How Much Has the Affordable Care Act Reduced the Share of Uninsured Patients Treated by the City’s Public Hospitals?

With the full implementation of the Affordable Care Act, the share of adults in New York City without health insurance dropped from 20.9 percent in 2013 to 13.8 percent in 2014, a 7.1 percentage point decline. To gauge the effect on New York City Health + Hospitals, we focus on adult outpatient visits to H + H hospitals and diagnostic and treatment centers because some conditions that require inpatient stays, such as medical emergencies, allow for temporary Medicaid eligibility.

  • Although the city’s public hospital system saw a reduction in the share of outpatient visits by uninsured adults, the decline was less steep—4.0 percentage points—than the city as a whole.
  • In 2015, the share of H + H’s outpatient visits by uninsured adults (25.2 percent) was 11.4 percentage points greater than the share of uninsured adults in the general population.
  • For both the city’s population and H + H’s patients, those adults who gained health insurance did so through Medicaid or commercial insurance in approximately equal proportions.

  • Both the share of adult outpatient visits by uninsured patients and the impact of the Affordable Care Act on this share vary widely across H + H facilities.
  • The hospital centers serving the largest shares of adult outpatients who are uninsured include Elmhurst, Queens, Bellevue, and Woodhull.
  • Although each of these four hospital centers saw declines in the share of adults without insurance from 2013 through 2015, all of the decreases fell short of the reduction in the share of uninsured for the city as a whole. Woodhull saw by far the smallest decline, 1.8 percentage points.

Prepared by Erin Kelly
 New York City Independent Budget Office

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SOURCES Department of Health & Mental Hygiene, New York City Community Health Survey, 2014. Health & Hospital Corporation Payor Mix Reports, September 2015 and September 2014, as reported to the Finance Committee.
NOTES: For the share of outpatient visits by uninsured adults at H + H facilities, pre-Affordable Care Act reflects fiscal year 2013 and post-Affordable Care Act reflects fiscal year 2015. For the share of New York City adults who are uninsured, pre-Affordable Care Act reflects calendar year 2013 and post Affordable Care Act reflect calendar year 2014, as reported by the Department of Health and Mental Hygiene Community Health Survey for those years. Coney Island Hospital is not included in the chart breaking out visits by facility because Hurricane Sandy had a lasting impact on the number of visits the hospital was able to provide in 2013 and 2014.

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Are Fewer Child Care Vouchers for 4-Year-Olds Being Used Because of the Expansion of Full-Day Pre-K?

Under federal and state law, families with young children receiving cash assistance and participating in work or training programs are guaranteed vouchers to pay for their choice of child care providers. A limited number of vouchers are also available to low-income working families. As the de Blasio Administration moved to vastly expand the number of full-day pre-kindergarten slots available for the city’s children, many expected that there would be a corresponding decline in the use of child care vouchers for 4-year-olds.

  • From October 2013 through October 2015 the number of children enrolled in full-day pre-k more than tripled, rising from 19,490 to 69,090.
  • Over the same period, the use of of full-time vouchers for the care of 4-year-olds fell. For the children of cash assistance families the decrease was only 9.5 percent, from 6,128 to 5,549.
  • For children in low-income families the number fell by 23.3 percent, from 1,395 to 1,070.
  • Together, these changes mean that as of fall 2015, 6,619 children were still in voucher-funded full-time child care rather than Department of Education pre-k classes.
  • The relatively small number of 4-year-olds in part-time voucher child care increased over the two years by 36.9 percent, from 279 to 382. It is possible that many of them were attending pre-k classes and using the vouchers for after-school care.

Parents who use child care vouchers can choose among a wide variety of child care providers including informal care, family child care, and center-based care. Not all of these providers offer the educational elements available to children enrolled in the Department of Education’s pre-k programs.

 

Prepared by Paul Lopatto
 New York City Independent Budget Office

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SOURCES: Department of Education; Administration for Children’s Services
NOTES: Pre-k enrollment is as of October of each year. The voucher numbers for school years 2013-2014 and 2014-2015 are averages for September through June. The voucher numbers for 2015-2016 are averages for September through December.

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Are Students With Disabilities Suspended at a Higher Rate Than Other Students?

Although students with disabilities comprised about 18 percent of the overall student body in school year 2012-2013, they made up about 30 percent of the suspended student population (defined as the population of students who have been suspended at least one time).

