CEO advocates for ‘civil obedience’ as Medicaid cuts loom

Westchester Medical Center Health Network in Valhalla, N.Y., is the state’s largest Medicaid provider north of New York City. It also has the only burn unit in the region, a pediatric hospital and 300 inpatient mental health beds as well as a resident training program.

“We really are an integral part of the healthcare ecosystem for a very large part of New York state, and because of that, we are incredibly impacted by what’s going on in Washington, the anticipated Medicaid cuts to the organization,” said David Lubarsky, MD, president CEO of Westchester Medical Center Health Network, during an episode of the “Becker’s Healthcare Podcast.” “We’re a public benefit corporation under New York State and we don’t exactly have huge margins. As a matter of fact, we don’t have any margins. These cuts are of great consequence to us and every hospital in New York state.”

The Medicaid cuts are not scheduled to take effect until 2027, which gives health system leaders some time to prepare. However, the long lead-up also presents challenges as hospitals begin both advocating against the reductions and planning for their potential impact.

“Hopefully, there will be an opportunity to address that at a political level because what has been done is bad for the health of America, and its productivity, which isn’t going to be helped by having people who cannot get basic medical care,” said Dr. Lubarksy. “It leads to a less productive workforce and a less advantaged community. But I think that it’s an opportunity to start planning.”

In that spirit, Dr. Lubarsky has been “advocating aggressively” for what he calls “civil obedience.” Unlike civil disobedience — the act of nonviolent refusal to obey laws to advocate for change — civil obedience highlights strict compliance with the law to achieve desired goals.

“I’ve always been a goody two-shoes, straight A student type person. I don’t believe in disobedience. I do, however, believe in taking full advantage of the law,” said Dr. Lubarsky. “A lot of disenrollments for Medicaid patients and the negative impacts on our communities are going to result from the inability to actually navigate the website to prove you’re working or volunteering, or that you deserve an exemption. There is no reason the medical establishment, all of my colleagues and all of the public health organizations, all of the social services organizations, cannot get together to make sure every single person who deserves to have Medicaid continues to have Medicaid.”

This level of collaboration will be essential for health system executives to lead thriving organizations in the future. Leaders have always needed to be fierce advocates for communities, and perfecting the pitch to legislators will make a difference.

“It has never been more important to be clear, concise and specific about the impact on patients. Not groups of patients, but examples of patients that people can really understand that these proposed cuts are not helping America,” said Dr. Lubarsky. “They’re not helping hospitals. Individual citizens are being denied healthcare and the ability to be productive citizens. In the long run, you’re just cost shifting to uncompensated care in hospitals like mine, in their ED, and that in turn hits the very infrastructure that supports U.S. healthcare.”

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