Medicaid Managed Care - U.S. Senate Special Committee on Aging

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July 16, 1997
796
The Odd Couple That Did the Heavy Lifting on
Pataki's <strong>Medicaid</strong> Deal
By STEVEN GREENHOUSE
N ew York state officials from Gov. George Pataki on down took credit
NTuesday for winning the Clinton administration's approval for a plan to
enroll most of New York's 3.5 million <strong>Medicaid</strong> recipients in managed
care. But two men who are not on the state payroll did much of the hard work
that clinched the deal.
Dennis Rivera, president of 1199, New York City's largest union of hospital
workers, used his considerable influence in Democratic politics to press the
federaf govermment to block Pataki's <strong>Medicaid</strong> plan until it was changed to his
liking, say officials involved in yearlong negotiations.
Kenneth Raske, executive director of the Greater New York Hospital
Association, a group of 175 health care institutions, had the difficult task of
lining up hospitals behind Pataki's plan.
It was Rivera who proposed that the federal government provide hundreds of
millions of dollars to cushion New York's hospitals and hospital workers as
they made the abrupt transition from <strong>Medicaid</strong>s fee-for-service payment
system to managed care for <strong>Medicaid</strong> patients.
Under the plan announced Tuesday, New York state is to receive $250 million
a year in federal money for five years to help hospitals and hospital workers as
the health care industry in New York undergoes a major overhaul.
Rivera also brought Pataki together with Vice President Al Gore at last
November's Al Smith political dinner at the Waldorf-Astoria to get them to
cooperate on revising Pataki's plan td-move most of the state's 3.5 million
<strong>Medicaid</strong> recipients into managed care. The plan required a federal waiver
from <strong>Medicaid</strong>'s fee-for-service payment system.
Raske, who said that his role was far less important than Rivera's, represented a
constituency concerned about its ability to hold onto a large part of its patient
base. Not being able to afford to build the walk-in clinics that many
managed-care patients use, many hospitals feared that Pataki's plan would
make them lose tens of thousands of lucrative <strong>Medicaid</strong> recipients once they
joined managed-care plans.
"Without Ken, without his cooperation, this-would have had a much more
difficult time," said Jeffrey Sachs, an adviser to Rivera and a deputy health
commissioner under Gov. Mario Cuomo. "He was able to bring the hospitals on
board. They weren't necessarily in favor of the waiver."
Raske, who is on far better terms with Pataki than is Rivera, also served as an