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Transcript: Mayor de Blasio Hosts Press Conference to Launch GetCoveredNYC Initiative

December 20, 2016

Mayor Bill de Blasio: Thank you very much.

[Applause]

Wellington Pellerano: Thank you for having me. 

Mayor: Wellington, I want to thank you. Aimee, thank you. You both provide very powerful, personal testimony to why this matters so much, why it’s so important to protect the Affordable Care Act, and also to make sure that every New Yorker who’s eligible is signed up for health insurance. Their stories are so straightforward – the difference it makes when people don’t have insurance, what it means in their life; the fear, the vulnerability when you don’t have insurance; the danger of a health problem that creates a catastrophic impact on your household budget, and obviously the horrible danger as Wellington has described of needing care and not being able to get it, especially with a serious illness. One of the most powerful things about the Affordable Care Act, and I give President Obama so much credit for this, was that it responded to decades of concern among New Yorkers and among all Americans that we couldn’t get coverage if we had pre-existing condition. That was the norm in this country. We’re the greatest country in the world, but if you had a pre-existing condition – God help you. And for millions of people that stymied their ability to get the healthcare they needed and created massive costs for families, often, again, debilitating costs. With the stroke of a pen, President Obama liberated this country from decades and decades of pain and families from that fear.

All of that is now up for grabs. All of that is hanging in the balance, and so many other good elements of the Affordable Care Act. And we need to think about this in very human terms. We need to think about people who are striving to do the right thing. We have two hard working New Yorkers to my left here, contributing to this city, striving to do all they can. And if it weren’t for the Affordable Care Act, they would not have health insurance period. And in Wellington’s case his life would be in danger for lack of care. It’s as simple as that. Wellington, I want to particularly thank you for being willing to tell your story because people need to hear – one, they should come forward when they have a problem, and people are there to help them like Kizzy.

Where is Kizzy? Okay, come forward, Kizzy so we can see you and thank you. This is the – come up here for a moment – you’re way too shy. Because this is an example of someone who made a difference by making sure that a person in need actually got their insurance. Let’s give Kizzy a round of applause. Thank you. Thank you very much.

[Applause]

Just that one phone call changed Wellington’s life, and that’s what all of the good people in our Get Covered initiative are doing. They’re reaching out all over the city to make sure people have the help they need. You know I was just in the van outside watching this, and it really made me proud as a New Yorker to see people who work for this City and care so deeply enrolling people on the spot. It’s just amazing to watch. I was there with two really talented folks – Sheila Glover who’s an enroller for MetroPlus and Christopher [inaudible], also an enroller for MetroPlus. Sheila and Christopher were there talking to people and showing them how easy it was to enroll.

Sheila’s talking to a man named Andre who had not had insurance for over a year, and she explained to me that once she got the information, it only took 15 minutes to confirm eligibility. So she was going to ask Andre to stay, get confirmation he was eligible, and then take the next step right away – immediately – to get him on insurance, and that he could have coverage within 72 hours. Here’s a guy who has not had health insurance for over a year and can get coverage within the next 72 hours. Christopher was talking to [inaudible] and Marcos. They’re a couple who have serious health issues and unfortunately just experienced unemployment in the last few weeks – just lost a  job and the health insurance that went with it. So these enrollers are doing amazing things for people right here and now, and the Get Covered initiative is making a huge difference in people’s lives.

You know, let’s be honest about the moment we’re in. There’s a lot of fear. There’s a lot of fear about the potential loss of the Affordable Care Act, and President-elect Trump has made very clear he intends to repeal it. Many in the Congress have said the same. For all the people like Amy and Wellington, like Andre and Marcos and [inaudible] out in the van – all of these people are depending on the Affordable Care act right this minute, and they’re hearing a sworn commitment to destroy it. Well we can’t take that lying down. We as New Yorkers need to fight back, and right now one of the best ways to fight back is to sign up the maximum number of people for health insurance under the Affordable Care Act. And this is something that we’re doing here in New York City, and it’s something that people are doing all over the country as we speak – signing up the maximum number of people, first, of course, because we want everyone to get health insurance, and that’s going to help them right now. And by any measure that insurance is going to last for a meaningful amount of time even as this fight over the future of ACA continues. But there is nothing more important than the facts on the ground. The more and more Americans that sign up for the ACA, the harder it is to take it away.

It is also an act of strength. It is sending a message that this City is going to stand by its people, and not let a single election change who we are. We believe people deserve health insurance. We’re going to fight income inequality. If we’re going to deal with the affordability crisis in this city, we have to go at all of the things that create a burden in people’s lives. And the lack of health insurance creates a huge danger, both health-wise and economically. Or, as Aimee described, if the only way you can get insurance is to pay a very high premium, then you’re making a choice between rent, healthcare, food – the basics. So we have to keep working to get every single person enrolled right now. And it’s everyone’s business. When I gave my speech at Cooper Union, I said to all New Yorkers – if you know someone who is not enrolled, help them. Tell them that they can get insurance right now – encourage them, support them, help them get linked to our GetCovered campaign. That can happen right now. The folks in the van are signing up as we speak. It’s straightforward; it’s simple; it’s fast.

The impact of Obamacare in this state and this city is extraordinary. In New York City alone, since the Affordable Care Act came into play, 1.6 million New York City residents have signed up for health insurance – 1.6 million people have health insurance in this city because of the Affordable Care Act. You know, for decades, we talked about the 40 million New Yorkers – excuse me, 40 million Americans – 40 million Americans who had no coverage. Well, 1.6 million of them were right here in our city, and now they have it. That’s what we’re fighting for.

