Mayoral candidate Andrew Cuomo’s health care record in NY isn’t just about COVID-19

Remember when former Gov. Andrew Cuomo overruled state Republicans to launch New York’s Affordable Care Act marketplace? Or when he slashed public health funding to New York City and no other municipality?

It’s understandable if the answer is no.

As Cuomo runs for mayor of New York City, the discussion around his health care record has often been dominated by competing narratives on his performance at the height of the COVID-19 pandemic — a key piece of his legacy. But Cuomo’s overall health care record during his decade as governor is much broader than his once-celebrated daily COVID briefings, which feature heavily in his first mayoral campaign ad, as well as state findings that his administration obscured the full death toll in nursing homes, which are now a talking point for his opponents.

Many of Cuomo’s other health care moves continue to affect New Yorkers and factor into ongoing debates over psychiatric hospitalization, equitable access to care, abortion rights, and the city’s ability to withstand federal cuts to health funding and insurance coverage.

While Cuomo seeks the Democratic mayoral nomination in this month‘s primary election, health policy watchers are calling attention to his restructuring of Medicaid in an attempt to reward better health outcomes — although opinions on the sprawling project are mixed. They also note he was an early and staunch supporter of Obamacare, which ultimately reduced the share of uninsured New Yorkers by more than half.

At the same time, Cuomo has drawn criticism for overseeing a reduction in psychiatric hospital beds, and some policy analysts say he has contributed to the long-term trend of hospital consolidation and closures, which has disproportionately impacted communities of color.

Cuomo spokesperson Jason Elan championed the former governor’s health care legacy in a statement to Gothamist.

“As governor, Andrew Cuomo reduced the rate of uninsured to 5% — among the lowest in the country — saved at least 10 safety net hospitals in New York City that would have collapsed without state subsidies, restructured our behavioral health systems to combat serious mental illness and addiction, and prioritized a culture of wellness and innovation that achieved savings while improving quality,” Elan said.

But former state Assemblymember Richard Gottfried, a Democrat who chaired the Assembly’s health committee and was New York’s longest-serving lawmaker, characterized Cuomo’s health care record as mixed.

He expressed concern that if Cuomo were to become mayor, he could “try to dominate the city health department“ rather than defer to its deep bench of experts.

“ More so than with any other governor that I served with, Cuomo consolidated power and decision-making not in the health department but on the second floor — the governor's office,” said Gottfried, who served with nine governors before retiring in 2022.

Elan countered that Cuomo appointed strong leaders and supported their health care agendas.

The candidates’ plans to improve mental health and public safety have emerged as central issues in New York City's mayoral race. Like City Comptroller and fellow Democrat Brad Lander, Cuomo has called for more supportive housing but hasn’t committed to the “housing-first” approach Lander says is needed.

Cuomo has echoed calls from Mayor Eric Adams, who is seeking re-election as an independent, for involuntary commitments and more street outreach, along with options for longer-term stays for psychiatric patients leaving the hospital.

State Assemblymember Zohran Mamdani, who is polling second to Cuomo in the Democratic primary, is the only candidate who has not called for more police. Instead, Mamdani has said he would set up a Department of Community Safety and add more outreach workers.

Mayoral candidates have attacked Cuomo's handling of the pandemic, mental health and safety-net institutions.

Here are five areas where Cuomo‘s gubernatorial policies on health care are still affecting New Yorkers.

Cutting public health funding to NYC (and only NYC)

Under Cuomo, the state reduced its share of public health funding for New York City while leaving it intact for other municipalities. According to acting city Health Commissioner Michelle Morse, the move has since cost the city about $90 million a year.

As the city faced steep federal cuts to public health funding this year, Morse testified before the City Council that the state money was more essential than ever. A group of 80 health care advocacy groups unsuccessfully called on state leaders to restore the funding during this year’s budget session.

The city “is treated as a separate entity in the eyes of many federal agencies, which gives it direct access to other federal funds that no other county has,” Cuomo spokesperson Rich Azzopardi told Healthbeat New York when asked about the cuts in February.

According to Elan, Cuomo offset the change by reducing other city health costs.

But some public health advocates have speculated this was another shot at New York City in the long-running feud between Cuomo and former Mayor Bill de Blasio.

“I think the animosity between Gov. Cuomo and then-Mayor Bill de Blasio played a much bigger role in this unfortunate decision,” David Jones, president and CEO of the Community Service Society of New York, which advocates for equitable health care access, wrote in a statement on the policy earlier this year.

