Life Happens

April 20th, 2024

Episode Transcript

(00:00):
Why morning everyone, Welcome to LifeHappens. I'm Lukepiro, your host for
this morning. I am live instudio with my associate Frank Heming, and
we have a very special guest onthe line, and I'm going to bring
him right on because we don't knowwhen he's going to get called in,
and that is Assembly Member John McDonald. Good morning, John, Hey lout,

(00:21):
good morning, and we are veryhappy to have you here. You've
been here before. We love hearingfrom our local legislators. You represent the
one hundred and eighth district, whichfor those of you that don't know,
is Albany, Rinseley or Saratoga Counties. And John McDonald has been a representative
that has done the people's business formany years now, and he's a local

(00:41):
businessman himself a pharmacist. And weare right in the heart John, of
budget season, right down to thewire. And just tell our listeners what's
going on. We have a livereport from Assembly Member McDonald from the Capitol.
Yep. Right now, I amactually sitting atop the Assembly chamber waiting
for session to resume. We're goingto start. We have three more bills

(01:03):
left to do, the big uglyis the major bill today. It'll be
a four to five hour debate,and with a little bit of luck,
by the time sunsets today, weshould be finished with the twenty twenty four
to twenty five budget. But it'sbeen an interesting process. And it's true
I'm on the Ways of Means Committee, so we have to vote the budget

(01:26):
bills out of committee, so atsome point I may have to duck my
head in and say I'm here.So let's get talking, all right.
So it's twenty days late, andit's been a very contentious budget from a
number of different perspectives. I've beenreading about some of the things that have
been debated, and why don't westart with your top three or four things

(01:48):
that maybe surprised you in the budgetand that our listeners should be learning about.
Well, what actually surprised me,which is not healthcare related, is
we were able to get across aneffort that I've been focused on for the
last couple of years, which issome changes to retail organized crime, particularly
in regards to raising penalties. Ithink average person when they're into Target and

(02:12):
they see somebody walk in with ashopping car and just throw in twenty boxes
of tide and walk right out area gas and it definitely gives the impression
because it's true that we must beliving in a lawless society. And to
be clear, this happens more frequentlyin Texas and in Florida and California,
but here in New York it's convenientjust to blame it on bail reform and

(02:35):
call the day when the reality is, that's not what it is. This
is just outright boldness. Fortunately,you know, and as an upstate member,
my philosophy is a little bit differentthan the downstate members. We needed
increased penalties when it comes to retailorganized theft, the people who are facilitating
it. We need to have protectionsfor the retail workers, usually minimum wage

(02:57):
folks working on the front lines.And you know, my colleagues in the
city are usually a little bit hesitantto do anything with increasing penalties, but
this year, to my pleasant surprise, we were able to get that done.
So that's number one, an importantthing. And also we had a
very sensible expansion to hate crimes becausethey continue to become more predominant, and

(03:22):
to me, it's a demonstration thatcivility is unraveling. Secondly, and actually
I was listening to your news.Well I was way to take it on.
We finally corrected the sin of twentynineteen. In twenty nineteen, we
voted to legalize adult use marijuana.But I remember my biggest protest at the

(03:43):
time was, please do not decriminalizeright away. You're going to allow all
these pot shops to open up andlaw enforcement will be in a pickle where
they can't do much about it.Well, sadly I was right. But
the only good thing is today beensigned by the budget yesterday. Excuse me.
We're taking the appropriate actions. We'regiving local law enforcement more tools,

(04:08):
more resources, given the ability topadlock these illegal pod shops that admittedly in
the Campital region they're not that predominant. They're there. In New York City
they are a dimo dozen. Andit's ironic that the individuals that I work
closely with that we're not looking toincrease penalties and crimes. We're all in

(04:29):
on this thing. So I'm veryhappy that happened as well. And then
let's talk about healthcare briefly. Althoughhealthcare, I know it's it's not going
to be a brief discussion here.You know, we once again you know,
last year was the first time ina long period of time that we
had some synatic increases in Medicaid ratesfor hospitals and nursing homes. And this

(04:54):
year again we're putting another three hundredand fifty million dollars in increases for hospitals
and nursing homes and also assisted livingfacilities, which usually get left out of
the conversation. Of course, allthose institutions will say it's not enough,
and that's probably true. However,we have a system that's like this glove
that's just running in different directions,and you know, there's a lot of

(05:16):
workforce challenges which is causing the upwardpricing to changes, and I'm glad that
we were able to build off ofthat. We built off repeat years now
three years in a row with COLAincreases for those individuals who care for the
disabled, which I think is veryimportant as well, and as we probably
will be talking about, we aremaking some significant changes to the cd PATH

(05:41):
program, And for those who don'tknow what that is, it's consumer directive
care where individuals who are not ina position where they need to be in
an assistant living facility or nursing homeare able to live at home, be
their own boss on directing their care. But it's a system that well intentioned,
as you know you're a student ofthis program, has grown significantly out
of control and there are many reasonsfor that, and I think the reasons

(06:05):
that are being cited are maybe alittle bit skewed. We deal with people,
and Frank's here with me. Frankdoes medicaid work. He files Medicaid
applications every day. And the allegedreason to cut the budget for cd PAP
for the Consumer directed program is fraudand abuse of the system, that people

(06:25):
are scamming the system, taking advantageof the system. We work with clients
every day, and granted we're mostlyupstate, we do have a downstate practice
as well. But what we seeis that people go to a home health
agency and they try to find anagency that can staff their case, and
there is nobody home they cannot staff, So they're put out there on their