Approximately 95 percent of students with disabilities fall into one of six disability classifications: autistic, emotionally disturbed, learning disabled, intellectually disabled, speech impaired, and other health impaired. There are wide variations in suspension rates across these categories (suspension rates were calculated by dividing the number of suspended students in each category by the number of all students in that category: for example, the number of learning disabled students with at least one suspension by the total number of learning disabled students).

  • Students without disabilities had a 2.7 percent suspension rate in school year 2012-2013.
  • Overall, students with disabilities had an average suspension rate of 7.4 percent.
  • Students classified as emotionally disturbed had a suspension rate of 15.4 percent, which is more than five times higher than the suspension rate of students without disabilities and about twice as high as the overall suspension rate for students with disabilities.
  • Students classified as learning disabled and other health impaired were suspended at rates almost three times as high as students without disabilities (7.4 percent and 7.1 percent, respectively).
  • Students with autism and students with intellectual disabilities were suspended at lower rates than students without disabilities, and were suspended far less frequently than students with other types of disabilities.

Prepared by Katie Mosher
 New York City Independent Budget Office

Print version available here.

SOURCE: IBO analysis of Department of Education data
NOTE: 2012-2013 was the most recent year of data available at the time of analysis. Excludes schools in the citywide special education district (District 75). For more information on students with disabilities, see http://schools.nyc.gov/academics/specialeducation/default.htm

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Has the Amount of Federal Aid to New York City Changed Over the Past Five Years?

Over the past five years, total federal aid to New York City has declined from $7.9 billion in 2011 to just under $7.0 billion in 2015, a decrease of roughly $933 million, or nearly 12 percent. The change was mainly due to the drop in American Recovery and Reinvestment Act federal stimulus dollars.

But the picture changes when stimulus dollars and disaster recovery funding related to Hurricane Sandy and other events are excluded: Federal aid to the city has been relatively flat over the five-year period, although with some spikes in individual sources of aid. Excluding stimulus and disaster-related assistance, federal aid increased from $6.3 billion in 2011 to $6.7 billion in 2012, and then slowly declined to $6.3 billion in 2015. When adjusted for inflation, the $6.3 billion received in 2015 is 6.4 percent, or $403 million, below the aid received in 2011. Federal aid comprised less than 10 percent of the city budget last year.

  • Federal aid, excluding stimulus and recovery funding, totaled $32.3 billion, or just over 85 percent of total federal aid received over the years 2011 through 2015.
  • Three city agencies received a combined $22.5 billion, or roughly 70 percent, of federal aid during the five-year period: the Department of Education ($8.4 billion), Human Resources Administration ($7.7 billion), and Administration for Children’s Services ($6.4 billion).
  • Three other departments, Housing Preservation and Development, Homeless Services, and Health and Mental Hygiene, also received a significant share of federal aid ($2.4 billion, $1.6 billion, and $1.6 billion, respectively) during the period.

Just five federal grant programs, excluding stimulus and disaster recovery funds, accounted for $16.8 billion, or over half, of the city’s aid from Washington.

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  • The largest source of federal aid to the city is Temporary Assistance for Needy Families, which provides cash and other assistance to very low-income families. Funding to the city grew from $1.0 billion in 2011 to $1.5 billion in 2013 as the state, which receives the funds from Washington, changed the formula for allocating the funds to localities. Funding then declined to $1.4 billion in 2015.
  • Title I funding, which supports special programs in schools with large concentrations of students from low-income families, decreased steadily over the five-year period and fell from $833 million in 2011 to $705 million in 2015, a decline of about 15 percent.
  • Federal aid to the city through the Child Care and Development Block Grant, which subsidizes preschool and school-age child care programs for lower-income families, remained relatively flat over the five-year-period, rising $22 million, or roughtly 5 percent from 2011 through 2015.
  • Section 8 funding, which provides rental assistance to low-income households, grew from $419 million in 2011 to $437 million in 2015, an increase of about 4 percent. (A separate Section 8 grant of about $1 billion annually goes to the New York City Housing Authority but does not flow through the city budget.)
  • While most federal Medicaid spending in the city flows directly from the state to reimburse health care providers, some federal Medicaid dollars—such as support for school-based health centers—become part of the city budget. Medicaid funding in the city budget went from $349 million in 2011 to $209 million in 2015, a decline of 40 percent. The amount of federal Medicaid funds received by the city each year is partially determined by the number of claims the city files for reimbursement.

Prepared by Frank Posillico and Ana Maria Ventura
 New York City Independent Budget Office

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Do Some City Schools Have an Unusually Large Share of Students Who Live in Public Housing?

