Mayor de Blasio today announced plans to boost New York City's cash-strapped network of public hospitals with nearly $2 billion in subsidies out of his just-revealed $82.2 billion 2017 budget. As Public Advocate, de Blasio described the city's public hospital system as "an outmoded style of care, which relies on... excessive reliance on emergency rooms, and inadequate primary and preventative care... failing patients and providers alike."

The new funding for NYC Health + Hospitals—$700 million more than the City granted last year—is intended to help close the network's yawning deficit. H+H describes itself as a "public safety-net healthcare system," serving patients regardless of their income or immigration status. According to the City, 70% of H+H patients are either uninsured or on Medicaid, compared to less than 40% at other city hospitals.

A City report [PDF] released in conjunction with today's announcement projects that H+H's deficit could reach $600 million within the next year and—without intervention—$1.8 billion by 2020. "Health + Hospitals is on the edge of a financial cliff," the report states.

While NYC's busiest public hospitals, Queens Hospital Center and Kings County Hospital Center, are typically full to near-capacity, the NY Times reports that North Central Bronx Hospital often has half of its beds full. According to the report, Metropolitan, Woodhull and Elmhurst all saw "double digit declines" in patients between 2012 and 2014.

Insisting that the new funding is not part of a "band-aid fix," de Blasio also released a series of recommendations for H+H this week, including selling vacant H+H land and underutilized hospital facilities to developers for the construction of affordable and supportive housing. (The Mayor has employed a similar tactic on NYCHA properties, to mixed reviews.) Not only would these sales bring revenue to H+H, the report argues, but they could provide mental health patients with stable accommodations.

Politico NY points out that such extreme repurposing of hospital properties would require approval from the State's public health council, which the report doesn't breach.

Indeed, several of the recommendations are not within the City's powers to enact, and will require State lobbying. For example, H+H currently relies heavily on federal Medicaid Disproportionate Share Hospital (DSH) payments, which are allocated at the State's discretion to hospitals that serve large uninsured populations. DSH funding is set to decrease nation-wide starting in 2018. Today's report promises to "seek legislative action" to increase H+H's share of the dwindling federal funds.

More broadly, the report calls on the H+H to establish more walk-in centers and clinics spread out in low income neighborhoods, so that uninsured patients don't have to rely on hospital visits for minor treatments. Over the next four years $100 million in new City funding will be directed to community clinics, specifically.

Mayor de Blasio stated on Tuesday that the shift of staffing and resources from hospitals to neighborhood clinics won't result in any staff layoffs. "Over the past 13 years, 18 private hospitals have closed throughout New York City. This plan will not close any more hospitals or layoff any workers," he said.

But the 55-page report amends this claim, stating that, "Even with re-training and shifting existing hospital staff to community-based health centers and clinics, there is likely to be a net loss of hospital-based jobs." According to the City, impacted workers could be shifted to other government jobs.