(06:46):
own and they're out looking and howdo you find care? Well, you
find care anywhere you can, andthe only way that you can pay for
it is through this consumer directed program. So it's become a lifeline. And
it's kind of that if you buildthat they will come well. Cd PAP
was built to accommodate people that couldn'tget an agency to staff your case.
I can tell you we'd rather callan agency and say, okay, give

(07:09):
us your Home Health aids, managethe case, do it or do it
well. But that's not the realityof the situation for many many people.
You're absolutely right and so, andyou know, it was interesting I saw
in one of the releases from theGovernor day. I was surprised to see
the word fraud actually used in therelease, or it was maybe it was

(07:30):
repeated in an article. I can'tremember which one. It gets a little
blurry and budget. As you know, fraud, there's a difference between fraud.
There's a difference between waste, andthere's a different way difference with abuse.
As one who is required to takefraud, waste and abuse training,
there is a distinct difference. Andquite honestly, if there was truly fraud

(07:54):
going on, then the issue iswhere was the Attorney General's office and where
is the Medicaid inspect in general?I'm dealing with that now. That being
said, do I believe that youknow where the cuts the changes we're making
I don't want to say it's cuts. It will It will result in probably
a half billion dollars a year savingsto the tax payers in the state of

(08:16):
New York. But what we're doingis we're going and trying to address the
middle manager we have in most statesthroughout this country. These fiscal intermediate area
is called the FIS in most states. In the state of California uses one.
We have six hundred and fifty two. Most states, actually most democratically
in states which New York is,use one fiscal intermediary. And I think

(08:39):
that's where we made the initial mistakewhen we started the program. We should
have started small and worked forward.Instead, we opened the floodgates, and
I think we we we lost controland oversight of the program collectively. And
therefore, as you see the numbersgo from six five million, five hund
six million dollars year one to fiveor six billion dollars a year. Now

(09:05):
you have to make some changes andthe same token the process we're moving to
where there'll be a single fiscal intermediarywho will be doing the administrative component,
but at a much reduced price.What was the problem, inherently is that
fifteen percent of whatever a fiscal interminarymade a decision on could be provided into

(09:28):
their pockets. So you had asystem where people were actually profiting. Well,
is that more services they ordered?Is that any different than a managed
long term care program? Well,that that the men's the MLTC program another
topic for this discussion is not cleaneither, and is not clean either.

(09:50):
You're absolutely right, and this iswhere there needs to be a little bit
of dependence. There needs to beoversight, and I think the intention is
to move in that direction. Sowe had the most Yeah, we're going
to be tearing all us apart atour Elder Law Forum, and I want
to thank you for joining us foranyone who's really interested in this topic.
May sixteenth, we're going to havethe chairs of the Senate and Assembly health

(10:11):
committees, Rivera and Paulin are goingto be with us, Jacob Ashby from
Rensler County, the Senator Ashby,and yourself on a legislative panel. We
have a Lieutenant Governor Delgado who's goingto be joining us. So we're going
to be talking about these issues ingreat depth, and we have I actually
got a cancelation just now from oneof the heads of a local consumer directed

(10:31):
agency who said, you know,they just took us out of business.
So I have to fill a spotin a panel, John, And it's
going to be an interesting time,and it's going to be an interesting discussion.
It's going to be a very interestingtime. It's going to have to
be dealt with very carefully, slowly. And you know the thing is,

(10:52):
we've done transmits, We've we've donetransformation. So it's a whole Medicaid population
back ten twelve years ago transferred intoa new program, but it was done
over an eighteenth month period. Whenit comes to the fiscal and the individuals
of the consumer directive choices, thepopulation isn't as large as the whole Medicaid
population, but in many circumstances,there are individuals who are not going to

(11:16):
be able to do this on theirown, and we need to make sure
it's handled properly to make sure thepatient and the people working in their home.
I do not see the impact.I think what's going to be the
challenge is that we are also reducingthe commissions in this process from fifteen percent
to three percent, and I thinkthat's where we're going to have challenges getting

(11:39):
individuals to fill those voices. Butthat as when MLTC came in, counties
were handling it. So you wentto the county Department of Social Services,
you filed in aplication, they didan assessment and they awarded you a number
of hours. Manag's long term carecame in through something called the Medicaid Redesign
Team, which was tasked with cuttingthe budget and cutting expenses. And I
understand that, but it put thisbuffer in between and now the independent assessment

(12:05):
process. It took it from abouta thirty day process to a four to
six month process. And one ofthe fears is that when you centralize this
and you have one agency that's goingto do all of these applications for CDPAP
across the state, how are theygoing to staff and how are they going
to be able to process this ina timely fashion. No, it's going
to be a challenge. It's definitelygoing to be a challenge, no doubt,

(12:28):
and it's going to be something that'sgoing to have to be done very
carefully. And we're saying, donot rush. I've made that no not
only to divisional budget but also Departmentof Health. They need to be strategic
and there needs to be a hugeeducation curve in this process. But it's
going to be a challenge, there'sno doubt about it. Unraveling a premium
product is never easy. No,And there was legislation this year, and

(12:52):
I'm sure you're familiar with it fromassembly Woman Paulin and Senator Rivera to actually
go back in time to the preMLTC days, to take that middleman out
of the process and go back toa fee for service. But I understand
that legislation has not moved. Well, it did not move because it was
being proposed as saving the state threebillion dollars a year, but it wasn't

(13:16):
taking an account that we need tohave people to work in the program.
So there was a little bit ofa flaw there that needed to be needed
to be addressed. You know,at the end of the day, when
you go back to fee for service, what's that? What does that mean?
That means you're relying on government hiremore people, push more paper by
the services, and that that comesout of cost to nothing against it.

