Itinerary for March 3, 2020

ITINERARY FOR MARCH 3, 2020

MEMBERS CATCH YOUR BUS & GET TRAINED (8AM – 11AM) Get breakfast with Lobby Day orientation & briefing Bus departure times vary. Contact your NYSNA Rep.

Members driving to the event Breakfast served from 9am - 10am and Lobby Day orientation and briefing will be in the Convention Hall at 9am

A Member & Student Bus Drop Off (9AM – 11AM) Madison Ave. The New York State Nurses Association is accredited as a provider of nursing continuing professional development by the American B NYSNA Member Check-In (8AM - 11AM) Lobby outside Conference Hall Nurses Credentialing Center’s Commission on Accreditation. Pick up T-shirt and proceed to your first Lobby Appointment. Meet Your Lobby Leader and team This program has been awarded up to six (6.0) contact hours outside the door of the legislator’s office through the New York State Nurses Association Accredited Provider Unit. C Student Check-In (9AM) Get breakfast with Lobby Day orientation and briefing in the Top Tier in the Convention Hall The New York State Nurses Association is accredited by the International Association for Continuing Education and Training D Lobby Visits (9AM – 3PM) “IACET” and is authorized to issue the IACET CEU. Meet your Lobby Team for 1-2 Lobby Visits to advocate for Equitable Healthcare Funding and Safe Staffing to Improve Patient Outcomes.. Check-in through security (multiple entrances underground and The New York State Nurses Association is authorized by IACET to above-ground) to Legislative Office Building or Capitol offer up to .6 CEUs for this program. E Lunch Available & Indoor Rally (12PM - 2PM) Convention Hall In order to receive up to 6.0CHs/.6 CEUs all participants are Enjoy a lunch with your colleagues before or after scheduled Lobby Visits required to attend the entire workshop, complete all in-session NYSNA & legislative leaders address the issues program assignments, complete an evaluation form, complete and return a post-program SurveyMonkey® questionnaire and/or E Debrief & Boxed Dinner Distribution (1PM - 3PM) complete and return a post-program checklist, where applicable. Prepare and turn in a Lobby Report Form on each visit outcome The New York State Nurses Association wishes to disclose that no Members go to table in Convention Hall commercial support or sponsorship was received. C Students go to upper tier in Convention Hall The New York State Nurses Association Program Planners and Buses Depart (3PM - 3:30PM) Presenters declare that they have no conflict of interest in this A Return to the bus that dropped you off. Roll Call. program.

DOVE STREET DOVE STREET

WEST CAPITOL WASHINGTON AVENUE WASHINGTON LEGISLATIVE PARK OFFICE BUILDING MADISON AVENUE MADISON

THE D CAPITOL

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E MADISON AVENUE MADISON WASHINGTON AVENUE WASHINGTON

1 WASHINGTON AVENUE WEST CAPITOL PARK CONVENTION CENTER LOB AND CAPITOL MADISON AVENUE 2

Summary of NYSNA talking points regarding the 2020-2021 Health and Mental Health Executive Budget Proposal February 15, 2020

1. Federal government tax and healthcare policy continues to threaten New York healthcare

 NYS is experiencing ongoing threats and uncertainties from Washington for 3rd year running.

 The 2017 Federal “Tax Cuts and Jobs Act”, not only gave huge benefits to corporations and to the wealthiest Americans, but also directly attacked New York’s state and local finances by limiting the deductibility of state and local taxes (SALT). Having purposefully and dramatically reduced its income, the federal government is now looking to cut funding to patients, hospitals and states. The Executive Budget presentation recognizes the punitive effects on the NYS budget of these federal tax and healthcare funding policies.

2. State Executive Budget for FY2021: What is wrong with cutting Medicaid?

 The Executive Budget for FY2021 is focused on addressing an estimated budget gap of $6.1 billion, of which more than $4 billion is identified as a Medicaid deficit or “structural gap” that exceeds the state’s self-imposed “Medicaid Global Cap” limiting year-to-year increases in state Medicaid spending.

 The Executive Budget proposal calls for the appointment of a new Medicaid Redesign Team (MRT II) to develop specific proposals to reduce the Medicaid gap by $2.5 billion, but does not provide much in the way of specific details as to how the gap is to be addressed. The MRT II, however, is supposed to avoid negatively impacting the availability or quality of health services with the Governor announcing that in carrying out this role, the MRT II would protect access to care and have “no impact on beneficiaries.”

 The state has already reduced Medicaid funding through executive action in the form of a 1% across the board reduction in Medicaid provider reimbursement rates implemented on January 1st as part of a mid-year savings plan. This action will reduce Medicaid funding by $559 million in FY2020 and an additional $851 million thereafter.

 NYSNA is generally opposed to any cuts to Medicaid spending, which provides health coverage to about 6.2 million New Yorkers, or about 30% of the population.

3  The Affordable Care Act (ACA) substantially increased Medicaid enrollment by raising the income eligibility levels for Medicaid and increasing the Federal matching rate on Medicaid costs for this expanded coverage to 90%. The ACA played a decisive role in the dramatic reduction in uninsured rates in New York. We need to maintain the gains in coverage from the passage of the ACA.

 The people receiving Medicaid services are the poorest and most vulnerable New Yorkers. Furthermore, adequate Medicaid funding and reimbursement rates are critical to keeping vital safety-net providers open and caring for our communities.

3. Medicaid Redesign Team should have included strong representation of direct care workers and healthcare advocates and patients

 NYSNA believes that the MRT II, must include a wide range of representatives of front-line health care workers, advocates for quality patient care, as well as patients. MRT II should not be stacked in favor of providers, but be evenly balanced with health care users and nurses, physicians, and other care practitioners that actually provide the care. On Feb. 4, Gov. Cuomo released the list of Medicaid Redesign Team members, chaired by Northwell President and CEO Michael Dowling and former 1199SEIU President Dennis Rivera (attached). The membership does not achieve that balance.

4. Cutting Medicaid to meet arbitrary spending caps will negatively impact health care

 NYSNA is concerned that the recent reduction in Medicaid reimbursement rates, coupled with any additional budget cuts, will adversely affect the overall healthcare delivery system and will be particularly devastating to the safety net hospitals and other providers of care for the 6.2 million New Yorkers receiving Medicaid coverage.  NYSNA has no objection to reducing Medicaid costs by rooting out fraud or waste in the system or by reducing administrative or overhead expenses. NYSNA, however, is opposed to broad spending cuts that reduce access to needed health care services and dilute the quality of care.

5. Cutting Medicaid spending is financially short-sighted

 Medicaid is a program under which New York receives matching funds from the Federal government. Under the normal FMAP formula, the Federal match is 50%, but under the Medicaid expansion provided by the ACA, the matching rate reaches 90%. In total, New York’s federal match is almost 60% of total spending.

