Archive for May 2024

How Safe Is New York’s Hospital Care?

Posted by NYPIRG on May 27, 2024 at 7:41 am

In the first year of Governor Andrew Cuomo’s tenure in 2011, he successfully established a Medicaid Task Force whose job was to figure out ways to curtail the program’s increasing costs.  The idea was to bring together Medicaid “stakeholders” and design programs to limit Medicaid spending.  That effort became known as the Medicaid Global Spending Cap program and was a component of the then-governor’s plans to keep the overall state budget at no more than a 2 percent annual increase.

One of the major components of the Medicaid Global Cap was a new program to limit the financial exposure of hospitals where a baby was born with catastrophic neurological damage due to medical malpractice.  The Medical Indemnity Fund offset the medical malpractice by shifting those payments from the hospitals’ insurance to the taxpayer.  Under the program, the future medical costs of treating a neurologically-impaired baby would be covered by the state.  In that way, the financial exposure of hospitals was limited and, at least theoretically, the lifetime medical needs of the injured baby would be covered – the money would never run out.

Unfortunately, it didn’t work out that way.  Earlier this Spring, the program ran out of money.  The Department of Health announced that it had run out of money and could not take new enrollees.  In this year’s budget, no new money was allocated so the families in the process of enrolling were now unsure if they would have the coverage needed for their neurologically impaired children.  This is devastating news for those families and threatens the precarious health of their children.

This past weekend, The New York Times reported that the state would add revenues in order to keep the program running for at least another year.  However, the Hochul Administration commented about the mushrooming costs that could put the program’s survival in jeopardy.

The overall financial health of the program only is sustainable if the state is doing all it can to reduce the number of injuries – thus keeping costs down as well as reducing the number of families caring for seriously injured children.  And in fact, New York pledged to do just that by instituting new safety protocols, such as increased staffing and training, to reduce the number of birth injuries.  Again according to the Times, no such reduction in cases has occurred: “Where actuaries predicted that roughly one in 10,000 children would be eligible for the fund as a result of a brain or spinal cord injury in 2011, by 2014 they were expecting nearly three times that number.”

In retrospect, that outcome is not surprising.  When it comes to patient safety, New York’s track record is not good.

The U.S. Department of Health and Human Services annually publishes, which reports the quality of the nation’s hospitals and other providers to the public.  Researchers use that information to compare states.  One national organization, the “Leapfrog Group” (established by the nation’s large employers in 2000 in order to measure “hospital performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions”) has issued annual reports on the quality of American hospital care for over 20 years.  Over those two decades New York has been consistently ranked poorly.

Earlier this month, in its latest annual report Leapfrog Group’s analysis found that New York State ranked 39th nationwide in terms of quality, well behind large diverse states like California (ranked 19th), Florida (12th), Massachusetts (30th), Pennsylvania (7th), and Texas (23rd).  Of New York’s 144 hospitals, only 17 received an “A” grade.

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.” 

The Leapfrog Group data relies on Medicare information, so these rankings do not directly explain what’s going on in the Medical Indemnity Fund (MIF).  But in a state that doesn’t “seem to have emphasized safety,” it isn’t much of a jump to conclude that in too many New York hospitals, the overall quality of care is below the national standard, Leapfrog says.  And when it comes to the MIF, that takes a bite out of the state’s revenues – putting taxpayers on the hook for the substantial costs of caring for children injured by the poor quality of hospital care.

When we go to the hospital, we should expect that all is being done to make us better, not worse.  It seems too often that isn’t happening in New York.  As state lawmakers deal with the MIF problem, they should look to the broader issue of weak patient safety.  When it comes to patient safety, New York policymakers should follow the Hippocratic Oath to “first do no harm.”

Governor Hochul on the Global Stage and the Scrutiny That Comes With It

Posted by NYPIRG on May 20, 2024 at 8:22 am

Governor Hochul was globetrotting last week with a trip to Italy to see the Pope and then to her ancestral home in Ireland.  The trip to Rome was in her capacity as the newly selected co-chair of the U.S. Climate Alliance. 

The Alliance sent a delegation of governors to meet with the Pope about the worsening climate emergency.  Pope Francis’s 2015 encyclical, On Care for Our Common Home, was a clarion call for action to address the climate crisis based on religious, moral, scientific and self-preservation grounds.

The U.S. Climate Alliance is a bipartisan coalition of governors working to achieve the nation’s net-zero future by mid-Century, consistent with the call by the world’s climate experts. Governor Hochul was appointed co-chair in early May. 

In his welcoming comments, the Pope said “The road ahead is uphill and not without danger.  The data emerging from this summit have shown that the effects of climate change loom over every aspect of our lives.”

The conference was organized around keynote addresses by the mayor of Paris and the governors of California and New York.  While California is ranked seventh in oil production, Governor Newsom used his speech to highlight the state’s strides in shifting toward a reliance on non-fossil fuel power.