Since launching his mayoral campaign, Cuomo has faced renewed criticism over his lack of coordination with de Blasio during the pandemic — a problem highlighted last year in a city report evaluating New York’s COVID response.

Cuomo’s desire to maintain control over pandemic measures delayed the opening of the Citi Field mass vaccination site, Politico reported in March. Azzopardi told Politico the account was “revisionist history from a bunch of de Blasio expats.”

Launching New York’s ACA marketplace

In 2012, Cuomo established New York’s Obamacare exchange via executive order, overruling conservative state lawmakers who had repeatedly blocked legislation to create the insurance marketplace. Nearly 7 million New Yorkers are currently enrolled in health coverage through the exchange, and most benefit from government subsidies, according to state data.

When Cuomo stepped in, a case challenging the ACA was pending in the U.S. Supreme Court. Members of the then-Republican-controlled State Senate worried they would be seen as endorsing the law if they agreed to launch the new insurance marketplace.

“I would fight very vociferously to make sure that we’re not seen as implementing and expediting Obamacare,” then-state Sen. Gregory Ball, a Putnam County Republican, told the New York Times in 2011.

In this case, Cuomo’s willingness to act unilaterally “was sort of a profile in courage,” said Elisabeth Benjamin, the Community Service Society’s vice president of health initiatives.

Closing psych beds

Cuomo’s mental health plan for New York City calls for doubling down on involuntary hospital commitments and finding ways to free up more psychiatric beds, echoing priorities set by Adams.

But state data shows that Cuomo cut more than 700 beds in state-run mental hospitals during his tenure as part of a “transformation” plan for the state Office of Mental Health, which called for redirecting resources toward community-based care.

Cuomo’s mental health plan makes the case that the beds were “underutilized” and the closures were offset by an increase in supportive housing for people with mental illnesses. Elan, his campaign spokesperson, said the beds cut were for “nonviolent individuals.”

In recent years, many private hospitals have also looked to scale back inpatient psychiatric care, which is generally not well-reimbursed by insurance. During the pandemic, Cuomo set off alarm bells within the mental health space by allowing hospitals to indefinitely shut down their psychiatric units to create “surge capacity” for COVID patients.

Many of those psych beds remained offline years later, and Gov. Kathy Hochul eventually threatened fines for hospitals that didn’t restore them.

Mandating no-cost abortion coverage

Cuomo took steps to reinforce abortion access and funding in New York during President Donald Trump’s first term, when the president nominated conservative judges to the Supreme Court who would eventually overturn the landmark Roe v. Wade decision.

In 2017, Cuomo mandated state-regulated insurance providers to offer no-cost coverage of “medically necessary” abortions. He also mandated coverage of most forms of contraception, a move designed to guard against federal attacks on the Affordable Care Act.

When Trump revoked Title X reproductive health funding from providers that performed or referred patients to abortions, Cuomo and the state Legislature had a contingency fund in place for New York’s Planned Parenthood clinics and other affected providers.

Now, Planned Parenthood of Greater New York is facing new financial struggles and federal threats, while Congress is targeting other types of care, including services for transgender patients.

Helping or hurting safety-net hospitals?

Cuomo has laid out a plan to reduce health care disparities, in part by fostering more collaboration between public and private providers. But some critics say Cuomo didn’t show enough of a commitment to supporting safety-net hospitals as governor.

Cuomo tried to keep down the Medicaid rates paid to hospitals in an effort to contain spending on the massive public insurance program. Experts say that disproportionately affects the institutions serving the lowest-income patients.

Elan pointed out that the state provided extra subsidies to keep precarious safety-net hospitals afloat, including several in New York City. But, like other recent governors, Cuomo also stepped in at times to promote hospital consolidation or closures as the most prudent move.

His top-down plan to consolidate financially struggling hospitals in Central Brooklyn into One Brooklyn Health resulted in the closure of inpatient care at Kingsbrook Jewish Medical Center.

Gottfried, the former state assemblymember, pointed out that hospital closures and consolidation are also driven by broader economic and medical trends. In Cuomo’s defense, he said, “doing it in an organized way is probably better than just letting the weaker institutions die haphazardly.”

But other health care advocates argue Cuomo’s actions exacerbated inequities that became glaring during the pandemic.

“I would hope, moving forward, if he does become mayor of New York City, which is a very diverse city, that he would think about these health care deserts,” Benjamin from the Community Service Society said.

The next mayor will be responsible for ensuring NYC Health and Hospitals, the city’s public health system, has the resources to serve low-income New Yorkers at a time when it could face serious financial headwinds because of proposed Medicaid cuts.