Why does NYC Care?
NYC Care is a Citywide Health Program Designed to Aid People Who Cannot Afford to Pay for their Entire Health Insurance Coverage
July 10, 2023 / NYC Healthcare / NYC Neighborhoods / Gotham Buzz.
Two weeks ago, on Monday, June 26, 2023 I attended a meeting in City Hall hosted by the Adams Administration. It was raining fairly hard as I approached City Hall on this warm June afternoon.
The purpose of the meeting was to highlight the achievements being made in providing healthcare to New Yorkers. The focus on this day, was the progress being made toward providing healthcare to those who cannot [fully] afford it, by enrolling them into the NYC Care insurance program.
The meeting was arranged by the Mayor's Office of Ethnic & Community Media. I arrived a bit early and spent time catching up with some of the other reporters while waiting for the meeting to begin.
The photo at right shows the NYC City Hall on a warm, rainy mid afternoon in late June.
What is NYC Care?
In the meeting we were told that, while the NYC Care program is a healthcare / insurance program that focuses on minorities, immigrants and those for whom English is a second language, it is available to everyone - including Whites - assuming all candidates for the insurance program meet the same preconditions.
Enrollees in the NYC Care healthcare insurance program need only meet three criteria to be eligible: 1) must be 21 years old, 2) they must have a valid government ID from the U.S. or a valid passport from their nation of origin, and 3) they may not be eligible for any other private or public health insurance program [such as Medicaid / Medicare]. There used to be a proof of six months of NYC residency requirement, but it was later rescinded.
- CLICK here to read the rest of our report on NYC Health & Hospitals NYC Care low cost / no cost health insurance in NYC.
NYC Care Origins & Brief History
After the meeting I did a bit of research which I am incorporating in this report to provide fuller context to supplement what we heard live in the discussion held at City Hall on this warm and muggy Monday in June.
The NYC Care health insurance program was started in May of 2019 during the de Blasio Administration. At the time NYC Health and Hospitals was experiencing a financial shortfall, owing in part to how federal and state funding is allocated to the City. While doing some of my background research, I found the following statement in Wikipedia,
" ... Prior to the creation of NYC Care, public hospitals in New York provided 52% of the state's uncompensated medical care, yet only received 15% of the state's charity care dollars..."
It's worth noting that NYC Care [.gov], which is a city operated health insurance program, is not related to NYC Cares [.org] which is a non-profit founded in 1987 designed to recruit and redeploy people who want to do volunteer work to aid their communities. Nor is NYC Care related to Cares NYC, which is a private company providing special services, focused on aiding folks / families dealing with,
"... Intellectual/Developmental Disabilities including Autism, Behavioral Health concerns and/or Mental Health issues...".
Speakers at the NYC Care Meeting
At the meeting today, there were three speakers. Jonathan Jimenez, Executive Director of the NYC Care program at NYC Health and Hospitals; Emira Habiby Browne, Founder of CIANA [Center for the Integration & Advancement of New Americans]; and Hewett Chiu, President & CEO of AMPHS [Academy of Medical and Public Health Services]. The latter two speakers operate community outreach centers / programs in Astoria, Queens and Sunset Park, Brooklyn, respectively, which work with NYC Care to reach out to the low income communities the program was developed to help.
After a brief introduction, Dr. Jimenez began his presentation of a recent study conducted by NYC Health & Hospitals about its NYC Cares program entitled, Engaging New Primary Care Patients: Access for Uninsured Patients at an Urban Safety Net System. The study covered the period from November 2020 to October 2021, focusing on the level of client engagement with the NYC Care physicians of NYC Health & Hospitals.
Based on the study, Dr. Jimenez and NYC Care had accomplished much during the one year study period [11/1/20 - 10/31/21]. Jimenez cited a number of the report statistics which included the following,
" ... [the] study demonstrated the program’s success in connecting new members to primary and specialty care, which resulted in even higher engagement when looking at members who had two or more chronic diseases and spoke English as a second language (ESL)...".
" ... Overall, 76.9% of new NYC Care members returned to primary care for an additional visit in their first year, 80.7% received a referral outside of primary care, and 75.4% visited specialty care. For new members with two or more chronic diseases, 86.1% returned to primary care, 87.1% received a referral, and 86% visited specialty care...".
"... There was also strong engagement for new members who are ESL, where 86.1% returned to primary care, 80.2% received a referral, and 74.7% visited specialty care. This data suggests that NYC Care has spurred patient engagement at rates comparable to Medicaid, and that the data reflects member satisfaction and confidence in the high-quality care they are receiving ...".
