UPDATE: New York: Mayor de Blasio makes surprise announcement of healthcare coverage expansion for 600K uninsured NYC residents

I...really don't know what to do with this announcement:

New York City will begin guaranteeing comprehensive health care to every single resident regardless of someone's ability to pay or immigration status, an unprecedented plan that will protect the more than half-a-million New Yorkers currently using the ER as a primary provider, Mayor Bill de Blasio said.

It's not health insurance, his spokesman clarified after the surprise announcement on MSNBC Tuesday morning.

"This is the city paying for direct comprehensive care (not just ERs) for people who can't afford it, or can't get comprehensive Medicaid — including 300,000 undocumented New Yorkers," spokesman Eric Phillips tweeted.

At a press conference Tuesday, de Blasio said the plan will provide primary and specialty care, from pediatrics to OBGYN, geriatric, mental health and other services, to the city's roughly 600,000 uninsured.

The city already has the foundation for such a plan — a public health insurance option that helps get direct care to undocumented residents.

That option will be expanded, the mayor said, and supported with the addition of a new program called NYC Care. Patients who seek health coverage through NYC Care will receive a card that allows them to see a primary care doctor and seek specialty care services, de Blasio said.

Those who can afford to pay will pay for services on a sliding scale, while those who can't will receive free coverage, he noted.

OK, so it's not single payer at all...it sounds like this effectively amounts to NYC expanding Medicaid (or a Medicaid buy-in) to 600,000 lower-income people on it's own dime, along the lines of Gavin Newsom's announcement yesterday that he wants California to expand Medicaid (actual Medicaid) to 19-25-year old undocumented immigrants on CA's dime. The main difference here seems to be that a) it's not technically Medicaid and b) it's being done at the city level instead of the state level.

Oh, and here's the real eyebrow-raiser:

New Yorkers will be able to access the program through the city's website or simply by calling 311. There will be no tax hikes to fund it, the mayor said.

So how much will it cost?

NYC Care is expected to launch in the Bronx this summer and be available in the other four boroughs in 2021, the release said.

It'll cost at least $100 million, accordinng to the release.

Interesting indeed. Medicaid cost an average of around $7,800 per enrollee nationally in 2017 (around $576B for 74 million people), although that varies greatly depending on the enrollee age, condition, state, etc. Assuming that's the norm for enrollees in this new NYC program, and all 600,000 actually enrolled, that'd come to around $4.7 billion if none of them had to pay anything. The sliding scale means the actual cost would be considerably less, but there's still a massive gap between $100M and $4.7B.

How is NYC gonna cover these folks for 1/47th the price of Medicaid? Aside from the sliding scale factor, it sounds like much of the program will involve restructuring and reallocating existing healthcare spending and resources, which is fine if it works.

UPDATE: Thanks to Ken Kelly for reiterating my point about the wide range in cost for different Medicaid populations. According to the Kaiser Family Foundation (using 2014 data), adults on Medicaid cost around 57% as much as the average, while children cost 45% as much. If the 600K target population falls somewhere in that range health/cost-wise, it's more like half as much ($3,900 apiece), but that's still a 24:1 ratio.

UPDATE x2: OK, as I suspected, there's less to this than meets the eye, as Bill Hammond put it:

Although his office called it “the largest, most comprehensive plan in the nation,” the proposal appears – based on limited details provided so far – to be a relatively modest expansion of existing safety-net programs. The total price tag for the plan, when fully implemented, was said to be $100 million a year, a fraction of what the city and state already spend on health care for the poor and uninsured.

...If, however, the initiative succeeds in connecting more people with routine care, and diverting them from emergency rooms for basic needs, that would both improve public health and save money – which is well worth doing.

The plan also illustrates a timely point: New York (and especially New York City) is closer to achieving universal access to decent health care than is commonly realized – close enough that the mayor can apparently make it happen for a mere $100 million.

ive tweeted a lot about this today – it is not what tou think it is – this is tailored toward improving customer service and making people aware of options that currently exist. This IS NOT new insurance or new benefits.

— Dan Goldberg (@DanCGoldberg) January 8, 2019

Not quite coverage. If you can afford it, the program refers you to @MetroPlusHealth. If you can't, you can get treated by @NYCHealthSystem in its hospitals or clinics. That was already an option, but this will make it easier. https://t.co/ftBAFwrmNF

— Jonathan LaMantia (@JonLaMantia) January 8, 2019

Here's the press release itself:

Mayor de Blasio Announces Plan to Guarantee Health Care for all New Yorkers
January 8, 2019

• State of the City 2019: Most comprehensive, universal coverage in nation will guarantee primary and specialty care to 600,000 uninsured New Yorkers

NEW YORK—Mayor Bill de Blasio today announced his administration will launch the largest, most comprehensive plan in the nation to guarantee health care for every New Yorker. The plan will serve the 600,000 New Yorkers without insurance by strengthening NYC’s public health insurance option, MetroPlus, and guaranteeing anyone ineligible for insurance – including undocumented New Yorkers – has direct access to NYC Health + Hospitals’ physicians, pharmacies and mental health and substance abuse services through a new program called NYC Care. All services will be affordable on a sliding scale. The programs will include customer-friendly call lines to help New Yorkers – regardless of their insurance – make appointments with general practitioners, cardiologists, pediatricians, gynecologists and a full spectrum of health care services.