 NYSNA is against any budget cuts that will reduce federal funding for NYS (effectively increasing the rate of revenue outflow to the federal government), particularly when those lost revenues are being used by the Trump administration to finance unprecedented tax cuts for corporations, billionaires and hedge fund managers.

4 6. The State should search instead for revenue enhancements and to maximize federal funding

 There is already a gap between how much New Yorkers send to DC in taxes and how much federal funding comes back to NY. Cutting Medicaid funding will significantly increase this gap, with negative consequences for the health care system and the broader economy.

 NYS should focus its efforts on maintaining or increasing Medicaid funding and closing the budget gap through increased taxes, surcharges and fees on economic actors that have profited from the changes in federal tax laws and/or from state health spending.

NYSNA urges the state to consider the following measures to address the Medicaid budget gap:

 Increase corporate tax rates Corporations, utilities, insurance companies and banks have greatly benefited from the federal tax law changes and are in a position to pay more to support vital social programs. In addition, they can fully deduct these increased levies from their federal tax obligations.

 Increase the millionaire surcharge The state should consider further increasing the tax rates on the highest income individual payers. Accordingly, NYSNA would support a restructuring of the personal income tax code to reduce tax rates for working people and to increase in rates for those with annual incomes in excess of $1 million.

 Target taxes and fees at corporate and business entities with major profits in healthcare We recommend that the state should increase taxes, fees and surcharges on the following healthcare market business entities:

. Private for-profit health insurers; . For-profit corporate providers, including pharmacy chains, urgent care companies, imaging and laboratory companies, large physician practices, medical device manufacturers and distributors, pharmacy benefit managers, and other for-profit entities that generate high profits in health care; . Pharmaceutical manufacturers and distributors; . Highly profitable hospital systems with low rates of Medicaid and uninsured/charity care services.

7. Reduce Medicaid costs by setting price controls on drugs/pharmaceuticals

 NYSNA supports the proposal to enhance the power of the Dept. of Financial Services to investigate and enforce restrictions on abusive drug pricing practices. But, the state should also consider stricter regulation of drug prices, including wider price controls and increased penalties for abusive practices. A more robust approach to drug pricing would reduce costs and increase revenues.

5 8. Medicaid funding flows should direct funding more equitably to safety-net providers

The MRT II should consider measures to more fairly allocate Medicaid funding, including reimbursement rates to hospitals and other providers, allocation of Federal Disproportionate Share Hospital (DSH) funding and the distribution of Indigent Care Pool funding. To this end, the MRT II and the final budget must consider and address the following issues:

o Incorporate the terms of A6677B/S5546A into the budget Under the provisions of the federal DSH program, funds are made available to states to distribute to hospitals to compensate for the unreimbursed costs of care for Medicaid and uninsured patients.

The federal DSH program is designed to provide additional funding to hospitals with high rates of Medicaid and uninsured patients and allow them to continue to provide vital services to their vulnerable patient populations.

New York distributes the DSH funding in a generally broad manner that allows many profitable hospitals with high percentages of privately insured patients to receive significant DSH allocations.

NYSNA strongly supports the inclusion of the provisions of the proposed legislation A6677B/S5546A in the final budget more fairly distribute ICP/DSH funding and protect vital safety-net providers.

o Maintain Enhanced Safety Net (ESN) Hospital funding

NYSNA fought successfully for extra funding for Enhanced Safety Net (ESN) Hospitals. The Executive Budget proposes to eliminate the entire $82 million in funding for ESN Hospitals that was previously appropriated. NYSNA strongly objects to the proposed zeroing out of ESN Hospital funding in the budget. Funding for these true safety net hospitals must be maintained or expanded.

o Apply means testing for determining Medicaid reimbursement rates & require minimum levels of Medicaid and indigent care services private providers

Medicaid reimbursement rates should be higher for providers with the highest rates of Medicaid and uninsured patients and should be substantially reduced for providers with the lowest rates of such patients.

6 9. NYSNA opposes proposals to dilute professional practice standards & jeopardize patient care

 The Executive Budget proposes to amend the Education law relating to pharmacist practice to among other provisions increase the range of vaccinations that may be administered by a licensed pharmacist to include all CDC recommended vaccines for persons older than 18

 Currently, pharmacists are entitled to administer influenza, pneumococcal, acute herpes zoster, meningococcal, tetanus, diphtheria and pertussis vaccinations. The proposed budget legislations would appear to add the following CDC recommended vaccinations: Anthrax, BCG, Cholera, DTaP/Tdap/Td, Hepatitis A, Hepatitis B, Hib, HPV, Japanese Encephalitis, Measles, Mumps and Rubella, MMRV, Polio, Rabies, Rotavirus, Smallpox (Vaccinia), Typhoid, Varicella (Chickenpox), Yellow Fever and Zoster (Shingles).

 NYSNA is opposed to the expanded list of vaccinations that may be administered by pharmacists, as many of these vaccinations have complex contraindications and may require a patient assessment prior to administration can be provided only by a registered nurse.

Medicaid Spending and Projected Cuts

Medicaid Spending Breakdown (Source: NYS Assembly Yellow Book FY2020-2021)

34% State Share Local Share 57% Federal Share

7 8 FEBRUARY 4, 2020 Albany, NY Governor Cuomo Announces Members of Medicaid Redesign Team II

 Co-chair: Michael Dowling, President and CEO of Northwell Health  Co-chair: Dennis Rivera, Former Chair of SEIU Healthcare  Dr. Steven Corwin, President and CEO, New York Presbyterian  Thomas Quatroche, PhD, President and CEO, Erie County Medical Center  LaRay Brown, CEO of One Brooklyn Health  Mario Cilento, President of New York State AFL-CIO  Christopher Del Vecchio, President and CEO of MVP Health Care  Pat Wang, President and CEO of Healthfirst  Emma DeVito, President and CEO of VillageCare  Wade Norwood, CEO of Common Ground Health  Steven Bellone, County Executive, Suffolk County  T.K. Small, Director of Policy at Concepts of Independence  Donna Colonna, CEO, Services for the UnderServed (S:US)  Todd Scheuermann, Secretary of Finance, NYS Senate  Blake Washington, Secretary of Ways and Means, NYS Assembly  Paul Francis, Deputy Secretary for Health and Human Services, Governor's Office  Dr. Howard Zucker, Commissioner of Health  Dr. Ann Sullivan, Commissioner for the Office of Mental Health  Arlene González-Sánchez, Commissioner of the Office of Addiction Services and Supports  Dr. Theodore Kastner, Commissioner of the Office for People With Developmental Disabilities  Robert Megna, Senior Vice Chancellor and COO, SUNY

https://www.governor.ny.gov/news/governor-cuomo-announces-members- medicaid-redesign-team-ii