Governor Newsom said “California has exceeded its nation-leading environmental goals.  I come here today on Day 32, 32 straight days, over one month, where California’s economy is literally being run with 100 percent clean energy.”

Like California, New York has set aggressive climate goals.  In 2019, then-Governor Cuomo and the state Legislature agreed to a new law that set climate goals consistent with the best climate science available at that time.  The new law required that state achieve

  • 70 percent renewable energy by 2030;
  • 100 percent zero-emission electricity by 2040;
  • 40 percent reduction in statewide greenhouse gas emissions from 1990 levels by 2030; and
  • Net zero emissions statewide by 2050.

While laying out an aggressive plan of action, New York is struggling to achieve those climate goals.

A recent audit by New York State Comptroller DiNapoli revealed the state’s slow pace. The audit found it is taking the state more than three years just to get a permit in New York to start a Renewable Energy Project.  Those delays, the Comptroller said, put the state in jeopardy of not reaching climate goals that were put into law in 2019.

In addition to the slow pace, projects are faltering due to rising costs – exacerbated by a slow permitting process.  Last month, it was reported that three ambitious projects to build offshore wind farms folded.

Despite that, in her speech at the Vatican Governor Hochul used the state’s climate law as the cornerstone of New York’s strategies and pledged to meet those goals.

Of course, the DiNapoli audit and the failure of three offshore wind farms make it at best unclear if those goals will be met.  The governor chose instead to focus her remarks on climate catastrophes: more intense storms, heat waves, and rising sea levels.  She then announced nearly $300 million in climate resiliency funding.

While $300 million is significant, it falls far short of the billions needed by the state to address expected climate costs.  Moreover, while committing hundreds of millions of dollars, Governor Hochul did not mention that those monies would come from taxpayers.  It was the governor who blocked a legislative budget plan to make the biggest oil companies financially responsible for at least some of the state’s mushrooming climate costs leaving taxpayers on the financial hook.  And it was last year that the governor advanced a budget plan to weaken New York’s efforts to rein in methane gas emissions. 

The Hochul Administration inherited an aggressive climate plan but is so far not doing enough to meet those goals.  Ironically, her appointment to the Climate Alliance and papal visit may lead to some uncomfortable scrutiny of New York’s climate track record.  The challenge now is to make the law reality by meeting the goals, withstanding the pressures to backslide, and providing the leadership to overcome the inevitable political, fiscal, and practical obstacles that always arise with undertakings of this magnitude.

While New York is only one of fifty states, its economy is one of the largest in the world.  It makes sense for New York’s governor to be part of the global discussion over how to avert the worst of the unfolding climate catastrophe.  Yet the state’s halting pace to tackle the climate crisis raises an important question: Is New York’s climate law really about optics and rhetoric, not about performance?  The world is watching.  Time will tell.

Lawmakers Make Another Run at Protecting Tropical Rainforests

Posted by NYPIRG on May 13, 2024 at 8:05 am

When it comes to the worsening climate catastrophe that we are living through, the news just keeps getting worse.  Last week, it was reported that the world’s leading climate scientists expect global temperatures to rise to at least 2.5oC (4.5oF) by the end of this century.  Many of the scientists see a “semi-dystopian” future, with famines, conflicts and mass migration, driven by heatwaves, wildfires, floods and storms that will intensify over time.

There are many reasons why their pessimism is warranted. Fundamentally, far too little is being done to shift the planet away from its reliance on fossil fuels in the face of ideological and partisan opposition.

There is no “magic bullet” to turn the tide.  It will take a comprehensive approach that touches upon all aspects of modern life.  Accomplishing what needs to be done will take political courage and leadership from elected officials at all levels of government.

Protecting the world’s rainforests is one of those essential measures.  Trees and other forms of vegetation are critical tools in fighting the climate crisis – they serve as natural carbon sinks, reducing carbon dioxide in the atmosphere, and help keep the planet cool.

However, deforestation of tropical forests is worsening the global climate crisis.  It has been estimated that global loss of tropical forests contributes approximately 20% of global carbon emissions annually.

An area of 18 million acres, more than half the size of New York State, is lost every year due to deforestation.  Not only is this contributing to global warming, but it also contributes to violations of indigenous land rights in many countries and loss of habitat for hundreds of animal species.

Last year New York lawmakers decided to do what the state could to help combat tropical deforestation.  The legislation that was advanced would ensure that New York does not contribute to these harmful practices by limiting the purchasing of tropical hardwoods.  Advocates cited the fact that as the eleventh largest economy in the world, New York State’s purchasing power is an important tool in helping to stop deforestation.

The legislation was approved by the state Assembly and Senate with overwhelming bipartisan support last year.  115 Assemblymembers voted in support of the bill.  In the Senate the margin was 42-19.  Both margins were “veto-proof” majorities, meaning that the votes could be there to overturn a gubernatorial veto.

