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New Yorkers would be forgiven if all the recent talk about “City of Yes” has begun blurring together in their minds. After all, the term refers to not one, but three different sets of reforms that Mayor Eric Adams is trying to get passed.

All three of the packages have to do with zoning — the city laws that govern what can be built where. But each one has a different focus: housing, businesses and the environment.

The Adams administration says the city’s zoning code, which has not gotten any major updates since it was adopted in 1961, has grown outdated and is ill-suited to address those issues. The result, he says, has been a city that says “no” to too much — from desperately needed housing to dancing in bars and restaurants.

To update the laws, the administration must shepherd all three rewrites, known as “zoning text amendments,” through the city’s monthslong public review process, starting with community board feedback and culminating in a binding vote by the City Council. His administration released the three packages one by one, starting with the least controversial — the climate-related package, which was approved in December — and ending, the mayor hopes, later this year with a vote on the thorny housing reforms.

Many of the reforms are likely to run into sharp opposition at the local level, even as they enjoy support from business groups and some policy experts. Altogether, they could amount to one of Adams’ most significant legacies — if he’s able to get all three passed.

Here are the most important things to know about each City of Yes proposal — who wants them, who doesn’t want them, and what they will and won’t do.

What’s its status?

This business-oriented plan is near the end of its public review, with the City Council set to hold a vote by late May.

What would it do?

This package has 18 different proposals that would generally loosen the rules about where different kinds of businesses can operate — helping to boost the economy and create jobs, according to backers. Its most notable proposals include:

• Allowing small “clean” manufacturers like 3-D printers, microbrewers, potters and bakeries to operate in regular commercial districts instead of only industrial zones
• Letting life-science labs expand more easily by permitting them outside industrial areas and alongside hospitals and universities
• Limiting the intrusion of commercial businesses in manufacturing areas, in hopes of preserving industrial jobs
• Allowing commercial activity on the upper floors of mixed-use residential buildings
• Ending the role of zoning in regulating dancing, including by allowing dancing in any bar or restaurant where live music is already allowed
• Letting corner stores open in residential areas if they get a special City Planning authorization, and allowing commercial space on residential “campuses” like public housing developments
• Allowing “micro-distribution” delivery centers in storefronts in an effort to get the e-bike-heavy hubs off of sidewalks

“When you are still having rules around typewriters but not rules around smartphones, iPads and other entities, it shows we have outlived the rules that are on the book and we need to look in a new direction,” Mayor Adams said during an April 8 rally for the package.

Who’s for and against it?

The Economic Opportunity plan enjoys support from a slew of business improvement districts, chambers of commerce, and other industry groups like the New York City Hospitality Alliance and the Real Estate Board of New York.

On the other hand, a majority of the city’s 59 community boards voted against it in the public review that began last fall. Opponents have mostly worried about the newfound mixing of commercial and residential uses; Republican Assemblyman Lester Chang of South Brooklyn criticized it for “giving businesses a free hand and driving into our residential neighborhood.”

Adams’ City Planning department tweaked the plan in March in response to that feedback. Changes included banning the conversion of apartments into commercial space to avoid incentivizing any loss of housing, and capping home-based businesses at 1,000 square feet.

What really matters is how the City Council feels. Lawmakers mostly praised the proposals’ goals during a hearing in early April, and Speaker Adrienne Adams thanked the administration for including some pro-manufacturing policies that lawmakers had sought.

Council members did demand some additions, such as regulations on last-mile delivery facilities and promises to increase funding for the Buildings Department to enforce the new regulations. A few Republican council members have harshly criticized the Economic Opportunity plan, but they hold little influence in the overwhelmingly Democratic council.

What’s its status?

A roughly seven-month public review will kick off sometime in April for this housing-focused plan, expected to be the most consequential — and controversial — of the three City of Yes packages. The City Council would vote on it by the end of 2024.

What would it do?

The Housing Opportunity package takes aim at the city’s desperate apartment shortage by allowing “a little more housing in every neighborhood,” the administration says. Mayor Adams says it could produce about 100,000 new homes over 15 years, although a precise estimate will be released in late April.

