{"id":117725,"date":"2026-01-30T19:52:08","date_gmt":"2026-01-30T19:52:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/us-ny\/117725\/"},"modified":"2026-01-30T19:52:08","modified_gmt":"2026-01-30T19:52:08","slug":"health-insurance-and-the-great-desensitivation-what-worries-ny-state-health-chief","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us-ny\/117725\/","title":{"rendered":"Health insurance and the \u2018Great Desensitivation\u2019: What worries NY state health chief"},"content":{"rendered":"

Public health, explained: Sign up to receive Healthbeat\u2019s free New York City newsletter here<\/a>.<\/p>\n

Dr. James McDonald is leading the New York State Department of Health at a tumultuous time for public health in America.<\/p>\n

Disruptions to federal health funding, vaccine recommendations, and operations at the Centers for Disease Control and Prevention are creating new challenges for state public health systems.<\/p>\n

As head of one of the nation\u2019s largest state health departments, McDonald is tasked with leading the response to those challenges \u2013 keeping New Yorkers insured at the top of the list.<\/p>\n

McDonald, 62, a pediatrician, joined the state health department in July 2022 and became commissioner<\/a> on June 9, 2023. He has also served at the Rhode Island Department of Health and the Indian Health Service in the Navajo Nation in Chinle, Arizona. <\/p>\n

This week, he sat down with Healthbeat for a conversation in his office at the Erastus Corning Tower in Albany, sharing his perspective on issues like looming cuts to Medicaid, a new public health alliance in the Northeast, how global health affects New York, and how the CDC is \u201cforever changed\u201d in this era he calls the \u201cGreat Desensitivation.\u201d <\/p>\n

Here\u2019s the interview, which has been edited for clarity and brevity.<\/p>\n

What are the top three public health health challenges facing New York this year? What keeps you up at night?<\/p>\n

The biggest threat is the change in how the current [federal] administration is looking at insuring New Yorkers. I have worried a little bit about Medicaid coverage. Starting in 2027, when you look at the work requirement that\u2019s part of H.R. 1, what they\u2019re trying to do is get people off Medicaid. It\u2019s based on a concept that people don\u2019t need Medicaid. The reality of it is a lot of people on Medicaid already are working. They don\u2019t make much money, and they need Medicaid because that\u2019s their health insurance. That\u2019s one of my biggest concerns for this year and next. <\/p>\n

Although the federal health policy is they want to make America healthy again, the actions look more toward just promoting suffering. This should bother more people than it does on a national level.<\/p>\n

\u2014 \u00a0Dr. James McDonald, New York state health commissioner<\/p>\n

One of my other big concerns is what\u2019s happened to the Affordable Care Act. We\u2019re addressing it as best we can. In 2024 we expanded our coverage to people up to 250% of the federal poverty level. Just to make that real, that\u2019s like an individual making up to $39,000 a year. Those are working New Yorkers, and that\u2019s changed. Now we have to change that to accommodate where the federal government is going. <\/p>\n

The third concern I have is that as a country we are in a period that I\u2019m going to call the Great Desensitization. We\u2019re tolerating things that we never would have tolerated before. That encompasses things like hearing misinformation about vaccines, and people are confused by this. I was concerned about how the shutdown was handled. The government was comfortable with people losing food benefits, and the state of New York stepped in to protect our New Yorkers. What I see with people becoming uninsured is an overarching theme, and one of my concerns is, although the federal health policy is they want to make America healthy again, the actions look more toward just promoting suffering. This should bother more people than it does on a national level.<\/p>\n

Let\u2019s go back to one of the things you\u2019ve just said: H.R.1.<\/p>\n

What I\u2019m concerned about is people who need health insurance won\u2019t get health insurance. The challenge for any state is going to be, how do you apply the exceptions for people who can\u2019t work, so you can actually keep them insured. One of the challenges states are going to have is we don\u2019t have the rules and regulations yet that the federal government is going to use to enforce this. Those come into being by June 30. So that gives us till Dec. 31 \u2014 six months \u2013 to implement a very substantive change. We are doing our best to get ready for that, but without seeing the regulations, there\u2019s only so much we can do. <\/p>\n

