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Since the mayor's recent brushes with illness and love, New Yorkers have been treated to what many are calling the "new Rudy," a man who tears up, holds hands in public, admits he's alienated people, and reaches out to them. Now we can add his recent HealthSTAT proposal to the evidence that the mayor is capable of empathy and other such human emotions.
Giuliani's first major initiative to come to the aid of poor New Yorkers without health insurance (his last big health idea was to sell off the city's public hospitals, which many of these same people rely on for health care), HealthSTAT will reach out to the roughly 900,000 city dwellers who are eligible for government-funded health insurance but haven't taken advantage of it. Stationed at schools, housing projects, and fire houses, HealthSTAT workers will help enroll these uninsured folks, about half of the total number of uninsured in the city, in medicaid, Child Health Plus, and the new Family Health Plus.
HealthSTAT is a relatively cheap fix for a huge problem, since most of the insurance itself is paid for with state and federalrather than citydollars. The plan is so obviously helpful, even city pols who can be counted on to clash with the mayor have had only kind words for it. Public Advocate Mark Green, Controller Alan Hevesi, and City Council Speaker Peter Vallone went so far as to join the mayor in announcing it.
The irony is that the widely embraced "new Rudy" plan is designed to eat away at a problem the "old Rudy" helped create. Many of the uninsured whom HealthSTAT workers will be trying to enroll in medicaid lost their coverage because of the city's overzealous welfare reform efforts. While the administration projects it will be able to get insurance for an additional 344,000 people by 2004 under the new plan, more than 200,000 city residents have lost their medicaid since 1996 when the mayor began implementing his own take on the federal Welfare Reform Act. What's more, many of those city policies are still in place.
The Welfare Reform Act made it clear that people who lost cash assistance under the law should be able to keep their medicaid coverage. Nevertheless, policies designed to whittle down the welfare roles have resulted in drops in medicaid across the country. A recent study in the American Journal of Public Health linked particular policies, such as requiring job searches in order to receive benefits, to drops in medicaid enrollment as large as 28 percent. Among parents, the drops have reached almost 50 percent in some states.
Even against the backdrop of this national problem, New York City's workfare rules and the decline in its medicaid population are particularly extreme. "The numbers affected in the city appear to be the largest anywhere," says Wendy Chavkin, a physician and one of the study's authors. "And that doesn't even account for all the people who never even filled out the application."
Indeed, the 1998 lawsuit Reynolds v. Giuliani alleges that the job centers set up by the Giuliani administration to oversee benefits routinely deterred people from filing applications for assistance, including medicaid. In some cases, job center workers even pressured people into withdrawing their applications once they were filed. While the class-action suit is still pending, some advocates report the problems cited in it remain largely unresolved.
"[The city has] shown almost no improvement," says Marc Cohan, director of litigation at Welfare Law Center, one of four groups representing benefit-seekers in the case. Cohan says there has been an improvement when it comes to the inappropriate closing of benefit cases (the subject of another pending lawsuit with the city), but that signing up for health coverage continues to be a problem. "Eligibility for medicaid is supposed to be separately evaluated," says Cohan, "but in many instanceswell over 80 percentit's still not happening."
Cohan partly blames logistics for the continuing problems of enrolling in medicaid. The computer system isn't designed to make separate evaluations for each benefit program, he says, and some workers haven't been appropriately trained. (The Human Resources Administration, which is responsible for the city's workfare program, did not return repeated calls for comment.)
Another, less charitable explanation for the ongoing difficulties is that, HealthSTAT notwithstanding, the city is still intent on keeping the number of benefit recipients as low as possible. Such a Grinch-like move would be signature "old Rudy," of course. With any luck, the new Rudy will see that it stops.