Governor Cuomo and legislative leaders said earlier today after their meeting that they are closing in on a budget agreement and expect to have bills ready to vote on by Thursday, the last day of the fiscal year. In order to vote on the bills which normally require three days to “age,” Governor Cuomo will have to issue a “message of necessity” to allow votes before the three days after bills land on the desks of legislators. The bills could be in print by tonight.
Specific details were not released until legislators were briefed on the details. However, the Governor and legislative leaders gave general information, saying the budget will include a paid family leave program and an increase in the minimum wage to $15/hour over several years though it isn’t clear if all areas of the state will have that wage level. It is expected that there will be different phase in periods for at least three regions of the state.
Final details of the paid family leave program were still being negotiated however, advocates are optimistic and hopeful that the program that will be voted on will be a good one without unacceptable changes from what has been proposed by the Governor and the Assembly. Senator Jeff Klein, head of the Independent Democratic Caucus told the media he was pleased with the negotiations on the program which he has been supporting in some form for the last few years.
Passage will be a major victory for one of the broadest coalitions ever assembled of labor, faith organizations, public interest, health care and human services advocates. The legislative campaign became a primary focus of many organizations who have argued that it part of a family and worker friendly agenda that reflects changing economic and family situations. Just a year ago, the Assembly passed the bill but Governor Cuomo said there was “no appetite” for the program and Senate was saying it was only willing to consider it. However, when the Governor reversed course and decided to include the measure in his budget and go all out to support it and the minimum wage, the political dynamics changed. His advocacy along with an increasing sense that income inequality was a major social problem and a major issue in the presidential campaign in this election year, legislative support quickly grew.
We will know the details of this program tomorrow when the bill is in print.
Last week, a state Supreme Court judge in Albany sentenced five people who deliberately targeted older people for scams for home repair and other work that was never done. The five were prosecuted for under state “hate crimes” statutes. A hate crime is defined as one in which criminals deliberately target their victims because of their race, color, national origin, gender, religion, age, disability or sexual orientation. Hate crimes carry greater penalties.
Some of the victims included a 90 year old woman with Alzheimers and a Korean War veteran who just lost his wife. There were about a dozen victims during eighteen months of the crime spree. One of the criminals sentenced was a 61 year old man with a walker and using an oxygen tank who pleaded for mercy. The judge noted though that many of his victims were just as frail and he gave him a sentence of 8 to 16 years in jail.
Some of the seniors did not come forward about the crimes because of fear they would lose their independence. An assistant District Attorney in Albany County told the Albany Times Union, “We had victims say to us point blank that they did not want to tell anyone what happened for fear that their family would remove them from their home.”
State legislators are leaving Albany for the long Easter weekend and will return Monday for the final week of budget negotiations and compromises that need to be made early in the week for budget bills to be printed and voted on by midnight Thursday, March 31. Discussions have centered on the push to increase the minimum wage to $15/hour. That issue remains a key to budget negotiations with discussions about exemptions swirling. Governor Cuomo hinted he could support an exemption for agricultural workers. Meanwhile there are some who want a minimum wage below $15 for upstate but that is a especially because the $15 amount is not scheduled to be fully phased in until 2021 upstate. Faith leaders are planning three events at the Capitol on Monday and Tuesday in favor of the minimum wage and paid family leave.
Human service organizations rallied in favor of the minimum wage on Tuesday but said that they need funds from the state to pay for it. The Assembly included $200 million in its one house budget to cover costs for the sector. Meanwhile, negotiations also continue on paid family leave, though the sides are much closer on that. The program proposed by the Governor and the Assembly may pass largely intact with perhaps some breaks to make it easier for small businesses. A press conference was held in the Legislative Office Building today with several business leaders speaking in favor of paid family leave programs that they offer.
