Richard Gottfried Chair, New York State Assembly Health Committee

Q: How big a problem is sepsis in New York, and will the governor’s plan to overhaul how hospitals treat the disease help?
RG: Thousands of people die each year from sepsis, a very dangerous infection. If it is diagnosed early enough, it is treatable with antibiotics. But the early symptoms of sepsis can also be the symptoms of fairly minor ailments. The Health Department’s new regulations require hospitals to pay closer attention to potential sepsis cases and change procedures so cases will be less likely to slip through the cracks. These rules were made in consultation with experts from across the country. I expect they will save thousands of lives a year.

Q: With the potential cutbacks to New York City’s Health and Hospitals Corporation, what can be done to provide the resources needed for the agency to provide necessary services?
RG: Most hospitals in New York State face federal cuts, mainly in Medicare rates. This will be partly offset because more patients will have health coverage, thanks to the Affordable Care Act. In this year’s state budget legislation we will hopefully change our system for distributing hospital “indigent care” money to better target treatment of truly uninsured patients. This will help hospitals serving large numbers of low-income patients, including the HHC hospitals.

Q: The Affordable Care Act gives the states a variety of policy options. How can New York best take advantage of these possibilities?
RG: Most important: New York should adopt a universal “single-payer” health coverage system covering everyone, and financed fairly by taxes based on ability to pay instead of regressive premiums, deductibles and co-pays. It’s a common sense, patient-centered, evidence-based approach. For more information, contact me at This email address is being protected from spambots. You need JavaScript enabled to view it. . President Obama recently said, “No American should have to spend their golden years at the mercy of insurance companies.” Why only our golden years?

Kemp Hannon Chair, New York State Senate Health Committee

Q: Where do you stand on for-profit hospitals? Can they be effective in delivering care, or is there too much risk when money is the motive?
KH: It would be a useful avenue for New York to explore using private equity because of the vast amount of capital needs that the hospitals have. We’ve tried the HEAL grants, and we’ve exhausted that, and there’s no appetite for those again. Therein lies the problem: Where are you going to get the money and the capital to start providing money to the health care system? To the extent that we’ve tried the alternatives, to the extent that this is one of the things that is available, I think it certainly should be explored.

Q: What changes are being made to long-term care for seniors?
KH: The Medicaid Redesign Team took a look at the long-term care and the community care aspects of New York State’s health care system and has proposed changes that essentially can be summed up in trying to introduce managed care. Whether it be to home care, for nursing home programs, or even for people with behavioral health or substance abuse problems, both long-term care and community care for people with problems is really being addressed in a comprehensive way for the first time in a couple of decades in New York.

Q: Has the global cap on Medicaid been effective in reducing costs to the program without affecting services?
KH: It certainly has provided a target, and people are wary if they’re getting close to the target because they know the global cap gives the commissioner power to make cutbacks. But we’ve also seen over 200,000 [people] headed to the Medicaid rolls during that period, so to some extent you could argue most of the growth in the cap has been taken up by the new enrollees. We need to go back and look at how well we’re doing and where we’re going, because the budget proposes an extension of the freeze on trend factors, and the extension of the two-year budgeting process, and the extension of the global cap.

Thomas Farley, M.D. Commissioner, New York City Department of Health and Mental Hygiene

Q: Mayor Bloomberg’s soda ban has gotten the most attention of his recent public health initiatives. Are there other efforts the city is making around nutrition that have not received as much publicity?
TF: The rule is not a ban but a cap on portion size. It is only one part of the Health Department’s multifaceted approach to promoting healthy eating and physical activity. In 2006 New York City became the first jurisdiction in the United States to require restaurant chains to post calorie information on menus and menu boards.

Q: What has been the impact of posting calorie information?
TF: After the regulation took effect in 2008, customers who used the calorie counts bought fewer calories: 15 percent of customers reported using the calorie information, and these customers purchased approximately 100 fewer calories at lunch than customers who did not see or use calorie information.

Q: With the closure of several hospitals in New York City over the past few years, how vital are community health clinics to providing services? Will there be a renewed emphasis on providing resources to these clinics should more hospitals be forced to close?
TF: There is a need for high quality primary care services through clinics of various types. Although in general the Department of Health and Hospitals does not fund medical care, we will be monitoring availability and access to primary care and will work with the state health department and others to increase access to quality care, especially for underserved populations.

Q: What do you see as the biggest public health crisis the city will face over the next five years?
TF: Smoking remains our city’s biggest underlying cause of preventable death. In addition, with nearly two thirds of New Yorkers obese or overweight, this crisis and its health consequences threaten to undermine public health gains made over the last few decades. Each year there are over 5,000 overweight and obesity-related deaths in New York City.

Nirav Shah, M.D. Commissioner, New York State Health Department

Q: Is it realistic that every New Yorker could have health insurance in 5 years?
NS: There are currently 2.7 million New Yorkers who lack health insurance coverage. New York’s efforts to create a health exchange will make it easier for people to obtain affordable health insurance, and it is projected that more than one million New Yorkers will gain coverage through the exchange in its first three years of operation.

Q: What has been the biggest success of the DOH over your tenure?
NS: We have made great progress in changing the mind-set of our health care system. Under the leadership of Gov. Andrew Cuomo and through the efforts of the Medicaid Redesign Team, New York has been able to contain costs and expand the number of insured New Yorkers while improving health care outcomes. As a result of Medicaid reform, an additional 191,000 low income New Yorkers obtained health coverage since March 2012, and MRT initiatives are projected to save New York State and the federal government more than $34 billion over the next five years.

Q: How do you reconcile the state’s interest in hydrofracking with the public health implications?
NS: In October the New York State Department of Environmental Conservation Commissioner Joseph Martens requested that I complete a public health review of DEC’s draft Supplemental Generic Environmental Impact Statement. Further, DEC requested that DOH identify highly qualified, external public health experts to help inform the review. The public health review is an analysis of potential public health impacts related to the use of high volume hydraulic fracturing in shale gas development to determine if any additional potential public health impacts should be considered beyond those already outlined in the draft SGEIS. Also, the review will determine if any additional mitigation measures are necessary. This effort also includes a review of existing and proposed environmental and public health surveillance systems to determine if they are adequate to establish baseline health indicators and detect and measure potential public health effects.

source: http://www.cityandstateny.com