The photo at right shows the speakers at the NYC Care meeting, including from left to right, a CIANA team member, CIANA Founder & CEO Emira Habiby Browne in Astoria, Queens; Executive Director of the NYC Care program at NYC Health and Hospitals Dr. Jonathan Jimenez; and President & CEO of AMPHS [Academy of Medical and Public Health Services] Hewett Chiu in Sunset Park Brooklyn.
Registering for NYC Care - Via Community Organizations in Each Borough or Directly
Essentially, after NYC Care validates eligible candidates for the low cost / no cost insurance program, they are provided an NYC Care card. This card enables NYC Care clients to access prescriptions, primary care visits, and access to other healthcare facilities / procedures covering conditions related to cardiology, dental, social services / mental health among others.
Dr. Jimenez noted that the level of community engagement with NYC Care is particularly notable given the hostile political environment in recent times, which has stirred fear within the immigrant communities. To dampen that effect, NYC Health & Hospitals NYC Care program has partnered with 22 community outreach groups throughout the five boroughs to enhance its reach into low income communities, by building awareness of the program, and establishing relationships and enough trust for immigrants to access / use the program without fear of reprisals.
Cut & paste the following link into your browser bar to access a page listing NYC Care community partners. These community organizations can help potential healthcare clients find the resources they need to access low cost / no cost healthcare / insurance.
https://www.nyccare.nyc/community-based-organization/
Alternatively one can call NYC Care directly at 646.692.2273 and they will guide you or people you know through the registration process, but be advised that registration may not be completed over the phone, nor online - only in person.
What the Community Based Organization [aka CBO's] Do
Essentially what the CBO partners do, is help NYC Cares extend their outreach within the community by getting word out to talk to people who may need healthcare services, but are unaware that they may be eligible to access them for a low cost / no cost fee. One of the statistics cited by Dr. Jimenez was that folks with two or more chronic conditions and over the age of 50 years, returned for a follow up healthcare visit.
At this point the two community organization leaders told us a bit about how they operate. Essentially, they provide a language and cultural bridge between potential community member clients and the city run NYC Health & Hospitals NYC Care program. Some of the issues CBO's are up against when trying to register community members are: 1) a lack of education on the part of potential clients, 2) a lack of English language skills, and 3) strong indigenous / cultural belief systgems which may not have been adapted / upgraded to the modern day world.
Hewett Chiu of the Academy of Medical and Public Health Services [AMPHS] in Sunset Park Brooklyn
Hewett Chiu's AMPHS [Academy of Medical and Public Health Services], is located in Sunset Park, Brooklyn, which is a community comprised of 30% Asians. As such, Chiu's group helps provide language and cultural support to help the clients effectively communicate with NYC Care, while providing a trusted source / intermediary between the [potential] clients and the NYC Health & Hospitals insurance program.
Emira Habiby Browne of the Center for the Integration & Advancement of New Americans [CIANA] in Astoria Queens
Emira Habiby Browne's CIANA [Center for the Integration & Advancement of New Americans] is located in Astoria, Queens. Astoria is 25% are Hispanic / Latino, 15% are Asians, 5% are African Americans and Whites make up most of the rest of the population. Browne has been operating in Astoria since 2006 and her goal is to provide a model for integration into and within the community. In describing her efforts, there is a strong social services component to it, helping people overcome fear so they are not abused, and building trust between them and the agencies designed to help them - such as NYC Care of NY Health & Hospitals.
NYC Care Successes - Identifying Illnesses & Other Health Conditions Early On
A few anecdotal examples of her work included helping a victim of domestic violence who had been stripped of all her cards by a co-habitant, helping a pregnant woman recognize and adjust to her changing circumstances, and helping someone with cancer identify their illness.
Some of the anecdotal successes imparted to us during the Q & A included sugar levels for a diabetic down 50% vs prior year, identifying hypertension as a key characteristic of folks for whom English is a second language, and helping many immigrant youths through depression, which they cannot talk about it with their families, because seeking social service counseling has been culturally stigmatized.
One NYC Care Objective is to Reduce Crisis / Emergency Medical Treatments Because they are More Expensive
Getting people to use their primary care physicians is believed will reduce the cost of providing emergency care. Proper nutrition and healthcare were once a bastion of only the rich, but NYC Care tries to spread the gospel of good health management through these community organizations in order to alleviate their pain and suffering and keep them healthy and productive.
