Wherever he goes to talk up his plan to tame the state’s budget, Gov. Andrew Cuomo has been telling New Yorkers how essential the work of his Medicaid Redesign Team is.
That’s what the governor’s budget director, Robert Megna, assured the task force’s members, anyway, two and a half hours into their second meeting, which was held Wednesday in New York City.
“I was just with the governor this morning on Long Island,” said Megna, “and I can tell you, traveling around the state with him, in every presentation he does, he talks about how important the work of the task force is and how vital it’s going to be in getting the budget done this year.”
The work of the task force is not glamorous, even for government work. Although the meeting was scheduled to last for four hours, ending at 2:30 p.m., there would be no lunch, as co-chair Dennis Rivera announced at the start of the meeting. The room was small, hot, and paneled in a neutral taupe. There was so little space between the horseshoe of tables at which the task force members sat and the wall that when State Sen. Tom Duane arrived late, he chose to drag his assigned table into the middle of the room and then drag it back into place, rather than squish behind his colleagues in order to take his seat.
The task force has 27 members, drawn from state and local agencies, the state Senate and Assembly, and organizations representing patients, nurses, doctors, hospitals, and unionized health care workers. Megna is an ex-officio member, as well. The task force has an executive director, Jason Helgerson, who is also the state’s Medicaid Director, and a staff, some members of which were on hand to run through detailed slide shows for the panel. Others, according to Helgerson, were back in Albany, frantically crunching numbers to come up with cost-saving figures for the hundreds of proposals the task force has already gathered.
These are the people onto whom Gov. Cuomo has shifted responsibility for coming up with the $2.85 billion cuts to Medicaid that he says are necessary to make the state’s budget make sense going forward. They are mostly men, and almost all white. They do not have very much time to finish the task they have been assigned.
The team first met about a month ago, and since then has been holding public hearings (five in total) across the state to solicit ideas for curbing Medicaid costs. It has also set up a Web site, another forum in which constituents can submit suggestions for change. Helgerson and the staff have also been meeting in 30-minute increments with interested stakeholder groups. (There are many interested stakeholder groups.) Less than three weeks from now, the team is scheduled to take its final vote on its recommendations to the governor about this year’s budget.
So far, the task force has collected more than 600 ideas from hearings and an additional 2,000 through the Web site, according to Helgerson. Many people have the same ideas, of course; when winnowed down to unique ideas, the suggestions numbered 274, as of the meeting. Helgerson suggested that they stop accepting ideas by this coming Friday, February 11th. He said he had been encouraging stakeholder groups who had not gotten a meeting yet to submit their ideas via the Web. He also encouraged the team members to submit any ideas they themselves had to the committee by Friday, a deadline they were not entirely pleased with.
As far as actual cuts, approximately two out of every five ideas submitted focused on “recalibrating” benefits and reimbursement rates, Helgerson reported. “Recalibrate” really means cut: the task force was given a list of the ideas, as collated by the staff, and the descriptions of the proposals in this category were studded with words like “reduce,” “limit,” and “eliminate.” Other types of proposals dealt with regulatory and malpractice reform, empowering patients, enrolling more Medicaid members in managed care, and cracking down on fraud and abuse.
Next week, the team will have an opportunity to evaluate in more detail a select group of the proposals: Helgerson initially suggested the number would be about 30, but task force members — in particular, Assemblyman Richard Gottfried, who chairs the Assembly Committee on Health — were concerned that they were only being asked to weigh in on a limited number of proposals, likely the ones that would save the most money the most quickly.
Ed Matthews, who heads the New York City chapter of United Cerebral Palsy, echoed Gottfried’s concerns and said he had hoped that the task force would be working from a “basic agreement about what’s important…that we could agree on some way to look at these things so some team members are not saying this is number one because it saves the most money.”
That, in the end, is the crux of the problem that the Medicaid Redesign Team faces. The governor asked them, in two short months, to come up not just with places to cut Medicaid, but places to cut Medicaid based on inefficiencies in the system. He asked them to make suggestions that would simultaneously save money and improve Medicaid. But, of course, the inefficiencies that drive the state’s Medicaid costs up are not confined to this one program. As Dr. Jeffrey Sachs, who co-chairs the JFK Jr. Institute for Work Education, said after just a few minutes of discussion, “We’re not talking about Medicaid; we’re talking about the health care system.”
But, at least in public, the redesign team is not doing all that much talking at all. Most of Wednesday’s meeting was taken up by updates from Helgerson and power point presentations by the team’s staff about the “Key/Complex Issues” they faced: problems like managing long-term care, limiting physicians’ ability to prescribe name-brand drugs, and incorporating “pay for performance” measures into the system. The task force discussed these complex issues for about an hour in total, and one member commented that the discussion felt “disjointed.” Members echoed and supported each others’ statements, but they rarely spoke to one another or debated any of the issues raised.
One assumes that won’t be true in two weeks, when, on Feb. 24, the redesign team is will meet in Albany to consider for the first time the staff list of recommendations, in preparation for their final vote, on March 1, on the report they will present to the governor. The Feb. 24 meeting is scheduled to last all day, and Helgerson assured the task force that they would have the use of that meeting room all of the 25th, as well, if they needed to extend their time together. Since the team is, after all, doing vital and important work at the behest of the governor, it seems that during this next round of meetings they might at least be given time to break for lunch.