9 10 Safe Staffing Fact Sheet

When nurses and caregivers are assigned Safe Staffing Reduces Adverse to care for too many patients, patients 2 Patient Outcomes in Hospitals are at risk. Healthcare administrators are and Nursing Homes forcing nurses and caregivers to take on • When registered nurse staffing is increased by 9, 10, or even more patients at once. only 5%, the number of adverse events, including pressure ulcers, catheter-associated urinary tract There is a solution: safe nurse- and infections, hospital acquired injuries, air embolism, blood incompatibilities, vascular catheter associated caregiver-to-patient ratios. Safe staffing infections and mediastinitis following coronary bypass saves lives—and can help save money for graft, are reduced by 15.8% (Quality Management in Health Care, 2010). our healthcare system. • Hospitals with lower nurse and caregiver staffing levels have higher rates of pneumonia, shock, cardiac arrest, urinary tract infections and upper gastrointestinal bleeds; all leading to longer hospital stays, increased 1 Safe Staffing Saves Lives post-surgical 30-day mortality rates and increased rates of failure-to-rescue, i.e. death of a surgical patient following a hospital-acquired complication • The number of patients assigned to a nurse and (Agency for Healthcare Research and Quality Pub. No. caregiver has a direct impact on our ability to 04-0029, 2004). appropriately assess, monitor, care for and safely discharge our patients. • In nursing homes, safe staffing standards have a positive impact on both facility processes and • Outcomes are better for patients when staffing on resident outcomes, for example, fewer facility levels meet those established in California. Research deficiencies for poor quality and improved functional demonstrates lives are saved, quality of care is status of the residents (Health Services Research, improved and hospital stays are shorter in other states, 2012). when hospitals meet the CA staffing benchmarks (Health Services Research, 2010). • There is a correlation between unsafe staffing and high nurse and caregiver turnover, and in nursing • Hospitals which routinely staff with 1:8 nurse-to- homes research has also shown that as staff turnover patient ratios experience five additional deaths per increases, the quality of resident care declines which 1,000 patients than those staffing with 1:4 nurse- and results in more frequent use of restraints, urinary caregiver-to-patient ratios (Journal of the American catheterization, and psychoactive drugs; increased Medical Association, 2002). risk of contractures, pressure ulcers and other adverse • The odds of patient death increase by 7% for each patient outcomes (Gerontological Nursing, 2008). additional patient the nurse must take on at one time (Journal of the American Medical Association, 2002).

11 Proposed Ratios Safe Staffing is a Cost-Effective Proposed ratios of RN-to-patients will also include proposals for appropriate number of caregiver staff as defined by the unions Way to Improve Patient Care and representing them. 3 Can Lead to Savings for Hospitals Trauma Emergency 1:1 ICU (Critical Care) in the ER 1:1 *unstable and our Healthcare System 1:2 stable Psych ED 1:4 (Adult) • In California, hospital income rose dramatically after safe 1:1 (Child with Constant Observation + 1 *NA) 1:3 (Child + 1 NA) staffing standards were implemented, from $12.5 billion Emergency Room Adult & Pediatric 1:3 from 1994 to 2003, to more than $20.6 billion from 2004 Non-urgent patients 1:4 to 2010. Not one California hospital closed because of Observation/Outpatient 1:4 ratio implementation. OR 2:1 (Complex surgeries) 1:1 (+1 scrub Assistant) • When compared to other ‘life-saving’ interventions, nurse Post Anesthesia Recovery 1:1 (Phase I Anesthesia PACU, Post procedure) staffing is a cost-effective way to improve patient care. 1:2 (Phase II) (Nursing Administration Quarterly, 2011) Cath Lab 2:1 • Safe staffing reduces turnover in hospitals. Inadequate EP 2:1 Endoscopy 1:1 (Phase I Anesthesia PACU, Post procedure) staffing levels are correlated with staff turnover and poor 1:2 (Phase II) patient satisfaction. The average cost to replace an RN Post and Pre procedural areas 1:1 (Phase I Anesthesia PACU, Post procedure) ranges up to $88,000. (Nursing Administration Quarterly, 1:2 (Phase II) 2011; The Journal of Nursing Administration, 2008)

All Intensive care 1:1 until stable • Safe staffing in hospital intensive care units saves lives. (ie: fresh hearts/balloon pump/ECMO/CRRT/Impella/TandemHeart/ VADS) RN has discretion to take additional A nurse-to-patient ratio of 1 RN to 1.5 patients (or less) Step down & telemetry 1:3 is independently associated with a lower risk of in- 1:2 (fresh hearts/ POD1) hospital death. Higher nursing care hours per ICU patient Transplant 1:3 *Abide by standards according to the law day significantly contribute to prevention of Central 1:1 First 12 H Neuro/Neuro Surgery/Stroke 1:3 Line-Associated Bloodstream Infections. (Critical Care 1:1 TPA or Thrombectomy for first 24 H Medicine, 2014; Nursing Care, 2013) Medical Surgical 1:4

• When regular (non-overtime) RN staffing is higher on a Oncology 1:3 without research 1:1 (ie: with Research/CART infusions/Stem cells infusion, Reactive unit, patients report higher quality discharge teaching Chemo/Desensitization of chemo therapy infusion) and are less likely to be readmitted within 30 days— Pediatric Oncology 1:2 1:1 (ie: BMT/Epidural first 12 H) saving patients and their insurers $608 per patient Pediatrics 1:3 hospitalized. (Health Services Research, 2011) 1:2 (ie: bariatric) Pediatric ICU 1:1 • Increased staffing helped hospitals reduce penalties 2:1 (ie: CVVHD)

for avoidable readmissions. For Medicare patients with Labor 1:2 (1st stage) 1:1 (2nd & 3rd stage) heart attacks, heart failure or pneumonia, this study 1:1 (ie: on Pitocin, on Magnesium) found hospitals with high nurse and caregiver-staff ratios At Delivery 2:1 had 25% lower odds of being penalized and 41% lower Combined L&D and Postpartum 1:3 odds for the maximum penalty for readmissions by CMS Antepartum 1:4 1:1 (ie: on Magnesium for the first hour and should continue until woman (Centers for Medicare & Medicaid Services). (Health is not contracting to degree that preterm birth is imminent) Affairs, 2013) based on quality of care (CMS.gov, 2013). Newborn Nursery 1:3 Neonatal Intensive Care 1:2 1:1 (ie: ECMO/CVVH/Oscillator/Full body cooling/ PD dialysis/ Critical Micro Premie/ critically ill pre & post opt) Research Establishes Ratios Intermediate care nursery 1:3 4 Post-Partum 1:3 (couplets) and Hours of Care 1:4 (mother only) Well baby nursery 1:6 • The hospital nurse-to-patient ratios in NYSNA’s proposal Acute care psychiatric Adult and Pediatric 1:4 are based on peer-reviewed academic research, evidence- Rehabilitation / sub-acute / transitional care 1:5 based recommendations from scholarly entities and 1:3 lessons learned from California’s experience implementing Ambulatory Infusion Interventional Radiology 1:1 Procedure nurse and caregiver staffing ratios. The minimum care 1:2 Recovery 2:1 Neuro Interventional hours specified for nursing homes are also based on Dialysis Adult and Pediatric 1:2 In Patient and Cohort research evidence and the recommendations of the 1:1 Off unit/bedside

Institute of Medicine’s report, Keeping Patients Safe: Nursing Homes/Residential Health Care Transforming the Work Environment of Nurses (2004). Minimum of Hours of Patient Care Per Patient Per Day (HPPD) Certified Nurse Aides 2.8 hours 12 LPN or RN 1.3 hours Of which RN minimum 0.75 hours

Economic Analysis of Statewide Staffing Legislation for Nurses and Caregivers

1. Hospital Industry Exaggerates the Costs of Compliance with Staffing Ratios Legislation According to written position statements issued by the GNYHA and HANYS, the cost of hiring nurses to comply with the proposed staffing ratios legislation is $2 billion.