A joint statement by the Senate sponsor and an Ecuadorian indigenous leader noted: “Yet despite our different contexts, we are united on a mission to stop deforestation in the world’s tropical forests — a critical effort to defend frontline communities, protect biodiversity, and curb the climate emergency.”  The legislation had a diverse coalition in support.

Despite those huge legislative margins and widespread support, Governor Hochul vetoed the legislation.  Hochul’s veto memo cited the bill’s burdensome impacts on businesses — “particularly small businesses.”  But it was big businesses who hired the lobbyists to oppose the bill.

Instead of voting to override the governor’s veto, this year lawmakers are instead moving a narrower version of it.  Seemingly, both houses are set to act soon since the bills are currently “live” and on the Senate and Assembly floors awaiting action.

New York has taken significant actions to address climate change within the state’s borders, although there is much that still needs to be done.  The legislation to protect tropical rainforests is a tangible contribution that New York can make to address the larger, global issue.  To combat tropical deforestation, the bill closes loopholes in existing law to more effectively limit the purchase of tropical hardwoods, as well as to require contractors doing business with the state to certify that goods derived wholly or in part from tropical forest-risk commodities and sold to a state agency or authority are not contributing to tropical primary forest degradation or tropical deforestation.

This year, lawmakers should anticipate that the governor will continue to have problems with the bill – even if they hope she will not.  Since the bills are poised to be acted upon, quick passage coupled with a decision to immediately send the bill to the governor could force her to make a decision while the Legislature is still in session.  Under New York’s rules, once the governor receives legislation, she has ten days to act.  Passage of this legislation this week could create a scenario in which those big legislative majorities could act to overturn a bad decision.

That action would reward the hard work of advocates and lawmakers, but most importantly send a clear message that New York wants to help to protect the world’s rainforests because they protect us.

Voting on College Campuses Could Make a Difference This November

Posted by NYPIRG on May 6, 2024 at 7:41 am

As the nation’s politics become increasingly polarized in a highly divided nation, new voters could easily become the “kingmakers” of November’s elections.  Polls show the nation is evenly divided as they consider the Presidential candidates of the major political parties.  Given the recent razor-thin votes in key Presidential battleground states, a swing one way or another can tip the balance into who gets a majority of the Electoral College ballots.

Here in deep blue New York, presumptive Republican candidate Donald Trump is extremely unlikely to win the state in November.  However, in determining control of the U.S. House of Representatives, a very small number of competitive seats can make all the difference.  The stronger-than-expected electoral performance of House Republican candidates in New York in 2022 provided the difference that swung control of that Chamber.

Once again this November, control of the House may turn on a small number of seats, five of which are located in New York State.  All of those incumbents won in 2022 with razor thin margins

Assuming tight elections again in 2024, new voters could make the difference in who controls the House.  And a large number of these new voters could come from colleges and universities across New York.

There are over one million college students in the state.  And there are many who live in the five districts in which the House incumbent won with a tiny margin.

Across New York, colleges are filled with students who historically are less likely to vote yet have a common community.  The unfortunate history of student voting has been one in which officials too often seek to suppress participation among this voter segment.

A key battleground has been the right of students to vote in their college communities.  Perhaps not surprising, local elected officials and boards of elections did not, in all cases, look kindly upon the newly enfranchised student electorate.  Even though college students are—for the purposes of the federal census—considered residents of college communities, efforts to limit the student vote persisted.  After years of court battles, boards of elections in New York are required to register students to vote from their campus addresses if the student wishes. 

As has been the case when fundamental rights are extended to new groups—which threatens the status quo—securing the legal right to vote did not mean that actually voting would be easy for young voters.  

As a result, barriers persisted.  Year after year, students have faced obstacles to registration and voting in counties around the state.  Some counties target students by further splitting campus populations into multiple election districts or removing the campus poll site.

In 2022, New York State enacted a new law that required General Election polling places be placed on colleges and universities that had at least 300 registered voters living on campus.  That legislation was approved to help college students vote in elections from their on-campus addresses. 

Under the new state law, colleges that have “three hundred or more registrants who are registered to vote at any address on such contiguous property” must have a polling place placed on “contiguous property or at a nearby location recommended by the college or university and agreed to by the board of elections.”  Despite the new law, New York’s college voter turnout in 2022 was disappointing, under 30 percent.

Part of the problem is that it appears that many colleges did not have polling places as was expected after passage of the new law.  A recent study showed that a majority of colleges in New York State do not have on-campus poll sites and there had been almost no change since the passage of this legislation.

The question is why?

That question has not yet been answered.  Was it a failure of the law or its enforcement?  It is imperative for policymakers to examine this issue and see whether state law needs to be strengthened or implementation falls short or both.  However, the issue must be examined – failure to allow college students the opportunity to cast their ballots on campus is an indefensible restriction on their constitutional right to vote.  And, a policy failure in this area could change the course of the nation’s – and the world’s – history.