(13:39):
But you have to basically be ableto weigh all the aspects of it,
and there's a trade off there.As you know, I know you're in
business or in business when you takea middleman and you put the middleman in
the government's paying them and they haveto take out administrative and profits from the
city. But we didn't know ourproblem with the cd pappalt as. We

(14:00):
didn't monitor the middleland. We didn'tthat's the problem. That's always a problem,
you know, going back to youknow, shopping and people stealing.
I used to be the assistant DistrictAttorney in Albany County and Gilderland was my
court. One of my courts.I went to night Court in Guilderland and
I'd have one hundred and fifty caseson and fifty of them would be petty
Larsen the out of Crossgates mall.And back then, it got caught,

(14:24):
it got prosecuted and people paid afine to penalty. If you're a repeat
offender, you went to jail.Yeah. Today, Actually, you know,
that's one of the the in theretail crime we talked about earlier.
The aggregation component flipped away years ago. We reinstituted it. If you get
over one thousand dollars, you're nowreading charge of the sammy and that makes

(14:45):
it a whole differ. Yeah,a whole different game, changes the whole
conversation. Yeah, and I don'tdisagree with you at all. We need
to be a lawful society, andlawlessness has ys it'd be over reported.
But I think it's also very real. I think there is a problem in
our society, and endemic problem thatthe respect for those institutions that used to
run our country has degraded to thepoint where people can do whatever they do.

(15:13):
I don't watch TV that much anymorebecause it gets frustrating. Because I'll
watch it. It doesn't matter ifyou're watching MSNBC or Fox, if you're
reading New York Times or New YorkPosts. The stories that are out there,
of which some of them are true, but they become with such a
bias that it leaves an indelible memoryin people's minds that I don't blame them

(15:35):
for feeling the way they do.You know, we're going through this right
now with you know, serious crime. The data has shown throughout the country,
including New York State and including NewYork City, that crime is coming
down. But I've been in governmentfor twenty five years. Data can say
one thing. If the public doesn'tfeel it, the perception is it's not

(15:56):
safe. You can't shake that.You can't shake that until some point it's
not in their mind. Don't nevercall people, have never called me up
as and listen, you know I'vebeen I was miracle host from two thousand
and twenty twelve during the mid twothousands, down before things bout them out.
In two thousand and seven and eight, our crime data was down to

(16:17):
almost nothing. No one ever calledup to say, hey, mayor thank
you, I feel safe today.Yeah. People reach out is when they
don't feel good about it. Yeah, and that's fine. That's what understandable.
When dog bites man, it's nota story. When man bites dog,
it's right. So you're looking forthings that are out of the ordinary,
unusual and just not the team ofcourse of things. And yeah,
I think a lot of that goeswith our current financial situation. I had

(16:38):
Hugh Johnson, who's one of ourlocal economists, on the beginning of the
year and he's like, well,you know, inflation went down, unemployment
still down, the GDP is up, all of these positive economic factors which
just get overblown by one or twothings that become the story. Nobody's looking
into the fact that we're the charts, flow charts of really what's going on

(17:02):
and people don't study anymore. Ithink we've had this conversation. You need
civics back in school, you needcitizens who are going to pay attention to
this guy. Well, the goodthing last year you and I talked about
financial literacy and finally, after yearsof advocating from the legislature, the Education
Department has agreed to work to incorporatefinancial literacy back into the curriculum. It's

(17:26):
something they're doing to regulation, whichis probably better than the legislation at times
because they also bring all the stakeholderstogether to make sure it works with all
the other educational requirements that they areat that schools and principles and superintendents are
responsible for. So that's a goodthing. And by the way, Hugh
Johnson is one of the finest peopleyou have us speak to. He is

(17:47):
one of our advisors as a numberof ways and means we meet as a
committee with him a couple times ayear, and great man who really has
a sense and you're right and he'sright. You can show as many charges
as you want, but at theend of the day, when I drive
by Stewards and streets and see threeseventy nine a gallon on gas. You
just don't feel it right aboutely,don't feel like it's workingly. Even if

(18:11):
you've gotten raises at your job,even if you've gotten a better job,
you've improved your situation. You're lookingat those couple of things that just dominate
the conversation. And financial literacy andand government literacy. You know, how
does a bill become a law?I remember a film strip that I watched
probably in third grade. I'm learningabout government, but that's just not part

(18:33):
of the curriculum anymore. No advocacyhas has tried to take over the process,
and it's it's a process. Andlisten, advocates. Advocates are important.
They bring a dynamic to a conversation. But from my perspective, when
I get caught up with these advocatesis when I talk about implementation, I
hear what you want to do.How do we make it sustainable? How

(18:56):
do we make it real? Howdo we make it so that it actually
accomplishes your goal? Because just sayingyou got a bill passed, uh,
that doesn't cut it off. Youknow, I gave the example early in
the conversation about the illegal pot shops. Now everyone's waving the flag. Hey
we we we created just marijuana.And then all of a sudden, almost

(19:17):
instantaneously, these illegal pot shops,particularly in the city and some of the
larger urban areas in Upstate, justkept multiplying and multiplying because people could do
whatever they damn well please, whichset into the lawless lawlessness that we've talked
about. I was in our NewYork City office yesterday walking down Madison Avenue
with then two blocks. I hada contact high because there's just everybody's spoken