Based on an assumed average cost per nurse of $100,000 (including salary and benefits), this means that in the aggregate NY hospitals claim that they will have to hire approximately 20,000 nurses to comply with the proposed law.1

It should be noted that the hospitals have failed to provide any data or concrete information to support this claim. We believe, based on a review of partial staffing data in our possession, that the hospital industry claims are grossly exaggerated.

The $2 billion cost claim is an arbitrary assertion that is unsupported by any concrete data.

2. The Cost of Compliance is Minor Relative to Total Hospital Revenues According to data obtained from the most recent Institutional Cost Report (ICR) filings submitted to the State DOH, the annual revenue of NY state hospitals (excluding the VA system) is about $80 billion.2

The $2 billion cost of complying with ratios alleged by the hospitals amounts to about 2.5% of total revenues, a very small relative share of total income and of costs.

3. Compliance Can Be Attained Without Additional Expenditures According to a review of IRS form 990 data for a sampling of hospitals, managerial expenses account for 20% to 25% of total hospital expenses.

The way in which expenses is reported in the IRS returns, however, masks the degree to which health care resources are used to cover managerial and administrative expenses, and many hospitals misleadingly include executive and managerial salaries and benefits, advertising, marketing, travel, trade association dues, lobbying, and legal accounting costs as direct patient care or “program expenses.”3

The high rate of administrative costs in the US health care system greatly exceed the rate in all other comparably advanced economies. Hospital administrative costs account for 25.32% of total expenses in U.S. hospitals, compared to 12.42% in Canadian, 19.79% in Dutch and 15.45% in English hospitals.4

1 See: HANYS and GNYHA memoranda in opposition to the bill. 2 Based on the net patient care and non-patient care revenues of $79.163 million reported by NY hospitals on their 2017 ICR filings. 3 For example, the 2017 IRS Form 990 return filed by NYU Langone lists $17.9 million in salary for corporate officers, but attributes $14 million to program service expenses and only $3.9 million to management expenses; of $31 million in advertising expenses, $25.3 million is attributed to program service expense and only $5.7 million is categorized as managerial/general expenses. The 2017 Form 990 filed by Northwell follows a similar pattern of hiding managerial and administrative costs in the program services category: All $21 million in key executive salaries is labeled as “program services” expense; of $22.8 million in advertising expenses, $18.5 million is categorized as “program services” expense. 4 See: Himmelstein, Jun, Busse, et al., “A Comparison of Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed All Others By Far,” Health Affairs, Sept. 2014 33(9), pp. 1586-94; Gee and Spiro, Center for American Progress, “Excess Administrative Costs Burden the U.S. Health Care System, April 2019. 13

Hospitals increasingly employ multiple layers of management and supervisory personnel at all levels of their operations, including at the patient care unit and department levels. These managers do not provide direct patient care and are not necessary to the operation of patient care units, but are claimed as “program expenses” and further mask the degree to which resources are diverted from direct patient care to non-patient care activity.

It must also be noted that executive level salaries in New York Hospitals are often inordinate and excessive. In New York City, the five big hospital systems paid their top executives as much as $11 million a year and employed 108 executives with salaries in excess of $1 million, with total compensation in 2015 of more than $234 million.5 A review of the 2017 IRS form 990 filings of just four New York City area hospital systems revealed that 75 top executives earned a total of $161 million, or an average of $2.15 million per executive.6

If we assume that the average New York hospital’s expenditure on managerial and other functions unrelated to direct patient care is 25% of revenues, then the aggregate spending on non-patient care operations is about $20 billion per year.7 The $2 billion that the hospitals claim it will cost to comply with minimum staffing ratios is thus only 10% of current aggregate managerial/administrative costs.

The hospitals could thus meet the costs of compliance with the ratios bill without incurring any additional expenditure by: 1) reducing executive salaries, 2) eliminating excess layers of management throughout hospital operations, 3) reducing or eliminating advertising and other similar wasteful spending, and 4) streamlining managerial and other non-patient care functions.

The $2 billion cost could thus be absorbed entirely by internally shifting 10% of current management and administrative expenses to hiring staff to improve direct patient care. This would only require reducing managerial/administrative costs from 25% of total costs to 22.5% (still much greater than comparable advanced economies).

Compliance with minimum staffing ratios thus would not cost hospitals a dime in extra spending. It would merely require hospital CEOs to spend less on themselves and more on caring for their patients.

4. Hospitals Do Not Account For Cost Savings from Improved Staffing In coming up with their $2 billion price tag, the hospitals have only accounted for the direct cost of hiring more nurses. They have not considered the dynamic cost effects of increased RN staffing, which include the following substantial off-setting cost savings:  Reduced length of stay and fewer incidences of unreimbursed excess hospitalization days;  Reduced rates of incidence of uncompensated or reduced reimbursements due to penalties for hospital- acquired complications;  Fewer unreimbursed unnecessary re-admissions;  Improved morale and productivity of nursing and other direct care staff;  Reduced RN turnover rates resulting in lower recruitment, training, and lost productivity costs;  Reduced penalties for failure to meet quality standards or metrics;  Lower rates of workplace injuries and illness among staff that are often attributable to short staffing, stress on the job and heavy patient loads;  Reduced incidence of assaults on nurses and other staff by patients and family members frustrated by long wait times and unmet care needs;  Lower legal costs of malpractice lawsuits by patients or their survivors; and

5 See: 2015 IRS Form 990 data for NY Presbyterian, NYU Langone, Mount Sinai, Montefiore and Northwell, cited in NYSNA Report “On Restructuring the NYC Health + Hospitals Corporation”, October 2017; “Paying for What Doesn’t Count, How Exorbitant Compensation and Frivolous Advertising Hurts New York Hospital Patients, Communication Workers of America, District 1. 6 IRS Form 990 for NYU Langone, Northwell Healthcare, New York Presbyterian, and Mount Sinai. 7 See footnote 2 above. 14  Increased patient satisfaction scores and other metrics that result in bonus payments under new reimbursement models.

