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November 22, 2006CORRECTION: OMISSION FROM SPITZER-PATERSON TRANSITION TEAM ANNOUNCEMENTS: We inadvertently omitted Daniel Sisto, President of the Healthcare Association in New York State from the list of individuals named to Spitzer-Paterson Transition Team for Healthcare. MHANYS TO HOLD 5 REGIONAL POLICY FORUMS: 5 Mental Health Association affiliates throughout the state will be hosting discussions about mental health policy issues in New York State in December, which will include updates and a dialog with MHANYS staff and members of the MHANYS Board of Directors. These discussions will include updates on the status of mental health policy issues currently pending in Albany and insight into what changes can be expected with the Spitzer Administration. Most importantly, this discussion will provide an open forum in which issues related to mental health can be raised and discussed for possible inclusion in the mental health policy agenda in Albany for 2007. All discussions are completely open to the public, and all individuals interested in mental health policy in New York State should participate. Most discussions will include lunch or refreshments. 5 Opportunities to Participate: •
Binghamton – December 4th hosted by the Mental Health Association
of the Southern Tier Location information for each event, as well as RSVP information is available at http://mhanys.org/policy/Forum-Dates%202006.htm or by contacting Michael Seereiter at mseereiter@mhanys.org or 518-434-0439 x221. NYS COURT OF APPEALS RULES AGAINST PATAKI ADMINISTRATION’S CONFINEMENT OF SEXUAL OFFENDERS IN PSYCHIATRIC FACILITIES – LEGISLATURE EXPECTED BACK IN ALBANY SHORTLY: In a unanimous decision on Tuesday, the NYS Court of Appeals on Tuesday overturned a lower court’s ruling that permitted the state use Mental Hygiene Law to “civilly confine” sexual offenders in state psychiatric centers after having served their prison sentence. The court did not rule the practice of “civil confinement” illegal, but cited the Pataki Administration for failing to “grant(ed) hearings to determine whether they (sexual offenders) were still dangerous before being transferred to psychiatric facilities. Since the offenders were still prison inmates - not mental-health patients - when the involuntary commitment process began, they should have been afforded the protections of state law, including pre-transfer hearings and court-appointed physicians to conduct psychiatric exams, Judge Carmen Ciparick wrote for the court” (The Journal News, 11/22/06). The Court did not order that these individuals be released, but rather that the identified sex offenders be provided with a court hearing to determine if their continued confinement in state psychiatric centers is necessary. In response, Governor Pataki has indicated that he will call the NYS Legislature back to Albany for a Special Session, specifically to take up legislation to authorize civil commitment of sexual offenders. Regular readers of the Update will recall that the Assembly and Senate were unable to come to an agreement on such legislation through the use of conference committees earlier in the year. So, it remains very unclear as to what will transpire on this matter. What is clear is that mental health advocates remain very concerned that a civil commitment law would 1) place individuals with psychiatric disabilities at a significant safety risk, 2) spend hundreds of millions of “mental health” dollars on sexual offenders inappropriately placed in the mental health system, and 3) do irreparable damage by associating sexual offenders with individuals with serious mental illness, further perpetuating unfounded myths about people with psychiatric disabilities being necessarily violent and dangerous. On the other hand, if the Legislature is called back to Albany for a Special Session, this could provide the opportunity for the NYS Assembly to pass the agreed upon version of Timothy’s Law that the Senate passed in September, allowing it to be sent to Governor Pataki for his consideration before the end of the year when he leaves office. IN THE NEWS: Pass
this Into Law - State Assembly needs to follow lead of Senate and