(19:40):
spoken pot on the street, andthe doors open and the scent just comes
out, and it's it's pretty amazinghow prevalent is becoming the city. But
it'll I'm hoping that the tide turnsback and it you know, the regulations
catch up to the market, andI'm sure they will. There you go,

(20:00):
But I said, you know,the challenge is is that, as
opposed to twenty thirty years ago,social media, which is a great,
great tool, is also a great, great problem because it gives people the
opportunity to send out the most craziestthings and keep repeating it time and time
again. When you know, isit the norm or is it the extreme

(20:23):
or is it the outlier? Andthe average public can't certain. I had
some lady messing with me the otherday on Facebook. I can't believe this
is happening. Why is this happening? I said, what are you talking
about? She refers me to thisarticle and I'm looking at it. I
said, it's it's a resource I'venever heard of, and I'm it's been
around a while, so I canit's turn between what is a fly by

(20:45):
night and what's real? I said, this isn't legitimate. You know,
people make up organizations to suit theirpurposes. Then they start to push their
their point. Some people would saypropaganda, but you can see why if
you step back. Why the publicis It's confused, it's perturbed and gets
aggravated. And it was it wasreported that, well where was it reported?

(21:07):
And then it gets passed on three, four or five times and then
it becomes real. So I justwant to touch base because I'm here with
my associate, Frank, and hehas a client that is also a constituent
of yours, and I just wantto mention it. This is Stanley,
and I'm sure you know who I'mtalking about when I mentioned Stan is a
great success story, but it's anunfortunate story that all the things he had

(21:33):
to go through to get what heneeded and deserved. And Stan is someone
who worked a career with New YorkState. He was a taxpayer, and
he's been very generous appearing at ourconferences and being part of our firm.
We represented him because he needed homehealth care. He's in a wheelchair,
and he had an AID that hewanted to hire to take care of him,
and that aid, according to Stan'sphysician, needed to be there sixteen

(21:56):
hours a day to provide him withthe care that he needed to stay in
old family home. And the MLTCgave him i think five hours, and
he appealed that and they gave himone more hour, six hours instead of
sixteen, and then Frank did afair hearing. So you have to go
through all of these steps to getto the point where, yes, we

(22:17):
finally got the doctor's evidence in andas you know, you don't get to
use your own doctor anymore in theprocess. Here it's a statewide independent physician.
And so Stan was able to getthe sixteen hours a day of care.
He's living in his own home.But part of this was that Stan
had to pay out a pocket duringthis interminable time period that he had to

(22:37):
pay for this aid where you know, he didn't really have a lot of
money and he had to pay outa pocket And that's kind of where you
came in. Yeah, I tellyou, I've known Stan. I've known
of his family for a long periodof time. I remember working in the
pharmacy as a kid, and relativesof him coming into the pharmacy because the
name, his last name is relativelyunique and I won't repeat it for his

(23:02):
confidence, for his protection, butnot protection, but whatever, privacy,
Yeah, confidence, Channity. Butit's interesting because Stan is very smart.
He is a classic example of whatis very rich in the Capital region is
people who are dedicated public employees whoreally know their stuff. He worked in

(23:22):
a very wacky state agency. I'llleave it at that. So he would
email me regularly about technical, verydry, but very critically important policies and
procedures of which we've been able tomove some of them into law. And
then you know, his health wassuffering and he started to communicate emails quite
regularly. And I always say toStan, if I don't respond, to

(23:45):
you that day. It's because you'reusually very in depth and detailed, and
I want to give them my falseattention because we average about five six hundred
emails a day and it gets alittle tiring after a while. But as
we've started to work on his case, it became very clear that he knew
what he was talking about. He'svery good self advocate, which I think

(24:07):
to your point, and the pointof mentioning is today is not everybody has
the capabilities that Stanley has. Butyou know, at one point it got
to lame it. You've approved me, where's my money? And that's where
I really got involved. I meanI was following literally the hundreds of emails

(24:27):
that were involved with this case,and I was responding and making things.
But at one point, to putthe carrier was just not complying, and
I reached out to him. Isaid, listen, here's the deal.
He's gone, the journey, he'sdone, and everything he's supposed to do.
You need to pay the claim now. To be clear, as a

(24:48):
state legislature, I legislature, Ican't force anybody to do anything, right,
I can't force them to pay aclient. Let's be because I don't
want people picking up the phone acall and saying, hey, you know,
I got a want to credit atTarget or anything like that. We
don't have that ability. What wedo have the ability is to make it
properly frame the situation, to explainwhere in this situation the health plan had

(25:11):
responsibilities and the nice part, greatself advocate John, We're gonna have to
take a short break for the news. Are you able to stay with us?
Absolutely? Ye? Okay, fantastic. Assemblyman John McDonald sharing his viewpoint
atop the Assembly chamber waiting for votesto finalize New York State's budget. So
you're getting it from the source,folks, stay with us. You're listening

(25:33):
to Life Happens Radio on talk radioWGY. We're going to take a short
break for the news. We'll comeback with the Assemblyman McDonald, and we
hope you can stay with us.We are back if Life Happens Radio.