Though more study is needed to fully quantify the cost savings that will result from increased staffing, and it is clear that some of the savings will not be immediately realized, it is clear that the net or final costs of compliance with minimum staffing ratios will be greatly reduced in the form of more revenue, lower costs, and better patient care and community health.

For example, CMS penalizes hospitals with high readmission rates by reducing Medicare reimbursement in an amount proportionate to the excess number of readmissions. In addition, CMS imposes a full 1% reduction in Medicare reimbursement for all hospitals with higher rates of hospital acquired conditions.

New York and California are both large states with a combination of dense urban and rural areas and similar demographic characteristics. The one major difference is that California has enacted minimum nurse to patient staffing ratios law and New York has not. This distinction finds expression in the difference in quality of care metrics, the rate of CMS quality of care penalties and Medicare reimbursement rates.

CMS Reimbursement Penalty For Readmissions In 20208 No. of Hospitals Hospitals Hospitals Not Average Hospitals Penalized Exempt9 Penalized Penalty New York 194 129 (66.49%) 52 (26.80%) 13 (6.70%) 0.85% California 378 217 (57.41%) 86 (22.75%) 75 (19.84%) 0.56%

CMS 1% Reimbursement Penalty For Hospital Acquired Conditions In 2020 No. of Hospitals Penalized Hospitals Exempt Hospitals Not Penalized Hospitals New York 194 56 (28.87%) 47 (24.23%) 91 (46.91%) California 378 96 (25.07%) 88 (22.98%) 199 (51.96%)

The CMS Medicare penalty data show that California hospitals, which are subject to minimum nurse-to-patient ratios had significantly better quality of care than New York hospitals for both unnecessary readmissions and for hospital acquired conditions in 2020. New York hospitals were almost 33% less likely to avoid readmissions penalties and the average penalty assessed more than 50% higher. New York hospitals were 11% more likely to be penalized for hospital acquired conditions.

In addition to the better quality measures evident in the Medicare penalties levied by CMS, it should also be noted that in California, the passage of staffing ratios legislation also corresponded to a dramatic increase in hospital net income. Median hospital operating margins increased from 0.1% in 2001 (before implementation of the staffing ratios) to 3.1% in 2010. The percentage of hospitals with negative operating margins dropped from 50% in 2001 to 34% in 2010.10

8 CMS Penalty Data for 2020. 9 Under CMS regulations, hospitals that are classified as sole community hospitals or that have too few Medicare patients for a valid statistical analysis are not subject to CMS penalties. 10 See: California Hospitals: Building, Beds, and Business, California Health Care Foundation, January 20013; see also See: http://www.chcf.org/publications/2009/02/assessing-the-impact-of-californias-nurse-staffing-ratios-on-hospitals-and-patient-care 15 16 The Safe Staffing for Quality Care Act calls on hospitals and nursing homes to maintain a responsible ratio of nurses-to-patients and caregivers-to-patients— ensuring better care and saving lives. Myth Fact There is no direct link The number of patients assigned to a 1 nurse has a direct impact on the ability to between safe staffing appropriately assess, monitor, care for, and standards and improved safely discharge patients. patient outcomes. Hospitals that routinely staff with a 1:8 nurse-to-patient ratio experience five additional deaths per 1,000 patients than those staffing with a 1:4 nurse-to-patient ratio (Journal of the American Medical Association, 2002).

Safe staffing standards California lawmakers passed safe staffing 2 legislation and guess what: not one could force hospitals California hospital closed because to close or cut services, of it. In fact, hospital income in California which could compromise rose dramatically from $12.5 billion from 1994 to 2003, to more than $20.6 billion access to care. from 2004 to 2010 after safe standards were implemented.

LEARN MORE BY VISITING CAMPAIGNFORPATIENTSAFETY.ORG 17 Safe staffing ratios would When compared to healthcare facilities 3 that meet safe staffing levels, unsafe be a financial burden to staffing hurts the bottom line by: New York’s hospitals and • increasing rates of costly hospital- nursing homes. acquired infections • increasing patient falls • increasing 30-day readmissions • increasing medical malpractice lawsuits • increasing nurse burnout • increasing staff turnover Evidence and experience demonstrate that safe staffing is a cost-effective way to improve patient care and lead to savings for our hospitals, nursing homes and our healthcare system.

Hospitals need flexibility in Standards set a minimum standard based 4 on research evidence, best practices and staffing – fixed ratios won’t the lessons learned in California. meet the needs of patients. Ratios will provide a safe minimum level of staffing. Hospitals and nursing homes will still have flexibility in staffing – but they cannot go below the levels that the research demonstrates are safe.

Hospitals will have Non-nurse staffing levels at hospitals 5 increased after safe staffing standards to lay off other caregivers were implemented in California. if safe staffing standards After standards were implemented in are implemented. California in 2005, the number of total nursing assistive personnel increased by 64%. That is a rate 59% higher than the rate of increase of hospital nursing assistive personnel nationally (Institute for Health & Socio-Economic Policy).

LEARN MORE BY VISITING CAMPAIGNFORPATIENTSAFETY.ORG

NEW YORK STATE AFL-CIO MAKE THE ROAD NY

NEW YORK STATE NURSES ASSOCIATION NEW YORK STATEWIDE SENIOR ACTION COUNCIL

COMMUNICATIONS WORKERS OF AMERICA, DISTRICT 1 CITIZEN ACTION OF NEW YORK

COMMITTEE OF INTERNS AND RESIDENTS / SEIU NEW YORK STATE ALLIANCE FOR RETIRED AMERICANS HEALTHCARE NEW YORK COMMUNITIES FOR CHANGE PUBLIC EMPLOYEES FEDERATION COALITION FOR ECONOMIC JUSTICE WORKING FAMILIES PARTY 18 METRO NEW YORK HEALTHCARE FOR ALL The New York Times How Chaos at Chain Pharmacies Is Putting Patients at Risk By Ellen Gabler Jan. 31, 2020

For Alyssa Watrous, the medication mix-up meant a pounding headache, nausea and dizziness. In September, Ms. Watrous, a 17-year-old from Connecticut, was about to take another asthma pill when she realized CVS had mistakenly given her blood pressure medication intended for someone else.

Edward Walker, 38, landed in an emergency room, his eyes swollen and burning after he put drops in them for five days in November 2018 to treat a mild irritation. A Walgreens in Illinois had accidentally supplied him with ear drops — not eye drops.

For Mary Scheuerman, 85, the error was discovered only when she was dying in a Florida hospital in December 2018. A Publix pharmacy had dispensed a powerful chemotherapy drug instead of the antidepressant her doctor had prescribed. She died about two weeks later.

The people least surprised by such mistakes are pharmacists working in some of the nation’s biggest retail chains.

