MW I'm New York City's new health commissioner. Here's how I'll help deliver on Zohran Mamdani's affordability agenda.
By Alister Martin
I have a plan to address the looming cuts to Medicaid and to help people access food and housing they can afford
"Affordability is the defining political and economic issue of our time. It's also the defining public-health issue of our time," writes Alister Martin, New York City's health commissioner.
Across the U.S., rising costs for housing, healthcare and basic necessities are taking a toll on people's well-being. That's why, when Zohran Mamdani ran for mayor of New York City and won, he did so on a platform to make the city more affordable. I'm an ER doctor who has spent my career addressing poverty as a root cause of our nation's biggest health problems, so this spoke to me. And as New York City's new health commissioner, I have an opportunity to deliver on this affordability agenda.
That's because public-health leaders are uniquely positioned to address affordability - not just as an economic issue, but as a public-health imperative. We can take bold steps to tackle affordability through a health lens. What we're doing in New York City can serve as a blueprint across the country.
Public health is often narrowly thought of as combating large-scale disease outbreaks like COVID-19 or addressing long-term health challenges like heart disease or diabetes. But the truth is this: Public health begins with meeting people's basic needs. Only when people have access to food, housing and affordable medical care can they focus on their long- term health. When people can't afford a visit to a primary-care doctor or they lack adequate health insurance, they end up in emergency rooms. I've seen it firsthand. So it's not just physical health that needs addressing, it's financial health. Poverty is making people sick, and affordability is the foundation upon which we can build healthier communities.
The connection between affordability and health is clear. Two-thirds of families with children report having to choose between buying groceries and paying rent. Sixty-eight percent of New Yorkers have experienced issues with affording healthcare, and 66% have delayed or gone without care due to cost. These numbers could worsen as millions of Americans could lose health coverage due to federal policy changes like cuts to Medicaid and the expiration of tax subsidies for people with Obamacare plans.
This isn't unique to New York City. Across the country, affordability is the defining political and economic issue of our time. It's also the defining public-health issue of our time. Polls consistently show that healthcare costs top the list of Americans' economic worries, far outpacing other concerns. Throughout the U.S., public-health leaders are grappling with the same question: What can we do to address affordability?
Let me tell you, there is a lot we can do.
You can't begin to have a conversation about affordability without talking about health. And you can't talk about health without addressing its broader social determinants: housing, food security and financial stability.
I am focused on four areas of affordability: keeping people covered by Medicaid, connecting them to other benefits like SNAP and WIC, eliminating medical debt and helping prevent evictions. These four pillars represent a blueprint that public-health officials in any city, county or state may also adopt to make a tangible difference in their communities. Let's dive in.
-- Medicaid coverage is one of the most powerful tools for reducing financial hardship and mortality among Americans with low incomes. Yet in the coming months, federal changes to Medicaid work requirements and eligibility will make it harder for millions of people to stay enrolled. We can help eligible people maintain their benefits by qualifying for exemptions and ensuring they meet new requirements, perhaps by volunteering. In doing so, we can prevent a wave of coverage losses with devastating consequences.
-- Every year, life-changing benefits go unclaimed because eligible people don't enroll in food assistance programs like the Supplemental Nutrition Assistance Program; Temporary Assistance for Needy Families; the Special Supplemental Nutrition Program for Women, Infants, and Children; or the earned-income tax credit. SNAP enrollment, for instance, is directly associated with reduced healthcare utilization and lower costs for each person. Public-health workers are often the first point of contact for people in need. Community health workers, doulas, peer specialists and others can serve as a front door to these programs. By screening individuals for potential benefits and connecting them to enrollment resources, we can help families access the full range of support they need.
-- Medical debt is the leading cause of personal bankruptcy in the U.S., and medical bills placed on credit reports result in reduced access to credit, difficulty securing housing and barriers to employment. It's a burden that not only devastates families financially but also takes a toll on their health. In New York City, we've helped eliminate $135 million in medical debt. We're committed to eliminating more and to identifying ways to prevent such debt from accumulating in the first place. By doing so, we can provide relief to families and help them focus on their health instead of their bills.
-- Lastly, housing is one of the most important determinants of our health. Housing and healthcare account for the largest share of family expenses. And when people don't have stable housing or they face eviction, it's nearly impossible to prioritize preventive care. The downstream consequences are severe and cascading. Legal representation in housing court is the single most effective tool for preventing eviction. In New York City, tenants facing eviction have access to free legal representation, but many New Yorkers who qualify do not take advantage of it. Public-health officials can help, by ensuring that individuals at risk of eviction are aware of and can access these critical resources.
The bottom line is this: Financial health affects physical, mental, social and overall health. By helping people keep their Medicaid coverage, connecting them to benefits, eliminating their medical debt and helping prevent evictions, we're not just talking about putting more money into people's pockets. We're talking about adding years to their lives.
Public-health leaders have a responsibility to address the root causes of poor health, and affordability is at the top of that list. Public health can be a powerful muscle for advancing affordability, and in New York City, we're using it. I urge my colleagues across the country to do the same. Together, we can build a healthier, more equitable future for all.
Alister Martin, an emergency-room physician, is the New York City health commissioner. He has spent his career building public-health initiatives that sit at the intersection of healthcare, policy and civic life, including founding Vot-ER, which trains healthcare providers to register patients to vote, and Link Health, which connects patients to unclaimed public benefits at the point of care.
-Alister Martin
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April 23, 2026 15:16 ET (19:16 GMT)
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