People are understandably fearful, as I said. But there is something they can do. Don’t be discouraged. Get active. Take a stand. Get covered. Get your friends covered; get your family covered. Make a difference.

And we have started a major outreach effort. That’s what we want to tell you about today. We are mounting an effort to sign New Yorkers up for health insurance under the Affordable Care Act, such as never has been seen in this city since this new insurance came into play. This is going to be the single most concentrated outreach effort we’ve ever had. It started in just the last two weeks, and in two weeks alone, there have been 20,000 calls and door knocks made – 20,000 folks who don’t have insurance have been reached out to already. Of them, 1,000 already have appointments scheduled to get insurance, like you could see right out there in the van. The goal for this next year is to enroll 50,000 more New Yorkers in health insurance under the ACA – 50,000 more in the course of the next 12 months.

Now we have a particularly important deadline coming up on January 31st. That’s when this current enrollment period ends. So we’re really blitzing to get as many in by January 31st as possible. And then we’ll continue to the next open enrollment period next November. This will be an ongoing effort.

I want to thank everyone who is a part of this effort, everyone who is supporting it and making it happen. From my administration, Dr. Mary Bassett, our Health Commissioner; Stan Brezenoff, our Interim President and CEO at Health + Hospitals; and Regina Schwartz, the Director of the Public Engagement Unit, which is doing this extraordinary outreach effort. I also want to thank our good allies: Kevin Collins, the Executive Director of the Doctors Council; Andrew Hoan, the President and CEO of the Brooklyn Chamber of Commerce; and Dr. Arnold Saperstein, President and CEO of MetroPlus. Thanks to all of them for their dedicated efforts in helping us to build this outreach effort and change people’s lives.

Realize that when people have insurance, they go and get care. They don’t put off taking care of problems. It means problems get solved. Their health is protected; it doesn’t deteriorate. People have insurance, they’re proactive; they accept preventative care. When people have insurance, they know that God forbid they get ill, it will not destroy their household budget, make it impossible to pay their rent. There are so many options, as Aimee said, where people can get insurance for very, very little money. There are plans as low as $20.00 a month. That means that anyone can find a plan that works for them. And anyone who is not reached by the GetCovered outreach team immediately, can simply call 3-1-1 and get connected to someone who will help them enroll. It’s as simple as a phone call to 3-1-1.

So please, remember that this is something we can do here and now. People come up to me all the time, and they say they’re worried, they say they don’t know what’s going to happen in the future. They’re uncertain – what can we do? Well, my message to all New Yorkers is there is something you can do right now – get everyone you know signed up for health insurance. Dial 3-1-1. When we say always New York, when we say we are going to stick to our values, we are not going to let an election change us, here’s a real live example of it – something we can do to protect our own people. A few words in Spanish –

[Mayor de Blasio speaks in Spanish.]

Now I want to turn to someone who for decades has been one of the strongest voices for protecting New Yorkers who deserved health insurance and deserved the basics in life – the President and CEO of the Community Service Society, David Jones.

[Applause]

[…]

Mayor: That’s what we can do to fight back and make people’s lives better this holiday season.

Let’s take questions on GetCovered and insurance issues and then we’ll go to other topics after. Yes –

Question: Mayor just to clarify, you are trying to enroll 50,000 people before January 31st?

Mayor: Fifty-thousand people over the next 12 months; the most possible by January 31st.

Question: So what’s the number of people that you have out there that would qualify? I guess it’s more than 50,000. I mean if you get that number 50,000 enrolled, how much money is that going to save the Health and Hospitals Corporation?

Mayor: I’ll start and then my colleagues Stan Brezenoff and Mary Bassett, Regina Schwartz can jump in, in turn. Broadly – and these are broad figures – broadly there are almost half a million New Yorkers who are eligible and don’t have insurance. They are eligible under the Affordable Care Act and they don’t have insurance. So we’ve got a lot of people that we’re trying to reach and we have a lot of information about them so that’s why those first 20,000 calls and door knocks are going right to people that we know are not enrolled, but are eligible.

And again, to have a thousand appointments made in just two weeks’ time says that there’s a real hunger for this and we are reaching people effectively. We are going to keep blitzing over these next weeks to reach more and more people. The effort over the next year will cost – between the advertising we’ll do for the GetCovered initiative and the actual workers who will go out and enroll people – that’s about eight million dollars. We expect to make that money back many times over in terms of savings at the Health + Hospitals Corporation. So Stan, Mary, you want to jump in?

Interim President and CEO Stanley Brezenoff, Health + Hospitals: So that number of 50,000 people, are coming to us to be treated and in their current status, uncovered, we absorbed the entire costs of the treatment. So, depending on the levels of expenditures and the continuing care that they might get, we have an estimate of around $40 million that this could work.

Question: Are you ready for the potential blowback from the President-elect and his team about your comments today? And also for NYC Well, can you give us some statistics about how many people called in [inaudible]?

Mayor: Am I ready? I was born ready.

[Laughter]

[Applause]

There is no choice but to fight here, and what I said at Cooper Union I was trying to lay out a game plan for the people of this city. Of course we are going to fight. What’s the alternative? To let our people have their insurance taken away from them – 1.6 million people robbed of their health insurance? We would never accept that. We’re not going to let people go without healthcare. We have to stand and fight, but we are going to do it the smart way. Not just with words, with deeds. So every additional person who signs up for the Affordable Care Act – again, it creates momentum to keep it in place. You know, these right-wing Republicans who think it’s going to repeal it, guess what?  A lot of people have voted for Donald Trump. When asked – and I’ve seen the survey information – when asked, how do you feel about not getting health care because of preexisting conditions? No, wait a minute. I didn’t mean I wanted that taken away. Well, how do you feel about your kids not being able to get insurance on your plan up until the age of 26? They’ll say – wait a minute; I didn’t think we meant that.