In letters to state regulatory boards and in interviews with The New York Times, many pharmacists at companies like CVS, Rite Aid and Walgreens described understaffed and chaotic workplaces where they said it had become difficult to perform their jobs safely, putting the public at risk of medication errors.

They struggle to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies, they said — all the while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less.

“I am a danger to the public working for CVS,” one pharmacist wrote in an anonymous letter to the Texas State Board of Pharmacy in April.

“The amount of busywork we must do while verifying prescriptions is absolutely dangerous,” another wrote to the Pennsylvania board in February….

The American Psychiatric Association is particularly concerned about CVS, America’s eighth-largest company, which it says routinely ignores doctors’ explicit instructions to dispense limited amounts of medication to mental health patients. The pharmacy’s practice of providing three-month supplies may inadvertently lead more patients to attempt suicide by overdosing, the association said.

“Clearly it is financially in their best interest to dispense as many pills as they can get paid for,” said Dr. Bruce Schwartz, a psychiatrist in New York and the group’s president.

19 A spokesman for CVS said it had created a system to address the issue, but Dr. Schwartz said complaints persisted.

Regulating the chains — five rank among the nation’s 100 largest companies — has proved difficult for state pharmacy boards, which oversee the industry but sometimes allow company representatives to hold seats. Florida’s nine-member board, for instance, includes a lawyer for CVS and a director of pharmacy affairs at Walgreens.

…The industry has been squeezed amid declining drug reimbursement rates and cost pressures from administrators of prescription drug plans. Consolidation, meanwhile, has left only a few major players. About 70 percent of prescriptions nationwide are dispensed by chain drugstores, supermarkets or retailers like Walmart, according to a 2019 Drug Channels Institute report.

CVS garners a quarter of the country’s total prescription revenue and dispenses more than a billion prescriptions a year. Walgreens captures almost 20 percent. Walmart, Kroger and Rite Aid fall next in line among brick-and-mortar stores.

…The specifics and severity of errors are nearly impossible to tally. Aside from lax reporting requirements, many mistakes never become public because companies settle with victims or their families, often requiring a confidentiality agreement. A CVS form for staff members to report errors asks whether the patient is a “media threat,” according to a photo provided to The Times. CVS said in a statement it would not provide details on what it called its “escalation process.”…

Pharmacists have written to state regulatory boards about their safety concerns. “We are forced to harass patients at check out to fill unnecessary meds, request unnecessary refills, and to enroll in automatic fill programs that result in dangerous duplications and meds to be filled that were intended for single time use.” Missouri pharmacist “My fellow pharmacists and pharmacy technicians are at our breaking point. Chain pharmacy practices are preventing us from taking care of our patients and putting them at risk of dangerous medication errors.” New Jersey pharmacist “The mistakes I have seen occur in this environment are both frightening and understandable when we are under the gun to perform the impossible. I’ve had a technician mix two strengths of a critical blood pressure medication.” South Carolina pharmacist

20 “A fatigued and distracted pharmacist in a fast-paced, chaotic environment is much more likely to make an error. The harm from a medication error ranges from being a slight inconvenience to being fatal.” Texas pharmacist “Something needs to be done about this before lives are lost. Our patients depend on us for their safety and wellness. We have to live up to their expectations.” North Carolina pharmacist “We are being asked to do things that we know at a gut level are dangerous. If we won’t or can’t do them, our employers will find someone else who will, and they will likely try to pay them less for the same work.” South Carolina pharmacist …. Too Much, Too Fast

The day before Wesley Hickman quit his job as a pharmacist at CVS, he worked a 13-hour shift with no breaks for lunch or dinner, he said.

As the only pharmacist on duty that day at the Leland, N.C., store, Dr. Hickman filled 552 prescriptions — about one every minute and 25 seconds — while counseling patients, giving shots, making calls and staffing the drive-through, he said. Partway through his shift the next day, in December 2018, he called his manager….

With nearly 10,000 pharmacies across the country, CVS is the largest chain and among the most aggressive in imposing performance metrics, pharmacists said. Both CVS and Walgreens tie bonuses to achieving them, according to company documents.

Nearly everything is tracked and scrutinized: phone calls to patients, the time it takes to fill a prescription, the number of immunizations given, the number of customers signing up for 90-day supplies of medication, to name a few….

In comments to state boards and interviews with The Times, pharmacists explained how staffing cuts had led to longer shifts, often with no break to use the restroom or eat.

“I certainly make more mistakes,” another South Carolina pharmacist wrote to the board. “I had two misfills in three years with the previous staffing and now I make 10-12 per year (that are caught).”

Much of the blame for understaffing has been directed at pressure from companies that manage drug plans for health insurers and Medicare….

21 While benefit managers have caused economic upheaval in the industry, some pharmacy chains are players in that market too: CVS Health owns CVS Caremark, the largest benefit manager; Walgreens Boots Alliance has a partnership with Prime Therapeutics; Rite Aid owns a P.B.M., too….

Pharmacists have written to state regulatory boards about their safety concerns. “There is so much pressure to work so quickly that there are nights I go home just hoping I haven't made a mistake in all the craziness. I work 8-10 hour shifts without a single break. Some days I go an entire shift without finding any time to leave to use the restroom.” Missouri pharmacist “I am expected to make 50-100 phone calls in addition to answering phone calls, consultations, vaccinations and prescription verification. This has resulted in dispensing errors. A member of our staff misfilled a narcotic prescription for immediate release rather than extended release which resulted luckily in only patient fatigue, but it could have easily been deadly.”

South Carolina pharmacist “Thank the Lord I have not had any life-threatening misfills, but I have had a number of ‘minor’ misfills mostly due to having to be responsible for so many duties at once and constantly being pulled away from verification to multitask.” South Carolina pharmacist …. “I've refrained from drinking fluids due to the fact that I couldn't get to the restroom. I have ended up with kidney stones and infections on more than one occasion.” South Carolina pharmacist … Falling Through the Cracks

Dr. Mark Lopatin, a rheumatologist in Pennsylvania, says he is inundated with refill requests for almost every prescription he writes. At times Dr. Lopatin prescribes drugs intended only for a brief treatment — a steroid to treat a flare-up of arthritis, for instance….

Pharmacists told The Times that many unwanted refill requests were generated by automated systems designed in part to increase sales. Others

22 were the result of phone calls from pharmacists, who said they faced pressure to reach quotas.

Research was contributed by Susan C. Beachy, Jack Begg, Alain Delaquérière and Sheelagh McNeill.

