The U.S. Congress returned last week to try to wrap up its work before the newly elected Congress is sworn in next month.  This return – known as the “lame-duck” session – has important topics on its to-do list.  Among the most critical items is to try to agree on funding for the federal government – at least through the winter – providing more disaster aid, approving a defense policy bill, confirming judges, and hopefully, taking on some important health care measures.

The term “lame-duck” session of Congress refers to the period when the Congress meets after its successor is elected, but before the successor’s term begins.  And that period is now.

The most important action for the lame-duck is for Congress to approve continued government funding, since lawmakers only have until December 20^th before the existing funding runs out.  Passing a budget was not the first item to be tackled, however.  The U.S. Senate leadership agreed to a deal to allow confirmation of some of President Biden’s judicial nominees.  

Top issues are replenishing the Federal Emergency Management Agency’s disaster relief fund and agreeing on funding of the defense department, with other potential topics including measures that impact health policy.

While it remains to be seen how much legislative activity occurs during the lame-duck, one of the possibilities is a measure known as “site neutral” health care payments. 

Last month, nearly 60 organizations joined the call to urge Congress to pass legislation that would require that hospital and non-hospital Medicare pricing be the same.  

Here is the background:  The amount charged for medical procedures or services can depend as much on where they are performed as on the type of procedure or service provided.  All else being equal, a procedure in a hospital is much more expensive than that same procedure done in a freestanding facility like a physician’s office or a clinic. The higher cost is meant to support a hospital’s more complex infrastructure, staffing and other expenses. 

However, these higher prices are being charged for services provided at non-hospital locations, which often operate at less expense.  That’s in large part because hospitals are buying up private practices, clinics, imaging centers and labs, using them effectively as a “cash cow” to charge more.   Once acquired, these facilities often begin using the hospital billing code to charge hospital prices for services that were previously less expensive.  When acquired by a hospital, physician practices charge about 14 percent more than when they were independent. That means patients and insurers begin to pay more for the same service. The only difference is that the non-hospital facility is owned by a hospital and begins to use the hospital billing code. And over half of physicians now work for hospitals and health systems. 

As a result, patients, Medicare, and employer-based insurance companies are paying much higher prices for care than they otherwise would.  For example, Medicare pays twice as much for procedures done in hospital-owned facilities as they would in independent physician’s offices. Don’t forget that for many patients, high deductibles and co-insurance policies mean that they may face a financial hit as well. 

The “site neutral” legislation that would be considered in the lame-duck requires that Medicare procedures and services are delivered at the same price regardless of the location, whether it’s a hospital, doctor’s office, imaging center or clinic.  This would save significant money for consumers, employers and taxpayers.  Decreased Medicare spending as a result of “site neutral” policies could save taxpayers $150 billion.

Those savings drove the House of Representatives to approve legislation that contained a “site neutral” provision.  In the U.S. Senate, Republican Senator Cassidy and Democratic Senator Hassan have released a legislative framework for “site neutral” payment policy.  Their proposal could be the vehicle for action during the lame-duck.

Of course, whatever happens during the lame-duck will have to be the product of bipartisan compromise.  Given the existing narrow Democratic Senate majority, which is soon to be replaced by a Republican one, the parties will have to agree to get anything done at all.

Yet, the bipartisan nature of the Cassidy/Hassan plan, coupled with the apparent support in the House, indicates “site neutral” legislation has a chance.  The prospects for success hinge on whether it’s a priority of current Senate Majority Leader Schumer.  Here’s hoping he’s able to get it done.

Americans are hearing about how states can change their laws to insulate themselves from actions expected from the incoming Trump Administration and the new Congress. New Yorkers hear the same. Policies impacting the environment will be a key battleground.

Of course, no one really knows what will happen when the new Administration and the new Congress convene next month, but it is expected that programs that protect the environment will be under a great deal of stress, if not on the chopping block. In the meantime, what can states do?

Here in New York, the state will soon approve new regulations to protect the environment – rules designed to protect wetlands.

The rules are the product of legislation approved in the 2022 New York State budget. The 2022 agreement amended the New York State Freshwater Wetlands Act. Prior to the changes, the state’s wetlands had to be included on official state maps before they could be protected by the Department of Environmental Conservation (DEC). However, those maps were not updated on an ongoing basis, which allowed for the filling, dredging, draining of and building upon many unmapped wetlands. 

