Hospital scrubs are a common sight in the leafy Norwood section of the Bronx, where employees, patients and visitors flowed in and out of the buildings on Montefiore Medical Center\u2019s main campus on East 210th Street on a recent morning.<\/p>\n
Montefiore is both a major health care provider in the Bronx, where residents suffer from high rates of chronic illnesses like diabetes, and one of the borough\u2019s largest employers \u2014 a dual role that has become increasingly common<\/a> in communities across the country. The array of other hospitals, nursing homes and clinics across the borough, including the city-run medical centers Lincoln and Jacobi, helps make health care a key piece of the Bronx\u2019s economy.<\/p>\n But health care in the Bronx largely runs on Medicaid, with about two-thirds of Bronx residents being insured through the program, one of the highest rates in the country<\/a>. That puts the borough on a collision course with the domestic policy bill President Donald Trump signed<\/a> on July 4. The legislation includes an estimated $1 trillion in federal spending cuts to Medicaid, along with an assortment of tax breaks and investments in immigration enforcement.<\/p>\n In communities across the state<\/a>, New Yorkers are expected to simultaneously lose health coverage and jobs as a result of the new spending bill \u2014 but nowhere more so than the Bronx, according to analyses from Gov. Kathy Hochul\u2019s office and state hospital groups.<\/p>\n The 15th Congressional District covering part of the borough is expected to be the hardest hit in the state. More than 100,000 residents are expected to lose coverage through Medicaid and its expansion program, known as the Essential Plan, the state has estimated<\/a>.<\/p>\n At the same time, the district is expected to lose nearly 3,000 hospital jobs, along with thousands more at local businesses and suppliers that depend on the medical centers, according to an analysis by the Greater New York Hospital Association and the Healthcare Association of New York State. The 13th District, also in the Bronx, will see similar fallout.<\/p>\n \u201cHealth care is synonymous with the economy of the Bronx,\u201d said U.S. Rep. Ritchie Torres, a Bronx Democrat. \u201c\u200aA trillion-dollar cut to Medicaid is not only bad morals, it’s bad economics.\u201d<\/p>\n Statewide, nearly 1.5 million New Yorkers are expected to lose health coverage through Medicaid and the Essential Plan, according to Hochul<\/a>.<\/p>\n As patients become uninsured and other measures in the bill sap billions of health care dollars<\/a> from the state, an estimated 34,000 hospital<\/a> jobs statewide are likely to disappear, along with tens of thousands of other positions at local businesses and suppliers that rely on these medical centers, according to the analysis by GNYHA and HANYS<\/a>.<\/p>\n New York\u2019s economy will take a $14 billion hit as a result, the hospital groups estimate. That\u2019s before considering the effects on other types of health care providers.<\/p>\n Trump has rejected claims that spending cuts will have serious consequences. Before signing the bill, he applauded<\/a> the cuts Congress delivered, saying, \u201cYou won\u2019t even notice it \u2014 just waste, fraud and abuse.\u201d<\/p>\n He also touted the bill\u2019s tax breaks. \u201cAfter this kicks in, our country is going to be a rocket ship, economically,\u201d Trump said.<\/p>\n Meanwhile, Hochul and state lawmakers are thinking about how to try to mitigate its impact.<\/p>\n \u201cI\u2019ve been very clear that no state can backfill the massive cuts in this bill,\u201d Hochul said in a statement on July 4, just after Trump signed the legislation. \u201cBut my team and I are working closely with the Legislature to brace for the impact and protect as many New Yorkers as possible.\u201d<\/p>\n Hochul and hospital groups analyzed major pieces of the spending bill as it was being finalized and paired their projections with urgent messages seeking to dissuade federal lawmakers from approving the bill.<\/p>\n But policy experts are offering a similarly dire outlook. The health policy nonprofit KFF estimates New York will lose about $82 billion<\/a> in federal health care dollars over a decade as a result of the new Medicaid policies.<\/p>\n The reality of how the measures in Trump\u2019s spending bill play out will ultimately depend on how they\u2019re implemented and what steps state lawmakers and health care providers take to minimize the pain.