Ellen Gabler is an investigative reporter for The New York Times. @egabler

23 24 Notes

25 ANNUAL LOBBY DAY TALKING POINTS 1. Safe Staffing for Quality Care Act Passage (A2964/S1032) We are advocating for the passage of the Safe Staffing for Quality Care Act. This bill will create a minimum staffing standard for all healthcare workers in healthcare facilities. The bill has been sponsored by a 32 of the 63 Senators and more than 2/3 of Assembly members. We are asking the Assembly and the Senate to vote the legislation out of committee and send it to the floor of each chamber for an up or down vote. We are also asking legislators to demand that the State Department of Health release the results of the staffing study that the DOH was directed to carry out and publicly release by the end of 2019. The release of the staffing study will provide a clearer picture of actual nurse staffing levels throughout the state’s hospitals and nursing homes and will inform the debate on the passage of the staffing bill. The DOH study is apparently nearly complete and it must be released promptly. Assembly – Thank Assembly members for their support of the legislation. If they are co-sponsors, ask them to (a) agree to sign on to a letter asking Speaker Carl Heastie to intervene to bring the bill to the floor for a vote and (b) calling upon the NYS DOH to promptly release the full results of the pending staffing study. If they are not yet co-sponsors ask them to commit to add their names to the list of sponsors and join their colleagues in demanding a floor vote on the legislation and the release of the staffing study data. Senate – Thank Senators for their support Safe Staffing for Quality Care Act; ask Senators to either co-sponsor the bill (if not already a sponsor) or sign a letter asking Majority Leader Andrea Stewart-Cousins for the bill’s passage. Also ask Senators to commit to sign onto a letter demanding that the DOH release the full staffing study. 2. State Budget – No Cuts to Medicaid, Increase Funding for Safety Net Hospitals The Governor’s proposed budget calls for a $4 billion cut in state Medicaid funding, of which $2.5 billion is supposed to be identified by the MRT II. This is on top of about $800 million in cuts that were unilaterally implemented in December, including a 1% cut in Medicaid reimbursement rates. These cuts will also reduce Federal matching monies, taking billions more out of our health care system. You can’t take that much money out of the system without causing some people to lose access to services or affecting the quality of care.

These cuts are not financially sound, because they will cause serious effects when the economy enters a recession. In a recession more people will need Medicaid when they are cut off from employer insurance, and state and county finances will be weakened and unable to respond.

New York should not be following the Trump administration’s lead in proposing cuts to health care when there are still more than a million uninsured New Yorkers.

26 Medicaid covers 6.2 million New Yorkers and we should consider revenue enhancements to cover any budget gaps. We should adjust the Medicaid cap to account for the increased numbers of people who get their health care from Medicaid funding. We should look at the following revenue options:  Increase corporate taxes, which can be fully deducted against already low Federal taxes;  Increase the millionaire tax;  Impose fees and assessments on health care providers that generate high profits or surpluses;  Reinstitute the Stock Transfer Tax on Wall Street speculators;  Assess levies or fees on hospitals and other health care providers that have high executive salaries and excessive managerial/administrative costs, based on the concepts in the Governor’s Executive Order 38; and  Implement strict state wide price controls on all drug producers and distributors.

We also need to go beyond short sighted funding cuts and look at the way in which Medicaid funds are distributed. Across the board cuts in Medicaid reimbursement will affect safety-net hospitals much harder than profitable academic medical centers and private providers.

Any Medicaid redesign also needs to seriously consider changes to the way in which Federal DSH and Indigent Care Pool monies are distributed. We need to follow the lead of other states in giving more Medicaid money to safety net providers and less to profitable providers who don’t need it.

To that end we urge the legislature to include in the budget the provisions of A6677B/S5546A, which would increase DSH funding for true safety net hospitals, fix the problems in the Indigent Care Pool and actually increase the draw-down of matching federal money.

We also urge the Legislature to reject the proposal to cut more than $100 million in funding for Enhanced Safety Net Hospitals.

Assembly and Senate – Ask legislators to (a) reject any MRT proposals that reduce health care services, (b) look for fair revenue enhancement to adjust the Medicaid cap and maintain health care funding and federal matching money; (c) support safety net providers by signing on as a co-sponsor A6677B/S5564A and advocating for its passage during this session.

3. Pass the NY Health Act – Universal Single Payer Health Care (A5248/S3577) The New York Health Act (A5248/S3577) will provide comprehensive, universal health coverage for every New Yorker. You and your healthcare providers will work to keep you healthy – New York Health pays the bill. We need to fight back against the Congressional attacks on affordable healthcare nationally and organize in New York for a healthcare system that guarantees coverage for all. Assembly - Thank Assembly members who co-sponsored the NY Health Act; ask others to Co- Sponsor & vote for the bill. Ask them to commit to sign a letter to Speaker Heastie demanding a vote and debate on the floor.

27 Senate - Thank Senators who co-sponsored the NY Health Act and ask them to ask Senate Majority Leader Andrea Stewart-Cousins to move the bill for a vote during this session; ask others to Co-sponsor.

THE ASSEMBLY STATE OF NEW YORK CHAIR ALBANY Mental Health Committee

CHAIR Subcommittee on Women’s Health Aileen M. Gunther Member of Assembly COMMITTEES 100th District Agriculture Environmental Conservation Health Real Property Taxation Steering

December 18, 2019

Howard Zucker, M.D., Commissioner New York State Department of Health Corning Tower Empire State Plaza Albany, NY 12237

Dear Commissioner Zucker,

We are writing to you to express our strong support for minimum statewide staffing ratios for healthcare workers in nursing homes and hospitals. There is currently a patient safety crisis due to inadequate staffing at our healthcare facilities. Decision-making processes regarding healthcare worker staffing vary widely, are not transparent to the public and can endanger patients and residents in our hospitals and nursing homes.

The study the Department of Health is conducting is an important and necessary step. However, studying the problem alone will not be sufficient to protect patient safety in our state. We are strong supporters of minimum statewide healthcare worker-patient ratios in hospitals and nursing homes. We believe that the costs of understaffing, in terms of the lives and health of New Yorkers in healthcare facilities, are significant and must be addressed.

Study after study has shown that inadequate staffing in healthcare leads to increased falls, risks of infection, readmissions, and even death. Study after study also shows that the exact opposite is true when minimum staffing ratios are put into effect for healthcare workers like nurses, certified nurse assistants, and others on the care team.

When the study is complete, we urge you to take action on the results and use your regulatory authority to establish minimum healthcare worker-patient ratios in hospitals and nursing homes. New York State must act on behalf of patients and families to raise the standard of care and safety in our hospitals and nursing homes.