“Health care is a right, not a privilege reserved for those who can afford it,” said Mayor de Blasio. “While the federal government works to gut health care for millions of Americans, New York City is leading the way by guaranteeing that every New Yorker has access to quality, comprehensive access to care, regardless of immigration status or their ability to pay.”

“With today’s announcement of NYC Care, New York City takes another leap ahead of the rest of the nation in providing mental health services,” said First Lady Chirlane McCray. “Guaranteed health care means guaranteed MENTAL health care and alcohol/drug addiction treatment. No other city or state provides these comprehensive services to ALL residents.”

“We have the tools and opportunity to guarantee health care for all New Yorkers,” said Deputy Mayor for Health and Human Services Dr. Herminia Palacio. “New Yorkers who can’t enroll in or afford health insurance will now be able to access comprehensive, patient-centered services through NYC Care. At the same time, we will amplify our efforts to increase enrollment into MetroPlus. Today we celebrate our City’s relentless commitment to accessible, high-quality health care.”

“Expanding access to care is a key step in eliminating health disparities in our city,” said Health Commissioner Dr. Oxiris Barbot. “The Affordable Care Act started us down this path, but it is time to finish the job. New York City is proud to lead the way. I stand with Mayor de Blasio today in declaring health care is a right for all, not a privilege for only those who can afford care.”

“NYC Care will be the biggest and most comprehensive health coverage program in the country,” said Dr. Mitchell Katz, President and CEO of NYC Health + Hospitals. “Building on the great work of our doctors, nurses and staff, and working collaboratively with community partners, NYC Health + Hospitals will help give all New Yorkers the quality care they deserve.”

Thanks to the Affordable Care Act, 8 million New Yorkers now have health insurance, and the uninsured rate is about nearly half of what it was in 2013. In the last two years, New York City’s Public Engagement Unit coordinated signing up more than 130,000 New Yorkers for plans through the exchanges created by the law. However, about 600,000 New Yorkers remain without insurance, because they do not or cannot enroll. Through this new initiative, New York City will create a bigger, better, more comprehensive program for guaranteed health care. The City aims to better connect people to more effective and affordable health care in one of two ways:

• NYC Care: The city will connect hundreds of thousands of New Yorkers who are ineligible for health insurance – including undocumented New Yorkers and those who cannot afford insurance – to reliable care. Anyone will be able to access comprehensive care across NYC Health + Hospitals’ more than 70+ locations, once the program is fully ramped up. NYC Care is open to anyone who does not have an affordable insurance option and will be priced on a sliding scale, to ensure affordability. NYC Care will provide a primary care doctor and will provide access to specialty care, prescription drugs, mental health services, hospitalization, and more.

• NYC’s Public Option: The City will double down on efforts to boost enrollment in MetroPlus, the City’s public option. MetroPlus provides free or affordable health insurance that connects insurance-eligible New Yorkers to a network of providers that includes NYC Health + Hospitals’ 11 hospitals and 70 clinics. MetroPlus serves as an affordable, quality option for people on Medicaid, Medicare, and those purchasing insurance on the exchange. The City is committed to strengthening MetroPlus and connecting more independent workers, City vendors and City workers to that option. It also will improve the quality of the MetroPlus customer experience through improved access to clinical care, mental health services, and wellness rewards for healthy behavior.

The City is taking an unprecedented approach to health care services by tackling mental and physical issues holistically. Through both programs, New Yorkers will be able to access addiction services and opioid treatment, mental health counseling, and counseling services for trauma victims. New Yorkers will be able to call MetroPlus or 311 to be screened for health insurance eligibility and get connected to their best coverage option.

As part of this initiative, H+H will be significantly enhancing 24/7 customer service to seamlessly connect patients to healthcare.

NYC Care will launch in summer 2019 and will roll out geographically, starting in the Bronx. It will be fully available to all New Yorkers across the five boroughs in 2021. The program will cost at least $100 million annually at full scale. Additionally, MetroPlus will announce a series of enhancements throughout the year.

Huh. Good for him, and I'll be watching this closely...