(25:55):
I'm Lupuiro, your host for thismorning. I'm live in studio with a
very quiet Frank Hemming. I amhere who is with me and has joined
me here in the booth, andJohn McDonald, who is down in the
Assembly and I just want to againlet you know that if you were interested
in the topics of healthcare and longterm care, seniors, people disabilities,

(26:15):
how they get care, check outthe Elder Law Forum. It's going to
be on May sixteenth, and AssemblymanMacDonald along with some of his colleagues from
the legislature, Lieutenant Governor Antonio Delgado, people from hospitals, nursing homes,
assisted living facilities, home health agencies, will all be there to kind of
tear apart these issues and look athow this really should be working and how

(26:36):
it's not working and what we cando to improve it. And that's the
goal of the Elder Law Forum.You can always sign up at pyrolaw dot
com. It's p I E RR law dot com and John. Last
year we had about one thousand peoplethat attended, most of them virtually about
three hundred and fifty in the room, and we're going to be trending towards
that number, maybe a little bitmore for this year. So we're looking

(26:59):
forward to the for him and Stanwho we just talked about, your constituent
and our client made an appearance.We got a standing ovation and I think
he's going to come back this yearbecause the victory last year when he was
appearing, he didn't yet have theaward from the fair hearing to get the
hours that he needed. And oh, by the way, John, he
is in the consumer directed personal Assistanceprogram. Yep, yep. Absolutely,

(27:25):
He's a classic example of this isthe year to come back into the victory
lap, but more importantly to sharethe story. Yes, so tell me
again what's going on down there.You're in the capital, you're in the
above the Assembly chamber and just waitingto move legislation to get to the budget.
And you think maybe by the endof today that's going to happen.
Yeah, we should be done.We will start to bay probably in the

(27:48):
next thirty forty minutes. The membersare all here and we've won through the
proper ways and means and rules committeemeetings that are necessary to move a bill
to the floor. And then we'veonly got three bills left to which will
probably take all of about thirty minutes, but one that will be a full
knockdown, drag out five hour debate. Which one is that, Well,
it's called the Alpha Bill, whichdeals with education labor. But the interesting

(28:12):
dynamic, and this is through thegenerations of time here at the State,
is that a lot of times.We have housing in this bill as well,
which is a controversial topic. They'llput a lot of different items in
here. It's like it's its ownsecret recipe and there's no secrets because everyone
knows what's going to be in there. But there are some topics in there

(28:33):
that people are going to like.There are topics in there people are not
going to like. And so atthe end of the day, they call
it one big, bad, uglybell and that's what we'll be dealing with
today. That'll be the bulk ofthe city's debates. Yeah, you talk
about the two things that government reallyfocuses on. Web three things. So

(28:53):
education is what right we have toeducate our population. You have to keep
them safe so that the security,police function, fire function, all of
those things. And then healthcare,and this has always been the debate how
much should government be in healthcare?How much does government need to regulate healthcare?

(29:15):
And that has led to some reallyinteresting legislation over the time, and
both federally. You look at theAffordable Care Act, which has been one
of the biggest political footballs in healthcareand going back and forth and are they
going to repeal Obamacare is it goingto stay? What are they going to
replace it with? And that getsto Medicare for seniors and for people with

(29:40):
disabilities and the different Medicare programs,and then that filters over to Medicaid,
and Medicaid is the program that NewYork State has to wrestle with. And
over time John New York State hasused Medicaid. It has become a verb
in New York. Oh, wehave a problem, let's medicate it.
There are federal dollars available, andso New York's program has become tremendously complex,

(30:03):
but very generous at the same time. And I lecture all across the
country on elder law and long termcare. And there is no other state
that has anything close to the homehealthcare program that we have under our Medicaid
umbrella. And that's the New York'scredit to keep people independent, keep them
at home, supply them with thoseservices. We have clients that go to

(30:27):
Florida come back to New York becausethey spend all their money in Florida during
their retirement. Now they need healthcareand they come back to New York for
it. So the budget is twohundred and thirty seven billion. I believe
yep, and thirty seven billion dollars. How much of that is medicaid in
despite about forty five to fifty billiondollars. Education run second, Health and

(30:52):
Medicaid comes first. You know,health includes Medicaid, so in all the
different plans, it's Medicaid. It'salso other programs like the Central Plan,
which not too many people are awareof but actually is helping so many aspects
relieve some of the stresses in Medicaid. Because we've had people who have grown
through the income ranges because they're gettingjobs and they're getting to work, which

(31:15):
is good, but a lot oftimes they fall off this financial cliff because
they can't afford the health insurance premium. So the Central Plan is a program
we utilize to help what I callthe working for the people who are going
to work every single day but justcan't afford the fifteen thousand dollars a year
in health insurance premiums, which iswhere these family plans have gotten to at

(31:38):
this stage of the game. Godforbid, do you have children. It's
an expensive ordeal, it really is. Yeah, people struggle with it.
They go on to exchange trying tofigure it all out, especially for kids,
it's got to be there for seniors. When you turn sixty five,
you get your Medicare card and youget deluged with literature on what you should

(31:59):
do to supplement Medicare and how youget to that. The big hole,
of course in Medicare, John islong term care, as we both know,
yep, and that falls to thestate and Medicaid, and that's where
most that's where the majority of ourmoney is spent. People like to talk
about the high cost of prescription drugsbecause they see it at the counter,
so it's more frequent. What theydon't see are the people living at home

(32:22):
the care that goes associated with andthey don't see the people unless unfortunately,
you've got a family over like myselfwho's in a nursing home. We don't
see that, you know so.And then, of course hospitals, which
is a whole other conversation. Thehospital system is under dramatic amount of stresses
in many different avenues and we reallyneed to we need to get a better

(32:45):
hand on And that's not to alludeto another Burger Commissioner stretch to imaginations,
but hospitals used to do much betterwhen you needed a hip or knee surgery.
You go into hospital, get itdone. It was a Luke business.
It was a safe setting at theexambilatory surgery centers, which actually the

(33:05):
public prefers, the payers prefer becauseit's less expective, it's easier for the
patient, easier for everybody involved.But they've taken away a lion's share of
the of the of the premium business, and therefore the hospitals are really in
a position where they have to reevaluatewhat they're going to be. That go
in and out of the hospital thatare on Medicaid is very, very high.