Sincerely,

ALBANY OFFICE: Room 826, Legislative Office Building, Albany, New York 12248  518-455-5355, FAX 518-455-5239 DISTRICT OFFICE: 18 Anawana Lake Road, Monticello, New York 12701  845-794-5807, FAX 845-794-5910 DISTRICT OFFICE 16 James St. - 3rd floor, Middletown NY 10940 845-342-9304 – FAX 845-343-9847 [email protected]

______M/A Gunther M/A Reyes

______M/A Gottfried M/A Simotas

______M/A Burke M/A Ryan

______M/A De La Rosa M/A Ortiz

______M/A Cruz M/A Barnwell

______M/A Simon M/A Seawright

______M/A Epstein M/A Jaffee

______M/A Thiele M/A Barrett

______M/A Dinowitz M/A Jean-Pierre

______M/A Abinanti M/A Buttenschon

______M/A Bronson M/A Cusick

______M/A Englebright M/A Ramos

______M/A Solages M/A Rosenthal

______M/A Rivera M/A Paulin

______M/A McMahon M/A Mosley

______M/A Weprin M/A Barron

______M/A Taylor M/A Nolan

______M/A Dickens M/A Benedetto

______M/A Carroll M/A D’Urso

______M/A Quart M/A Rozic

______M/A Cahill M/A Pichardo

______M/A Niou M/A Fernandez

______M/A Joyner M/A Lavine

______M/A Montesano M/A Miller

______M/A Schmitt M/A DeStafano

______M/A Brabenec M/A Morinello

______M/A LiPetri M/A McDonough

______M/A Raia M/A Tague

______M/A Smith

31 32 33 34 GUARANTEED HEALTHCARE: WHY THE NEW YORK HEALTH ACT MAKES SENSE (A.5248/S.3577)

Federal threats to healthcare funding are dangerous to the public’s health in New York: • Tax reform delivered deep cuts to corporations and the wealthiest 1%, resulting in less revenue for social programs like Medicare and Medicaid, threatening the coverage for millions of people who rely on these programs. • Because of the repeal of the individual mandate, nearly one million New Yorkers who get insurance through the individual market are at risk of losing health coverage; an estimated 13 million will lose insurance nationally.

The status quo for healthcare is also unacceptable:

• Over 1 million New Yorkers are currently uninsured. Millions more are underinsured. • The U.S. spends more than $3 trillion on healthcare annually, nearly double per capita compared to any other nation. Yet our healthcare outcomes are far behind in nearly every category. For example, maternal mortality is actually increasing in the U.S. despite every other developed country making significant gains in reducing deaths related to pregnancy. • Financial barriers and lack of access to care are significant drivers in these shameful health outcomes. Each year, 1/3 of patients WITH INSURANCE go without prescribed medicines or fail to get the medical attention needed because of high deductibles and co-pays. Hundreds of thousands of people file for bankruptcy because of medical debt every year. • An estimated 2,000 New Yorkers die every year due to lack of access to care. • The current system relies largely on private commercial health insurance, which spends exorbitant amounts of money on CEO salaries, advertising to healthy “customers” with expensive ads, and creating huge amounts of paperwork and administration. Health insurance companies in the U.S. spend up to 20% of each dollar on administration; Medicare, by comparison, spends 2 cents of each dollar. WE THROW AWAY BILLIONS ON COMMERICAL HEALTH INSURANCE UNRELATED TO DIRECT PATIENT CARE. • Inequality is rapidly increasing, and your zip code can actually determine your life expectancy. The richest 1 percent of American men lives 15 years longer than the poorest 1 percent, 10 years longer for women. • The current system is designed to make profits—which it does very well—not provide healthcare. In fact, most bankruptcies are linked to medical debt. Even for those who are privately insured.

https://www.governor.ny.gov/news/governor-cuomo-announces-impact-potential-affordable-care-act-repeal-new-york https://health.data.ny.gov/Health/Child-Health-Plus-Program-Enrollment-by-Month-and-/cucz-jjkg https://www.kff.org/uninsured/issue-brief/estimates-of-eligibility-for-aca-coverage-among-the-uninsured-in-2016-october-2017-update/ https://www.cdc.gov/nchs/fastats/health-expenditures.htm https://www.ncbi.nlm.nih.gov/pubmed/27500333 http://www.commonwealthfund.org/~/media/files/publications/in-the-literature/2013/nov/pdf_schoen_2013_ihp_survey_chartpack_final.pdf http://www.pnhp.org/excessdeaths/excess-deaths-state-by-state.pdf http://www.pnhp.org/publications/nejmadmin.pdf

New York State Nurses Association 131 West 33rd Street, 4th Floor, New York, NY 10001

212.785.0157 | nynurses | nysna.org 35 Continues on back THE SOLUTION: GUARANTEED HEALTHCARE FOR ALL NEW YORKERS Under the terms of the New York Health Act, all residents of New York will have access to quality health services without fear of financial ruin.

How New Yorkers will benefit:

1. Comprehensive coverage. All residents, regardless of immigration status, will be covered for: primary, preventive, and specialty care; hospitalization; mental health; reproductive health; dental, vision, and hearing; and prescription drugs and medical supplies. The revised legislation includes long- term care and support services, making it more comprehensive than any public or commercial health plan currently available. It is designed to meet the healthcare needs of New Yorkers.

2. Freedom to choose. No network restrictions. Patients will choose the nurses and doctors they want, and make healthcare decisions with them, not insurance company bureaucrats.

3. Fair funding. No more premiums, deductibles, or co-pays. Universal coverage funded through a graduated tax on income, based on ability to pay. Healthcare costs will be lower for most New Yorkers and businesses. Public hospitals and clinics in New York will receive fair payment for the patients they serve.

4. Equality of Care. It is well documented that there are different standards of care based on whether you are uninsured, have Medicaid, or private insurance. With the New York Health Act, everyone will be treated equally and covered for the same high quality care.

5. Decreased administrative costs. No more paying insurance companies’ administrative costs and profits. No more time spent by doctors, hospitals, employers, and patients completing forms and negotiating with insurance companies. The total savings is estimated to be billions of dollars for the state, and lower costs for individuals. Healthcare will be accountable to the public’s health, not to insurance company stockholders.

6. Reduced cost of drugs and devices. Direct negotiation with pharmaceutical companies and medical device makers will bring prices down by as much as 40%, putting money in your pocket and giving a boost to the economy.

For all these reasons, support across the state for the New York Health Act is growing. We desperately need a healthcare system that will reverse decades of inequality through progressive funding; ends the horrors of delaying needed care due to medical costs; and relegates medical-related bankruptcy to a footnote in history books. With your help, we can make healthcare a guaranteed right for all New Yorkers!

To get involved, sign up with the Campaign for New York Health at www.nyhcampaign.org

36 2020 NYSNA Lobby Day March 3, 2020 Empire Plaza, Albany, NY

Lobbying for Equitable Healthcare Funding and Safe Staffing to Improve Patient Outcomes – Understand the Impact of Government Healthcare Funding Decisions Regarding Patient Care and the Research on How Safe Staffing Protects Patients Your name: and Nursing Practice

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38 2020 NYSNA Lobby Day March 3, 2020 Empire Plaza, Albany, NY

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40 2020 NYSNA Lobby Day March 3, 2020 Empire Plaza, Albany, NY

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42 2020 NYSNA Lobby Day March 3, 2020 Empire Plaza, Albany, NY

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