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A Wish List for 2017

By David Sandman, President and CEO, New York State Health Foundation
Published in the Huffington Post on December 13, 2016

Every new year brings hope and a spirit of renewal. This year more than most, I sense a yearning among Americans for just that. The Presidential campaign was downright vicious and demeaning, beneath the dignity of our nation. Insults, allegations, and false news from all sides often took precedence over issues. The results themselves show a nation divided, a nation where compromise and working together have come to be seen as signs of weakness and losing strategies. Somehow, some way, we need to find our way back to a spirit of civil discourse. I respect that the policy disagreements are genuinely wide, the fights will be fierce, and the stakes are high. I don’t expect Washington’s divisive political climate to change overnight. But I know this: we’re sunk if we cannot even engage in dialogue with those with whom we disagree passionately. My greatest wish is to leave the bitterness of the campaign behind and to roll up our sleeves to work together for solutions. As Eleanor Roosevelt said, “It is not fair to ask of others what you are unwilling to do yourself.”

If that is too much to ask for, and it does actually feel like a lot, I have a more specific wish list for the New Year that will make New Yorkers healthier. I won’t be greedy; I’ll keep it to three items:

1. Universal free school lunch for all of New York City’s children. Seventy-five percent of New York City’s 1.1 million public school students are eligible for free or reduced-price lunch. Yet many of them do not participate. The reason is heartbreakingly simple: students skip the lunch program to avoid the stigma associated with being poor. Kids can be mean, and kids who get free lunch are teased and bullied. I can hardly think of an image that is sadder or that more starkly represents inequity than a hungry child. We can do better.

We made universal pre-K happen, so why not universal school lunch? Making meals free for all students would delink school food from family income. It’s not such a stretch: we already offer all New York City students free breakfast and make free lunch available to students in standalone middle schools. And universal school lunch is already in place in other parts of the State (Albany, Rochester, and Buffalo) and in other large cities like Boston, Chicago, Dallas, D.C., and Detroit.

It’s workable, it has broad support—everyone from parents and principals to pediatricians and prominent labor leaders—but it still hasn’t happened. New York should be leading, not lagging, and we need to make this program a reality here in NYC. This would be one of the biggest pro-health, pro-child, pro-education, and pro-equality policy changes we can make. I’ve written about this issue, and we must get over the finish line. 2017 is the year to make it happen.

2. New York patients empowered through OpenNotes. How often have you gone to the doctor and, a few hours or days later, thought, “Wait, what did she say about my bloodwork?” or “What exactly am I supposed to ask the specialist when I see him next week?” How often have you tried to get information from parents or other loved ones about a medical appointment, and realized that they were confused about their diagnosis or follow-up instructions?

If that sounds familiar, you’re not alone: research shows that patients immediately forget 40%–80% of what is said in a doctor’s office, and half of the information remembered is incorrect. But when patients have access to the visit notes written by their doctors, nurses, or other clinicians, they have a clear record of their diagnosis, test results, and medication and follow-up instructions.

Today, more than 11 million Americans have access to their visit notes through the OpenNotes program. OpenNotes ensures that everyone involved in the medical encounter—including the patient—has access to the same information either electronically or via print-out. And OpenNotes has been shown to be effective, with patients reporting better compliance with medication and feeling more in control of their care.

Yet take-up in New York has been slow. Only a handful of hospitals have adopted OpenNotes or similar approaches to sharing visit notes with patients. It’s a simple but effective tool to improve communications and empower patients with the information they need to manage their care and their health. In 2017, I wish that providers adopt OpenNotes and that many more patients have access to their own complete health information.

3. Stable and affordable health insurance coverage for all New Yorkers. Approximately 2.8 million New Yorkers have gotten health insurance coverage through the New York State of Health Marketplace—a truly impressive number. The rate of uninsured New Yorkers is the lowest it’s ever been; in 2010, more than 11% of New Yorkers had no health insurance; by 2015, it was down to less than 5%. Those gains are under perilous threat, with Congress and President-elect Trump poised to repeal or erode the Affordable Care Act. The most likely “repeal and replace” scenario is turning into a “repeal and delay” approach that tables any replacement action for two or even three years.

The human and financial consequences could be dire for New York. Even if key parts of the law remain intact, a delay in replacement will create tremendous upheaval and confusion. Health insurance plans are likely to exit the marketplace; providers will demand the payment cuts they accepted as part of the ACA be restored; consumers will be uncertain about their options; and coverage will be unaffordable for many more New Yorkers. The Urban Institute last week estimated that 1.1 million New Yorkers will lose health insurance coverage by 2019 under this “repeal and delay” strategy. The State could lose more than $10 billion by 2028 in premium tax credits and cost-sharing reductions, and $47 billion in funding for Medicaid and Child Health Plus. In addition, funding could disappear for the Essential Plan, which insures nearly 600,000 people in New York State; that alone could cost the State as much as $850 million per year.

The ACA is imperfect and there is little chance it will be left fully intact. Given the federal landscape, it is unrealistic to wish for no changes in law. New policies and approaches, however, must protect the gains we’ve seen over the last six years. We can’t go backwards. My wish is that federal policies continue to make affordable coverage available to as many as possible. If we can’t get that, then we in New York will continue to make coverage a priority, just as we did for all those years preceding the ACA. To continue to be a leader among states, we will need to think creatively, develop solutions that work for New York, and deal with financial realities.

All these hopes can be reality if we don’t just wish but also take action. Join the Lunch4Learning campaign to support school lunch. Tell your own health care providers about OpenNotes; get the conversation started. Keep a close eye on the implications of federal action—and inaction—on the ACA for our State, and what we can do to protect health insurance for New Yorkers. Once again, an Eleanor Roosevelt quote comes to mind, “It isn’t enough to talk about peace…One must work at it.”

My final wish: a healthy and happy new year to you.

Follow David Sandman on Twitter: www.twitter.com/davidsandman1