(33:29):
It is scent of people that comethrough our Medicaid and our emergency receive
rooms are turning out to be primarycare centers because people, you know,
I always use the expression, okay, you want healthcare, I'd rather have
healthy lives, and basically we needto and that's what primary care has played

(33:50):
and should be playing a more criticalrole where people are I don't want to
say they're required because I'm not amandid guy, but strongly incentivized a primary
care provider who can help chart yourcourse, to chart where things are going
to go in your life. Yeah, the unfortunate reality of that is you
don't get to see your primary carephysition very often, and usually you're seeing

(34:14):
a PA today, So in manycases you're not talking directly to your primary
care physician, and they don't havethe ability to go patient by patient and
prepare that plan. They just don'thave the time. There are schedules.
How many minutes do you spend inthat primary care visit, five, ten,
fifteen minutes with your doctor? Yeah, there needs to be a broader

(34:36):
spectrum of services, and I thinkthe health insurers ultimately have to play a
big part in this, and Ithink that's coming. I think no,
And you know, I got totell you, you know, there's a
difference between in the health plans.And once again, I'm a business person
too, so I believe in capitalism. However, I do have to say

(34:57):
here in the Capital region we havesome pretty healthy nonprofit health plans that are
smaller now small meaning only four orfive hundred or seven hundred thousand lives,
you know, whether it's City PHP, MVP in the high Mark. But
what's been interesting is the the thethe large, the big three large commercial
plans United Health Signa and now they'veintegrated vertically from right down to the pharmacy

(35:24):
level and a hospital level, rightup to the payer, and it's caused
a very interesting dynamic where they've gottensobic and they really control the market.
But in the same token, Ifound out in my experience that when there's
an issue, and when you needto deal with an issue for a constituent,

(35:45):
you know, we have access tothe plans and we have access to
the liaisons, and I find outthat the local plans are more non response,
they're more responsive, excuse me,more responsive. They're part of the
community, and it's I and I'veseen, particularly through CDPHP, community programs
roll out that really try to addressother issues. It's not just making sure

(36:07):
you have a doctor, it's alsomaking sure you have access to the variety
of different services that have always beenavailable to people. They're just not aware
of it. You know. Casemanagement is key, and I think we
see the local plans and not forprofit plans hone in more on that because
they're looking, you know, theythink and they believe time will tell that

(36:30):
they have better health outcomes for thepatients. Yeah. I've had CDPHP and
our law firm has for many yearsand we've been very very happy with the
service and what we get from them. And you mentioned the two that are
going to be on our panel atthe Elder Law farem on May sixteen,
Alisha Kelly, who is the vicepresident for Governmental Programs at CDPHP. And

(36:51):
Alisha was on this program back inJanuary talking about Medicare advantage plans and all
the things that CDPHP has done toinnovate with regard to me care advantage.
And we also have Bob Hartman fromMVP, who's vice president of Product Design
and Strategy. They're going to eachbe on a different panel talking about what
the health insurers can do to integratewith this. And I look at the

(37:14):
world in terms of trying to makesense, John, and very often it
doesn't, and healthcare is part ofthat because the silos that exist both in
terms of provision of care and paymentfor care, those silos are rigid and
they're very hard to overcome. Andwhen you're looking at someone who is on
Medicare, they get one set ofservices, one set of providers. You

(37:35):
look at someone on Medicaid, theyhave a different set of services and a
different set of providers, and thepayment streams are tremendously different. Between the
two programs. Medicaid you have tobe impoverished to get Medicare. Everyone gets,
so unfortunately a lot of the servicesfall over to the Medicaid program where
you have to be poor to getit. Yep, Oh, you're right.

(37:57):
And so healthcare and I think Ithink CMH and Washington is doing some
innovative things. I think that wellnessand you mentioned this, how do we
bring wellness into it? And thegovernor has a master plan on aging that's
been unfolding. I've I'm on oneof the committees, the Home and Community
Based Services Committee. Have you beenwatching that and following that and what's coming

(38:20):
through the master plan? I've participatedin some of the forums. However,
admittedly, the first quarter of thisyear is all budget all day long,
and so I'm looking forward to thebudget being done so i can get a
little bit more re engaged. Butyou know, it makes sense. You
know, it's funny because people sayagent, what the agent? Now the
aging is really also helping us makesure our healthcare system works for everybody.

(38:45):
I just want to take one moment. Mentioned something you know, you mentioned
the Medicare advantage plans that goes backto the George Bush days, right,
and you know I will see this, you know, being in pharmacy that
I've worked there for fifty one fiftytwo years now, I've seen a lot
happen over time. Programs, thesimple programs like Silver Sneakers. I know

(39:07):
it sounds kind of giddy, butthat's encouraging people to exercise, to take
care of themselves, to help controltheir way, which can, by the
way, control your diabetes or controlyour blood pressure. Those are the type
of things we need borrow. Weneed to keep supporting and growing those programs
because at the end of the day, let's face it, no one enjoys

(39:28):
being sick. Everyone enjoys being healthy. And they have another thing called Popa
Pals as part of cdphp's Medicare AdvantagePlan, which is a companion care program
YEP, and they provide that topeople that are enrolled in the Medicare Advantage
Plan and they get companions that maybecan take them to an appointment, can
socialize with them, and it's somethingthat just helps people see to their wellness.

