Replacing Obamacare? Look to New York

Before signing the Affordable Care Act in 2010, President Barack Obama proclaimed it part of “the core principle that everybody should have some basic security when it comes to their health care.” Many Americans, unconvinced the legislation above his signature was the best way to achieve this goal, put the fate of the law at issue in every successive election.

Having finally achieved the electoral success necessary to fulfill their commitment to repeal the ACA — also known as Obamacare — Republicans should consider looking to an unlikely source in finding its replacement. For decades New York State has provided catastrophic heath coverage to Empire Staters in need. Unlike some programs out of Albany, this one works. I know firsthand.

On August 30, 2007, our son Robert Thomas was born at North Shore University Hospital on Long Island just thirty and a half weeks into the forty-week gestation cycle. My father, a retired NYPD police officer not prone to tears, cried when I told him the news as he considered the challenges his grandson could face being born so prematurely. I assured him by relaying a nurse’s remark that the 3 lb. 12 oz. addition to our family was the “strongest kid in the NICU.”

Unfortunately, my optimism was short-lived and my dad’s fears realized when 12 days later Robbie was rushed into emergency surgery to correct an abnormality in his small intestine caused by a bacterial infection known as necrotizing enterocolitis (NEC). Upon completion of the nearly four-hour procedure, the surgeon entered the hospital’s family room and asked another couple whom we didn’t know to give us a moment. He then told my wife and I pointblank five words I would have never expected to hear from a medical professional: “He’s in God’s hands now.”

Later that afternoon, Robert’s head was blessed with sterile water from a medical container for the hastily-organized Baptism sacrament performed by Sister Maureen Mitchell, a volunteer at the facility. As my wife and I stood alone beside his tiny incubator, we listened to every word of the blessing through blurred eyes and dizzying senses. “I beseech those present to unite themselves with me in prayer for this child….” The only certainty in our lives at that moment was the sobering reality that we couldn’t completely come to pieces. In addition to our newborn son, our two-year-old daughter needed us too.

Robert’s start to life was the beginning of a difficult journey. Shortly after the surgery he was transferred to nearby Cohen Children’s Hospital where the surgeon could keep a closer eye on our pride and joy. We were getting the care we knew he needed but, thirty days after this ordeal began and no end in sight, medical expenses were mounting and had already exceeded $250,000.

Nearly fifty percent of those who file for bankruptcy do so following a medical catastrophe they couldn’t possibly have planned for. This statistic was one that never sunk in with me until I was facing the same dilemma. The cap on our employer-based insurance plan — sizable under normal circumstances but inadequate in this crisis — also hadn’t been something I spent much time considering. Like all families confronted with this situation, we were prepared to do whatever needed to be done financially to see that our son was properly healed.

A light in the darkness arrived when hospital billing staff informed us we could apply for catastrophic heath coverage — a state extension of Medicaid — that was not subject to means testing and was designed to help us and others similarly situated. Our financial difficulties were eased. And it was our fellow New Yorkers — combined with a common-sense law passed nearly four decades ago — that helped to ease them.

“The Assembly gave final passage late last night,” read the NY Times article published on July 20, 1978, “to a bill establishing an experimental pilot program that extends insurance against extraordinary medical expenses to all New Yorkers.”

New York State’s catastrophic coverage plan was signed into law by Governor Hugh Carey, a Democrat, but it was State Senator Tarky J. Lombardi Jr. of Syracuse, the Republican chairman of the Senate Health Committee, who introduced the legislation. The Democratic-controlled Assembly, according to published reports, had “reluctantly agreed to the bill.” The cost of the plan in its first year were projected to be $65 to $75 million.

The law initially created a pilot program that transferred sizable medical costs to the state medicaid program. Individual eligibility would be achieved when medical expenses exceeded more than half of the household’s after-tax income.

New York’s catastrophic coverage “could help a large number of people and is one of the active models to look at,” said State Senator Kemp Hannon in a recent interview. Hannon, a lawmaker from Long Island and the current Chair of the New York Senate Health Committee, was sworn into the NYS assembly in 1977. During his first session in the legislature Hannon voted in favor of Lombardi’s health care plan.

Our national health coverage considerations should begin with a simple premise: We will help our neighbors when they can’t help themselves. Instead of dismissing the ACA’s intention, we should be seeking a middle ground that could be found in providing coverage to those most in need. A sprained arm while skateboarding or a broken nose while playing basketball, a situation President Obama citied as happening to him in college, would find these individuals with a bill to be paid off over time. Catastrophic health coverage, like New York State has and our nation should adopt, would allow a family facing financial ruin to be provided assistance.

Three surgeries and ninety-three days after being born, our son was on the way home just in time for Christmas. His health is and will always be the best gift we have ever received. Since then we keep a picture on the shelf in his bedroom of him being cradled in the hospital ten years ago by the doctor who performed his surgeries. It is a reminder to my boy — and to us — that good people often do good things for those they don’t even know.

Last May, Robbie got to meet Dr. Stephen Dolgin for the first time since those difficult months a decade ago. When he thanked the surgeon for saving his life, my dad, standing right by his grandson’s side, couldn’t help but cry.

Published in The Hill on March 4, 2017.

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