What I\u2019m concerned about is that you\u2019re going to end up with people who aren\u2019t going to get health care. Most of us would agree, generally, if you find cancer early, you get better outcomes, whether it\u2019s breast cancer or colon cancer. But if you don\u2019t have health insurance, you\u2019re not going to have a mammogram, because you\u2019re going to say, I\u2019m not going to pay for that. That\u2019s not something you go to the emergency department for. But if you don\u2019t have health insurance, you\u2019re not going to have a colonoscopy. If you don\u2019t have a mammogram, we\u2019re not going to find your breast cancer before it turns into cancer or the early stages. As annoying as a colonoscopy is, they\u2019re really important to have. If you don\u2019t have a colonoscopy, we\u2019re not going to find that polyp that was precancerous and remove it.<\/p>\n

We all learned growing up, an ounce of prevention is worth a pound of cure. I see the federal health policy being this smorgasbord of chaos and confusion.<\/p>\n

Could the new CDC guidelines that seem to emphasize \u201cchoice\u201d deter New Yorkers from getting vaccinated, and what is New York state doing to push back on this messaging and reach people who might need to hear these guidelines?<\/p>\n

It\u2019s important to know there was no new science presented; there was really no new information presented. This was implementing something that was really politically motivated. <\/p>\n

No vaccine in New York or any state is given without informed consent. I\u2019ve been a pediatrician for over 35 years. I\u2019ve given over 100,000 vaccines easily in my career, and every single one of them has had informed consent. No one gets vaccines without consent, and shared clinical decision making is simply a risk-benefit conversation with your health care provider. That already happens. <\/p>\n

What happened to the CDC schedule is it went from something that was easily understandable to something exceptionally confusing. I don\u2019t think the impact in New York is going to be significant. New York\u2019s vaccine requirements, which are mandated by New York state law, haven\u2019t changed. I don\u2019t think they\u2019re going to change. <\/p>\n

Stay informed on bird flu, measles, and more across New York.<\/p>\n

Coming soon: The latest news on critical public health issues, all in one place. Get it in our free newsletter.<\/p>\n

How might you be able to reach people who are skeptical of vaccines?<\/p>\n

There\u2019s no one way to solve that issue. We put forward honest, objective information. We go to different communities. We work with local leaders, we work with local health departments, we work with community-based organizations. What a lot of people want to do is they want to hear the truth from people they know. <\/p>\n

We are not going to convince everyone of everything about every vaccine and people still have informed consent. Having said that, there\u2019s still the vaccine requirements. If they want to enter school, they\u2019re going to have to adhere to the vaccine requirements. The thing I worry about, as a physician and as a pediatrician, is I\u2019ve seen adverse health consequences and vaccine-preventable diseases. <\/p>\n

One of the first children I took care of in medical school, before the Hib [Haemophilus influenzae type b] vaccine came out, was a little 3-year-old who had amputations below her knees because of Haemophilus influenzae type b meningitis. There was no vaccine then. That was terrible. It\u2019s someone who had to live a whole lifetime with health consequences. <\/p>\n

I\u2019ve seen less than a handful of kids with Hib meningitis who weren\u2019t immunized for whatever reason. But this is a disease that should really not be something we\u2019re even worried about because it\u2019s a vaccine that works so well. I worry about parents having to live with a preventable tragedy. <\/p>\n

One of the things I\u2019m concerned about the current vaccine direction with the federal government is this nonchalance about the seriousness of vaccine-preventable disease, almost as if being hospitalized for a child for a vaccine-preventable disease is no big deal. I can tell you, when a child is in the hospital, the child is very sick, the child is suffering, and the parents are suffering along with their child. <\/p>\n

In light of the changes at the CDC and other federal health agencies, we\u2019ve seen the Northeast Public Health Collaborative come to fruition and work as a regional outfit focused on public health. What role do you see the collaborative playing in the region?<\/p>\n

The Northeast Public Health Collaborative is 17 jurisdictions from Maine to Maryland. It\u2019s health departments collaborating with each other in an organized manner \u2014 it was something we used to do informally. But what\u2019s different about this is that it\u2019s health departments collaborating in an organized manner about matters of common interest, so we can coordinate efforts and learn together. We should have done it years ago, but it\u2019s part of our forever future. It\u2019s not a political response. One of the things I think about too is that sometimes one state might have experience with a problem, another state might not, but we can share the expertise. One of the things about the collaborative is there are tiny states and big states. New York is 20 million people, Rhode Island is 1 million.<\/p>\n

You said that the collaborative is not meant to be a political response, but there could be some who view it that way and might see it as a rival to the CDC. What would you say to that?<\/p>\n

