More on Advocacy Update – Spring 2022 Newsletter

Since the last IHA newsletter the advocacy team has been hard at work anticipating the needs of IHA members and advocating for the resources and operational flexibility necessary for hospitals and health systems in upstate and rural New York to continue to serve their communities under difficult circumstances.

As you all know this has not been easy. First, we continued our push back on the State’s original vaccine mandate and track related litigation while urging flexibility in the mandate’s enforcement. All of this while the state was re-orienting to a new Governor and a new Health Commissioner.

State of the State and the Executive Budget

On January 5, when Governor Hochul delivered her first State of the State address we were excited to learn that many of the priorities for which IHA is advocating are shared with the Governor. In the days following, Governor Hochul released her first executive budget proposal, which provides the most promising outlook for healthcare in years.

The Governor emphasized the need to invest in healthcare and workforce initiatives, with which IHA wholeheartedly agrees.

Among Governor Hochul’s and IHA’s shared budget priorities are:

  • Expanding workforce by 20% over the next 5 years
  • Investing $10 billion in health care workforce
  • Investing in healthcare infrastructure
  • Increase Medicaid Rates and State supported funding
  • Increasing training capacity and tuition incentives
  • Recruiting Medical Professionals to work in underserved areas
  • Allow Medical Professionals from other states to relocate and practice in NY
  • Retaining existing workforce allowing for regulatory flexibilities and improved training

Although IHA supports the Governor’s efforts laid out in the budget, IHA is urging policymakers to go even further to relieve the longstanding structural funding issues faced by Upstate and rural hospitals. Since the Governor presented her budget, IHA has met with the Governor’s counsel, various legislators and committee chairs and the legislative leaders to explain the severe reality of the staffing crisis in Upstate.

Thanks to IHA members responsiveness in sharing pertinent staffing data, IHA is able to provide striking empirical evidence clearly demonstrating how important it is to invest in Upstate hospitals.

With this information IHA continues to urge legislators to fight for additional investment in Upstate and rural hospitals in the form of a rural add-on, state supported funding and additional investment in direct payments to these hospitals.

In addition, Gary Fitzgerald, IHA CEO & President, submitted testimony to the state policy makers outlining the state of hospitals and health systems in Upstate New York. IHA also proposed solutions highlighting that one size fits all solutions often leave Upstate at a disadvantage and urged solutions tailored to Upstate. You can find the full written testimony here.

IHA will continue its strong advocacy as the March 31 state budget deadline approaches.

SUCCESS on the COVID-19 Vaccine Booster Mandate 

Without a doubt the hardest fought advocacy campaign IHA has recently engaged on is the work we did to reverse course on the vaccine booster mandate that was set to take effect on February 21. Very shortly after it was announced that the State’s Public Health and Health Planning Council would review and consider the mandate, IHA began communicating with policymakers about the detrimental impact this mandate would have on staff in IHA members.

We made clear that IHA and its members support vaccination and are taking all possible steps to encourage staff to get boosted. However, the staff reaction to this mandate was much different than the reaction to the previous mandate. IHA argued that the science is evolving with respect to immunity from COVID infection, that there is the possibility of a more effective vaccine in the very near term, that IHA members have the expertise to keep their staff and patients safe, and ultimately that IHA members could not afford to lose any more staff.

IHA communicated with the Governor, the Governor’s Counsel, the Health Commissioner, the Governor’s top health advisors, and coordinated the unified and concentrated voice of our member hospitals to communicate with the Governor. IHA was unrelenting in its advocacy on this issue. In the end and to her credit, Governor Hochul assessed the information available to her and agreed with IHA that the best course to take is to not enforce the mandate. In doing so, she announced that the State would not enforce the booster mandate for a period of 90 days. After which, she would reevaluate her decision based on the current state of the pandemic. IHA encourages members to continue your vaccination activities to make the booster available and encourage employees to get boosted.

IHA is very pleased with this outcome. We are thankful to you our members for your extraordinary support in this advocacy effort. IHA is proud to have delivered this victory to Upstate hospitals.

As the end of the 90-day period approaches, IHA will continue to communicate ongoing concerns to state officials.

Travel Nurse Anticompetitive Practices

In our effort to address the issue of the exorbitant rate being charged by nurse staffing agencies, IHA contact members of the state Congressional delegation urging them to ask the White House to investigate the anticompetitive practices of nurse staffing agencies and the negative impact they are having on hospitals. The effort illustrated the severe staffing shortages that healthcare is experiencing and how nurse staffing agencies are taking advantage of this with prices exponentially higher than pre- pandemic.