approve Timothy's Law. Editorial Old prejudices die hard. So it is with the compromise version of Timothy's Law that passed through a special session of the New York State Senate early this year. The Assembly has not yet considered the measure, but there's time -- and no good reason not to act. For those who have lost track of the many legislative initiatives named after victims, this law is named after 12-year-old Timothy O'Clair, a Schenectady boy who committed suicide after his parents fought for years to get him adequate mental health care. The family's insurance coverage was limited, and the last-minute desperate attempt to get Timothy care by relinquishing custody to the state proved too late. No family -- no one -- should find themselves in such a position or have to make such a choice. But years of negative stereotypes about mental illness still cling to us, and insurance companies less than eager to weaken profits have been reluctant to alter that norm. If a person is diagnosed with a heart ailment rooted in a physical imperfection in that organ, treatment is generally undertaken and continues until full recovery or a long-term maintenance plan is set. Insurance companies follow all the way along. If someone is diagnosed with bipolar disorder, an ailment rooted in a physical imperfection in the brain, treatment is too often refused or limited, regardless of the health impact of that policy. Old notions that mental health issues are a defect in character, rather than a flaw in brain function, have long buried that health care disparity under a cloak of shame. With its passage of Timothy's Law, the Senate tried to help change that. The law sets minimum outpatient and inpatient visit insurance standards for everyone. In addition to assisting small businesses in meeting any potential added costs, it broadens the scope of coverage large employers must provide to adults and at-risk children -- including health issues such as major depression and panic disorders, illnesses long dismissed as an indulgence to the weak willed. It is far from a perfect package. Too little is done to address addictive disorders such as alcoholism and substance abuse -- diseases with deep physical roots also long dismissed as indulgences of the weak willed. An earlier Assembly-backed version of the bill included this coverage, but this compromise version does not This Timothy's Law is an important first step, and the Assembly should return before year's end to add its approval. A spokesman for Sheldon Silver, D-Manhattan, said Wednesday the speaker has no plans to call a special session. We strongly urge the speaker to change his mind. Assemblyman James G. Bacalles, R-Corning, agrees with us. "I can't believe that leadership in the Assembly would let this slide by without a vote," Bacalles said Wednesday. "My guess is that we will be going back before the end of the year. I'd be surprised if we didn't." Without Assembly approval this year, the measure would die. Don't let that happen without a vote, Mr. Silver. Breaking down this barrier is essential and long overdue.
Pataki Rebuked on Confining Sex Offenders. By Nicholas
Confessore New York State’s highest court yesterday struck down the Pataki administration’s practice of confining sex offenders in psychiatric hospitals after their prison terms end and ordered immediate hearings to determine whether those being held should be released. The 7-0 decision by the state Court of Appeals was a sharp rebuke to Gov. George E. Pataki, who last year ordered the confinement of 12 sex offenders after lawmakers failed to agree on legislation that would have explicitly permitted such detention. In yesterday’s ruling, the court found that the state erred in using mental hygiene laws to confine the 12 men, 11 of whom are still held involuntarily at psychiatric hospitals in New York City. The men had legal protections as prisoners that entitled them to hearings before being ordered confined upon their release, the court found. “These people were characterized as being free citizens. The fact is that they were prisoners, and were entitled to the protections built into the correction law before they can be sent from prison to a psychiatric hospital,” said Stephen J. Harkavy of Mental Hygiene Legal Service, a state agency that represented the 12 men. Reacting to the ruling, Governor Pataki, who is a possible candidate for the 2008 Republican presidential nomination, said he would call for a special session of the Legislature next week to push for legislation to allow for the civil confinement. The governor has made tougher treatment of recidivist sex offenders a signature law-enforcement issue, and he blamed Democrats in the State Assembly for stalling on the matter in years past. In a statement, Assembly Speaker Sheldon Silver dismissed that criticism as “lies and mistruths.” He noted that the Assembly, like the Republican-controlled State Senate, had passed civil confinement legislation in January, but that Senate Republicans had avoided reconvening a conference committee to work out differences in the two bills. Hinting that Mr. Pataki called for the session to bolster