Later this afternoon, the health and aging subcommittee of the Budget conference committee met after learning it was given only $25 million in addition funds to allocate. Some of the legislators complained and said that this amount was a lot less than other “tables” or issue areas received. Assemblyman Richard Gottfried, chair of the Health committee noted that this funding is outside of Medicaid so it does not account for the entire health budget. However, Senator Kemp Hannon, chair of the Health committee in his house said the budget subcommittee had identified over $60 million it wanted to add to the budget for important services, some of which he cited would pay themselves by keeping people out of nursing homes.
On aging issues, several legislators mentioned the need to restore the cut and add $2 million in the NORCs (Naturally Occurring Retirement Communities) program – a cut in the budget that was proposed by the State Office for the Aging. Senator Martin Golden, former Chair of the Aging Committee spoke in favor of NORCs. The Assembly Aging Chair Stephen Cybrowitz is also on the subcommittee and supports the restoration of funds which the Assembly added in its budget.
On another note, State Office for the Aging Director Corinda Crossdale will be leaving her position this spring to take a position as Commissioner of the Department of Social Services in Monroe County where she is from. She formerly ran the office for the aging in that county and then came to Albany as Deputy Director at the State Office. She then worked in the Governor’s office as an assistant secretary to the Governor on human services programs. She has been a great professional in the field of aging and we wish her well.
here is a news story from the Fiscal Policy Institute that received wide media coverage around the country this week
Some of the wealthiest New Yorkers have sent an open letter to Governor Andrew Cuomo and the New York State Legislature urging passage of the “1% Plan for New York Tax Fairness” to replace the temporary ‘millionaires tax’ set to expire at the end of next year. The Fiscal Policy Institute’s 1% Plan calls for new tax rates ranging from 7.65% to 9.99% applied to new tax brackets starting at $665,000, the income threshold for the top 1% of New Yorkers. The plan also calls for continuation of the lower rates now in place for lower and middle-income New Yorkers. The full text of the letter is included below.
The signers, including Steven C. Rockefeller, Leo Hindery, Jr., Abigail Disney, Agnes Gund, Dal Lamagna, Martin Rothenberg and Lewis B. Cullman, also support the similar “Millionaires Tax” advanced by the New York State Assembly in their one house budget resolution released last week.
The letter was organized jointly by the Fiscal Policy Institute and the Responsible Wealth project. The signers of the letter, many of whom are members of the Responsible Wealth project, are all New York residents in the top 1% of income in the state.
Note: I am serving as Chair of the Board of Directors of the Fiscal Policy Institute – Mike Burgess
Beginning on next Sunday, March 27 New York State will require that all prescriptions be filed electronically by doctors or medical personnel. This provision was passed in legislation a few years back to better control and track narcotic use however it was delayed in implementation after hospitals and medical personnel said they needed more time to implement it. Many doctors and hospitals have already made the change now.
A recent report in the New York Times said that one result of the change to electronic prescribing is that doctors may prescribe more standard medications that they know are going to be in stock rather than have to spend time writing a different prescription if the one they prescribed is not available. The patient will also have to say which pharmacy they want the prescription sent to.
Health records continue to be moved into the electronic realm. I reported before that hospitals and doctor practices are setting up patient portals for patients to access their medical records, appointments, test results and even send messages to their health care practitioners. Some patients have balked though because of the highly publicized theft of data from insurance companies like Anthem.
As care becomes more coordinated, doctors, hospitals and other providers want to have access to a patient records if several are providing treatment in the same network. The medical providers will be able to easily access the list of medications a patient is taking along with test results and notes from a visit to other medical providers.
**A rally was held to push again for paid family leave outside the legislative chambers at the Capitol on Thursday. Assembly Democrats say they are not open to exempting small businesses from paid family leave but they may consider tax credits for small businesses which would be burdened by the plan. The Senate wants to pass paid family leave in a way that doesn’t hurt small businesses.
