The Senate has wrapped up a much needed gift to our nation of health care reform. But it will be incumbent upon the Senate/House conference who will determine the final bill to ensure the package doesn't contain a lump of coal for states, such as New York, that have led the way in caring for the uninsured and vulnerable. As a doctor who works at Bellevue Hospital -- the oldest public hospital in the country -- I can tell you this is a moral and public health necessity.
Under the Senate version of the bill, states such as New York that have maximized coverage of poor patients with Medicaid or Medicaire will receive little or no additional funds and in fact stand to lose substantial funding through dangerously deep cuts in Medicaid Disproportionate Share Hospital (DSH) payments. Such funds are crucial to supporting critical public and safety net hospitals and to reimbursing hospitals for substantial levels of uncompensated care -- which will continue even after the expanded coverage of health care reform. For example, undocumented immigrants will continue to turn to public and safety net hospitals for needed care. While denying care to such individuals may be appealing to anti-immigrant pundits and politicians, the clinical, public health and moral realities don't support this.
So, the Senate/House conference committee needs to make its New Year's resolution now, that in our quest to maximize coverage, we don't destroy the essential safety net. Our health and well being depends on this.