(39:52):
And that is the shift, theparadigm shift that our healthcare system has
to make because it's a sick caresystem right now. Like you said,
er is emerging is primary care fora lot of people. They get an
ambulance, they go to the er, they wait two days forty eight hours
just to get in, and thenthey get into the hospital. Then they
can't get out because there's no servicesat home. And why put yourself through

(40:15):
that. At the end of theday, I'm hoping you've got better things
to do than spending two to fourdays on that hospital. It's a disaster
for the family and it just bodsthe whole system down. And you know,
the problem we mentioned also speaks toanother issue that continues to emerge,
and I think it's finally getting someof the attention deserves. Mental health plays

(40:35):
such a large role in people's physicalhealth and loneliness that you speak to just
play role. Think about it.We all have our days when we're a
little down, and what do wedo. We sit there, she learns
something and watch TV, don't feellike doing much and things like that,
and you know that doesn't lead toa good healthy lifestyle, and not that
you can be going one hundred andten miles an hour every single day,

(40:58):
but there needs to be a balanceand for those individuals, particularly of lost
family or don't have family around,or hardly anybody. I mean, you
know, we have hundreds of patientswe delivered to with the pharmacy. I
can tell you very candily, eithera conversation with one of our pharmacists or
our drivers might be the only conversationthey have for the week. It's not
the month. Yeah, that's asad situation. And granted, you know,

(41:21):
some people will look at it ina different light, but I think
we need to be cognitant because itdoes have an impact on people's physical health.
Yeah. I know, COVID hasreally exacerbated a lot of problems,
and I think the isolation and lonelinessbecause you couldn't visit people during that time
period. I think a lot ofthat still lingers, and we have a
little bit of a COVID hangover,I'm afraid. Oh yeah, absolutely,

(41:43):
So I take one more short breakand we will be right back. You're
listening to Life Happens Radio Assemblyman JohnMcDonald, and we'll be right back after
this. Right, we're back,and we have assembly Men John McDonald waiting
to be called in to vote onsome legislation. I'm here with Frank Hemming,

(42:04):
my associate, and John, wehave about ten minutes left and I
just wanted to get some of yourfinal thoughts on the budget. And one
more issue, and that is there'san eleven to fifteen waiver that has been
awarded to New York funds and they'rebeing designed, I think to focus on
health equity and bringing services into peoplein the community. Is this part of

(42:27):
that wellness? Is that where thetarget is for this money. Yeah,
it focuses on that larger area thatwe you and I have talked about in
the past, social determines of health. And if focuses on really making sure
to connect people with services, italso is going to have an impact in
helping on an eleven fifteen waiver.At least there are twelve downstate hospitals that
are in very, very bad AtChepe, they have a Medicaid ratio of

(42:54):
maybe nine and a half patients toeveryone which have Medicaid, and therefore,
you know, the reimbursement of Medicaidis never not that that great, and
therefore there's a major issue with sustainabilitythese hospitals. In this budget this year,
there was a proposal to close SunnyDownstate. Now, people who have

(43:15):
gone on to medical school, andI know many doctors here in the Capital
region said they should have closed downstateforty or fifty years ago, but for
the people in that community, it'san important aspect. And so these hospitals
are struggling with this high pair mixof medicaid, but we also have to
help transition them for the future.And part of this eleven fifteen funds is

(43:38):
to help these safety net hospitals startto make that shift. It's not easy.
It's not easy to turn around adinosaur by any stretch of imagination,
but you've got to start sometime.But it also gets back to pushing primary
care wellness, self awareness of certainthings that are out there. And the

(43:58):
timing is good, right because youcan't go by on your social media or
a TV with all the new contraptionsand devices out there to put you out
how to you know what your weightis, what your pulse ox symmetry is,
all these ideas and so let's seemwe can help people live healthcare.
We're going to see some of thatat the Elder Law for them. A
company that's going to be demonstrating facialscanning technology that diagnoses eighteen different biometric readings

(44:27):
and they've created algorithms with a panelof thirty or forty physicians that are predictive
of stroke, heart attack, diabeticissues, fall risk. So they're going
to be demoing. So this isreally, I think, John, the
future of healthcare. AI has beenbashed a little bit. I think it's
gotten some negative publicity. But whatAI can do in these realms to keep

(44:49):
people well and to motivate them,I think is an enormous potential. Responsibly
used AI can be a game changerin that same total, and it does
need to be made sure that weknow what is responsible what's not. And
you know, we're grappling that herewith the State of New York and the
budget. We have a lot ofmoney put aside for an Empire AI center.