It turns out – and of course, the tens of millions of people who – because of the Affordable Care Act have health insurance who didn’t have it a few years ago in red states and blue states both. They don’t want to get that phone call saying, “Oh by the way, we just cancelled your policy because of an act of Congress.”

So, I think this is going to get real complicated real quick for the Republicans. And we want to make it even more complicated by increasing the number of people who are signed up. So, this is one of those moments, where sort of the human – as Corey said – the moral imperative of signing people and getting them insurance combines with the strategic imperative of doing everything we can to defend the strength of the Affordable Care Act. They both go together.

If – what are they going to do to us? They’re trying to take away health insurance for 1.6 million people. What’s worse than that?  Right?

We have to stand and fight. And by the way, if they try and penalize us further, I think it will undermine everything they’re trying to do. They’re trying to penalize a city that’s trying to insure its own people and help its own people? I don’t think that’ll fly.

David.

Question: Just curious. How many – you’re trying to get 50,000 people to sign up in this coming year. How many signed up in 2016? I mean we’ve had, obviously, far more than 50,000 signing up thus far.

Mayor: Right. So, the original – and I think Mary knows some of this history – obviously, there was huge momentum in the beginning when it was new and a lot of people signed up. It’s been important to try and build on that momentum. So, we think this is a realistic goal over the next year. But you can speak to what’s happened so far.

Commissioner Mary Bassett, Department of Health and Mental Hygiene: Sure. So, the number that the Mayor gave, that covered three enrollment periods. So, over three enrollment periods, 1.6 million New Yorkers signed up for health insurance through the exchange. So, that’s the kind of momentum that we’ve had. In setting a targeted 50,000, the GetCovered initiative is increasing by 20,000 our previous targets which were at about 30,000 people newly signed up over a year.

Mayor: Right. And what’s been a problem, David – the nagging problem for a while is this last half-a-million people. And again, my colleagues can speak to this more in detail. But the last half-million people we have not seen the kind of movement we wanted and that’s why we needed to do a much more aggressive outreach effort. There’s a lot of people who are eligible, don’t know they’re eligible, who think it’s cumbersome to sign up, who think that it will be more difficult or costly than it is. So, there’s been a lag. There’s been a group of people that the previous, sort of, more general outreach efforts haven’t reached. So, we’re doing the community organizing approach which Regina is leading. We’re going to their doors. We’re calling them on the phone and engaging them very, very personally.

Question: [Inaudible] more information about this half-a-million people? Like, whether you have done surveys or any kind of research to figure out what the major limiting factors are? And also what was the genesis of this particular added initiative? Was it Trump? Was it also the HHC budget –

Mayor: Okay, you’re good at multi-faceted questions. Let’s take the first one. And we’ll come to the second one. Okay, so, the first was –

Question: If you had research on –

Mayor: On the half-million eligible. Okay, who wants to speak to that?

Unknown: [Inaudible]

Mayor: Go ahead. Don’t all speak at once.

[Laughter]

Commissioner Bassett: Why don’t I start? So, these are people who we don’t know who they are. We have – our estimates are based on surveys that the Health Department does among others. The State also does surveys. Before Obamacare began there were 21 percent of New Yorkers who lacked health insurance. Our most recent estimate, which is from 2015, shows that there are 12.6 percent of New Yorkers who lack health insurance. That’s a 40 percent decline. So, we use those numbers to estimate the number of people who lack health insurance in the city. Now, some people who lack health insurance aren’t eligible for it – principally people who are undocumented. So, that’s how we have an estimate and it is an estimate that about 500,000 people or more have not got health insurance and are eligible for it. We also can make some estimates based on our survey work on what neighborhoods these individuals are in. And they are, not surprisingly, neighborhoods that are served by the 11 hospitals the – our public hospital system. Neighborhoods like Sunset Park, like Bushwick, like West Queens, like the South Bronx – neighborhoods in our city that are low-income neighborhoods are where we have an excess of people who are uninsured. And that’s why this outreach effort that’s not just dependent on a public media campaign which is also ongoing – covers the subways and so on – but actually is reaching out to people with a boots-on-the-ground, door-to-door, leafleting on sidewalks. It’s focusing on neighborhoods that are in the catchment areas of our public hospitals.

Director Regina Schwartz, Public Engagement Unit: Right, so we have a –

Mayor: Hold on, David then – no you go ahead then Regina.

President and CEO David Jones, Community Service Society of NYC: Okay, just to echo what’s been said. We do a survey every year called the Unheard Third which has about 1,700 respondents – telephone and cell phone – and it concentrates on low-income New Yorkers. And we’ve been asking health questions for a while. And it echoes what the Commissioner said. We’re finding that people don’t do it, some out of fear of government involvement which is one of the things we have to recognize is one of the dangerous problems that’s emerging in the Trump administration of trying to terrorize people in terms of saying, “You better not come to government.”

And Stan and I remember the first act in our former lives at HHC was to promise people who came in that we’re respective of their status and they were going to get treatment. So, all of these things mixed together – we have trouble with the undocumented or people who are in various stages of getting documentation, and we get the poor who just are afraid of government generally.

