A Wish List For 2018
Around this time last year, I shared my wish list for 2017. Happily, two-and-a-half of my three wishes actually came true this year. On the first day of the school year, all 1.1 million students in New York City public schools had access to universal free school lunch. At least 10 hospitals across the State are implementing OpenNotes. And we may have dodged a bullet when it comes to maintaining health insurance coverage: as of now, the Affordable Care Act (ACA) remains intact and early enrollment figures from the New York State of Health Marketplace for 2018 plans have been encouraging. But I can’t place stable and affordable health insurance firmly in the “win” column, given ongoing efforts to undermine the ACA, so it’ll stay on my list for 2018.
I’ll again keep my New Year’s wishes to three:
1. Access to a veterans treatment court for every veteran in New York State. More than 800,000 veterans, including more than 100,000 who served in the post-9/11 era, call New York State home. While most of these veterans adjust to civilian life without major difficulties, some do experience challenges when they reintegrate into their homes and communities. Several studies have shown increased risk of criminal behavior for veterans with substance use issues and post-traumatic stress disorder.
Veterans treatment courts, or VTCs—which were first established in Buffalo, New York—are a type of specialty court that provide an alternative to incarceration for veterans who have committed low-level crimes and have mental health or substance use issues. Veterans choosing to use treatment courts are offered mental health counseling and can be connected to various community-based services and agencies specializing in veterans’ affairs. These courts have been associated with reduced recidivism, lower alcohol and drug use, more stable housing, more opportunities for employment, improved relationships with friends and family, and improved mental health among participants. VTCs help those who served their country get their lives back on track for success.
New York is home to 33 veterans treatment courts in 25 counties. They tend to be located in the counties with the largest veteran populations, so about two-thirds of veterans in New York State have access to a VTC.
That’s good, but not good enough. New York should take steps to guarantee access to VTCs for every veteran in need. One way to do that is to enact a transfer policy so that veterans facing criminal charges in a jurisdiction without a veterans treatment court can be transferred to a nearby county that does have one. Michigan, Missouri, and Illinois have enacted this type of legislation and could serve as models for New York State.
2. More transparency on health care prices and quality. New Yorkers find it hard to find information about health care prices and quality. Although consumer information tools are available, their usefulness is variable, and use of price and quality websites and tools is low. People do want to know more about what they can expect to pay and the quality of care they can expect to receive; a recent survey found that at least half of consumers are looking for this information in multiple places. But they simply don’t know where to find it.
It’s clearly not true that “if you build it, they will come.” What good are these tools if no one can find or use them? Aggressive, creative marketing efforts are needed to increase awareness and use. A new consumer tool for New Yorkers, YouCanPlanforThis.org, has been promoted on billboards in Times Square and ads on subway platforms in taxicabs in New York City; upstate, it’s being promoted at bus stops and in shopping malls and fitness centers. That kind of saturation may be what is needed to get people to pay attention and be aware of the availability of consumer-friendly health care tools.
With more transparent, accessible, useful information, people can make better health care decisions. They can play a more active role in managing their own care and making choices based on quality and value. With patients paying more and more out of their own pockets for health care, having access to good information is increasingly important.
3. Stable and affordable health insurance coverage for all New Yorkers. The most pressing need is for Congress to renew the months-expired State Children’s Health Insurance Program (SCHIP). As I wrote this summer, the program provides vital health care coverage for nearly 9 million American children, including nearly 700,000 in New York State. It’s unconscionable that the program—which has long enjoyed bipartisan support and should be a no-brainer—has not been renewed. Millions of low-income kids are at risk of having their health insurance taken away. So, SCHIP renewal needs to be priority #1, and I hope even before the new year.
Shoring up affordable insurance coverage for all, not just for kids, will be an even tougher task. Even as Congress failed repeatedly to repeal the ACA in 2017, federal efforts are still underway to destabilize the law through administrative action and through the pending tax reform bill. The threat of repeal seems like a zombie that just won’t die. I hope that in 2018 we’ll see more bipartisan efforts in the vein of the Alexander-Murray proposal, which would restore cost-sharing reduction payments to insurance companies and make some other fixes to stabilize insurance markets. New York should also continue to ensure that coverage is available to Dreamers (those with Deferred Action for Childhood Arrivals, or DACA, status) regardless of whether the DACA program is renewed by Congress. (I wrote about DACA here earlier this year.)
It’s a tall order, I know. Maybe I’m spoiled since many of my wishes from last year came true. But all this can be reality if we don’t just wish but also take action. Let’s get to work. And one final wish: a healthy and happy new year to you.
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