The amendments to the Freshwater Wetlands Act eliminated this requirement and will allow DEC to require permits for activities that impact wetlands larger than 12.4 acres beginning in 2025, and then wetlands that are larger than 7.4 acres in 2028. Wetlands are of tremendous importance, providing myriad, significant benefits, such as reducing flooding, providing critical habitat for wildlife, sequestering carbon, increasing climate resilience, and maintaining clean drinking water. 

The law also protects smaller wetlands of “unusual importance,” defined to mean changes over wetlands that are, among other things, located in a watershed that has experienced significant flooding in the past, is expected to face significant flooding due to climate change, or contains the habitat of an endangered or threatened species.

The rationale for state protection of wetlands, which include swamps, marshes, bogs, fens, and wet clay meadows, is that these areas provide critical ecosystem services for communities across the state. Wetlands protect drinking water by naturally filtering out heavy metals, toxic contaminants, and other pollutants.  Additionally, wetlands offer flood protection, with one million gallons of water being stored for every one acre of wetland, while also mitigating shoreline erosion.

Wetlands act like sponges; slowing down and soaking up water that might otherwise cause devastating floods. Wetlands also hold water in place until drier conditions prevail and then release it downstream. In this way, they protect not just against floods but against drought, too. Wetlands are also “carbon sinks”; they hold carbon dioxide thereby reducing the amount of heat-trapping pollution in the air.

According to the U.S. Environmental Protection Agency, over 60 percent of New York’s wetlands have been lost due to human development. In recent years, pressures have significantly increased from sprawling human development, the proliferation of invasive species, extreme weather, and continued threats from pollution. With weaknesses in existing federal freshwater wetlands protections, it is up to states to protect these critical resources before more wetlands are lost. Given the Trump Administration’s previous record of weakening wetlands protections, the prudent thing is to expect more of the same in the new one.

That’s where the new state law and its implementation matter.

Estimates are that the new law, once implemented, will be the equivalent of adding one million acres of wetland under the state’s protection. But before the new law goes into effect, the DEC must allow public comment and then finalize regulations to implement it. The state’s public comment period for the wetlands regulations closed on September 19, 2024. Opponents, including those who like to develop wetlands, are pushing to weaken the regulations. Environmentalists, on the other hand, are arguing that the proposed regulations are not strong enough. Protecting wetlands – particularly in an era of climate change – is of critical importance.

It’s now up to the DEC to decide how these regulations turn out. There’s an enormous amount at stake. Getting the regulations right will help bolster the resiliency of wetlands and will help to curb the worst impacts of climate change.

Wetlands provide a wide range of important benefits for humans and wildlife. Wetlands serve as natural filters and sponges, purifying surface waters and recharging groundwater supplies. Yet, wetlands are disappearing at an alarming rate, due to development pressures. The loss of wetlands not only destroys important habitat for plants and wildlife, but it also jeopardizes water quality and removes natural flood controls. The destruction of wetlands puts human health and property at risk.

When it comes to protecting the state’s wetlands, the DEC should do all it can to ensure that those areas are protected for decades to come.

Last year, much of New York choked on the smoke from massive Canadian wildfires, at one point turning New York City’s air orange, giving City residents—temporarily—the worst air quality in the world.

This past month, New Yorkers again experienced smoke from wildfires, but this time the fires were closer to home.

The ongoing dry conditions since August created fire-danger conditions in the region to develop and persist, according to the U.S. Drought Monitor. The worst drought conditions have been in large parts of Massachusetts, New York, New Jersey, Pennsylvania, Vermont, and West Virginia.

The first half of November was among the 20 driest such periods on record. Temperatures were also warmer than normal, with streamflow, groundwater levels, and soil moisture continuing to decline. With that, drought and abnormal dryness expanded or persisted for much of the Northeast. Extreme drought increased across all of the Northeast.

In comparison, last year during the same period New York State Forest Rangers responded to nine fires affecting 18 acres. This year saw a huge jump: 61 fires affecting almost 3,400 acres.

Even areas which have seen little in the way of wildfires experienced them. New York City has experienced brush fires in Manhattan’s Inwood Hill Park, Washington Heights, Queens and Brooklyn’s Prospect Park. There have been 18 brush fires (so far) on Staten Island. This was the first time in 22 years that New York City issued a drought warning.

Rain and snow that arrived last week aided efforts to contain these fires. According to the governor, the worst of the fires is now 100% contained.

Wildfires have not been the only bizarre environmental events experienced by New Yorkers. The National Weather Service documented that 32 tornados touched down in New York this year. That’s the most since tornados were first recorded in the state in 1950.