The proposals include:

• Allowing more density in low-rise neighborhoods across the city, including 3- to 5-story buildings near public transit
• Giving a 20% density bonus to developers if they include affordable apartments in higher-density parts of Manhattan, Western Brooklyn and Queens
• Eliminating requirements for new developments to include parking spaces
• Legalizing accessory dwelling units of up to 800 square feet in backyards, basements or garages
• Allowing housing above shops on outer-borough “main streets” where apartments are currently restricted
• Legalizing shared amenities like kitchens, which could ultimately allow for the return of single-room occupancy-style housing
• Encouraging more office-to-residential conversions by permitting them in more outer-borough neighborhoods and in buildings built before 1991, later than the current cutoff of 1961 in much of the city

The mayor unveiled the housing plan in a speech last September, and City Planning released all 790 pages of text in early April before sending it out to community boards for review.

Who’s for and against it?

The housing plan has early support from some developers and policy experts, including the Regional Plan Association and the New York Housing Conference. More surprisingly, it also won praise from the preservation-oriented Municipal Arts Society, whose president wrote a Crain’s op-ed calling the proposals “a welcome departure” from the more piecemeal rezonings led by previous mayors.

A handful of Manhattan officials, like borough president Mark Levine and City Councilmen Keith Powers and Erik Bottcher, have endorsed parts of the plan. Most importantly, Council Speaker Adrienne Adams has come close to outright endorsing the package — although she has also predicted challenges in persuading fellow lawmakers from low-rise neighborhoods to get on board.

“We are homeowners, and we are used to the characteristic of our community,” the speaker said of her own southeast Queens district at a housing policy event in February. But she added, of City of Yes: “We have to be up to meet that challenge.”

Indeed, neighborhood leaders from Bayside, Queens to Riverdale in the Bronx have already railed against the plan publicly. Changes to parking rules in particular may prove controversial in the outer boroughs, even though the plan would not touch any parking spots that already exist.

On the opposite end of the spectrum, the Housing Opportunity plan may not be especially tantalizing for left-wing lawmakers, who tend to be more interested in tenant protections than supply-oriented policy fixes that encourage development.

"There's folks who have been outwardly supportive of it, and members who have concerns about individual pieces of it,” one City Council member told Crain’s in March.

Well aware of the fight they have in store, Adams administration officials have downplayed the plan’s potential impact, saying it was crafted to avoid dramatically changing any neighborhood’s appearance.

“It’s really designed to not have the types of impacts people are fearing in terms of changing their neighborhood character,” said Leila Bozorg, executive director for housing at the mayor’s office, at an event in February.

What’s its status?

Approved by the City Council in December, in a 38-8 vote.

What will it do?

The Carbon Neutrality package aimed to remove bureaucratic obstacles to climate change projects, including building retrofits, electric vehicle infrastructure and renewable energy. The Adams administration hopes it will help the city reach its goal of an 80% reduction in carbon emissions by 2050.

It contained 17 policy proposals, including:

• Removing limits on the number of solar panels that can be installed on a roof
• Loosening rules on where well-insulated walls can be added to buildings
• Opening up more of the city to electric-vehicle charging infrastructure

Who was for and against it?

Environmental groups supported the Carbon Neutrality rewrite, as did some renewable energy business groups, the Partnership for New York City, and the EV-inclined transportation company Revel.

There was no major push against the package, but the eight lawmakers who voted against it in December were all Republicans or conservative Democrats.

Caroline Spivack contributed reporting.

This article will be updated as the City of Yes proposals move through their public reviews.

Memorial Sloan Kettering Cancer Center posted more than $164 million in operating income last quarter, marking a recovery from last year’s losses due to increases in revenues from outpatient treatments, chemotherapy and surgeries.

The Upper East Side oncology center earned more than $2 billion in total revenue in the fourth quarter of 2023 — an 8% increase from the previous year, according to financial documents released Monday. Rising patient services revenue boosted total earnings, with hospital care and patient services bringing in $1.6 billion during the fourth quarter.

Memorial Sloan Kettering’s quarterly financial performance was a reflection of its annual operations. The health system brought in more than $7.4 billion in total revenue in 2023, an increase driven by a nearly 13% increase in earnings from patient care compared to 2022. Outpatient visits surged 11% year-over-year, while surgeries, radiation oncology and chemotherapy treatments rose by roughly 8% each.

