New York State
MANAGING EXPECTATIONS
AFL-CIO
Helping Working Families Achieve A Better Life
Economic Development or Corporate Welfare
STATE’S SHIFT TO MANAGED CARE FOR MEDICAID PATIENTS RAISES CONCERNS By ALLISON HIBBS
By Mario Cilento, New York State AFL-CIO President It is important for our state and local communities to lure and assist private sector employers to create jobs. However, corporations accepting government assistance need to be held to a higher standard than private employers that start-up on their own funding and pay their regular taxes.
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It is not enough that our economic development strategy helps investors and developers increase their profit on investment; working men and women also need to see increased earnings and benefits. It is not enough that local governments, through the virtually unchecked authority of IDAs, grant tax breaks to business simply for setting up shop. The fact is that profitability does not equal job creation. The term “jobless recovery” is clear evidence of that as Wall Street breaks records while income disparity grows to historic levels. The goal should be to replenish the revenue that state and local governments forgo so existing taxpayers are not left holding the bag and taking on additional costs because the new businesses are not paying their fair share. That means the people who work in these new businesses need to earn enough to buy houses and pay local taxes themselves.
city & state — February 24, 2014
We need better oversight and transparency in how businesses get tax breaks and what our state and communities are getting in return. We need to make sure that our job creation programs are clearly defined as public works projects and project labor agreements are authorized on construction so that all jobs created have standards greater than the bare minimum. And we need to make sure that if an employer accepts government assistance that it honors the agreement or returns the taxpayer gifts. Enacting these common sense reforms will help ensure that publicly funded economic development programs work for hardworking New Yorkers. The New York State AFL-CIO is a federation of 3,000 affiliated public sector, private sector, and building trades unions throughout the state representing 2.5 million members, retirees and their families. Our State Federation, which is the largest and most diverse in the country, is committed to making New York work for hardworking New Yorkers. For more information on the Labor Movement in New York, visit www.nysaflcio.org.
Nwork Y making
makingNYwork.org
Jason Helgerson (far left) led the governor’s Medicaid Redesign Team, which has saved billions of dollars, some of which may be used to help struggling hospitals. Some Medicaid reforms have raised concerns, however.
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ov. Andrew Cuomo’s Medicaid Redesign Team has reduced government spending, slowed rising healthcare costs and freed up funds to help struggling hospitals. But one reform—the shift to managed care programs—is still “making lots of people nervous,” said Assemblyman Richard Gottfried, the longtime chair of the Assembly Health Committee and a member of Cuomo’s Redesign Team. More than four million Medicaid consumers have been moved to care management programs over the last two years as a result of the Medicaid Redesign Team’s recommendations. The “Care Management for All” initiative, just one aspect of the much larger statewide Medicaid overhaul, calls for 95 percent of Medicaid recipients to be enrolled in care management plans by 2018. The New York State Department of Health has said that the initiative, which aims to improve coordination of benefits, quality of care and patient outcomes, will shift Medicaid spending to a system under which a managed care organization is paid by the state
to organize patient care and reimburse healthcare service providers. This will almost entirely replace fee-forservice Medicaid, under which service providers bill the state directly, patients receive fragmented care and there is less accountability for outcomes. The initiative aligns with the primary goal of the MRT: to control Medicaid costs by promoting healthy Medicaid patients rather than simply cutting benefits or reducing payment rates. Taken together, MRT initiatives are already projected to reduce Medicaid spending growth by billions of dollars. Managed care organizations—or, in some cases, a health management organization, or HMO—will be closely regulated and monitored by the state. But providers have raised concerns, including in the mental health field, where the bulk of the patient population has yet to be shifted over to the new plans. “It’s all supposed to start in 2015,” said Glenn Liebman, CEO of the Mental Health Association in New York State. “At this point we’re trying to figure out where the points are where we can really advocate strongly cityandstateny.com
DARREN MCGEE/EXECUTIVE CHAMBER
The state and local governments now spend $7 billion each year in various tax incentive and economic development programs in the name of creating jobs. Clearly, we are not getting the most from those incentives. And we clearly cannot keep cutting state and local services while we continue to fund corporate welfare.