New York City hospital patients who are minorities, uninsured or on Medicaid are "strikingly underrepresented" at the city's private academic medical centers, according to a new study.

In 2009, before the Affordable Care Act took effect, whites were about three times as likely to be hospitalized at an academic medical center in New York City as blacks were.

Five years later, after Obamacare had been implemented, whites were still more than twice as likely to be treated at such institutions, according to the study, published online last week by the International Journal of Health Services.

The study also found that Medicaid recipients and uninsured patients were much less likely to receive care at academic medical centers—teaching hospitals with affiliated medical schools—a disparity that became more pronounced in 2014.

The report comes as the city's public hospital system is struggling to stay afloat and as the state is evaluating a proposal to consolidate four cash-strapped facilities in Brooklyn. Meanwhile, the city's teaching hospitals, such as New York-Presbyterian and NYU Langone, report annual operating profits in the hundreds of millions and continue to expand their reach.

"The findings were even more stark than we expected," said Dr. David Himmelstein, a co-author and professor of public health at the City University of New York, a lecturer in medicine at Harvard Medical School and a physician at Montefiore Medical Center. "The academic medical centers are taking care of well-insured white people. That's their audience."

The researchers analyzed adult hospital discharges in 2009 and 2014 in New York and Boston. "This pattern has not improved—and, regarding insurance status—became even more pronounced after the passage of the ACA," the researchers found.

But Kenneth Raske, president of the Greater New York Hospital Association, called the study "significantly flawed" and noted recent acquisitions that have led academic medical centers to serve more Medicaid patients. One of those deals was NYU Langone's 2015 acquisition of Lutheran Medical Center in Brooklyn.

Last week NYU Langone's chief clinical officer, Dr. Andrew Brotman, told Crain's that the health system would spend $500 million to expand the outpatient services of NYU Lutheran, which serves a patient base that is 43% Medicaid-covered.

Other recent deals include Mount Sinai's takeover of St. Luke's, Roosevelt and Beth Israel medical centers and Northwell Health's affiliation with Maimonides Medical Center in Brooklyn.

Raske said geography can partly explain the study's findings, as more than 5 million New Yorkers live in Brooklyn and Queens, which have only two combined academic medical centers. One of those, SUNY Downstate Medical Center, was not part of the study.

Raske said city hospitals "are deeply committed to serving New York City's vulnerable communities and reducing health disparities."

The study's authors recommend that the state reconsider the teaching hospitals' tax-exempt status if it's determined they don't provide a substantial community benefit.

In New York City, researchers studied the Hospital for Special Surgery, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center's Moses and Weiler campuses, Mount Sinai Hospital, NYU Langone's Tisch Hospital and Hospital for Joint Diseases, New York-Presbyterian's Columbia and Cornell medical centers and Long Island Jewish Medical Center.

The authors said the disparities could be explained in part by the fact that financial pressures encourage academic medical centers to care for fewer uninsured and Medicaid patients, given how low reimbursement rates are for Medicaid. But, they added, such pressures alone couldn't account for the low numbers of black and other minority patients at the city's private teaching hospitals because the disparity persisted even after adjusting for insurance type.

"This confirms it," said Judy Wessler, a community health advocate who has long decried disparities at city hospitals. "There are classes of care depending not only on insurance coverage but also based on race and ethnicity."

For more health care news, subscribe to Crain's Health Pulse.

New York City hospital patients who are minorities, uninsured or on Medicaid are "strikingly underrepresented" at the city's private academic medical centers, according to a new study.

In 2009, before the Affordable Care Act took effect, whites were about three times as likely to be hospitalized at an academic medical center in New York City as blacks were.

Five years later, after Obamacare had been implemented, whites were still more than twice as likely to be treated at such institutions, according to the study, published online last week by the International Journal of Health Services.

The study also found that Medicaid recipients and uninsured patients were much less likely to receive care at academic medical centers—teaching hospitals with affiliated medical schools—a disparity that became more pronounced in 2014.

The report comes as the city's public hospital system is struggling to stay afloat and as the state is evaluating a proposal to consolidate four cash-strapped facilities in Brooklyn. Meanwhile, the city's teaching hospitals, such as New York-Presbyterian and NYU Langone, report annual operating profits in the hundreds of millions and continue to expand their reach.

"The findings were even more stark than we expected," said Dr. David Himmelstein, a co-author and professor of public health at the City University of New York, a lecturer in medicine at Harvard Medical School and a physician at Montefiore Medical Center. "The academic medical centers are taking care of well-insured white people. That's their audience."

The researchers analyzed adult hospital discharges in 2009 and 2014 in New York and Boston. "This pattern has not improved—and, regarding insurance status—became even more pronounced after the passage of the ACA," the researchers found.

But Kenneth Raske, president of the Greater New York Hospital Association, called the study "significantly flawed" and noted recent acquisitions that have led academic medical centers to serve more Medicaid patients. One of those deals was NYU Langone's 2015 acquisition of Lutheran Medical Center in Brooklyn.

Last week NYU Langone's chief clinical officer, Dr. Andrew Brotman, told Crain's that the health system would spend $500 million to expand the outpatient services of NYU Lutheran, which serves a patient base that is 43% Medicaid-covered.

Other recent deals include Mount Sinai's takeover of St. Luke's, Roosevelt and Beth Israel medical centers and Northwell Health's affiliation with Maimonides Medical Center in Brooklyn.

Raske said geography can partly explain the study's findings, as more than 5 million New Yorkers live in Brooklyn and Queens, which have only two combined academic medical centers. One of those, SUNY Downstate Medical Center, was not part of the study.

Raske said city hospitals "are deeply committed to serving New York City's vulnerable communities and reducing health disparities."

The study's authors recommend that the state reconsider the teaching hospitals' tax-exempt status if it's determined they don't provide a substantial community benefit.

In New York City, researchers studied the Hospital for Special Surgery, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center's Moses and Weiler campuses, Mount Sinai Hospital, NYU Langone's Tisch Hospital and Hospital for Joint Diseases, New York-Presbyterian's Columbia and Cornell medical centers and Long Island Jewish Medical Center.

The authors said the disparities could be explained in part by the fact that financial pressures encourage academic medical centers to care for fewer uninsured and Medicaid patients, given how low reimbursement rates are for Medicaid. But, they added, such pressures alone couldn't account for the low numbers of black and other minority patients at the city's private teaching hospitals because the disparity persisted even after adjusting for insurance type.

"This confirms it," said Judy Wessler, a community health advocate who has long decried disparities at city hospitals. "There are classes of care depending not only on insurance coverage but also based on race and ethnicity."

For more health care news, subscribe to Crain's Health Pulse.

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