his presidential credentials, Mr. Silver said, “Instead of participating in another political road show aimed at misleading New Yorkers and garnering headlines, the governor and the Senate should work with the Assembly on tough, effective laws that crack down on sex predators.” The ruling plunges New York back into a volatile national debate over the treatment of sex offenders. Eighteen states — including four in the Northeast: Massachusetts, New Hampshire, New Jersey and Pennsylvania — have laws that allow the confinement of sex offenders after they are released from prison. The United States Supreme Court ruled in 1997 that such programs do not constitute double jeopardy, and that the laws are legal as long as the state can prove the offender suffers from a mental abnormality that makes him “unable to control his dangerousness.” The men covered by yesterday’s ruling were serving sentences for a range of crimes; one was convicted of raping a 3-year-old boy, for example, another of sexually abusing three young girls. About 100 other men throughout the state were also transferred to civil confinement while the original case worked its way through the courts. The new ruling, however, will not directly affect them. The law already permits them to challenge their confinement after they have been committed, and each of the plaintiffs is doing so. Advocates for the detainees say, though, that the order may hasten those hearings. In yesterday’s ruling, Judge Carmen Beauchamp Ciparick, who was appointed by Mr. Pataki’s predecessor, Gov. Mario M. Cuomo, wrote, “We do not propose that these petitioners be released, nor do we propose to trump the interests of public safety. Rather, we recognize that a need for continued hospitalization may well exist.” The decision reversed an earlier ruling by an appellate court, which had overturned a 2005 State Supreme Court ruling in favor of the 12 men. In his statement yesterday, Mr. Pataki said he was “deeply disappointed” by the high court’s ruling. Though his successor, Governor-elect Eliot Spitzer, also supports new civil-confinement legislation and said yesterday that he would push for it when he takes office next year, Mr. Pataki signaled that he wanted to make one more effort at passing the law on his own watch. “I remain committed to do everything in my power as governor to keep these predators away from our children and away from society and have been working for years to give our mental health and criminal justice professionals the tools they need to protect our children and families from sexually violent predators,” the governor said. Mr. Pataki originally sought to have the 12 men confined in September 2005 under a novel interpretation of the state’s mental hygiene laws, which usually govern hospitalization of the noncriminal mentally ill. Later that year, Justice Jacqueline W. Silbermann of the State Supreme Court in Manhattan held that while it was reasonable for state officials to be concerned about the risks to the public should the men be released, state law required that court-appointed doctors examine the men to determine whether they met the requirements for civil confinement. In upholding that initial decision, the court of appeals said that prison officials had ignored the corrections law governing such confinements, which is more restrictive than the mental hygiene laws under which the men were transferred to the psychiatric hospitals. The corrections law requires that court-appointed doctors determine whether an inmate is mentally ill and a formal court order to commit them involuntarily. It also allows the inmate to contest the order before a judge prior to being committed. A spokesman for Mr. Pataki, David Catalfamo, said yesterday that the governor would continue to seek civil confinement for imprisoned sex offenders who are near release and deemed likely to commit crimes in the future. But he will do so under the corrections law, “with all attendant procedural requirements,” said Mr. Catalfamo, rather than under the mental hygiene law. Abby Goodnough contributed reporting.
High Court Ruling on Sex Convicts Criticized. By Cara Matthews