The CDC is forever changed. There are still good people doing great work at the CDC, and we talk to them every day. What you\u2019ve seen now is politics dictating change at CDC. When I really think about what health departments are collaborating on, it\u2019s like, how do individual health departments work better together? If you think about public health, we all have similar missions. We might write them differently, but most health departments want to improve the health and well-being of the population.<\/p>\n

There\u2019s no political affiliation with the Health Department. We\u2019re objective. We don\u2019t want to deliver public health based on political party [affiliation]. That\u2019s never part of the conversation. There is no politics built into the collaborative. It isn\u2019t about that. Most people in public health aren\u2019t interested in politics. They\u2019re interested in public health. They\u2019re very different things. <\/p>\n

Let\u2019s say there\u2019s a disease outbreak here in New York state, or somewhere else in the Northeast. Would New York state or the collaborative reach out to the CDC? Would you all be in touch?<\/p>\n

We do that routinely. Let\u2019s take measles. When we have a case of measles, we talk to the CDC, but it\u2019s usually informing them. It\u2019s not getting their advice. Because most health departments know what to do when it comes to containing a disease \u2014 this is really fundamental public health. We don\u2019t usually need CDC to help us with an outbreak. Where CDC helps with an outbreak is when you have something unusual going on in your state or in a very large number and then CDC will still send what\u2019s called an Epi Aid Team<\/a>, and that can still happen. There\u2019s no reason that that will change in the future, and this is where CDC will still be a helper.<\/p>\n

I don\u2019t know that they\u2019re going to be the national lead on things as much as they used to be, because what you\u2019re seeing now is the political overlay. What you\u2019ll see is we do work with CDC every day in New York state, and we still will, and they still work with us, but when it comes to health policy for states, states are going to rely less and less on CDC and more on their own state health department, and that is probably a better thing for everybody in the long run anyway, because your state health department and local health departments know your state better than any federal entity will. <\/p>\n

One thing about the CDC is the CDC was trying to create recommendations for the entire United States, which is all the way from Maine to the Northern Mariana Islands \u2014 very different places. Regionalized and localized recommendations make more sense for everybody.<\/p>\n

Last week, California Gov. Gavin Newsom said <\/a>his state will join the World Health Organization\u2019s Global Outbreak Alert and Response Network. Have there been conversations here in Albany related to that? Is this something that you all have considered doing? <\/p>\n

We\u2019re looking at it. One of the things the New York State Department of Health does is we created something called the Global Update<\/a>. Every week we give a weekly report for anyone who wants looking at what are the global outbreaks going on. If you want to know what\u2019s going on with chikungunya, we\u2019ll tell you. <\/p>\n

It\u2019s important to underscore that the United States leaving the World Health Organization has a much larger impact, because what we\u2019re not doing is we\u2019re not financially supporting global immunization campaigns \u2014 overall, helping people be healthy. And one of the reasons why I\u2019m concerned about it in New York state is we\u2019re the gateway to a lot of America. But generally, if people are healthier overseas, that benefits New York state and the United States, because they don\u2019t bring the disease here. The World Health Organization does a lot of things coordinating with CDC and others when there\u2019s a viral hemorrhagic fever.<\/p>\n

For example, no one talked about the Marburg outbreak in 2024 in Tanzania, in the United States, because it didn\u2019t come here. The reason why viral hemorrhagic fever didn\u2019t come here is because the World Health Organization worked with CDC to address it in Tanzania. We knew what was happening, and we were ready in case it came here, but it was contained. And one of my big concerns is by pulling out of the World Health Organization and by underfunding CDC, what risk are we inviting in the United States? Because people get in planes and travel, and you are literally 12 hours away from the biggest surprise ever. I don\u2019t understand why we\u2019re willing to live in this period of ignorance.<\/p>\n

Trenton Daniel<\/a> is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal<\/a> at trentondaniel.88.<\/p>\n","protected":false},"excerpt":{"rendered":"Public health, explained: Sign up to receive Healthbeat\u2019s free New York City newsletter here. Dr. James McDonald is…\n","protected":false},"author":2,"featured_media":117726,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[51912,5237,44321,9,11,10,49,51,50],"class_list":["post-117725","post","type-post","status-publish","format-standard","has-post-thumbnail","category-new-york","tag-dr-james-mcdonald","tag-health-department","tag-healthbeat","tag-new-york","tag-new-york-headlines","tag-new-york-news","tag-new-york-state","tag-new-york-state-headlines","tag-new-york-state-news"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/117725","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/comments?post=117725"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/117725\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media\/117726"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media?parent=117725"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/categories?post=117725"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/tags?post=117725"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}