The Health Care in New York City Program seeks to reduce the number of uninsured city residents and improve access to needed health care services. By producing independent information and generating ideas on improving health coverage and delivery in its home city, the program helps local leaders make informed decisions in a rapidly changing health care environment and tests strategies that could be replicated nationally. In December 2002, The Commonwealth Fund received a certificate of appreciation from Mayor Michael Bloomberg in recognition of the Fund's contributions to the city's successful effort to enroll more than 106,000 New Yorkers in health insurance.
The dual impact of a weak economy and continued health care inflation has posed unique challenges in meeting the health coverage needs of New York City residents. More than a quarter of New Yorkers under age 65 were uninsured in 2001, well above state and national rates, and policy analysts predict further growth in uninsured rates in New York City. A Fund-sponsored survey of employers in the city and state found that most firms intend to cut back health benefits and pass on more costs to their workers in the future. If firms carry out those plans, three-fourths of New York employees with job-based benefits will see their insurance deteriorate and their health care costs increase.
The survey report,
(41) by Heidi Whitmore and colleagues at the Health Research and Educational Trust and the Fund, also emphasized that low-wage and small business workers in New York are especially likely to lack health insurance. Only two in five firms employing low-wage workers in New York State offer health insurance to their employees, compared with over half of comparable firms nationally. And when low-wage workers receive employer coverage, they are more likely to experience long waiting periods, pay higher premium costs, and get less generous benefit packages than their counterparts in other businesses.
The Fund's New York City program is exploring ways to make private coverage more affordable and appealing to small firms. Stephen Rosenberg, M.D., has been evaluating a purchasing alliance called HealthPass that enables small firms in New York City and its suburbs to offer a choice of several health plans within a defined contribution model. His work
(42) indicates that the program's basic structure, management team, and interaction with the broker community have been key factors in its success. On track to achieve self sufficiency by 2005, HealthPass has great potential to move beyond the demonstration phase and serve as a useful model for programs elsewhere.
For New York's low-income seniors, Medicaid and EPIC, the state-funded pharmacy assistance program, play a crucial role in providing supplemental coverage for needed medications. Together, the two public programs reach a substantial share of the 2.4 million seniors in New York. Even so, a survey sponsored by the Fund and the Henry J. Kaiser Family Foundation found that nearly one-fifth of New York seniors had no coverage for medications in 2001. According to the survey report,
(43) prepared by David Sandman and colleagues at the Fund and Dana Gelb Safran at Tufts-New England Medical Center, lack of prescription drug coverage places seniors' health and financial security in jeopardy. One-third of seniors without drug coverage reported that they skipped doses of their medications or did not fill a prescription due to cost concerns. Likewise, over one-third of seniors without drug coverage spent $100 or more per month on their medications - twice the rate of those with coverage. The threat of rising drug costs could force more seniors to forgo potentially life-saving medications or deplete retirement savings.