This practice negatively affects hospital’s ability to provide adequate care to their patients, draining already depleted resources.

Staffing Ratios and Staffing Committees

Due to the staffing shortages in Upstate New York hospitals, exacerbated by the state’s COVID-19 vaccine mandate and COVID-19 itself, IHA continues to strongly urge state policymakers to delay the implementation of Chapter 155 of the Laws of 2021 and Chapter 156 of the Laws of 2021 related to hospital and nursing home staffing ratios and staffing committees.

Now more than ever with a new scarcity of talent to fill the ever-growing list of open positions, these new staffing laws will easily overwhelm and adversely impact hospitals in our membership, particularly critical access hospitals, sole community hospitals, and hospitals with affiliated nursing homes, all of whom have patient and staff safety as their hallmark.

IHA continues to emphasize that it is no exaggeration and cannot be overstated that the current workforce crisis facing hospitals across Upstate New York is severe and dire. IHA members wish for nothing more than to access a robust labor pool that would allow them to meet such ratios. The obvious fact remains that recruitment and retention of these workers in Upstate New York is difficult at best.

These new staffing mandates lack adequate safety valves necessary to account for the unique circumstances faced by Upstate hospitals. In addition, they overlook the scarcity of available labor to fill long vacant positions across Upstate.

IHA has raised concerns with mandated staffing ratios for many years, and believes that these new laws open the door, widely, to a reality of unattainable staffing levels.

IHA has led the charge to address the issues raised by these well-meaning policies. Unfortunately, these new policies miss the mark. IHA continues to call on policymakers urging a delay in the implementation of these new laws and regulations. IHA also suggested that any regulations resulting from these laws contain safety valve language clarifying that they should not penalize hospitals and nursing homes where there are significant and longstanding workforce shortages, and language that recognizes the unique circumstances found in critical access/sole community hospitals whose size alone does not allow for this type of mandated staffing committee structure process.

Staffing decisions should remain with local hospitals, nursing homes, and healthcare clinicians. Hospitals and nursing homes are already required to have staffing plans tailored to individual patient care needs. These plans include considerations for factors such as patient acuity, the level of education and experience of staff, technological considerations, and more. State and federal regulations from the New York State Department of Health (DOH), Centers for Medicare and Medicaid Services (CMS), and other accrediting entities provide safeguards to ensure staffing adequacy, education, credentialing, quality measures, care delivery, and patient satisfaction.

DOH recently published in the State Register its proposed regulation implementing hospital staffing committees starting the clock running on a 60-day comment period. IHA is reviewing this proposal and preparing its comments on these regulations.

Political Landscape

The gubernatorial race continues to prove interesting as the June primary approaches. NYS Attorney General, Latisha James, a top competitor for incumbent Governor Kathy Hochul dropped out of the race in December. This still leaves a long list of candidates such as NYC public advocate Jumaane Williams and Long Island Congressman Tom Suozzi as direct competitors in the Democratic primary. Congressman Lee Zeldin from the east end of Long Island has been selected as the Republican candidate. Zeldin has primary challengers of his own.

Early polls show that incumbent Hochul is leading the pack, but there is still a long way to go until November.

A.G. James’ decision to give up the gubernatorial race and focus on her current duties led several candidates to drop out of the race for attorney general. As the months go on we will monitor if any more candidates throw their hat into the ring, including a possible re-entrance of disgraced former Governor Andrew Cuomo.

The state has re-drawn congressional districts and the Governor has signed them into law. New York is dropping down to 26 seats and close to 22 of them could favor Democrats. This caused several gerrymandering accusations to be leveled at Democrats from Republicans and a pending lawsuit from the G.O.P.

At the state legislative level, the redrawing of Senate and Assembly Districts will likely lead to Democrats picking up a few more seats in both houses of the legislature. This will solidify Democratic control of the legislative branch, likely for some time to come.

Putting redistricting to the side, many legislators have announced that they will retire at the end of 2022. This will mean many more new faces in 2023. It will be interesting to see how the power dynamics begin to shift as many long tenured legislators retire or perhaps lose seats in primaries. IHA’s advocacy team is constantly evaluating and calibrating to the ever-changing political landscape to ensure our advocacy remains sharp.