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New York City will spend at least $100 million to ensure that undocumented immigrants and others who cannot qualify for insurance can receive medical treatment, Mayor Bill de Blasio announced on Tuesday, seeking to insert a city policy into two contentious national debates.
The mayor has styled himself, in his 2017 re-election campaign and during his second term, as a progressive leader on issues like education and health care, and as a bulwark against the policies of President Trump, particularly on immigration.
In making the announcement, first on national television, Mr. de Blasio appeared to be trying to heighten that contrast and thrust his efforts on behalf of undocumented New Yorkers into the national debate over immigration, hours before Mr. Trump was to go on television Tuesday night to make his case for a border wall.
“Everyone is guaranteed the right to health care, everyone,” Mr. de Blasio said during a news conference at Lincoln Hospital in the Bronx. “We are saying the word guarantee because we can make it happen.”
New York City already provides health care to the uninsured and the undocumented through its hospital system, a roughly $8 billion behemoth whose history of service to the poor, regardless of an ability to pay, can be traced to the founding of Bellevue Hospital in the 18th century. A person without medical insurance has long been able to go to a city emergency room and get care, free of charge, or to seek a primary-care physician.
But the financially challenged system did not work well to connect patients to doctors, Mr. de Blasio said. He promised a streamlined approach — complete with a hotline and dedicated membership card — and one that would be focused on the primary-care doctor, rather than the emergency room.
“We were only covering them in the sense that they could go to the emergency room,” the mayor said. “It was not a way to live.”
The announcement came as proponents of universal health care coverage have increasingly looked to local governments, rather than Congress, to make meaningful progress in the short term. Also on Tuesday, Gov. Jay Inslee of Washington said he would seek to create a public option in the state.
A day before, Gov. Gavin Newsom of California, on his first day in office, announced his plan to move toward a single-payer system for that state. As mayor of San Francisco, Mr. Newsom oversaw the creation of a health care system in that city in 2007.
The top health official who created the San Francisco program, Mitchell H. Katz, is now the head of New York City’s hospital system and will oversee the city’s effort, branded as NYC Care. “It’s a much bigger and more compassionate vision,” said Mr. Katz, comparing New York’s proposed program to the much smaller one in San Francisco.
The mayor was quick to say that the plan would not be a substitute for any universal health care at the state level or a national single-payer plan. But, aides said, it was something the city could do immediately and on its own, without approval from the State Legislature, which is weighing some form of universal health insurance for New York State.
Indeed, the mayor’s proposal is a mix of insurance and direct spending, and Mr. de Blasio said it would take about two years to get it fully running. The city already has a kind of public option for health insurance for low-income New Yorkers, through an insurance plan run by city hospitals known as MetroPlus.
The new proposal would improve that coverage, which already insures some 516,000 people, and aim to reach more of those who are eligible, such as the young and uninsured, and others who qualify but have not applied.
It would also provide additional direct city spending, at least $100 million per year when fully implemented, officials said, for the city’s hospital system to support care for those without insurance. The city estimates the uninsured population to be about 600,000 people, including as many as 300,000 undocumented residents. A major component of that effort would be improving customer service, including the phone line, to help those with questions about their care.
Part of the goal of NYC Care, aides to the mayor said, was to direct people to medical care earlier — before they seek more expensive services in an emergency room — while providing them with better health care.
The effort is also aimed at getting some of the so-called young-and-invincible uninsured population into the health care system, either through the city’s insurance plan or through its hospital system.
“It appears that the mayor is ramping up outreach so that more people can avail themselves of services, regardless of ability to pay, that have been made available to them by Health and Hospitals for decades,” said Andrew Rein, the president of the nonpartisan Citizens Budget Commission. “The details are critical,” he added. “We still need to learn more.”
The $100 million would go to both establishing the customer service component and hiring additional doctors and nurses, but officials could not provide a breakdown of how much would be spent on each. Indeed, details of how those seeking care could do so under the new plan were not immediately clear, nor was an exact start date.
Mr. Katz said that the rollout would begin in the Bronx and that the city would start enrolling people in the NYC Care program this summer. The borough was chosen because the health care needs were greatest, he said.
Such endeavors can be difficult for the city to implement quickly. Mr. de Blasio oversaw the creation of a municipal identification card for undocumented immigrants in his first term. But last week, he said that an ambitious goal of providing MetroCards to about 800,000 residents whose incomes are below the federal poverty line would fall far short of that goal initially, starting this month with cards for only about 30,000 people, or about 4 percent of the total.
Mr. de Blasio said that the NYC Care system will also employ what amounted to a membership card in the city program. “They will have a card that will empower them to go to that doctor whenever they need,” he said.
The city’s hospital system has been under severe financial strain and running deficits for years. The current financial plan for city hospitals anticipates budget shortfalls of more than $156 million in 2018, increasing to $1.8 billion in 2022, according to the city’s Independent Budget Office.
Melanie Hartzog, the city’s budget director, took issue with those figures during the news conference. She said that the hospital system — which has received significant infusions of city money during the de Blasio administration — was now in “a very cash-strong position.” She said more details would be provided during a forthcoming budget briefing.
Advocates for immigrants and health care analysts were encouraged by the plan, even if many were still looking to Albany, where debate over health care is likely to consume the coming months.
“We hope it is a step toward making larger changes at the state level,” said Rebecca Telzak, director of health programs at Make the Road New York, an immigrant advocacy group supportive of the mayor’s plan. “Ending here is not enough.”