Research and clinical trial grants and contracts also grew by $47 million from the previous year, the documents show.

Memorial Sloan Kettering earned $134 million in operating income in 2023, recovering from a more than $230 million loss in 2022. Hospital management said that operating income in 2023 marked a “significant improvement,” adding that the system enhanced efficiencies in patient care while controlling operating costs.

Total expenses declined by less than 1% in the fourth quarter, representing a shift from the significant expense growth that hospitals have faced in the wake of the pandemic. Memorial Sloan Kettering spent $938 million on wages and benefits in the last three months of 2023, a slight drop from the same time the previous year.

Despite quarterly declines, total annual expenses grew. Total costs in 2023 surpassed $7.2 billion, up 5% from 2022. Hospital management said rising expenses come with rising patient volume, noting that most expense growth was associated with purchases of additional pharmaceuticals and medical supplies. Other costs included a one-time, $10.9 million expense associated with the layoff of 337 workers in January 2023.

Memorial Sloan Kettering has nine patient care locations in the New York City area, including transfusion centers and outpatient locations. The hospital system employs more than 20,000 physicians, scientists, nurses and other health care workers.

Congenital syphilis in New York state is rising faster than any other sexually transmitted infection, pointing to dwindling prevention efforts and public health workforce shortages that emerged at the height of the pandemic, a new state report shows.

Congenital syphilis was detected among 51 infants in 2022, the latest year data is available, marking a 24% annual increase, according to a report released by the Health department on Monday. The disease has climbed in New York for the past few years, rising 75% from five years ago.

New York’s congenital syphilis rate places it among the 10 states with worst infection rates in the U.S., the state Health department said. While congenital syphilis cases have increased nationwide, skyrocketing rates oftentimes point to weaknesses in the public health system, experts say.

Congenital syphilis occurs when a pregnant person who has contracted syphilis passes the infection to the baby, either in the womb or during a vaginal delivery. The disease, which is entirely preventable with adequate screening and treatment, can result in serious side effects like nerve damage or infant death.

The Health department said that public health prevention efforts and control of sexually transmitted infections were “severely disrupted” in 2020 and 2021 at the height of the Covid-19 pandemic, leading to increased syphilis diagnoses as well as upticks in chlamydia and gonorrhea.

Chlamydia, the state’s most frequently reported sexually transmitted infection, increased by 2% between 2021 and 2022, affecting nearly 104,000 New Yorkers. Gonorrhea increased by less than 1% and was detected in more than 43,000 people by 2022.

Most sexually transmitted infections were observed among young New Yorkers, people of color and men who have sex with men, the Health department said. The rise of congenital syphilis has also revealed pregnant people as an at-risk group.

New state data comes as congenital syphilis cases skyrocket in New York City. Congenital syphilis rose by 133% between the 2023 and 2024 fiscal years, according to the mayor’s preliminary management report released in February.

There were 14 congenital syphilis cases recorded in the city between July and October 2023, the data showed. While those numbers may seem minimal, experts said that any case points to weaknesses in the public health system.

PROJECT APPLICATION: NYU Langone filed an application with the state Department of Health Friday to renovate the inpatient acute renal dialysis unit at Long Island Community Hospital, a project that would cost $5.5 million. According to the filing, the renovation would bring the unit up to compliance and create four patient bays and one airborne infection isolation room while renovating patient support areas. Long Island Community Hospital is affiliated with NYU Langone Health and based in Patchogue.

NURSES RALLY: Nurses who are part of the New York State Nurses Association at Ellis Hospital in Schenectady will rally today at 11 a.m. to demand a new contract with improved wages and safe staffing ratios. The nurses argue that hospital conditions currently create an unsafe work environment; they will be joined by elected officials and community advocates.

RETIREES RALLY: Lawmakers and about 200 municipal retirees rallied in Albany on Monday, urging the state to pass the Health Equity for Retirees Act, sponsored by state Sen. Pete Harckham and Assemblyman Ken Zebrowski. The legislation would prohibit public employers from diminishing health insurance benefits for retirees and their dependents or reducing contributions for coverage. The bill was introduced in the aftermath of retirees' fight against the city over its attempt to switch them onto Medicare Advantage health insurance.