So, there’s a lot of work to be done here and it really is going to take a concentrated effort, perhaps more so now against some of the fears that are out there.

Mayor: Regina.

Director Schwartz: So, for our GetCovered initiative we have a [inaudible] list of folks who have used the Health + Hospitals system and we are going to their doors and making phone calls to them and then case managing them to enroll appointments. After they become enrolled, we then schedule them for a preventative care visit at Health + Hospitals. We’re making sure they're getting the service that comes with the enrollment. So, we’re starting those boots-on-the-ground around Lincoln, Woodhull, and Elmhurst Hospitals as well as other areas citywide. But as everyone before have said, it’s mostly low-income. It’s focused in those areas for now but we’re also taking community intakes, partnering with elected official’s offices across the city, and doing work to catch those individuals who are eligible but haven’t had the time or the knowledge of the paperwork or the ability to schedule that enrollment appointment, and we hold their hands through the process and then make sure they’re using the resources that they now have available to them.

Mayor: And we – I know you had another part of your question. Corey and then we’ll go to other part of your question.

Councilman Corey Johnson: I just want to say one thing which is I think it’s important – and it was mentioned earlier – that language access is one of the biggest barriers. And I think the most demographic, statistics are that nearly 40 percent of New Yorkers were not born in the United States of America which means many of them – English is not their first language. And so as I’m sure Regina’s team is doing and as Lisa said with public health solutions – you know, if you’re going to go into the Bengali community, you need someone that speaks Bengali. If you’re going to go to Sunset Park and do outreach to the Chinese-American community, you need someone that speaks Mandarin and Cantonese. And so one of the major factors is making sure that you have certified application counselors that do this type of work that are culturally competent to let people get that access.

And then lastly, I would say this GetCovered initiative is not new. The City has done it every time there’s been an open enrollment period. I think it’s just sort of a relaunch for this enrollment period. But the City has been very successful in the past in the previous GetCovered iterations.

Mayor: Actually, friendly amendment to that – Regina can speak to it. There’s been an initiative in the past but not with this kind of door knocking, phone banking, you know, classic community organizing effort to really blitz and blanket areas to get to people. That’s part of what we think is a big difference here. It’s that we’re going to be much more hands-on. We certainly found this with the pre-K initiative as well – that more hands-on engagement with people because a lot of the folks whose kids ended in pre-k initially were concerned they couldn’t find the right location or it was going to be difficult to navigate. They got an enrollment specialist who saw them through to the right site. We want to take that same approach and do that to get people in the health insurance. And given how many people are not enrolled, it is even more urgent in this case to get to people quickly and get their families covered.

What was your second part?

Question: Just the genesis of this particular new push. I don’t – GetCovered NYC [inaudible] that’s new or no?

Mayor: Regina, why don’t you talk –

Director Schwartz: Yeah, the boots-on-the-ground portion of it that are proactively engaging folks that we believe are eligible but uninsured at their doors and at the phone – and then that case management of them to the enrollment appointment with the certified enroller – that part is new. There have been folks previously in community-based organizations and in hospitals and DOHMH and HRA and MetroPlus and some of the same GetCovered messaging that has happened before but you have never seen folks out at doors with the GetCovered sweatshirts and making phone calls. And our team that is of course incredibly multilingual, making sure that we are giving people services in the languages that they need.

Question: And then [inaudible] looking at the HHC budget and thinking about – or looking at HHC –

Interim CEO Brezenoff: It’s an example of two parallel goods. This is critically important as has been described for New Yorkers and it makes a tremendous difference in people’s lives to not rely on emergency rooms and episodic care and so on, and has implications for their economic lives – their ability to hold a job. And it’s good news for the HHC budget and that’s a very good thing too.

Mayor: Right. And we – as you know from our vision of how to address the Health + Hospitals dynamic, getting more people covered was important already before November 8th. One of them we were already going to do a major outreach effort. One of the things that has put this, sort of, into a supercharged dynamic is that we do not want people to shy away from coverage under the Affordable Care Act because they think it’s not going to be there. Again, this is another dangerous element of the moment we’re in. That people who need help are going to say, “Why should I bother, it’s going to be repealed.”

We have to show them, not only will they get health insurance for a meaningful period of time under any scenario but one of the best ways to save it is to sign up.

Question: You alluded to it just now saying you don’t want people to shy away from it. You’ve talked about this as kind of a way to block [inaudible] but, I mean, are you worried about the implications of encouraging people to sign up for something that they might then abruptly lose just as far as how it will affect them personally?

Mayor: Fair question but consider the alternative which is people continue without insurance which is the most unacceptable state of affairs. Our vision is that from everything we understand of even the most draconian approaches to repeal, you’re still talking a year or more before anything could actually be implemented. So, anyone who gets health insurance for a full year – their family has health insurance for a full year, that’s a huge human impact to begin with.

As I mentioned, I think it’s going to be a lot harder for the Republicans to repeal this than they think. So, we don’t want to bet on failure. We want to bet on success that there’s going to be a huge fight. This is going to be one of the most dramatic fights in the new presidency to save what was, I think, President Obama’s number one accomplishment which has massive support in this country. And every public opinion poll shows it.

So, I think the winning strategy is to say let’s believe we’re going to save this. Let’s get people enrolled as part of saving it but even under the worst case scenarios people will have insurance for a meaningful amount of time. And then God forbid it was gone, we at least have them working with us so we can help them find other alternatives.

Yeah.

