Published: Wed, March 29, 2017
USA | By Yvette Dunn

GOP Medicaid bill: Counties see mandate relief

According to Rose Hoban of N.C. Health News, North Carolina's share of Medicaid spending was a little over $3.5 billion a year ago, which accounted for a bit more than 16 percent of the state's $22.3 billion budget.

"It is cheap politics at best because, what the Congresspeople say is, well, if the county doesn't have to pay their share, then the county can reduce taxes", Cuomo said Tuesday in New York City.

In an effort to round up votes for the AHCA from Republican congresspeople from New York, Rep. Chris Collins (who represents the Buffalo area) won an amendment that would effectively force New York to stop sending any part of the bill to localities except New York City. That prompted House GOP leaders to make a series of 11th-hour changes Monday night in a bid to secure more votes.

This would make the city a fiscal victor, and most other counties - in the much more Republican parts of the state outside NY - into losers.

Medicaid is usually described as a joint federal-state program, but NY has an unusual arrangement in which counties pay 13% of the bill for Medicaid.

Faso said the counties in the 19th Congressional District, which he represents, paid more than $224 million in property taxes to support the Medicaid program in 2015.

"I understand their concerns, " said Rob Astorino, the Westchester County Executive and Republican Party candidate against Cuomo in the governor's successful 2014 re-election. The block grant scheme it would perpetuate was estimated to short New York's Medicaid support by some $5 billion.

The proposal would stop local governments in NY from paying a portion of the state's Medicaid charges.

The Empire Center analysis found that, with Medicaid costs in Saratoga County at $25.4 million annually, if the state took back 1.2 percentage points of the 3 percent sales tax, it would mean almost $49.1 million in lost revenue for the county.

The Senate minority leader said the GOP's replacement of the Affordable Care Act is a "modern-day Trojan horse" that will deprive over a million upstate New Yorkers of health care coverage, including seniors, children, individuals with disabilities and those receiving treatment for opioid addiction.

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If the proposal passes, NY state would have to cover the loss in Medicaid funds, according to Assembly Speaker Carl Heastie, D-Bronx.

"This bill appears to be on life support for now - it should be killed once and for all", Cuomo said in a statement after the bill was pulled Friday.

The House is expected to vote on the health care bill Thursday.

But now the state faces the prospect of picking up an additional $2.3 billion in Medicaid costs from counties, which Cuomo said the state could not afford.

Taken together, Cuomo said, Washington is telling "New York to drop dead". "The counties have no business, and the property taxpayers, should have no business paying for state Medicaid costs".

Ossenfort said since both counties pay some of the higher percentages of Medicaid dollars per taxpayer, this could help the counties lower their tax burden. Schumer said rural hospitals and nursing homes will be especially at risk of shutting down because fewer people are covered by Medicaid.

A similar county phaseout was proposed by none other than Gov. Mario Cuomo early in his tenure. Cuomo had spent much of this week warning that the amendment would lead to deaths and hospital closures across the state.

State Assembly Speaker Carl Heastie said the idea that the Medicaid cuts would result in lower property taxes is "a ruse".

But for counties, the measure proposed by two upstate Republican congressman would give them the mandate relief they have sought for decades: A state takeover of Medicaid - their largest single expense.

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