At a time when most states and the federal government continue to exclude millions of people from health insurance, the NYC Care health care access program offers an innovative approach for local governments.
Launched by NYC Health + Hospitals in 2019, NYC Care connects uninsured New Yorkers, particularly those excluded due to income or immigration status, to affordable, high-quality primary and preventive care. With over 135,000 members and counting, NYC Care is a testament to what is possible when cities invest in and streamline access to care for the uninsured.
The 135,000-plus members we've enrolled are more than statistics; they represent hundreds of thousands of opportunities to improve people's health and save lives.
An early member and kidney transplant recipient enrolled just before the start of the COVID-19 pandemic. Even though he was uninsured, because of NYC Care, he knew exactly where to go when he developed severe COVID-19 symptoms. He spent over a month in the ICU and credits NYC Care with connecting him promptly to care and saving his life. One Latina grandmother, encouraged by our right to healthcare advertisements, enrolled in NYC Care after 40 years without healthcare. At the end of her primary care visit, we asked why she had not come sooner — "I didn't think I deserved it," she said, breaking into tears.
While the Affordable Care Act made substantial strides in reducing the uninsured rate in the United States, it left behind critical populations — undocumented immigrants and those whose incomes are just above the threshold for federal subsidies but still find insurance premiums burdensome. In New York City alone, nearly half of the estimated 476,000 undocumented residents remain uninsured. The consequences are severe: delayed care, unmanaged chronic conditions and poorer health outcomes. With NYC Care, we aim to rewrite this story.
We designed NYC Care to simplify, centralize and facilitate access to healthcare for the uninsured. We offer a membership card, a 24-hour customer service line, and direct access to primary care medical homes across the city's public health care system, NYC Health + Hospitals. We have an integrated EMR and referral system to ensure that care is coordinated, reducing fragmentation and providing clear, speedy paths to needed specialty care. With NYC Care, we reduce bureaucracy and improve patient experience through a single point of entry and a standardized enrollment process.
Through a citywide NYC Care public-awareness campaign, we have been able to reach the eyes and ears of New Yorkers in every corner of the city. That campaign includes multilingual marketing across community and ethnic media in print, radio and social media platforms. In addition, we work with community-based organizations to conduct outreach, education and enrollment. A welcoming public message and trusted messengers ensure that eligible individuals can overcome one of the most stubborn barriers to care — the stigma of being undocumented.
Now in our fifth year, our results show we are helping people live healthier and longer lives. More than half of program members are new to primary care, many establishing relationships with PCPs for the first time in their lives. More than half of enrollees with diabetes and over 70% of those with hypertension saw improvements in their conditions within six months. These are life-saving outcomes — we know blood sugar and blood pressure control lead to reduced risk of cardiovascular disease, still the most common cause of death in the nation.
NYC Care's structure and successes, described in a June article of The Journal of Public Health Management & Practice, offer valuable lessons for our fellow public health care systems.
First, direct access to primary care can significantly increase health care engagement among the uninsured. Second, integrating services under a single umbrella reduces fragmentation and improves the overall patient experience. Lastly, a strong public awareness campaign that speaks to people in their native languages and addresses their concerns can build the necessary trust to bring them into the safety-net healthcare system.
Healthcare access programs like NYC Care can provide affordable and accessible care, not only improving individual health outcomes but also creating healthier, more resilient communities. Cities across the country should look to our program as a model, adapting its structure and practices to local contexts. With NYC Care's approach, local governments can take health care access into their own hands and healthcare for all is within reach.
About the authors
Jonathan Jiménez, MD, MPH, Executive Director of NYC Care, NYC Health + Hospitals. Dr. Jiménez is a family physician and is the Executive Director of NYC Care, an award-winning health care access program that ensures New Yorkers without access to health insurance can access primary and preventative care, regardless of immigration status or ability to pay. Dr. Jimenez has also been medical director for the Test & Trace Corps testing and vaccination effort and, is currently, for the Humanitarian Emergency Response & Relief Centers.
Dr. Ted Long, Senior Vice President of Ambulatory Care and Population Health, NYC Health + Hospitals. Dr. Long is a primary care doctor and senior vice president of ambulatory care and population health at NYC Health + Hospitals. He is also the leader of the New York City’s Arrival Center and 15 humanitarian centers currently housing approximately 25,000 asylum seekers.
Dr. Mitchell Katz, President and Chief Executive Officer, NYC Health + Hospitals. Dr. Katz is President and Chief Executive Officer of NYC Health + Hospitals, and is a practicing primary care doctor. He has led the health system through the COVID-19 crisis, housed 350 persons into permanent housing, overseen the adoption of a modern electronic health record system, increased the number of nurse positions, developed a modern ambulance transport system, and expanded outreach to support homeless New Yorkers. He also led the financial turn-around of the health system by eliminating the deficit through enrolling more New Yorkers into health insurance and appropriately billing insurance plans.