and Yancey Roy ALBANY - The son of a White Plains murder victim killed by a convicted rapist slammed a ruling by the state's top court yesterday that said New York had no authority to keep sex offenders locked up after they completed their criminal sentences. In a 7-0 decision, the Court of Appeals found that sex offenders who are still in custody should have been granted hearings to determine whether they were still dangerous before being transferred to psychiatric facilities. The ruling ordered that hearings take place immediately. Gov. George Pataki, whose term ends Dec. 31, Gov.-elect Eliot Spitzer and other lawmakers also said they were disappointed with the decision. They said it underscored the need for quick action to keep the public safe. Pataki said he would call a special session of the Legislature to address the issue soon. Frustrated that the Legislature had not enacted a law authorizing the state to hold sex offenders deemed still a threat to society after their prison terms ended, Pataki had invoked mental-hygiene law to transfer such inmates to mental-health facilities. That was improper, the Court of Appeals ruled - overturning a midlevel court. Since the offenders were still prison inmates - not mental-health patients - when the involuntary commitment process began, they should have been afforded the protections of state law, including pre-transfer hearings and court-appointed physicians to conduct psychiatric exams, Judge Carmen Ciparick wrote for the court. "Obviously we're very disappointed by this,'' said Jonathan Russo, the eldest son of Concetta Russo-Carriero, who was murdered in June 2005 by convicted rapist Phillip Grant in White Plains. "The decision by the Court of Appeals reaffirms our determination to see that the New York state Legislature pass a meaningful civil-confinement law to deal with sexual predators. We look forward to working with Governor-elect Spitzer to pass legislation this spring.'' Russo-Carriero, 56, was walking to her car parked in a municipal garage next to the Galleria mall when Grant stabbed her twice in the chest with a knife he had stolen at the mall. Grant, 44, had spent more than 20 years in prison after being convicted of raping three Bronx women at knife point in a six-week period in 1979, when he was 17. He served the maximum sentence before he was released in 2003, classified as a high-risk sex offender. In a rambling confession to police after the murder, Grant, who is black, said he killed Russo-Carriero because she was white and he was fighting a race war. Grant, convicted of second-degree murder in July, was given the maximum sentence of 25 years to life for the slaying. "Dealing with sex offenders is a growing problem," said Russo, whose family has worked for enactment of a civil-confinement law that he hopes will be named after his mother. "Legislation is needed, and 'Connie's Law' is that legislation." Ciparik said the court understood that the state proceeded as it did "in an attempt to protect the community from violent sexual predators." Still, she wrote, "We do not propose that these petitioners be released, nor do we propose to trump the interests of public safety. ... We therefore order that those petitioners remaining in custody be afforded an immediate retention hearing." "We're gratified by the decision because we believe this vindicates what our legal position was," said Stephen Harkavy, who represented the 12 plaintiffs in court and is a deputy director of Mental Hygiene Legal Service. Pataki said yesterday that 787 inmates have been screened and 112 remain confined. There are about 5,000 sex offenders in New York's prisons. "We took these actions with the knowledge that the existing involuntary commitment law was not designed with the unique characteristics of sexually violent predators in mind," the governor said in a statement. "While I am deeply disappointed by today's decision of the Court of Appeals, I am pleased that the court recognized the danger to public safety posed by these sexual predators and did not order their release." Pataki, blaming the Democrat-controlled Assembly for the lack of an agreement on sex offenders, said he would call the Legislature back into session. Senate Majority Leader Joseph Bruno, R-Brunswick, Rensselaer County, would be willing to hold a special session on the civil-confinement law a spokesman said. Enacting legislation on civil confinement for dangerous sex offenders has been one of the top issues for the GOP-controlled Senate. In the 2005 session, the Senate and Assembly passed differing versions of a sex-offender bill and convened a committee to try to negotiate a compromise. But it quickly broke down. The tension between the Senate and Assembly on civil-confinement legislation continued yesterday, with Assembly Speaker Sheldon Silver, D-Manhattan, accusing the Senate majority of sabotaging the conference committee process and being "more interested in staging press conferences and delivering sound bites than sitting down in open forums to enact effective legislation." A spokeswoman for Spitzer said the outgoing attorney general, who argued the court case for Pataki, was unhappy with the ruling and would work to get legislation enacted.