Question: Can folks who are not here legally sign up for this? And second, how much does that cost HHC, serving those people?

Mayor: Yeah, that’s a big challenge. So, Stan and Mary, you want to speak to that?

Interim CEO Brezenoff: Well, the – those who are not here legally cannot sign up for Medicaid or use the exchange. What does it cost? Well, the cost to the Health + Hospitals Corporations – since we serve everyone without regard to their ability to pay, that’s a big chunk of what we lose every year against our bottom line.

Question: Do you have an estimate of what that chunk is?

Mayor: We can get you that but I want to say that piece, although there are some things we can do to mitigate, this is the area where we have much more impact, more opportunity to reduce the burden by getting the almost half-a-million who are eligible. It’s you know, very roughly two half-million people populations – almost a half-million undocumented New Yorkers, almost a half-million people who are legal, eligible, not getting insurance. That second group is the one where we can really make an impact on reducing cost.

Question: And just to follow up – is there some health program for folks who are not here legally who need health services –

Mayor: Mary, you want to speak to that?

Commissioner Bassett: Yes, we’re – as you probably know, there’s a program called Action Health NYC which is a demonstration project that’s based – actually this is one of the sites here – Gouverneur Hospital. It involves several federally qualified health centers as well as two public hospitals – the other one being in Queens. And that’s trying out the idea. Now, we should all be clear that because we have this public hospital system in New York everyone can get care. They just can’t get care in the way that we want to see people get it which is care where they have an assigned doctor and regular, continuous care by a name provider. And that’s what Action Health NYC is doing. It’s piloting with philanthropic support the idea of giving people case management on top of their access to these facilities with a fixed fee scale. And the enrollment is complete and we are looking forward to being able to talk about what we’ve found from it.

Mayor: Just – let me – let me just add real quick that this is the classic conundrum of American healthcare. If people don’t have insurance, it is the guaranteed way to make sure they get their health care through the emergency room which is the most inefficient; when it’s already too late, when someone’s really sick – it’s the most expensive. Everything in American healthcare is trying to [inaudible] the idea of the ACA, reorient people to preventative care. You know having that primary care relationship with a doctor or a clinic. So, it is imperative that we move everybody onto insurance so we can actually get them to get health care the right way.

What’s your last follow up?

Question: What is case management?

Commissioner Bassett: Oh, it means that there is somebody who helps you to coordinate your care, who follows up and reminds you to keep your appointments, helps to navigate the healthcare delivery system. So, it applies to a whole range of potential activities but in this case it’s to make sure that you get your appointments, to help you keep your appointments.

Mayor: Okay, back there. Yeah.

Question: Mr. Mayor, Dr. Bassett – does the City have a contingency plans in place in case Obamacare is repealed or portions of it are dismantled?

Mayor: As I said, we – by everything that we understand at this point even on the worst scenario there’s still a substantial play out here where the existing insurance policies will continue. So, we would have time to build that contingency. Right now, the focus is on never ending up in that situation. And I really believe it’s a simple thing – the more people sign up, the harder it is to get away with repealing it by the Republicans. And we also have an obligation – just get as many people covered right now because of the virtues of getting covered right now.

So, we’ll have time to see how this plays out and attempt contingencies. I got to be honest with you – they are not easy contingencies.

You want to speak?

CEO Jones: Yeah. There’s just one, sort of, ray of hope here – a recent Georgetown study indicates that the worst impacts will be in red states among voters – I think this has been brought up – who may have voted for Trump but never had any idea how bad this could be for them. So, there are going to be pushbacks as the Mayor said because this is not going to be focused solely on New York.

Mayor:  To say the least. Mara?

Question: Two questions. The $40 million in savings to HHC with the enrollment of 50,000 New Yorkers – is that recurring or is that a one time savings?

Mayor: I’ll start and then Stan can jump in. The basic reality is once you sign people up, although they have to go through a re-up process and these guys can speak to how that works. So, it’s not like they’re signed up for the rest of their life. They do have to regularly re-up over the years. But once someone is signed up you have a much greater chance of them sticking with insurance and therefore the reimbursement to HHC is great. So, basically, the simplest way I could say it is – you get them the first time, you have a very high likelihood of keeping them, and then that means more and more reimbursement for HHC.

Interim CEO Brezenoff: So, it’s an estimated figure –

Mayor: Wait, turn on your microphone.

Interim CEO Brezenoff: It’s an estimated figure that’s predicated on the fact that we’re not getting reimbursed for services to these individuals. These are individuals who are presenting themselves for services and are then, while being served, they’re being referred for enrollment. So, the getting them enrolled means the services that we’re providing for them at that point and on a continuing basis will be reimbursed. So, it’s a combination of – its more revenue than it is reduced expenses. These enrollment periods are for a year anyways in most cases and we will be working with our patients to ensure that they continue to be enrolled. But there’s every reason to believe that enrolling individuals in insurance programs means that we’re going to get revenue streams from them for their care.

Mayor: Okay, yeah?

Question: [Inaudible] so, how much has Health + Hospitals saved or made in revenue based on the 1.6 million New Yorkers –

Interim CEO Brezenoff: Well, I don’t know that we’ve tracked it in exactly that way but – and not all of the people who have been enrolled over the years have gotten their services at the Health + Hospitals Corporations.

Mayor: Yeah, so, what we have to do – which we can get you is how many do we know got H+H coverage meaning that’s where they went for their care on a regular basis. We can get you that.

Question: Do you have the numbers for how many people have enrolled during enrollment period that began in November?

Mayor: Regina, do you happen to know that or we can get it to him?

