Health care crisis, lack of state and federal aid crushing American cities

A recent report highlights the economic threat the current health care system creates for American cities, which are typically ignored in the discussion about health care reform. The report, put out by Families USA---a nonprofit and nonpartisan national organization that advocates for high-quality, affordable health care for all Americans---found that, "...cities are profoundly affected by the rising number of uninsured Americans and the rising cost of providing coverage for their own employees. These problems have an impact on all city residents, regardless of their health insurance status, and they affect cities’ ability to fulfill other municipal functions as well."

"Our cities face the dual challenges of assisting a rising number of uninsured Americans and providing increasingly expensive health coverage for their own employees," Ron Pollack, Executive Director of Families USA, said.

Pollock's statement summarizes the key findings of the report, which concluded that cities have been overlooked and left to manage local health care crises on their own, which poses a risk to the budgets of other city services, such as police and fire protection, schools, parks, and the repair of city streets and other infrastructure.

"Today's report makes crystal clear what many of us in cities across America—who are faced with the spiraling costs of health care both for our employees and our citizens—understand all too well," said Philadelphia’s Mayor Michael A. Nutter. “It's threatening our economies, our families and our futures. It is time for Washington to stop the excuses and fix our broken health care system.”

The report is based on extensive surveys and research of thirteen cities nationwide, which all had consistent results. Immunizations are one of the largest burdens on cities.

Other key findings include...

The report found:

• increasing numbers of citizens are uninsured or underinsured, which has caused an increase in the demand for health services in the last year
• increased demand is straining city budgets, and more than half of the cities reported that they are barely able to meet the demand
• the demand is spread across all types of health care, from safety net clinics to emergency rooms, on to mental health and substance abuse services, and even schools
• four of the cities are trying to deal with the extra problem of area hospitals closing
• a secondary problem is budget strain due to increases in the health care plans the cities offer to their employees

When it came to what would most help the cities address this crisis, the city leaders of all cities unanimously agreed that they required state, and more importantly, federal assistance. All also agreed that raising eligibility levels for Medicaid and/or the State Children’s Health Insurance Program (CHIP) would ease the burden the uninsured place on their city.

Eleven cities asserted that health care should be one of the top three priorities for the current president and Congress, and all 13 cities responded that health care should be among President Obama's top five priorities.

Mayor David Cicilline of Providence, Rhode Island, said the solution requires all levels of government to work together and cities and states depend upon the federal government, "There's no question, the lack of comprehensive health care reform on the national level has a severe impact on America's cities and America's working families. Cities, and even states, can't solve this problem alone—this requires real leadership and immediate action on the federal level.”

Mayor Gavin Newsom of San Francisco agreed, "As mayor of San Francisco, which offered the first universal access program for the uninsured, I know that America's cities can provide compassionate and innovative health care to their residents. But we can't do this job alone. An overhaul of our nation's health care delivery must be one of the top priorities of a new administration and Congress in Washington in 2009."

The mayors' unanimous agreement about health care as a top issue matches the words of most state and federal leaders and candidates, but the actions aren't backing up the words, so far.

Consider Ohio, where, two days after this report, Governor Ted Strickland vetoed a bi-partisan budget and cut programs for child immunizations and a mental health care crisis center, among other things. Despite his statement about fiscal responsibility in a time of economic uncertainty, the bottom line is that these issues must be taken care of, and somebody is going to have to foot the bill. If not the federal or state government, it will be left to the cities.

However, cities will ultimately have to make choices, too, because budgets are not infinite, nor are they fair and equal across cities.

Note: Many thanks to Dave Lemmon, Director of Communications, Geraldine Henrich-Koenis, Deputy Director of Communications, and Robert Meissner, Press Secretary of Families USA for the information and report findings used in this article.