<\/p>\n The ripple effects of Trump\u2019s Medicaid cuts<\/b><\/p>\n By the end of 2026, the new spending bill will require adults on Medicaid who don\u2019t have children under 13 to log 80 hours of work a month, or prove they qualify for an exception. The bill also introduces<\/a> more eligibility checks and paperwork for both Medicaid enrollees and people insured through Affordable Care Act plans and restricts coverage and subsidies for some categories of legal immigrants, among other measures.<\/p>\n Rep. Nicole Malliotakis, who represents Staten Island and parts of Brooklyn and is New York City\u2019s only Republican in Congress, defended the new restrictions.<\/p>\n \u201cWe fully protect the seniors, disabled, children, pregnant women, and those below the federal poverty level who rely on Medicaid,\u201d Malliotakis said in a statement.<\/p>\n She added that the bill takes action to \u201celiminate ineligible fraudsters\u201d from the Medicaid rolls, while implementing \u201creasonable part-time work requirements for able-bodied adults.\u201d<\/p>\n More than 50,000 people in Malliotakis\u2019 district are expected to lose insurance coverage as a result of the bill and hospitals in her district are expected to slash more than 600 jobs, according to state and hospital group projections.<\/p>\n Nationally, the majority of Medicaid enrollees are already working<\/a>, but all the red tape is likely to result in many people who remain eligible for Medicaid losing coverage, according to the health policy nonprofit KFF. Studies show that\u2019s what has happened in states that have implemented Medicaid work requirements on their own.<\/p>\n \u201cA lot of people are going to show up to emergency rooms uninsured and a lot of people are not going to be getting the care that they need,\u201d said Sherry Glied, an expert in health care economics and dean of NYU’s Robert F. Wagner Graduate School of Public Service.<\/p>\n Either way, that means less money for hospitals and other health care providers.<\/p>\n The spending bill further reduces revenue to New York\u2019s health system in other ways \u2014 for instance, by scaling back certain taxes<\/a> that fund health care and slashing federal funding for the Essential Plan, the program that was used to expand Medicaid coverage in New York.<\/p>\n With less money coming in, hospitals are likely to start laying people off and cutting services, according to providers and health policy experts.<\/p>\n \u201cThese consequences will not only affect Medicaid enrollees, but also harm everyone who requires hospital care, leading to longer wait times and less access to critical services,\u201d Hochul said in a statement on the bill last week.<\/p>\n Dr. Mitchell Katz, president and CEO of NYC Health and Hospitals, told the City Council in May<\/a> that the Medicaid changes that were then pending in Congress were likely to force the public hospital system to cut administrative staff and reduce medical services, possibly starting with specialties such as cardiology.<\/p>\n Hospitals that serve more patients with commercial insurance will have an easier time weathering the storm, Glied said.<\/p>\n \u201cThe Hospital for Special Surgery is not going to suffer terribly from the Medicaid cuts, but the hospitals in poor areas of New York will,\u201d said Glied, referring to a medical center specializing in orthopedics and rheumatology on the Upper East Side.<\/p>\n For its part, Montefiore\u2019s finances tend to bounce between the black<\/a> and the red<\/a>. But Montefiore, which is part of a broader health system that has expanded into new parts of the state in recent years, may be better equipped to absorb funding losses than smaller independent safety net hospitals with fewer resources.<\/p>\n Montefiore and several other Bronx health care providers contacted by Gothamist declined to comment for this story.<\/p>\n In the final hour of negotiations, Congress tacked on $50 billion<\/a> to the spending bill for rural hospitals, which are expected to be hit particularly hard, to alleviate some Republican lawmakers\u2019 concerns about the potential impact on their home states.<\/p>\n \u201cNotice that there\u2019s no equivalent fund for urban centers like the Bronx,\u201d Torres lamented.<\/p>\n State Sen. Gustavo Rivera, a Democrat who represents the Bronx and chairs the Senate Health Committee, said he was worried about his constituents but emphasized that residents across the state and country will be affected. Rivera echoed the hopes expressed by some Democrats in recent days that this bill will ultimately lead voters to oust Republican lawmakers in the midterm elections.<\/p>\n In the meantime, Rivera said he plans to advocate for raising taxes on the wealthiest New Yorkers to try to generate more revenue to cover care for the most vulnerable.<\/p>\n Hochul has generally not been amenable<\/a> to the idea of increasing taxes on the rich.<\/p>\n