Director Schwartz: We can get it.

Mayor: We can get it to you. Yeah?

Question: Am I hearing correctly that people who live around the public hospitals are using them for emergency care but not getting signed up for the ACA. Is that what that means?

Mayor: I think you hit the nail on the head there, right?

Yes.

[Laughter]

Question: [Inaudible] when they come into the hospital, the ER, why aren’t they getting – I mean if you can do it out in the van in 15 minutes, why aren’t they getting signed up? The language thing –

Commissioner Bassett: I’m not sure – one thing about the uninsured in this city is that we don’t have, generally, a list of people by name. Once somebody signs up for health insurance then we have a name for them and a phone number which may work a lot of the time, an address. So, that’s the way – that’s the brilliance of the system that you’ve heard described as a boots-on-the-ground that it uses the H+H individuals who, by name, who were seen and were not reimbursed – they had a non-reimbursable visit. So, you’re right that we need to make it easier for people to get signed up. But no one who walks through the doors will be turned away because they don’t have health insurance.

Mayor: And stating the obvious – I think there’s – we’re always looking for, whenever we come in contact with someone, taking full advantage of the moment to do all we can do. In the middle of an emergency room visit, it’s kind of a double edge sword. Sometimes that might be a good time. Sometimes that might be a really bad time to do it. People’s minds are going to be elsewhere. But, you know, we’re going use every approach we can. I think the other differentiation here with this new approach which again parallels with what we learned from pre-K is the first contact begins the process – seeing them through to enrollment, keeping them enrolled is about direct, human contact and that’s where this very hands-on approach makes a huge difference, and then ultimately saves us a lot of money too.

Let’s see – last call if there’s questions. Yeah?

Question: [Inaudible] the first one is – the word the use today to encourage people to register sounds very similar to the words that [inaudible] was launched. They said, oh, you should just apply. The more people apply, it will be harder for the future president to repeal it. But now people are in fear. So, are there any possible negative impacts on people who are registered if the program –

Mayor: I think it’s a fair question. But I would argue, obviously, very different realities. DACA was about people who lacked documentation but as you heard earlier with the answer, the only who can sign up for insurance under the Affordable Care Act have to have documentation. So, I think there’s not a direct parallel. But even in the case of DACA, I would argue – and it was very striking, as I mentioned after I met with the President-elect I brought up the issue of DACA and the human cost of an effort to deport the Dreamers who came here not by their own choice. It was one of the more powerful moments in the meeting. And you – not because of that meeting I think a lot of people have said it to him since – you noticed a week or two ago, he started to change some of his language about DACA.

So, I do think, again, this fundamental human and political idea – the facts on the ground matters a lot. I think the more that trying to move a policy that’s going to hurt a lot of people and those people are going to be vocal, and their families are going to be vocal and their friends are going to be local – it gets a lot harder to keep one of these militant promises when you stare down the reality.

And the point that David made is really important in this. The – you could make a really strong argument that a number of red states are particularly dependent on Obamacare and we can say with certitude there will not be an alternative offer that will be anywhere near as inclusive. I think you’re going to see a backlash and I think you’re going to see a lot of senators and Congress people start to get cold feet when their constituents understand what it means. I think the same is true on DACA.

Question: [Inaudible] there are a lot of scams in the immigrant communities. So, when the City specialists go to knock their door to talk about Obamacare, how do they tell whether these are the real ones or the scammers?

Mayor: Regina, you want to speak to that?

Director Schwartz: Well, we have our City IDs which we always show. We are not taking their information from them directly. We are talking to them about what they need in order to enroll and then we are scheduling them for an appointment with a certified enroller. And we are making sure that they are then paired, that they go to the certified enroller that we accompany them if they need help with a specific language or a specific setup. So, everything that we are doing is formalized and it’s going through the certified enroller process.

Mayor: Okay, last call on this topic. We’ll go to other topics in a moment. Last call on GetCovered. Going once, going twice – that was like a half-hand there. Let me offer to everyone else – I know you have other things to do, so, feel free to do other good things.

Mayor: Okay. Almost ready? Because you have such a fast hand, you get to quick draw there, all right. Okay, fire away.

Question: So, [inaudible] –

Mayor: Yep.

Question: [Inaudible] specific threats any specific measure by the [inaudible].

Mayor: No specific threats and definitely specific measures. NYPD is re-enforcing the Christmas market locations around the city. Critical Response Command and Strategic Response Group are deployed right now and happened within just an hour or two after the attack in Berlin. And we will continue that as long as we deem necessary. Further, there’s been a special outreach effort to truck rental agencies to deepen the dialogue. This is something the NYPD had developed a long time ago as a general outreach to make sure there was a deep connection to those companies, so they knew if they saw anything suspicious that they could report it in right away. Went back and went to a number of companies – NYPD went back to a number of companies in the last 24 hours to check in and to check for anything suspicious. Obviously, so far, nothing has been brought up – so no specific threat, but they’ll be a lot of re-enforcement of the Christmas markets – a lot of vigilance. Definitely another opportunity to say – if you see something, say something. If you anything, if any New Yorker sees anything suspicious around one of these Christmas markets, we need to know right away. Yeah?

Question: [Inaudible] I was wondering if any update on the timeline on the [inaudible].

Mayor: We will – I will get you that. I don’t know the exact time. I’ll get you that. Go ahead.