New York has suffered even more than wildfires and tornados. This year (as of November 1, 2024), there have been 10 confirmed weather/climate disaster events with losses exceeding $1 billion each to affect New York, according to data from the National Oceanic and Atmospheric Administration.

It is unclear whether increases in storm events, including tornados, are directly linked to climate change. But warmer temperatures have led to more energy in some storm systems and more variability in where and when storms occur. Scientists also know that climate change is making other weather events, like heat waves and flooding, more common.

Temperatures in the Hudson River have risen two degrees Fahrenheit in the past two decades, five times greater than the increase in ocean temperatures per decade. New Yorkers sweltered through weeks of extreme heat this summer—by mid-July this year, New York City had already experienced more 90+ degree days than the last two years combined. Torrential rain and flash flooding in New York City and on Long Island from Tropical Storm Debby on August 13 destroyed homes, disrupted trains, and caused major, costly damage all over Suffolk County.

Clearly the worsening climate is expected to cost New York a lot. New York is facing staggering—and growing—climate costs. In 2023 alone, Governor Hochul announced $2.2 billion in taxpayer funding for climate-related infrastructure repairs and upgrades and resilience projects. The U.S. Army Corps of Engineers estimates that it will cost $52 billion just to protect New York Harbor. On top of that, another $75-$100 billion will be needed to protect Long Island, and $55 billion for climate costs across the rest of the state. The state Comptroller has predicted that more than half of local governments’ costs will be attributable to the climate crisis. 

It’s irresponsible to not expect a worsening climate and with that more disasters and public health threats. In these dangerous times, it only makes sense to develop a response that relies on science and accountability. And let’s make sure that those responsible for the mess are on the financial hook for at least some of the costs. The Climate Change Superfund Act will soon make its way to Governor Hochul. The Act makes Big Oil climate polluters financially responsible for the environmental damages that they have caused.

The first response must be to hold those responsible for our worsening disaster. Governor Hochul can do that with the stroke of her pen. Time will tell.

With Donald Trump returning to the presidency and Republicans set to control both houses of Congress, the incoming Administration’s promise to cut $2 trillion in federal spending does not seem far-fetched. Yet how? The President-elect has promised not to cut Social Security and Medicare; and during the campaign he vowed to bolster the military. He also promised to cut taxes.

For now, how that math works is anyone’s guess, but the nation will soon see his plans. One thing that is likely is that whatever the new Administration decides, federal support for the states will be reduced – perhaps dramatically.

One area that is expected to take a hit is the nation’s health care delivery system, most notably the Medicaid program, which provides health care for low-income and other vulnerable Americans. The federal government spends nationwide about $600 billion annually on Medicaid, helping to underwrite coverage for nearly 70 million Americans.

Medicaid is a joint program of the federal government and the states. States are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees. Because Medicaid is administered by states within broad federal rules, Medicaid programs and spending vary across states.

New York offers the most generous Medicaid benefits of any state, and it costs both a lot. Thus, if Medicaid is on the chopping block, it could be devastating to New York.

New York Medicaid provides coverage to 7 million of the state’s nearly 20 million residents. And that number is growing. Over the past decade, New York State has added 1 million individuals to its Medicaid program. The current state budget appropriated over $100 billion to the Medicaid program, with New York providing $37 billion – the difference is almost entirely covered by the federal government.

Thus, big cuts at the federal level could have big impacts on New York.

When it comes to health coverage, New York policymakers will do everything they can to avoid cutting benefits to needy residents. It will take creative measures to ensure that the state is getting everything it can out of its health-care system.

One step that must be taken is to tackle substandard hospital care.

Last week, a national think tank established by some of the nation’s largest employers and purchasers, released a report examining the quality of care in America’s hospitals. The Leapfrog Group has been issuing these analyses for over two decades. The Group relies on Medicare hospital quality data to make the best “apples-to-apples” comparisons of the nation’s hospital care. Over those two decades New York has been consistently ranked poorly.

In last week’s report, the analysis found that New York State ranked 34^th nationwide in terms of quality, well behind large diverse states like California (ranked 6^th), New Jersey (5^th), Florida (13^th), Massachusetts (23^rd), Pennsylvania (9^th), and Texas (15^th). The ranking is based on the percentage of a state’s hospitals that received an “A” grade. Only 22% of New York’s hospitals received an “A” grade. The report allows consumers to see the quality scores of individual hospitals as well as states’ averages.

Why do New York hospitals perform comparatively so much worse? In July 2019 the director of Leapfrog Group explained what she knew about New York’s hospital safety:

“The system as a whole didn’t seem to have emphasized safety. We’ve seen other states work together and look at what’s working well at other states and implement it. It just doesn’t seem to be happening in New York.”