**Both the Senate and the Assembly have rejected provisions in the Governor’s budget to eliminate “prescriber prevails” in the Medicaid program which allows doctors to have the final say in prescriptions. Both houses also rejected the Governor’s plan to eliminate “spousal refusal” which allows a community spouse to keep more money when the other spouse is on Medicaid.
**Stocks of pharmaceutical companies suffered major losses earlier in the week after Valiant said its strategy of buying older drugs and jacking up the prices to exorbitant levels was no longer viable. It’s amazing how tone deaf greed can be that these companies don’t understand that adverse reactions from consumers and politicians can impact their stock price. Valeant’s stock has lost over 75% of its value in the last six months.
**The State Employees Federated Appeal which allows state workers to make payroll deductions to charities released its annual report this week. The drop in the state work force plus the retirements of many higher income workers has led to a dramatic decline in giving. Contributions fell by $422,737 statewide from 2014 to 2015 with a total of $5,236,798. Contributions in the Capital District fell $150,460 to a total of $1,355,178. In 2007, contributions reached a high of $9,785,318. There has been a drop of over 40% since then. The statewide SEFA Committee met on Thursday and discussed ways to reach out to new and younger workers and to work better at marketing the campaign. Committee members also want more support from the Governor and state agency leaders in promoting SEFA.
**Bills introduced in other states to allow assisted suicide are being withdrawn or defeated. A bill in Minnesota was withdrawn this week after a public hearing
Bills in Iowa, Colorado, Hawaii, Utah, Arizona, Maryland and Wisconsin are now considered dead for this year. Bills in Alaska, Nebraska, Missouri, Kansas and Tennessee also appeared to be heading nowhere. Here in New York, supporters have not had the bill scheduled for the Assembly Health committee, indicating there probably are not enough votes to pass it there. Some Democrats on the committee are known to oppose the bill.
Thousands of union members and activists rallied on the Empire State Plaza in Albany yesterday to support the “Fight for 15” to raise the minimum wage. Governor Cuomo spoke to the crowd under the banner for he “Mario Cuomo Campaign for Economic Justice.” Cuomo is pushing for the minimum wage hike which is proposed to be phased in over several years. He wants it included as part of the upcoming budget. Senate Republicans have not included language for the minimum wage in their budget. Cuomo again rejected calls for added funds for health and human services agencies with state contracts to cover the costs of the wage hike.
Cuomo also pushed for paid family legislation as part of the “pro-worker” agenda. The Governor, Senate and Assembly are closer on that issue. While the Senate put language in its one house budget bill that is very similar to the Governor’s and Assembly’s language, the Senate passed a resolution on Monday that seeks modifications to accommodate small business.
Today, the budget conference committees begin meeting in Albany to discuss spending in each of the program areas.
The Assembly and Senate are preparing their budget bills and it is now clear that both are very close to an agreement on paid family leave, to the delight of the coalition promoting the program. In recent weeks, the Senate had not made its intentions definite on whether it would even include paid family leave in its budget bill though Senate Republicans were expressing interest. Now, their budget language has been released and it looks very similar to what the Governor and Assembly proposed.
This means all sides now want to pass paid family leave. There are some areas of difference in the timing and wage replacement coverage of the bills but it certainly seems that these are not major issues and they will be resolved as the budget is done.
I will be updating this information when I get more details in the next two days when we get a full analysis of the Assembly and Senate bills.
Both the Assembly and Senate are expected to present their version of the state budget next week as the next step in approving a final plan before the start of the next state fiscal year on April 1st. Both houses then set up a conference committee with subcommittees in program areas to negotiate added spending. Key issues like the minimum wage and paid family leave will be left to negotiations by the Governor and legislative leaders. The Senate remains resistant to the minimum wage increase but Republican leaders seem more open to paid family leave if it is paid by employees. Governor Cuomo and coalition supporters have continued a campaign like advocacy for the program with another rally yesterday with House Minority Leader Nancy Pelosi.