NYC Care Demographics vs New York City Demographics
According to an NYC Care fact sheet, NYC Care members are approximately 64% Hispanic/Latinx, Black or African American are 15%, and Asian/Native Hawaiian/Pacific Islander are 6%. That accounts for 85% of the NYC Care client base, with the remaining being White and everyone else.
I compared the NYC Care demographics to the New York City demographic which were as follows: White 39.8% [White alone, not Hispanic or Latino 31.9%], Hispanic or Latino 28.9%, Black or African American alone 23.4%, Asian alone 14.2%, Native Hawaiian / Pacific Islanders are 0.6% and Two or More Races, percent 7.1%.
It was notable that Whites have very low representation at NYC Care, especially vis a vis their presence in the NYC population. The same was true for African Americans and Asians, who were represented in NYC Care at half the level of their presence in general NYC population. On the other hand, Hispanic / Latinx folks have double their representation in NYC Care as they do in the general NYC population.
Naturally this elicits one to ask questions, like why the huge demographic skews in the NYC Care clientele vis a vis the demographics of the NYC general population? I don't have answers to those questions at this time, but I do have a few hypotheses that need to be looked into at another time, at a future meeting. Remember these are hypotheses - not confirmed facts.
Questions for Future NYC Care Meetings
1) Whites and African Americans are less represented in the NYC Care program because they are more likely to have a higher percent of U.S. citizenship documentation than Hispanic / Latinx and, as such are eligible for state and federal health insurance programs like Medicaid / Medicare.
2) Whites and African Americans are less likely to reach out to NYC Care because they have a far higher degree of English fluency than Hispanics, and thus may be able to navigate their option without the help of CBO's or NYC Care.
3) The community outreach programs, which operate in tandem with religious institutions, elected officials, schools and civic groups may be able to more easily identify eligible Hispanic / Latinx for the NYC Care program than other potential participants.
4) Chiu told us that Asians are the poorest demographic in NYC, which I confirmed. So, it's possible because of an English language handicap, and a smaller Asian population in NYC vis a vis Hispanics, Asians have a more difficult time connecting with the right community groups required to translate / help them understand how NYC Care can help them.
5) And I suppose it's possible, that outreach efforts evolved in such a manner that they favor certain demographic groups.
NYC Care has Interacted with over 202,000 New Yorkers and Over 110,000 are Using the Program Today
Since 2019, 202,000 New Yorkers have interacted with NYC Care program. As of this posting [July 2023] approximately 110,000 New Yorkers are actively engaged in the program. Reasons behind the difference in total number of people interactions and current people engaged with the program include eligibility, current healthcare needs, and some / many have been moved into Medicaid or Medicare because they were found to be eligible for the state and federal programs which tend to provide more robust healthcare options.
Last Thoughts. Looking at Healthcare Access as an Income Level Issue, Instead of Labeling it with Racial, Cultural and Gender Biases
Oftentimes income discrepancies are color / racially / gender coded. And while poverty impacts people of color more than white people at this time, there are also a lot of poor white people out there too. The same is true of gender. While males still outperform females in income levels, there are still a lot of impoverished males out there too. Lastly, because of females' higher level of biological complexity vis a vis males [aka bearing children], they generally require more healthcare interactions.
I think it would be helpful to add / open up a civically oriented conversational track that decolorizes / deracializes / degenderizes income inequities, so that folks can also focus on the real problem, without all the labels and attached biases, which is that poor people - regardless of race, creed and gender - have trouble obtaining good, affordable, preventative healthcare.
This is not to say that we should not recognize - as many of the community outreach centers do - that there is a higher proportion of lower income New Yorkers who are people of color and female. And that - at least prior to NYC Care - did not have access to good affordable, preventative healthcare. But it's worth noting that black and brown and women are not the only ones who can be poor, and whose access to affordable healthcare is limited.
So, returning to our opening question in the headline of this report, Why does NYC Care? I found the following in attending this meeting and preparing this report: 1) it's less expensive to pay for health maintenance, than health crisis management [aka the Emergency Room], 2) all people should have access to affordable healthcare, especially if their employers are unwilling to pay them a living wage, and 3) a healthy workforce is a productive one.
All in all, it was a good introductory session to the NYC Care program of New York City Health and Hospitals. In the future we will work to obtain additional information to add to this report.