Question: [Inaudible] Basically Governor Cuomo has taken a [inaudible] in the MTA [inaudible] and touting his efforts on the Second Avenue subway line. Do think this bodes well for the future of State funding for the MTA or the State really taking ownership of –

Mayor: It could. I mean – look, first of all, I always appreciate it when you remind your many viewers, listeners, and readers that the MTA is controlled by the State of New York, and that the people of this city should make their concerns known to the State of New York. I think what’s happening with the Second Avenue subway is great. It has been a long journey – everyone knows that. But if it gets done, it’s going to be a great thing for this city. And yeah, of course the more energy the Governor puts into the MTA, the better – particularly to what the MTA does in the five boroughs. So I think it is an encouraging sign. In the back?

Question: The State says that [inaudible] may be re-inspected because workers for a contractor likely cheated on certification tests. Con Ed, National Grid, and the State are all investigating. Have you been briefed on this? And what’s your reaction to what is the City doing?

Mayor: Have not been briefed, but we can get you a reaction today. Yeah, Erin?

Question: Tony Avella announced his campaign against you [inaudible] this weekend. And he chose to do it at the site of the proposed homeless shelter, now being used to house homeless families in Maspeth. You’ve been very critical of that group of protesters. I just wondered what you think of that strategy and seizing on that issue as [inaudible].

Mayor: Don’t have much to say about it. You know we are going to keep doing the work we need to do to get people off the streets with our HOME-STAT initiative, which is really starting to bear fruit. And you’ll be hearing more on that shortly. And to reduce the number of people in shelter. We’ve already gotten 45,000 people out of shelter and into permanent housing. We’re going to be deepening those efforts as we go forward.

Question: Mr. Mayor, following up on Erin, Senator Avella was just on the Brian Lehrer Show this morning. In this particular exchange, it was over Vision Zero – and he seemed to sort of suggest that he didn’t believe the information coming out of the administration that Vision Zero had made progress, had made pedestrians safer. He said he didn’t believe the data coming out of City Hall. What does that say to you about the tone of this campaign?

Mayor: I’m not going to prejudge a campaign that’s just beginning. The data comes from the NYPD. So, I think people who question the NYPD don’t end up being proven right. I think this an age-old thing – we’ve seen it for years now – people questioning the NYPD’s statistics as it has continued to drive down crime, and now played a crucial role in reducing fatalities because of traffic incidents. This is a good thing for the city. And people should celebrate it and help us deepen it. But you know, anyone who wants to question the NYPD’s statistics, I think will be proven wrong.

Question: Mr. Mayor, when Phil Walzak [inaudible] City Hall for the campaign, I asked you if you’d replace him, you said we’ll stick with the group we have. But now you’re bringing in a new communications director. I’m wondering what changed, and why you felt like you needed to bolster?

Mayor: Well, at the time, we just didn’t have an immediate plan for change. But as we saw an opportunity, we went with it. I think Andrea Hagelgans is the right person to pick up the role that Phil had and Peter Ragone had before that. And Mike Casca brings a whole new capacity to this team that I think is really wonderful. And it just made sense – we saw the right package and we put it together. Yeah, please?

Question: Last year, at the – I think it was right around this date, you did a roundtable for the press at City Hall and talked about sort of the end of the year and how your term is going. And are you going to do that again this year?

Mayor: I don’t think we’ve thought about that yet. So we’ll think about that. Juliet?

Question: Yes, Mr. Mayor. Back to the safety and security issue – other than the outdoor markets, you know, there are areas where there are a lot of people on tours – Fifth Avenue, Rockefeller Center, [inaudible] in our area. What if anything is being done in those locations where there are people on ground level, on streets and sidewalks?

Mayor: Oh, that’s something. First of all, a lot of those sites are well protected all ready. But, clearly, when we have any kind of international incident, we look at the specific nature of the incident and that informs where we re-enforce. But we also double back on the most prominent locations in the city and the highest activity points in the city. So places like Rockefeller, places like Times Square, World Trade Center – of course we’re going to have extra presence there. You know this is – we know this time of year. This is not – I think it’s a very sad reality, but it’s not new to us. Around the holidays, from Thanksgiving to New Year’s Eve, we’re at a heightened state of alert on top of our already high state of alert, and we move our assets constantly to keep locations safe. Please?

Question: And Berlin was closing down these outdoor markets. Any thoughts given to that here?

Mayor: No. We, first of all – the constant reality we deal with, with terrorism. We are not going to let terrorists intimidate us. We’re not going to let them change our way of life. We have extraordinary capacity here to protect our own people. And we are vigilant against such attacks. So it is very important that we continue to go about our lives here in New York City. Yeah?

Question: Following up on that, security around Trump Tower with traffic moving down Fifth Avenue – the idea that a truck – I know there are police barricades, but they don’t seem sufficient to stop a truck.

Mayor: There’s a lot of restrictions in place and a whole lot of personnel to back them up. So I don’t know all of the details of what happened in Berlin. I’ve seen mostly what you’ve seen. But we can safely say there were not restrictions and huge amounts of armed personnel to stop that from happening. The situation is the exact opposite around Trump Tower. There’s truck restrictions well before you get to Trump Tower. There’s an extraordinary number of officers, including with long guns. They would be in a position to stop anything if there was evil intent.

Question: Mr. Mayor, payroll records show that there’s a significant percentage of the ACS workforce that is comprised of managers as opposed to let’s say caseworkers. I’m just wondering if you have any concerns about the agency perhaps being a little too top-heavy with managers and whether that might be something that you’d like to take a look at.