In two recent high-profile school rezoning controversies, overcrowded schools primarily serving higher-income students were located in close proximity to underutilized schools largely populated by students in public housing. To shed light on this issue, IBO examined the distribution of students from public housing across New York City’s public schools.1

The New York City Housing Authority provides housing to low- and moderate-income residents throughout the five boroughs. In 2013, public housing was home to 4.8 percent of the city’s residents, but the nearly 95,000 students who lived in public housing made up 8.6 percent of the public school population, including charter school students.

IBO calculated the share of elementary and middle school students in each school who lived in public housing in order to gauge how the students were distributed across schools during the 2013-2014 school year. We chose to look at grades K-8 because high schools tend to be less tied to specific geographic zones.

 

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  • In 123 schools serving grades kindergarten through 8, students in public housing comprised more than 35 percent of enrollment.
  • This 9 percent of schools accounted for more than one-third of all K-8 students living in public housing.
  • Conversely, most schools served few students living in public housing: In 702 schools, 5 percent or fewer of their K-8 students lived in public housing.
  • The average K-8 student attended a school where 8 percent of students lived in public housing.

Prepared by Stephanie Kranes
 New York City Independent Budget Office

SOURCE: IBO analysis of Department of Education and New York City Housing Authority data
NOTE: 1“Race and Class Collide in a Plan for Two Brooklyn Schools,”  “For Two Sharply Divided Manhattan Schools, an Uncertain Path to Integration

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How Much Has the City Spent on Overtime Over the Past 10 Years?

Over the past 10 years, New York City’s overtime spending has increased from $928 million in 2006 to $1.659 billion in 2015, an increase of $731 million, or close to 80 percent (about 40 percent after accounting for inflation). While the increase in overtime spending over the 10 years appears sizable in dollar terms, as a share of total city spending the increase looks somewhat more modest: growing from 1.7 percent in 2006 to 2.2 percent in 2015.

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  • Uniformed personnel including police, fire, correction, and sanitation accounted for roughly 70 percent of total citywide overtime spending, with the cost increasing from $635 million in 2006 to $1.190 billion in 2015, an increase of $555 million, or close to 90 percent (about 45 percent adjusted for inflation).
  • The city’s civilian workers, roughly three-quarters of the municipal labor force, accounted for the remaining increase in overtime spending. For them, overtime spending grew from $293 million in 2006 to $469 million in 2015, an increase of $176 million. About half of that increase, $89 million, was for civilian workers in the police, fire, correction, and sanitation departments.
  • The agency with the largest increase in overtime spending over the 10-year period was the police department. Overtime spending for uniformed and civilian staff in the police department grew from $412 million in 2006 to $716 million in 2015, an increase of $304 million, or 74 percent. Uniformed staff accounted for $252 million of the increase and civilian staff $52 million.
  • Though the dollar amounts were less, the fire department also had a 74 percent increase in overtime spending during the 2006-2015 period. Overtime spending grew from $194 million in 2006 to $337 million in 2015, an increase of $143 million ($124 million for uniformed personnel and $19 million for civilians).
  • At the Department of Correction overtime spending increased by 180 percent, rising from $70 million in 2006 to $196 million in 2015, an increase of $126 million ($116 million for uniformed staff and $10 million for civilians).

Prepared by Frank Posillico
New York City Independent Budget Office

SOURCE: New York City Financial Management System

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Where Are Funds Going Under the Mayor’s Task Force on Behavioral Health and Criminal Justice Plan?

Before the recent announcement of ThriveNYC, the de Blasio Administration’s initiatives to improve access to mental health programs for youth, adults, and seniors, the Mayor had previously launched measures to boost behavioral health programs for the city’s inmate population. With an increasing share of inmates in the city’s jails struggling with behavioral health issues—from about 30 percent in 2010 to nearly 40 percent in 2014—the Mayor appointed a task force in June 2014 to develop a plan to improve the way the criminal justice system addresses the needs of this population. Six months later, the task force issued a plan with five key components and a price tag of $134 million over four years, all but $40 million of it is funded by the city itself. While the task force report identified the total amount of spending, there was no breakdown of the spending for each initiative. IBO has obtained detailed spending plans from the Mayor’s Office of Criminal Justice, which are shown below.

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 Prepared by Nashla Salas

New York City Independent Budget Office

 

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Do Some Schools Have a Disproportionate Share of Students Living In Homeless Shelters or Doubled Up in Another Household?

