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November 2, 2007
Testimony before the Health Committee of the New York State Assembly on behalf of New York City Americans for Democratic Action

Good Afternoon! I am Evelyn Jones Rich, Executive Director of the New York City Chapter of Americans for Democratic Action.

Thank you, Chairperson Gottfried and the other members of the Assembly’s Health Committee, for giving me the opportunity to present our members’ views on Developing a Primary Care Agenda.

NYCADA, the NYC chapter of Americans for Democratic Action, is a liberal political organization dedicated to building a just society through education and political advocacy.

Other speakers – representing the spectrum of the Health Care Community - have highlighted their views on the issues you’ve identified from the perspective of the organizations, institutions, and the populations they serve.

Our comments address the question, Is access to primary care a particular problem for the uninsured? I f yes, are there successful strategies for assuring access. Please describe.

Among the list of speakers we note only one young person – within the Asian community – and no seniors to present the concerns of the oldest and youngest among us.

All too often others either speak for these most vulnerable groups in our population or overlook and sometimes miss our interests and concerns.

There are about 47 million people in the US – more than 15% of the population – without health insurance. Six of ten of those without health insurance have gone without care because of cost. Nine million of the uninsured are children, including 6 million who are eligible for but not enrolled in SCHIP (2 million) or Medicaid. SCHIP must be expanded significantly in the next few months despite the failure of Congress to pass veto proof legislation.

These uninsured children are at greater risk of living with a chronic or acute condition than are children living in families with higher incomes.

For them and those from working class and lower middle class families lucky enough to have access to some kind of medical insurance, access to primary health care is essential.

Most uninsured children attend public schools. A whopping 85% are African-Americans, Hispanics, and Asian Americans . And, the data tell us that large numbers are eligible for free and reduced lunch as well as special education services

These factors play a significant role in the academic performance of students. Down the road the future of our nation is endangered if we fail to provide adequate primary health care services to poor children now!

Just as public schools were used 20+ years ago to insure that all children received necessary immunizations, we propose that we return to the practice of placing primary health clinics in schools providing access to basic health services. Given the projected expansion of school building facilities as a result of increased funding deriving from the successful Campaign for Fiscal Equity law suit, we believe that space will be available to host a health center in every school in the near future.

Regular examinations would identify nascent health problems and provide for early interventions, preventing the development of major health problems in the future.
So, too, would simultaneous provision of dental services which few poor children now receive.

Good health including good nutrition nurtures academic achievement and put students on the road to graduation.

Similar challenges face our growing aging population. The New York City Department of the Aging (DFTA) projects a significant expansion of the baby boomer population in coming decades. For our current crop of seniors, lack of an adequate income continues to be a critical problem.

Data indicate that in 2005, 20.3% of New Yorkers age 65 and older lived in poverty compared with 9.9% nationwide. The trend is toward increasing numbers of senior citizens living in poverty. There was about a 27% increase between 1990 and 2005.

Most affected are the oldest and frailest, particularly women, minorities and those living alone or with disabilities.

We propose the expansion of the Naturally Occurring Retirement Community (NORC) program with revised guidelines in ways which embrace a significantly larger number of seniors who have aged-in-place and are living in multiple units. Access to a program which includes in its partnership the Visiting Nurse Society (VNS) would bring access to basic health care to large numbers of seniors presently unserved or underserved.

These services include regular blood pressure and other health screenings, medication review, needs assessment for home health care services and nutrition education.

The United Hospital Fund is currently assessing the impact of the health care component in the NORC program to determine the extent to which it deters or delays nursing home admissions – the Health Indicators Project. We await the outcome of that study.

In closing, NYC ADA sees access to adequate health care as a right. We believe that the time is now to expand that care to cover all children and seniors on the way to achieving universal health care for all.

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