Mayor: We’ll keep looking at everything we can do to strengthen ACS. Again, I remind you and everyone that this is an agency that has between 50,000 and 60,000 cases a year. And in the vast majority of cases, protects children very effectively. And again, you don’t hear about it. You don’t hear about it when they succeed. You hear about the small number of tragedies that we are going to move Heaven and Earth to stop because again, I think it’s so important to understand – this is an agency I ask for perfection from. I don’t believe that’s very doable in human life in general, but that’s the mandate to ACS – to literally save every child. And we’ll keep providing them the resources, and the personnel, and the reforms – whatever it takes. I think, to your question, we’ve worked to reduce caseloads over the years. Some of that started in the previous administration, we’ve deepened that. But I think another important point is you do need a substantial amount of supervisory talent because these are very complicated cases. And it’s important that higher level people get eyes on them. So, as part of all the reviews that we’re doing now, we’ll have more to say on that. But I don’t think it’s as simple as saying you don’t want a lot of high-level talent. I think you do need a very substantial amount of high-level talent. Okay, go ahead?

Go ahead.

Question: Mr. Mayor, you were on Errol’s show last night talking about the Campaign for One New York and MIH as a priority and you implored reporters to look at the foes of those fights. I’ve looked at MIH and the only foes I find are the construction unions and New York Communities for Change, the affordability advocates like [inaudible]. Who are the powerful foes of MIH in your mind?

Mayor: I think all those folks, obviously. I think there were – as you remember – a lot of opposition locally, on, unfortunately, mistaken assumptions about what it would do. And when we started that fight – and I think a lot of you were predicting we would lose; I remember it vividly. And so it was – you know, I was convinced, I remember during the Bloomberg years many, many advocates said, you know, one of the biggest change makers would be to have mandatory inclusionary housing. And, of course, the Bloomberg administration would never even entertain mandatory requirements for developers. So, when we started to move on it there were organized forces and there was obviously some of the classic New York City nimbyism at play as well. But it was a tough fight and we had to reinforce it.

Question:  Did you feel like you were fighting the real estate developers on it?

Mayor: I think there were some developers that didn’t like it for sure, but I think it was all of the above is the answer. There were elements of real estate community; there were all the individual organizations you mentioned, and there were a lot of folks locally. But what was to me most distressing was this is something to put new requirements on developers and maximize affordable housing and a lot of people were not getting that message. They were getting a very different message about what it was and we had to set the record straight.

In the back.

Question: Mr. Mayor, there were repeated emails to the Department of Homeless Services –

Mayor: Speak up a little, I’m sorry.

Question: There were repeated emails to the Department of Homeless Services regarding the Bushwick Economic Development Corporation. This is the nonprofit that oversaw the apartment where the two infants were killed by steam a couple weeks ago. Have you talked to DHS about the fact that they received repeated warnings about the conditions of the apartment that the Bushwick –

Mayor: I have not seen the emails you’re referring to, so I can’t comment. We’ll certainly get you a comment, but I don’t know specifically what you’re referring to.

Question: Are you at all concerned though that DHS received warnings about the conditions of these –

Mayor: Again, until I see what they are I can’t comment. I am obviously concerned; this was a tragedy, as you know, I went there and saw it with my own eyes. And it is very, very painful, but I want us to be very careful about understanding the difference between what folks involved knew and didn’t know. And so far, I have not seen anything that suggests to me that there was a way to know anything like this could happen and it was unprecedented unto itself.

Question: This is a time of year for reflection, for looking back – I’m wondering – looking back over the last year what would you say is the biggest mistake that you made this year?

Mayor: Look, I think – I’m not going to give you a snap answer on that. I feel – looking back on the year in general – I feel very satisfied with the year because on the big things we came here to do; pre-k and continuing to increase the graduation rate, the test scores I feel good about that, I feel good about the reduction of crime, and the fact that we are continuing reform in the police department. You know, the big things – I think there is a lot of good news in this city – obviously, the 60 million tourists is a very good piece of news for this city. You know, I continue to be very concerned that we have to find new ways to address the homelessness issue and better solutions, but I think some of those are starting to really take hold. So, I don’t have a simple answer for you. I’ll give that some thought.

Question: Anything you would have done differently?

Mayor: I didn’t say that at all. I said I don’t have a simple answer for you.

Question: I want to ask about [inaudible] Tony Shorris had come under some criticism before. People were questioning whether he was overextended in his vast [inaudible] is the appointment of [inaudible] a way to address – I mean are you trying to help him out; take some of the duties he has off his plate?

Mayor: I think it is a way of just making the team stronger. She’s a real proven leader, tremendous experience particularly at the State level. And, you know, Tony has a huge portfolio – and again a lot of the successes I just referred to are part of that portfolio. I think he has done a fantastic job, but it gives us the ability to – you know – support his work more effectively. It is as simple as that.

Back there.

Question: As of late last week –

Mayor: A little bit louder.

Question: As of late last week, [inaudible] no one from City Hall has been called to testify for a federal or State grand jury. Has it changed since then?

Mayor: The lawyers can give you updates on anything that is going on with that. I don’t want to speak about stuff I am not sure about.

Question: During the extreme cold how was the homeless outreach?

Mayor: The homeless outreach was very strong. I don’t have my handy numbers that I often have when we’re in the middle of one of those extended periods, but I feel very good about what I am seeing; in terms of the HomeStat apparatus getting out there and working very closely with the NYPD and EMS and getting people in. And so, I think that is working really well. Obviously, the vast majority of people come in voluntarily, but when we do need to act involuntarily we do.

Alright, thanks everyone.

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