latina, Black, and Latina women, we’ve seen firsthand how our health-care system reproduces racial and gender inequities in our beloved New York.

Our city and state are now more than two years into a pandemic that has disproportionately affected the Black, Latino, immigrant, and low-income communities we represent and brought our already broken health-care system to its knees. As representatives of districts in the Bronx, Brooklyn, and Queens, we have a mandate to fight for the health and wellbeing of the constituents who elected us, and we know that what’s good for them is also good for millions of other New Yorkers. It’s time that we and our colleagues in the Legislature pass, and the Governor signs, the New York Health Act. 

It’s been nearly 31 years since our colleague in the Assembly, Richard Gottfried, first introduced the New York Health Act. Yes, you read that correctly – 31 years. The bill has had several iterations since then, but its core tenets remain the same: the New York Health Act would “create a universal single-payer health plan – New York Health – to provide comprehensive health coverage for all New Yorkers.”

The New York Health Plan would replace existing private insurance plans for every single worker and resident and include all benefits covered by Medicare, Medicaid, Child Health Plus, and those mandated by the Affordable Care Act. With universal single-payer, New Yorkers would no longer have to rely on family members or employers, pay exorbitant monthly premiums, or forgo coverage altogether. While the plan would require the state to impose two new progressively graduated taxes, research shows that New Yorkers would still pay significantly less overall for health care under the New York Health Act than they do now. 

Decoupling health insurance coverage from employment and reducing health-care costs would have dramatic positive impacts on the Black, Latino, immigrant, women, and low-income New Yorkers we represent. We know that over the last two years, Black and Latino people have experienced higher rates of unemployment for longer periods. According to a 2021 Community Service Society of New York report, 22% percent of low-income New Yorkers who lost employment income since the first wave of COVID-19 also lost health insurance coverage. Among that 22%, over half were Latino.

We know that women and marginalized genders have disproportionately left the workforce altogether to provide childcare for their families where the state has failed to do so, losing employer coverage as a result. Undocumented New Yorkers still don’t have access to Medicaid, as Coverage for All was excluded in our recent state budget. Lack of coverage, inadequate coverage, gaps in coverage, and health-care costs are some of the greatest barriers to accessing care for communities of color. The New York Health Act would all but remove those barriers.  

In addition to reducing costs for vulnerable families and ensuring every New Yorker can access comprehensive health care no matter their circumstance or status, the New York Health Act would help improve the quality of care New Yorkers receive overall. By reducing costs and leveling the coverage playing field, our safety net hospitals would no longer be overburdened by New Yorkers who have nowhere else to go. Safety net hospitals in each one of our districts, which all serve predominantly Black and Latino members of our communities, were at the frontline of the pandemic. They’re also the most under-resourced, thanks to years of inequitable distribution of Medicaid funding.

Our profit-driven healthcare system has pushed New York’s entire hospital system and the providers who work within it, to the brink. Without adequate funding, data show that hospital quality of care declines. This has had devastating consequences, not only for the Black New Yorkers who were twice as likely to be hospitalized with the recent Omicron variant than their white counterparts, but for all the birthing people in our communities who rely on hospitals for pregnancy and postpartum care. In the last two years, at least three Black women, one from each of the boroughs we represent, have died from preventable causes during hospital childbirth or shortly thereafter.

Single-payer, universal health care would give the nurses, midwives, home-care workers, and other health-care providers power to bargain for fairer wages and safer working conditions, and allow providers to focus on patient care, not costs. It would also allow us to define what comprehensive coverage looks like and expand the scope of reproductive and LGBTQ health care, both of which are under attack across the country.

The New York Health Act has already passed the Assembly four times. We finally have majority support for the bill in both houses of the Legislature after years of advocacy and securing a Democratic majority in the State Senate. This is the year to get it done.

We’re sick and tired of having had to work with a fractured Legislature and an uncooperative Executive that stopped us from delivering reform for years while our constituents suffered. We’re sick and tired of all the talk about leading on progressive causes without real progressive action. We’re sick and tired of trying to tinker around the edges to reform a health-care system that is fundamentally unjust and perpetuates the same gender and racial inequities we were elected to address. We’re fed up. We need the New York Health Act now. 

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Assemblymember Jessica González-Rojas is the first Latina Assemblymember to represent Assembly District 34, which encompasses sections of Woodside, Jackson Heights, East Elmhurst, and Corona, Queens. Before running for office, she served as Executive Director of the National Latina Institute of Reproductive Health, where she fought for policies to expand access to reproductive and sexual healthcare for Latina/x communities, including in New York. 

Assemblymember Karines Reyes, R.N., represents the 87th Assembly District in the Bronx, which includes the neighborhoods of Castle Hill, Parkchester, Van Nest, and West Farms. She serves as a per diem registered nurse in oncology at Montefiore Medical Center. In 2020, she notably returned to nursing during the peak of the COVID-19 pandemic.

Assemblymember Phara Souffrant Forrest, R.N., represents the 57th Assembly District, which consists of the neighborhoods of Fort Greene and Clinton Hill as well as parts of Bed-Stuy, Prospect Heights and Crown Heights. Prior to her election, she worked as a maternal health nurse and organized tenants in the neighborhoods she now represents.

On Twitter @votejgr, @KarinesReyes87, and @phara4assembly.

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