Court Ruling Won't Affect Marcy - Says state shouldn't have kept
sex offenders in jail. By Cara Matthews and Yancey Roy ALBANY — A ruling by New York's top court Tuesday that Gov. George Pataki had no authority to keep 12 sex offenders locked up after completing their criminal sentences won't immediately affect the sex offender facilities at Marcy, a spokeswoman for the state's Office of Mental Health said. "Today's ruling by the Court of Appeals will have no direct impact on the delivery of treatment services at the Sex Offender Treatment Program at Central New York Psychiatric Center," said Jill Daniels, a spokeswoman for the state's Office of Mental health, which oversees the program. In a 7-0 decision, the Court of Appeals found that the sex offenders, who are still in custody, should have been granted a hearing to determine whether they were still dangerous before being transferred to psychiatric facilities. The ruling ordered that hearings take place immediately. Pataki, whose term ends Dec. 31, Gov.-elect Eliot Spitzer and other lawmakers said they were disappointed with the decision, and said it underscored the need for quick action to keep the public safe. Pataki said he would call a special session on the issue soon. Local state-level representatives said the ruling highlighted the need for the state Legislature to create its own legislation to govern the civil confinement of sex offenders. "It highlights the need for a specific law that we need to address these kinds of cases," said state Sen. Raymond Meier, R-Western. A statute also would deal with other ambiguous areas relating to the sex offenders, such as the level of training the security staff should have. "What we need here is a statute to provide the due process and for the level of security to be outlined in the statute," said state Assemblywoman RoAnn Destito, D-Rome. One local resident, Agnes McGee, who lives on Chaminade Road in Marcy, said she has lived near the psychiatric facility all her life, and knows that if such institutions are run properly, there is nothing to worry about. "I just hope it's all done right, instead of making mistakes," she said. Pataki, frustrated that the Legislature had not passed a law ordering that certain sex offenders (those deemed still a threat to society) remain in state custody, had invoked mental hygiene law to transfer inmates to mental-health facilities after their prison terms ended. That was improper, the Court of Appeals ruled in overturning a mid-level court. Contributing: Elizabeth Cooper, Observer-Dispatch
Healing Found in Tragic Stories - Loved ones gather for National
Suicide Survivors Day. By Kate Perry EAST GREENBUSH -- When Mary Jean Coleman's brother shot himself with a hunting rifle in the woods behind their father's home in 1979, she suffered in silence. Suicide was taboo and there were just a few relatives and friends she could talk too. There were no support groups for the then-21-year-old college student. "I went back to college and never spoke about my brother, let alone that he had taken his own life," she said. Tomorrow marks the 27th anniversary of Eddie's death and thankfully, Coleman said, things have changed. There are prevention programs, advocates and even money in the state budget for education. And there are places for those left behind to speak. Coleman, who lives in Ballston Spa, spent Saturday with dozens of other survivors commemorating National Suicide Survivors Day at the University at Albany's School of Public Health. They shared their stories and watched a national teleconference featuring others who lost loved ones to suicide. The conference was hosted by the American Foundation of Suicide Prevention. Coleman, who is the upstate New York Area director for the AFSP, said the organization has sponsored the special day for eight years, but Saturday was the first time the Capital Region hosted a conference. Each year, the AFSP said, 30,000 people commit suicide in America, 1,300 in New York. Selkirk resident Deborah Davis, whose brother Thom committed suicide in 1997, stood at a lectern recounting her struggle with grief as people in the audience dabbed at their eyes with tissue. After her brother's death she'd be laughing one minute and sobbing the next. Thom's death infused every part of her life. For a while she couldn't be intimate with her husband without crying. Davis said talking was imperative to her healing. Those that have experienced similar losses are the best -- and often the only -- people to talk to, she said."Here I can talk about him, and cry and I know that they understand," she said. In the back of the room hung quilts covered in photographs of those who took their own lives. There was a 15-year-old in one square and a man who was 90 in another. One woman, photographed in her wedding gown, half-smiled out from her quilted square. Her fingers were covered in wedding cake, evidence of a happier time. No one is immune, Coleman said. Suicide reaches across age, gender and economic boundaries. Survivors are left to face life without their loved one and never-ending questions about why the person chose suicide. Coleman has devoting her career to suicide prevention and survivor support. On Monday, she'll light a candle in her kitchen next to Eddie's picture. She expects she'll be smiling.