Tri-state area hospitals saw a performance decline in February and still lag noticeably behind the rest of the country, according to the latest data from research firm Kaufman Hall.

The data, released Monday, shows that the vast majority of tri-state hospitals’ revenue and volume metrics fell in February from January. Inpatient and outpatient revenue decreased by 12% and 3% month-over-month, respectively. Bad debt and charity, or a measure of whether hospitals can obtain reimbursement for the care they provide, dropped by 14%. Discharges and patient days fell by 7% and 9%, respectively, while emergency department visits declined by 6%.

Erik Swanson, senior vice president of data and analytics at Kaufman Hall, attributed the dips to the short month, adding that volume decreases can be typical in February. Hospitals’ performance could have also been affected by the Change Healthcare outage at the end of the month, he said, which limited the ability to process prescriptions and get paid for services.

Despite the month-over-month decreases, Swanson said, hospitals’ expenses continue to ease, and tri-state facilities are outpacing their performances in years past. Median operating margins show a 23% improvement over 2023 and a 73% improvement over 2022, hospitals’ worst year since the pandemic began.

However, he said, these reasons to be hopeful do not outweigh the fact that tri-state hospitals still lag behind the rest of the country as they struggle with high costs of providing care.

“The punch line remains very much the same. It very much has to do with the cost of labor as well as the cost of non-labor and some of those drug expenses in the tri-state area that tend to [pull] this down,” Swanson said.

He noted that these pressures have made long-term sustainability a challenge for many tri-state facilities. He pointed to operating margins as an example. While margins have improved from early in the pandemic, February’s hovered at -1.5%. The typical mark of success for hospitals is a 3% operating margin; Swanson called the February numbers “quite challenging.”

By contrast, facilities around the country achieved a median margin of 4%, and other regions saw smaller declines, or even increases, in inpatient and outpatient revenue. Hospitals in the South, for example, saw a 2% month-over-month decrease in inpatient revenue per calendar day and a 6% boost for outpatient revenue.

Area hospitals must get creative to overcome high costs and “mediocre” volumes and revenues, Swanson said. They’ve already been aiming to do so by lowering their reliance on contract labor, building local talent pipelines and moving more services to outpatient facilities.

Going forward, he said, he expects more institutions to attempt to control patients’ acuity and how long they stay in the hospital. Sicker patients drive up expenses, and hospitals are caring for a higher percentage of them as less-intense care shifts to outpatient sites. Therefore, hospitals will need to work on their relationships with post-acute-care facilities such as nursing homes to make sure patients can be transferred successfully and don’t stay for too long.

“I think we're going to see a fair amount of that work in what I would call care coordination, care transitions,” Swanson said, “as well as coding and revenue cycle accuracy improvement that'll occur in those spaces for some longer-term stability.”

He expects facilities to outsource coordination work to third parties and use artificial intelligence tools to make the work less burdensome. While that might create administrative challenges, he added, it will be essential for area hospitals to stabilize.

Kaufman Hall is based in Chicago and releases hospital flash reports each month.

State officials and lawmakers reached a deal to crack down on Medicaid spending, pledging in a “conceptual” budget agreement to reduce administrative costs of a growing home care program by $500 million a year.

Gov. Kathy Hochul announced Monday that the state will contract with a single company to handle payroll and administration for the 250,000 people enrolled in the consumer-directed personal assistance program, a home care program that allows New Yorkers to hire a caregiver of their choosing, which could be a family member.

New York currently contracts with up to 700 nonprofits and businesses, known as fiscal intermediaries, to pay personal care aides and take care of other administrative services. State officials have agreed to whittle down the number of businesses doing this work, making a single entity responsible for the $9 billion home care program.

Hochul chalked up the deal to a need to control exorbitant Medicaid costs and eliminate fraud and abuse in the consumer-directed personal assistance program. State spending on the program increased by 1,200% in the last decade, she said.

“It’s well-known that Medicaid is one of the single largest expenses in our state budget,” Hochul said, adding that officials have a responsibility to rein in these costs. The governor called the change an “enormous victory” but said that New York is not done with its crackdown on Medicaid spending. The Commission on the Future of Health Care, an advisory group appointed by the governor last year, has been tasked with guiding Medicaid spending in the next budget year, Hochul said.

