As New York Gov. Andrew Cuomo works to end the state budget crisis, Americans across the state risk their access to affordable health care. At least two well-known family clinics in Brooklyn risk permanent closure due to the budget changes. The clinics, which serve mainly Black and Latina women living on low incomes, shed light on the growing need for healthcare access in a state where Black women’s maternal mortality is three to four times higher than the national average.
According to NBC News, based on Cuomo’s latest budget proposal, the two clinics are set to lose almost $1.8 million in state funding. Without the funding, the clinics will be unable to serve their patient base, which is made up of more than 3,500 low-income women, most of whom identify as women of color. While the money previously allocated for the clinics wasn’t cut from the budget entirely, it has been moved to the health department’s budget line, which the organization running the clinics may not qualify for, Lisa David, CEO of Public Health Solutions, told NBC News.
Public Health Solutions runs both clinics and has been treating generations of families accessing their services. According to David, if the state doesn’t restore Public Health Solutions' Title X replacement funding in the final budget due Thursday, the clinics will begin closure plans. "I can't run these programs on half the revenue for nine months," David said.
The issue follows an announcement by Cuomo in January during which he said he planned to access billions in savings from “runaway Medicaid spending,” The New York Times reported.
Medicaid is a state and federal program that provides health care to low-income residents, which accounts for a third of the state's $6.1 billion budget gap, according to the Times.
According to the Times, the state’s Medicaid program costs about $75 billion, with more than $20 billion shouldered by the state. In recent years, the cost of Medicaid has increased as Cuomo not only increased the minimum wage but pushed through an increase in reimbursement rates to healthcare providers. Additionally, enrollment in the program has grown in the last few years.
While Cuomo insists that no negative impact would occur on localities or for beneficiaries of Medicaid, as funding is cut clinics are forced to close, leaving patients stuck looking for health care elsewhere. These issues disproportionately impact people of color and in a sense punish the counties that have more individuals dependent on the program.
As local healthcare facilities close, individuals are not only forced to find new facilities but may also experience less affordable options. In the case of New York’s Public Health Solutions clinics, most patients are Black and Latino with incomes classified under the federal poverty line. As these clinics that do not turn anyone away—including undocumented folks—close, those without insurance or with Medicaid face obstacles of finding care in places that accept them.
According to Dr. April Lockley, the center’s medical director, many people access care without insurance at the center, which provides low- to no-cost reproductive health care. Lockley noted that if these clinics were to close, local private OB-GYNs who offer the same services might not accept patients with Medicaid or without insurance. She also shared that patients have previously come in and expressed that they were unable to get appointments at nearby providers for weeks. This means that should these facilities close, healthcare access will be even further restricted with extended waiting periods for service.
Additionally, these facilities provide family planning services and other resources for reproductive health. Without them, individuals may be left without these much-needed services because federally qualified healthcare centers don't specialize in family planning services and are thus less likely than reproductive health clinics to offer contraceptive methods on-site.
The pandemic has widened racial health disparities already present in the country. With these budget cuts, Black and Latina women are put at more risk because of the maternal health crisis they continue to face. Black and Latina women are more likely than others to experience pregnancy-related deaths, a phenomenon present in the U.S. prior to the COVID-19 pandemic.
Compared to white women, Black women are three more times likely to die from pregnancy- and birth-related causes, according to the Centers for Disease Control and Prevention. In New York the disparity is even greater, with Black women eight to 12 times more likely to die.
With people losing their jobs and employer-sponsored health insurance amid the COVID-19 crisis, cutting funds to organizations that provide medical access to all is wrong. It furthers the obstacles already in place for low-income communities, which often only have such clinics available as sources of health care.
"I really, really like it there," said Latavia Hippolyte, a patient in Brooklyn. "Like, where am I going to go now?" Hippolyte shared negative experiences with other clinics in the area.
According to NBC News, clinics like those operated by Public Health Solutions play a strong role in Black and Latino communities because they work more closely than hospitals do with pregnant patients. These facilities not only provide both physical and emotional support during pregnancy but after birth as well. Studies show that this method results in better health incomes, shorter labor, and lower rates of cesarean sections and preterm births, according to the March of Dimes.
Additionally, racism within the healthcare field also contributes to access and emphasizes the importance of all-inclusive clinics like Public Health Solutions. Lockley told NBC News that many patients fear “the racism within health care and how the rates of maternal morbidity are so high.” By building relationships with patients and approaching health care with an open mind, these clinics not only give patients the care they need but make them feel safe. Such facilities cannot be replaced by local OB-GYN offices, and they deserve the funding they need.
Since the Trump administration, funding to programs that provide reproductive health services has been severely impacted. Under Trump’s administration, Title X-funded services that predominately served low-income patients were restricted from referring patients for abortion care under the Global Gag Rule. Additionally, the policy blocked Planned Parenthood health centers from receiving funding through Title X. Facilities that made abortions accessible or even recommended them were threatened with revokation of funding and closure by the administration, Daily Kos reported.
Following these policies, alongside some of Public Health Solutions clinics, nearly 900 reproductive health clinics nationwide lost funding as well. While the Biden administration is working to undo these politics, Cuomo’s budget cuts do not help the situation.
It’s important to remember that these clinics, while predominantly servicing low-income patients, serve all, no matter their immigration status or whether or not they have insurance. Many of these services provided by these clinics that rely on Title X funding are unavailable elsewhere for low-income communities. Lack of investment in the healthcare system is already an issue for people of color and those experiencing poverty, with budget cuts to community clinics obstacles for these already struggling communities.
"When we look at other high-income countries like ourselves, they invest in universal health care, they invest in primary health care, and they have lower maternal death rates and maternal morbidity rates, and those are all connected," Dr. Laurie Zephyrin, an OB-GYN and the vice president of Health Care Delivery System Reform at the Commonwealth Fund, told NBC News.
Zephyrin added that limiting the funding for affordable, low-cost, and free reproductive health centers may cause other issues, including “more maternal complications and deaths.” "Community health centers are places that we need to invest in — not just keep the lights on — we have to truly invest in them.”
Access to health care is a basic and fundamental human right. Every person should have access to it at an affordable cost. Cuomo’s proposal looks to save money in the state budget by disinvesting in the state’s public health infrastructure. This disproportionately impacts people of color, specifically women. We cannot “advance” the state at the cost of its most vulnerable residents. Now more than ever, health care access is needed. The pandemic has already strengthened the divide between economic groups. Instead of widening this gap, we must work to make health care more affordable and accessible. Cutting Medicaid is not the solution to a state budget deficit.