Our Great Depression. Op-Ed by Andrew Solomon DEPRESSION is the leading cause of disability worldwide, according to the World Health Organization. It costs more in treatment and lost productivity than anything but heart disease. Suicide is the 11th most common cause of death in the United States, claiming 30,000 lives each year. Despite medical advances in the last 20 years that have greatly improved our ability to help those who suffer from depression, we lack an effective system for administering care. Only a very small percentage of depressives who seek help receive appropriate treatment for their condition. Research often stalls short of being translated into useful medicine. Depressives continue to be stigmatized, which makes their lives even more difficult and lonely. Finally, many sufferers are left to spiral, unsupported, into despair because their insurance companies refuse to pay for treatment. These problems are similar to those cancer patients once faced, and the best way to address them might be similar as well. We need a network of depression centers, much like the cancer centers established in the 1970s. Through the National Cancer Institute, federal funds were dispersed to interdisciplinary centers like Memorial-Sloan Kettering in New York and M.D. Anderson in Houston. The idea was to make sure that 80 percent of the American population lived within 200 miles of such a center. As this network of institutions took root, the quality of cancer treatment advanced dramatically. The centers brought researchers and clinicians under one roof, ensuring that basic science was applied to achieve medical results. Scientists communicated both within and between centers, so that everyone could make use of everyone else’s work to accelerate progress. Following this model, the National Institute of Mental Health should coordinate and subsidize a national network of depression centers, ideally based at research universities with good hospitals and departments devoted to the subject. The University of Michigan, host to the country’s first national depression center, which opened its doors last month, has been a pioneer in this regard. More than 135 experts on depression and bipolar disorder will collaborate there, about half of them psychiatrists. The center has a large clinical treatment program and a genetic database that will house samples from tens of thousands of depressed and bipolar patients. It is sponsoring social and biological research and pressing for policy initiatives related to mental illness. Among the thousands of depressed people I have met with, the majority have sought treatment but feel that they are not getting good care. Many of them have been prescribed antidepressants by family doctors who lack training in psychiatry and have conducted only cursory interviews before rendering their diagnoses. Antidepressants vary in their chemistry and effects; and human brains vary as much as human minds. To treat the most complicated organ in the body appropriately demands considerable expertise. The question I am asked most frequently is how to get better care, and it can be devilishly hard to answer. Depression centers that could deliver a high standard of comprehensive care would be a dream come true — not only for millions of depressives, but also for the research community. Last winter, the Library of Congress organized a conference where theoreticians met with mental-health consumer advocates and clinicians. The combination was unusual and wonderful. Everyone left with fresh ideas. We need formal bodies to sustain such fruitful intimacy. Research related to a major disease should not unfold in a purely intellectual context, nor should consumer advocacy exist solely in a lobbying context, nor clinical practice exclusively under the shadow of profit-driven pharmaceutical research. (Full disclosure: my father is the chief executive of a pharmaceutical company that manufactures antidepressants.) Before the cancer centers came around, cancer was as taboo as depression is now. But as antibiotics and vaccines for other illnesses lengthened life expectancy, cancer became more pervasive and less shameful. Depression, too, is becoming more widespread and more frequently diagnosed. Depression and bipolar illness will affect some 20 percent of Americans during their lives, and yet the stigma endures. People often come up to me after lectures to whisper about their affliction, as though everyone else in the room weren’t grappling with precisely the same thing. It is neither wise nor feasible for a large proportion of the population to be trying to keep a secret. A national network that helped to medicalize depression in the public imagination would reduce sufferers’ shame. The very waiting rooms of depression centers would provide incontrovertible proof of the ubiquity of the illness and ease the isolation of sufferers. Within the centers, patients would find themselves the focus of an elite community of insight and support. Alleviating stigma will also make it harder for insurance companies to deny treatment. As it is established that these mental illnesses are not character defects, but instead can be characterized in terms of brain symptoms, the false distinctions between them and cancer or heart disease will become impossible to sustain. The fiscal irresponsibility of leaving untreated an illness that causes enormous loss of productive work years would be clearly demonstrated. We’ve made stellar progress in treating mental illness since the Prozac revolution but there is a catastrophic divide between research and practice. We must come up with a seamless way to support scientific progress and to administer the treatments we have, in order ultimately to alleviate as much suffering as possible. Andrew Solomon, the author of “The Noonday Demon: An Atlas of Depression,” is on the national advisory board of the University of Michigan Comprehensive Depression Center. Spitzer
Catches a Break on Medicaid.