Some lawmakers and advocates have pushed back on the proposal to reduce fiscal intermediaries in the consumer-directed personal assistance program, which they say will disrupt care for thousands of older New Yorkers and people with disabilities and put the 700 nonprofits and businesses doing this work out of business.

Hochul outlined additional health care funding in the preliminary budget deal, including a $7 million allocation for compliance efforts associated with new regulations that require hospitals to get people with mental illness into follow-up care more swiftly after discharge. She also announced $3 billion for distressed hospitals and $20 billion for health care infrastructure.

The governor told reporters Monday that New York is still waiting on the federal government to greenlight a potential tax on managed care organizations, a type of health insurer, to access additional federal funding to ease pressures on the Medicaid program.

Gov. Kathy Hochul has reached a “conceptual agreement” with state lawmakers on a $237 billion budget for the next fiscal year that includes wide-ranging housing reforms, she announced Monday afternoon.

The tentative deal, reached two weeks past the initial deadline, is $4 billion higher than the governor’s initial spending plan for the 2025 fiscal year. It will include measures to crack down on illegal cannabis shops, $2.4 billion to help New York City pay for the migrant crisis, and many of Hochul's proposals to combat retail theft.

“This budget is a blueprint for a safer, more affordable, more liveable New York,” Hochul said in a late-afternoon press conference at the state capitol. Adding some last-minute confusion, state senators had been told by Senate leaders just minutes earlier that no final deal had been struck, but Hochul appeared set on smoothing over any remaining disagreements.

The state Senate and Assembly will try to pass the budget by Friday. Hochul’s announcement Monday was light on specifics — as is tradition in Albany, details about the budget will emerge in the coming days once the budget documents are printed.

The housing deal, reached after years of failed attempts, appears to match the framework previewed last week: a new tax break for housing construction, a scaled-back version of “good cause” eviction protections, raising New York City’s cap on residential density, allowing bigger rent hikes for landlords who renovate stabilized apartments and incentivizing more office-to-residential conversions. Big developers and unions appear content with the deal, which comes with wage guarantees for workers, but tenant advocates have lamented the watered-down eviction measure, and landlords said it did little to help rent-stabilized building owners.

Finer points of those proposals, especially tenant protections, have yet to be finalized in talks between Hochul and Senate and Assembly leaders. The governor, acknowledging her prior opposition to the good cause proposal, said Monday that the deal would take a “balanced approach” intended to avoid discouraging new construction.

Tenant advocates blasted the scaled-back policy as a “sham”, while the Real Estate Board of New York, which had stayed quiet publicly, released a measured statement after Hochul’s speech. REBNY President James Whelan said the package would help drive construction, but added that the new tax break 485-x “will produce less rental housing than its predecessor, 421-a.”

“What's more, the minor changes to the rules governing rent regulated units will fail to reverse the declining quality of that housing stock,” Whelan said. “And while there were several modifications to the original legislation, good cause eviction will still create significant new risks for owners, developers and funders.”

Whelan said the package “must be reassessed in the coming years” to steady the rental market.

The budget deal also includes policies to help localities shut down illegal cannabis stores that have boomed across the city, undercutting the state’s legal marketplace, Hochul said, without providing detail about whether it was the same policy that Mayor Eric Adams has been promoting. Lawmakers also agreed to sign onto Hochul’s request to increase criminal penalties for assaults on retail workers and spend $40 million on anti-shoplifting programs.

No taxes will be raised in this year’s budget, Hochul said proudly, having rebuffed requests from the state Senate and Assembly to raise rates for high-income earners.

The deal contains good news for Mayor Adams, whose administration had pushed hard for housing action. An extension of mayoral control of city schools had appeared dead in budget talks but has reportedly been revived at the last minute, although Hochul said the issue was still being decided; and the $2.4 billion in migrant aid matches what Hochul had sought throughout budget talks — although Adams had expressed a desire for even more help.

“We called on Albany to step up for the City of New York and you did just that,” Adams said in a video message his office released Monday.

The added spending compared to Hochul’s January executive budget was made possible by increasingly strong tax revenues, she said Monday.

“It allows us to continue investing in programs that New Yorkers depend upon,” she said.