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

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Raske, who is on far better terms with Pataki than is Rivera, also served as an
important go-between in shuttling information about Pataki's plans to Rivera
and federal health officials.
Although the hospital association often clashes with Rivera's union, 1 199, the
National Health and Human Service Employees Union, Raske said, "If it wasn't
for Dennis' persistence, this thing would have never happened."
Some political analysts say politics played a large part in Gore's decision to
push for the <strong>Medicaid</strong> waiver and the transition money. Gore, they said, wanted
to show some federal generosity to New York state to help position himself for
the state's Democratic presidential primary in 2000.
Perhaps more important, these analysts said, Gore wanted to curry favor with
Rivera, who is close to House minority leader Richard Gephardt, who is also
expected to run in the 2000 Democratic presidential primaries. Candidates often
seek out and woo Rivera, because his 120,000-member union is widely
considered the most powerful of all of the state's unions on the national
political scene. With its phone banks and printing presses, 1199 often turns out
more voters in a statewide primary than any other union.
Two-years ago, when Pataki proposed to move all of the state's <strong>Medicaid</strong>
patients into managed care during an 18-month period, Rivera urged his
friends in the Clinton administration not to grant a waiver. He feared that
Pataki's plan would greatly reduce business for hospitals and would cause many
hospital employees to lose their jobs.
"That plan would not have worked, because there just wasn't a system of
primary care doctors or clinics in place to serve the <strong>Medicaid</strong> population once
it moved into managed care," Rivera said. "And a lot of health care workers
would have been dislocated and needed to be retrained."
Recognizing that moving <strong>Medicaid</strong> patients into managed care would save the
federal government huge sums, Rivera proposed that the federal government
pump a large part of those savings back into New York to ease the transition.
Pataki liked the idea because it would mean more federal money. Hospitals
backed the idea because it would give them money to build clinics that
managed-care patients would use. Hospital workers liked the idea because part
of the money would be used to retrain them to work in walk-in clinics.
After Rivera met with Gore last fall and persuaded him to support a large
transition fund, Rivera lifted his opposition to Pataki's request. Then the Pataki
,administration formed a committee with Rivera's union and Raske's association
to rework the govemor's <strong>Medicaid</strong> waiver plan.
Two years ago, Rivera and Pataki were at loggerheads not only over the
goveror's plan to move <strong>Medicaid</strong> recipients into managed care, but also over
his plans to cut health care spending by more than SI- billion. Rivera's union
sponsored a S I million advertising campaign to attack Pataki's budget cuts, a
campaign that caused Pataki to back away from many of those cuts and to seek
a detente with 1199.
Praising the role of Rivera and Raske in the <strong>Medicaid</strong> waiver deal- state Health
Commissioner Barbara DeBuono said: "They were very important to the
process. They identified the need for some assistance that could be given to
hospitals that would help them survive the transition into managed care."