About 75,000 students—or over 7 percent—of the city’s 1.1 million public school students lived in the city’s homeless shelter system or were doubled up in the home of a friend or family member at some point during school year 2013-2014.  A disproportionately large share of temporarily housed students were concentrated in a relatively small number of city schools.

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  • About four hundred schools (close to 25 percent of the total 1,669 schools examined) served a population where at least 5 percent of students enrolled were identified as living in shelters and at least 7 percent of students were identified as living in doubled-up housing during all or part of school year 2013-2014.
  • One hundred and twenty schools served a population where more than 10 percent of students were identified as living in shelters; there were 12 schools in which more than 20 percent of students were identified as living in shelters.
  • Two hundred and eighteen schools served a population where more than 10 percent of students were identified as living in doubled-up housing. There were 34 schools in which more than 20 percent of enrollment was identified as living doubled up.
  • More than 560 schools, or roughly 34 percent, have less than 1 percent of their student population living in a shelter. Nearly 280 schools have virtually no students identified as living in doubled-up housing.

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  • Analysis of student data from 2013-2014 shows that students living at least part of the school year in homeless shelters were absent from school far more frequently—about 18 days more—than their permanently housed peers as well as those who were doubled up.
  • Students who resided in homeless shelters were suspended from school at more than twice the rate of students who lived in permanent housing.
  • State test scores for 3rd through 8th graders were also significantly lower for both students living in homeless shelters and those in doubled-up housing situations compared with their permanently housed peers.

 Prepared by Liza Pappas

New York City Independent Budget Office

 

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How Many Rent-Regulated Units Are Rented at Preferential Rates and Where Are They Located?

It is commonly assumed that rent regulation limits the amount owners can charge tenants, keeping rents below what the market would otherwise command. Yet for thousands of apartments across the city, landlords charge their tenants rents that are lower than the maximum allowed under rent-regulation rules. This is known as a preferential rent. While landlords will sometimes forgo additional permissible rent to retain a reliable tenant, in neighborhoods where there are large shares of tenants paying preferential rents, it is an indication that local market rents are not constrained by rent regulations.

Using apartment registration data from the New York State Division of Housing and Community Renewal, IBO found that of the 765,354 state-registered units subject to the traditional rent-regulation rules in 2013 (the most recent data available), 23 percent—more than 175,000 apartments—were rented at a preferential rate.

Share of Regulated Units Rented at Preferential Rates

Click on a neighborhood to see number of rent-regulated apartments and share with preferential rents.

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  • Neighborhoods with some of the highest shares of tenants in regulated units paying preferential rates were Oakwood in Staten Island (62 percent), and Fresh Meadows and Bay Terrace in Queens (61 percent and 60 percent, respectively). The overall number of regulated units in these areas, however, was small.
  • In neighborhoods with large numbers of regulated units, those with high shares of units receiving preferential rents include Flushing (38 percent), Astoria (35 percent), and Hunters Point-Sunnyside (34 percent).
  • Some of the neighborhoods with substantial numbers of regulated units and the lowest shares of apartments with preferential rents include the West Village (10 percent) and the Upper West Side (10 percent). Outside of Manhattan, Borough Park (15 percent) and Prospect-Lefferts Gardens (17 percent) in Brooklyn had low shares of preferential rents.

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  • The prevalence and extent of the rent preference varies among the boroughs. Brooklyn had the largest number of regulated units receiving preferential rents, followed by Queens.
  • In terms of the median preferential rent discount—the difference between what the tenant pays and the maximum legal rent the landlord could charge under rent regulation—apartments in Manhattan had the largest median discount, while units in Brooklyn had the smallest.

The fact that in some parts of the city more than a quarter of units receive preferential rents indicates that rent regulation is not always the most important factor in determining a tenant’s rent. Barring substantial increases in market rents in the neighborhoods with large shares of regulated units with preferential rates, continued regulation might not make much difference in determining the cost of housing for tenants in those areas.

 Prepared by Sarah Stefanski

New York City Independent Budget Office

SOURCE: IBO analysis of data from the New York State Division of Housing and Community Renewal
NOTES: A total of 862,254 regulated units were registered with the New York State Division of Housing and Community Renewal in 2013, approximately 84 percent of the total estimated number of rent-regulated units in the city. A total of 96,900 units added into rent regulation after 1974 in exchange for certain financing benefits, such as the 421-a and 421-g tax incentive programs, were excluded from this analysis.

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