Activists, Cuomo in “Full-Out War” Over Poor People’s MAT Access

Drug-user activists are fighting to ensure access to medication-assisted treatment (MAT) for some of New York State’s most vulnerable citizens, in the face of a governor seemingly reluctant to help and an administration that continues to offend.

On October 29, advocacy groups including VOCAL-NY, Families for Sensible Drug Policy (FSDP) and Truth Pharm gathered in New York City to demand that Governor Andrew Cuomo end his four-month-long stalling on key legislation⁠—Assembly 7246B and Senate 5935⁠—and sign it. The legislation would guarantee access to medication-assisted treatment (MAT) for all eligible Medicaid recipients.

“It’s mind-blowing [that] we are in a full-out war over a bipartisan bill that removes bureaucratic processes that are literally killing people, and allows doctors to see more patients,” Jasmine Budnella of VOCAL told Filter. The legislation passed both state houses in the legislative session that ended June 2019, with the governor yet to make a final decision.

If Cuomo signs, people seeking buprenorphine would no longer need to obtain prior authorization from the state’s Medicaid program. Alexis Pleus, founder and executive director of Truth Pharm, told Filter that the status quo makes people in the “throes of withdrawal” wait for Medicaid approval for a doctor’s Suboxone prescription—even though Medicaid is already required to cover it.

Staffers in the governor’s office have told VOCAL-NY advocates that the issue comes down to cost—and specifically, that costs will go up.

“He’s right: Costs will go up,” Budnella recognizes. But for her, that shouldn’t be a bad thing when low-income New Yorkers are not currently able to access care simply because of their inability to navigate bureaucratic processes. She added that costs will eventually go down when people no longer rely on expensive emergency department visits to access care.

Pleus points out that those costs are already being absorbed by people and organizations who shouldn’t have to be carrying the burden. “My organization ends up paying for the Suboxone prescription,” she said, referring to what she has observed to be a weekly occurrence of at least one of their nearly 250 clients being denied their medication. “Which is bullshit, because insurance companies pay less [the negotiated price] than what we would have to [the cash price].”

“The ironic thing,” Pleus said, is that a Medicaid program ends up reimbursing Truth Pharm organization for fronting the costs of the prescriptions. “So in the end, where these clients are connected to someone like Truth Pharm, the state ultimately pays more for these medicines.”

The governor has also yet to sign off on a similar bill that removes the same prior authorization requirements for commercial insurance holders—which seemingly would not increase any financial burdens carried by the state.

The governor’s press office did not respond to Filter‘s request for comment by publication time.

Other advocates have also heard staffers cite budgetary considerations when justifying the governor’s reluctance to sign the legislation. Pleus and FSDP’s Carol Katz Beyer, both of whom became activists after losing their children to overdose, were told by a staffer in an October 29 closed-doors meeting that the wellbeing of people who use drugs is competing in the budget with that of people in nursing homes and people with mental disabilities.

“It’s just a way to disarm people and it’s inappropriate to say such a thing,” said Pleus. “Is there a scale to say whose lives are more important? The message to me is that the lives of people who suffer from addiction are not of value.”

“Spare me the rantings of the Advocacy Industrial Complex and whomever funds them.”

For Steve Rabinowitz, FSDP’s vice president who was also present in the meeting, “pitting the needs of persons in need of MAT against those of nursing home patients and others in need within the healthcare system is a red herring when the insurance industry continues to reap bloated profits from the system.”

While Pleus and Katz Beyer both described the staffer as being welcoming, they felt that a conversation about the lives of “human beings” was being made into more of a business meeting.

One of the reasons they requested the meeting was that a Cuomo spokesperson had made an incendiary comment just a week earlier that that seemed to dismiss the moral and human imperatives to sign the legislation. Responding to a similar rally held on October 22 by many of the same organizations, spokesman Richard Azzopardi told the Times-Union: “Spare me the rantings of the Advocacy Industrial Complex and whomever funds them.”

“You are stripping the humanity of people fighting for this issue and are calling it fake news,” Budnella said.

For Pleus and Katz Beyer, his comment misses the reality of their organizations. “The grassroots organizations that have taken flight exist out of necessity because our policies and laws are abysmally failing to deliver a standard of care that serves our affected families,” said Katz Beyer, emphasizing that his “incredibly insensitive” remark dismisses her hard work as as an activist and “mother who lost two beautiful and vibrant sons to preventable overdose.”

The idea that their organizations are the tool of big money is a “joke,” said Pleus. It simply doesn’t align with her experience as an activist who founded and now serves as the executive director of a small nonprofit with a shoestring budget.

“We don’t get funded for advocacy work. We only do that because we don’t want people to suffer,” said Pleus. The people she serves through her organization “have no benefit for coming. They couldn’t afford for them to come if we didn’t pay for their parking, their lunch, or their tolls.”

The October 29 rally sought to win a signature and an apology—both of which have yet to be seen.

As of October 23, “a little north of 500” out of “900” passed bills have been reviewed by agencies needed to get the governor’s signature, according to the Times-Union article. The clock is ticking on turning this legislation into law.

“We are deeply concerned as we move into the last months before the next session starts,” said Budnella, fearing that Cuomo will veto the bill during the holidays when activists and journalists are unprepared to hold him accountable. “This should’ve been a noncontroversial bill. His action on this bill reflects his legacy on this issue: not much.”

Activists in New York City on October 29, 2019; by VOCAL-NY via Twitter

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