By E.J. McMahon and Tarren Bragdon In a trend that has gained little notice outside state and federal budget offices, the growth rate in Medicaid expenditures across the country has slowed to subinflation levels that were last seen in the 1990s. It's even happening in New York — home to what is by far the nation's most costly Medicaid program. Governor Pataki's final executive budget assumed an underlying Medicaid growth rate of roughly 7% a year over the next three years, reflecting the state's experience during the first half of this decade. But in a pre-election briefing at Albany's Rockefeller Institute, John Cape, the state's budget director, revealed the annual increase in Medicaid costs had slowed to 3.8%. The common denominator in the nationwide Medicaid spending slowdown is a shift in prescription coverage for the elderly from Medicaid to the Medicare Part D program. Mr. Cape said New York State's budget was also benefiting from lower-than-projected enrollment in the Medicaid-subsidized Family Health Plus program, which covers households with incomes up to 150% of poverty, and from an increase in the number of disabled Medicaid recipients opting for the kind of managed care coverage that is required of many recipients with less severe illnesses. This all translates into at least $388 million in New York State budget savings in the current fiscal year — which, in turn, has reduced the shortfall that Eliot Spitzer must address in his first budget plan, due February 1, 2007. From the next governor's standpoint, slower Medicaid growth is doubly good news, because the state government has begun to cap the share of non-federal Medicaid expenses financed by New York City and county governments. If the current trend persists, although it is by no means clear that it will, the budgetary baseline could drop more than $1 billion below previous projections for the next gubernatorial term. But impressive as this may sound, Medicaid costs in the Empire State are still running well ahead of national trends. A recent Kaiser Family Foundation survey found that the average Medicaid increase in all states was just 2.8% during the fiscal year ending last June 30. Even smaller numbers are anticipated for 2007. For example, federal officials report that California's Medicaid growth rate, which was nearly 12% in 2003, is projected at less than 2% for the current year. In fact, according to the federal Centers for Medicaid and Medicare Services, 16 states actually spent less on Medicaid in fiscal 2006 than in 2005. Medicaid reductions have occurred in "a mixture of large, medium, and small states," including Georgia, Maryland, Michigan, New Hampshire, Nevada, South Carolina, South Dakota, Texas, and Wisconsin, a CMS fact sheet noted. New York's conspicuous absence from that list should be troubling to Mr. Spitzer. After all, as things now stand, the state's Medicaid spending per recipient is nearly twice the average for other states. Its total Medicaid budget of $45 billion exceeds the amount spent by Texas and Florida combined. A greater slowdown in Medicaid spending elsewhere will only increase the relative disparity between New York and other states. And by relieving the fiscal pressure for change in the short run, the trend could lead to bigger increases in the long run. This has happened at least once before. After Medicaid expenditures flattened out during his first five years in office, Mr. Pataki initiated the program's biggest expansion since the Rockefeller era. Governors and legislators in many other states followed similar courses at roughly the same time. Their timing turned out to be terrible: Medicaid spending began to rev up again just as state tax revenues were tanking between 2001 and 2003. So far, aside from pledging stronger fraud prevention efforts, Mr. Spitzer's only firm proposal in this area is to expand Medicaid by signing up hundreds of thousands of uninsured children to the program, which could easily cost another $500 million a year. Supporters of the idea fail to note that while 18 states have lower rates of uninsured children compared to New York, only one of these 18 has a significantly larger share of children on Medicaid. The same is true when it comes to adults. Other states have fewer uninsured because they have done a better job of promoting access to affordable private health insurance. The new governor shouldn't allow politically powerful health care unions and providers, or their friends in the legislature, to seize on the slower Medicaid growth rate as an excuse to avoid fundamental reform of the program. As other states are showing, New York can and should do better. Mr. Spitzer can achieve greater savings by: •
Requiring all Medicaid recipients with access to employer-provided
coverage to go on their employer's plan when their share of the
premium is less than the cost to taxpayers. New York State is still a long way from reducing its health care costs to a number close to the national norm. Strengthening market forces and making it easier for more New Yorkers to find affordable private coverage would be a giant first step in the right direction. Mr. McMahon is a senior fellow at the Manhattan Institute and director of its Empire Center for New York State Policy. Mr. Bragdon is the health policy analyst at the Empire Center |
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