So, what should be done? There is a vehicle for the Hochul Administration to demand higher quality. In 2023, the Hochul Administration established the Commission on the Future of Health Care. The Commission is charged with offering recommendations to transform the health care system in New York State.

Given the storm clouds gathering over the nation’s capital, the Commission should be preparing for how changes there can impact New York’s health care system.

Improving quality of care must be a top priority for New York. According to experts, higher quality care is less expensive care. Thus, developing recommendations to improve the quality of care will not only lessen unnecessary patient injuries and deaths, but it will also make the system more efficient in its use of public dollars.

There can be no doubt that New York policymakers have not made quality of care the priority it should be. Given the potential for dramatic changes at the federal level, not acting to improve care will hurt taxpayers, too. Here’s hoping that the Hochul Administration will make quality of care a top health priority.

While the vote tallies for the nation’s elections last week are not fully complete, it is clear that it was a decisive victory for Republicans, with Donald Trump handily taking the Electoral College and winning the national popular vote, a possibility that seemed unlikely in the run up to the vote. Republicans also regained control of the U.S. Senate, with the House of Representatives races still too close to call. Here in New York, however, it was a different story.

Incumbents largely prevailed in state Legislative races and Democrats appear to have won four of the five swing seats for Congress. In addition, New Yorkers solidly supported the constitutional question on the ballot that strengthened legal protections against discrimination.

The Congressional races and the constitutional question were top political priorities for Governor Hochul. From a Democrat’s point-of-view, her marshaling of political resources to achieve those victories must be considered feathers in her cap.

Heading into Election Day, the governor pledged to raise money and distribute resources on behalf of Democratic Congressional candidates and in support of the constitutional ballot question. She did and her efforts bore fruit.

In the swing Congressional elections in Syracuse, the Hudson Valley and on Long Island, Democratic candidates won – or appeared to have won – in 4 races. The incumbent Republican representatives appear to have lost in Syracuse, the upper Hudson Valley and on the south shore of Nassau County. The one Democrat incumbent facing a tough race won. Only in the lower Hudson Valley did the Republican incumbent fend off a challenge.

The performance of New York Democrats stands in contrast to the party’s performance nationwide. But there are warning signs for state Democrats.

This is true because Kamala Harris received far fewer votes in New York than Joe Biden did in 2020 and Donald Trump fared better in New York than four years ago. Comparing the two Democrats’ performances shows that Biden received almost a million more votes than Harris did. Trump received 150,000 more votes last week than he did in 2020.

Harris received 4.3 million votes to Biden’s 5.2 million four years earlier. Yet, there are 6.5 million registered Democrats in New York. Trump received 3.4 million in 2024 – an increase over the 3.25 million he received in 2020. There are 3 million registered Republicans in New York State. It seems pretty clear that Republicans showed up for the Presidential race and Democrats did not.

Democrats’ warning signals don’t end there. Since 2020, there has been a drop in Democratic voter enrollment: There are nearly 300,000 fewer registered Democrats in New York than there were four years earlier. Republican party enrollment is up nearly 100,000. By the way, voters who are not registered in any political party have also seen growth and now outnumber the Republican total.

Why the shift in voter enrollment? It could be a shift in how voters feel about politics in New York. Polling on how New Yorkers feel about the direction of the state has been negative. In addition, it is likely that at least some of the shift in Democrats’ total has to do with the net outflow of people from the state. While the total number of registered voters is up from four years ago, the state’s population has declined. Perhaps one explanation can be that Democrats have been more likely to move out-of-state.

Lastly, Republicans in state legislative races seem to have survived in a Presidential election year. Typically, Presidential years bring out more voters than in off years and in a state as heavily dominated by Democrats as in New York, Republican candidates suffer.

Instead, Republicans appear to have been able to protect their incumbents and even solidify their gains in south Brooklyn – until recent years a Democratic bastion. And a look back at the governor’s race in 2022 – when a Republican candidate ran a strong race against Governor Hochul – underscores a potential longer term shift in the political fortunes of Republicans.

As with any election, who wins and loses matters most. In New York, Democratic gains in the Congressional races and the solid approval of the constitutional amendment are undoubtedly victories. Success by Republicans in maintaining their support in legislative races in a Presidential year must offer some solace.

The trends in voter enrollments and the Republican gains in New York City are encouraging signs for their party and flashing warning lights for Democrats. How they proceed going forward will plant the seeds for future election outcomes.