(45:12):
It's going to based out of SunyBuffalo. But the sense of the
matter is a lot of the issuessurrounding AI deal our federal constitution, and
the federal government is working in earestand I believe in a bipartisan manner to
address this because they realize that asmuch as we may struggle from time to
time with civility in government, itcan become a banana republic if AI takes

(45:37):
over. Yeah, we've seen someof that in social media already, the
deep fate stuff that's going on,but when you're using it in healthcare,
and I'm kind of on some ofthis in a couple of different ways,
but watching what's coming in terms ofthe data that can be collected and the
use of that data and the abilityto be predictive in nature, so that

(45:59):
wellness becomes the mantra, so thatpeople are monitoring their conditions and get early
warnings and an ability before the earvisit to deal with issues, to get
treatment, to get primary care inthe home. And I think that's really
the push is to bring that kindof care into the home absolutely, you
know, I think of you knowthe fact that and this does not mean

(46:20):
that doctors and nurses are going awayby any stretch of the imagination. What
it means is more information is beingbrought to them sooner and no better examples.
As you know, this is adeadly killer sepsis. There are some
very helpful tools in determining when theonsaw the onset of sepsis is occurring in

(46:40):
patients, and as you know,it's cepsus. Minutes in hours can make
a huge difference. In the outcome. Once people are able to access treatment
properly diagnosed, it can make adifference between life and death. So it's
a big project of the Home CareAssociation of New York State al Cardillia,
who's been a tremendous advocate. Ohyeah, yep. So we have about

(47:02):
five minutes left. Final thoughts onthe budget and the budget season and what
you see coming down the pipeline.You know, it's interesting for a budget
that went on a little bit longerthan it should have. It's not the
most controversial now, you know.And thenarly over the next couple of days,
different medias will be bringing out thethings that they find to be aghast

(47:27):
and you know, it is allin the whole nine yards, and then
people go back to their lives inthe whole nine yards, and at the
end of the day, you know, I think we have a good budget.
You know, the relationship between Speakerof the Assembly, the Senate Leader
and the Governor is it's a professionaland respected relationship. But I'm glad the
Governor finally just said day afternoon,we're done, we're moving on, and

(47:52):
that's a good thing. You know. The rest of the session, we
finish up June sixth or seventh,probably the seventh. Now at this rate,
I've got areas I'm focusing on.I am a big proponent that we
need to continue to allow healthcare professionalsto practice at the top of their scope,
and so I've got some scope changeswhich are very difficult to get done
here in the state. But I'mworking soon, particularly in the mental health

(48:15):
area and of course in the pharmacyarea, to help relieve the overcrowding and
emergency rooms. I've got a fewbills I'm trying to work through that's going
to help provide those individuals struggling withsubstance use disorder to get access to treatment
and greater days of treatment sooner furtherthan later. We have this arcade law

(48:36):
in New York State where if somebodystarts off on suboxone, the hoppook only
discharge them with one days supply.We need to move it to three,
which is allowed by the federal government. And you know, I've also got
some other bills to help paramedics playa larger role in regarding to initiating suboxone
treatment for patients because let's say saidthey meet them literally at the Street,

(48:58):
So we've got a lot of thingsto do. The budget is done.
I think the financial issues should beover. The states in a very good
financial position overall, we're about fifteenpercent of our reason it's good because we
had to prepare for tomorrow YEP,and that the eleven fifteen waivers seven and
a half billion dollars. So Ihope that money gets spent well and can
solve some of the problems that you'realluding to. Anything on EMS services.

(49:22):
I know that there was some legislationproposed. We are we are, that's
one of the last priorities, youknow. One of the things I want
to do, like I said,is how paramedics to have access to be
able to initiate people on Slovak's owntreatment industries. But the other aspect that
we're trying to do is one determiningEMS to be an essential service, which

(49:42):
allows local governments to consolidate services toprovide that service. And we're also looking
to make sure that if for somereason those costs happen to rise, that
it doesn't negatively impact their calculation ofthe tax cap. You know, I
know many local government officials they're willingto raise taxes to make sure they have
a good service in place. Butright now, the way the laws are

(50:05):
structured, they can't. And youknow, I've worked with a lot of
different ums providers, and you knowit's a mixed bag. You have inicible,
you have private for profit, youhave not for profit, you have
volunteer. It's it's it's in thecontroller just put out a great report about
this. It's a candied mess.They're all over the place. But we
need to make sure it's sustainable becauseunfortunately the volunteers just aren't there as much

(50:29):
as they used to be. Butwe also have to allow for test and
release or excuse me, treat andrelease. You know, we are by
law right now you have to goto the hospital and you wonder why they're
backed up and they don't get paid. So if they leave the house right
right, But the responding yeah,yeah, privietors responding they should get paid,

(50:51):
plain and simple. The bottom lineis so whe a doctor on the
other end of the phone or avideo tablet, maybe you might bestow some
constant page because the don't need togo to the hospital. We could breet
an urgent care. Well, bythe way, here's what I need to
do we need to get to startthese prescriptions. Tell me your pharmacy,
will I have it delivered, stayat home, save the system some money,
but more point, you save yourselfsome time and trauma you go to

(51:13):
the emergency room. Now you're guaranteeda twenty four hour wait, if not
more, John, if not more. And that whole system you just described
telemedicine. There's a company here locally, UCM Digital Health had a pilot program
with EMS services. It was fundedI think by Mother Cabrini. And those
are the things, the innovations andthe use of resources where these silos have

(51:36):
to get broken down and people haveto be able to do the things they're
trained to do at the highest levelsthat they can do them. John McDonald,
thanks for staying with us for thehour. Good luck with the rest
of the day and the rest ofthe budget. I hope to read about
it in tomorrow's Times Union. Andas always, we thank you all for
listening to Life Happens Radio. ThankFrank Hemming for his patients and sitting here
with me for the hour. Happyto be here, and we'll afford to

(51:59):
see John on May sixteenth. It'sgoing to be an interesting day and all
of you who want to join ussign up on our website Purolo dot com
for the Elder Love Forum on Maysixteenth. Have a great weekend.