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
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.
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
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.
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
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