Both houses have been releasing details of their budget plans during the past few days. The Assembly and Senate are differing sharply on taxes. The Assembly wants to raise taxes on the wealthy and lower them slightly for everyone else. Republicans in the Senate are pushing for major cuts in the tax rate for everyone. Both houses are pushing for increases in state aid to education.
The Assembly budget includes a restoration of a cut and an increase to the NORCs (naturally occurring retirement communities) program in the State Office for the Aging budget. There was a cut of almost $1 million in the budget but the Assembly added $2 million more for the programs which provided services to neighborhoods and housing projects where older persons have “aged in place.”
CMS which runs Medicare is concerned about the growing cost of prescription drugs and has put out for comment proposals to change the way Part B costs are paid to doctors and hospitals. 72% of drug costs are paid to pharmacies but doctors and hospitals provide and administer drugs that account for 28% of costs through Part B. These costs are separate from the Part D drug plans which beneficiaries use to purchase regular prescriptions. Part B drugs include cancer medications and treatments in hospitals. Another high Part B drug cost is for eye injections for macular degeneration in older people.
Medicare believes the formula used for payment provides little incentive to keep costs down since it adds 6% to average prices. Doctors and hospitals make more if the drug is more expensive. Medicare spent $20 billion on Part B drugs in 2015. CMS says drug spending accounted for $457 million in health care costs which is 16.7% of health care spending in the United States. CMS says the proposals are part of its ongoing efforts to make “value based payments” that reflect not just a price formula but the impact of the drugs used on the health of the patient.
While this initiative is targeted to Medicare Part B, there is growing outrage about high drug costs that are in the thousands of dollars per prescription and Congress and state governments are looking at proposals to increase scrutiny of these costs in Medicare and Medicaid. Some insurance companies are threatening to eliminate some high price drugs from their formularies. Some state attorneys general are looking into price gouging charges against some drug companies. Recent news stories have reported on how some rogue companies deliberately inflated prices to maximize profits and sought to control the supply of their drugs to further drive up prices. Companies respond that their list prices are not what most insurers or the government pay, however overall costs and profits are still rising rapidly.
The press release from CMS identified six alternatives it is considering in pricing for Part B drugs “to improve outcomes and align incentives to improve quality of care and spend dollars wisely”
1. Improving incentives for best clinical care. Physicians often can choose among several drugs to treat a patient, and the current Medicare Part B drug payment methodology can penalize doctors for selecting lower-cost drugs, even when these drugs are as good or better for patients based on the evidence. Today, Medicare Part B generally pays physicians and hospital outpatient departments the average sales price of a drug, plus a 6 percent add-on. The proposed model would test whether changing the add-on payment to 2.5 percent plus a flat fee payment of $16.80 per drug per day changes prescribing incentives and leads to improved quality and value. The proposed change to the add-on payment is budget neutral.
2.Discounting or eliminating patient cost-sharing. Patients are often required to pay for a portion of their care through cost-sharing. This proposed test would decrease or eliminate cost sharing to improve beneficiaries’ access and appropriate use of effective drugs.
3.Feedback on prescribing patterns and online decision support tools. This proposed test would create evidence-based clinical decision support tools as a resource for providers and suppliers focused on safe and appropriate use for selected drugs and indications. Examples could include best practices in prescribing or information on a clinician’s prescribing patterns relative to geographic and national trends.
4. Indications-based pricing. This proposed test would vary the payment for a drug based on its clinical effectiveness for different indications. For example, a medication might be used to treat one condition with high levels of success but an unrelated condition with less effectiveness, or for a longer duration of time. The goal is to pay for what works for patients.
5. Reference pricing. This proposed model would test the practice of setting a standard payment rate—a benchmark—for a group of therapeutically similar drug products.
6. Risk-sharing agreements based on outcomes. This proposed test would allow CMS to enter into voluntary agreements with drug manufacturers to link patient outcomes with price adjustments.