A proposal to block New York from using county taxpayer money to pay for Medicaid sounds good on paper, but as always, the devil is in the details, says County Manager Jay Gsell.
Gsell's biggest fear is that even if the proposal is passed by Congress, Gov. Andrew Cuomo's office would just find a way to shift other expenses to the counties.
"My sense of the reaction from the governor and the lieutenant governor over the last week is that it is very likely how they would respond," Gsell said. "They’re still putting a state budget together. Things could change on a dime."
The proposal comes from Rep. Chris Collins, who is having it added as an amendment to the House GOP's health care bill aimed at replacing the Affordable Healthcare Act.
From a Collins press release put out earlier today:
The Medicaid Local Share Limitation, which was proposed by Congressmen Chris Collins and John Faso, would bar federal reimbursements for New York State Medicaid funds raised from local governments. The proposal would only apply to the $2.3 billion being raised from counties outside of New York City. New York State currently raises $7 billion from its local governments to fund its $27 billion Medicaid liability, which is the largest amount in the nation.
“This is a huge win for our constituents,” Congressman Collins said. “I want to thank President Trump, House leadership, Congressman Faso, and the rest of my fellow New Yorkers for getting this key provision included. Year after year, Albany’s leadership relies on counties to foot the bill for New York State’s out-of-control Medicaid costs. Enough is enough.
"This amendment will stop Albany from forcing its unfunded mandate down the throats of taxpayers, and help counties lower the property tax burden on hardworking families. We understand the devastating impact New York’s reckless spending is having on everyday New Yorkers, and I’m proud to join with members of our delegation to bring vital tax relief to our constituents.”
In a tweet today, Collins said his amendment to the bill, called "Ryancare" by some, and "Trumpcare" by others, would save Genesee County taxpayers $9.4 million that the county currently pays as a local share of Medicaid expense.
Gsell said it's more than $9.6 million of an overall $68 million expense, with the Federal government and state government picking up the balance of the cost.
The proposal from Collins has brought forth blistering attacks from Gov. Andrew Cuomo and Lt. Gov. Kathy Hochul.
Last week, Hochul said in a statement:
"What’s worse, a New York Republican Congressman, Chris Collins, is offering an amendment that would wreak havoc on the state. While I understand that the Democrats in Washington are attacking Collins on ethics issues and are having a heated political fight, they shouldn’t be played out at the expense of everyday New Yorkers.
“Here are the facts: The overall Medicaid plan would cost the state billions of dollars of lost federal funds and jeopardize hospital stability."
She said the Collins proposal would amount to a $4.7 billion tax increase on the people of New York.
According to a report in the Democrat and Chronicle, Cuomo ripped the bill as a "death trap" that would devastate hospitals, nursing homes and assisted living facilities in Upstate New York.
"My greatest fear from last year’s election has actually come true, which is you have a rabid, conservative ideology in Washington that would tell New York to drop dead, and that is exactly what is going on," Cuomo said.
At $60 billion per year, New York is topped only by California (at $85 billion) in total Medicaid spending. In New York, counties cover $7 billion of the state's share of the Medicaid expense, by far the highest share of any state in the union.
This for a program that is defined by the Feds as a "Federal and state" (not county) medical coverage benefit for people with limited income.
In her statement last week, Hochul offered up a history of how counties came to help pay for Medicaid, saying the counties agreed to take on this expense, but Gsell said that's not his understanding of the history.
Gsell said the counties got roped in against their will in the 1960s when Congress created a long-term care program and ordered states to help pay for it and New York turned around and told counties they would share in the expense. Then when Medicaid was created a few years later, New York told the counties they would pick up 25 percent of the tab, though at the time, the program was a lot less expensive than it is today.
"I saw some comments by Ms. Hochul last week that said, ‘oh, the counties have nothing to be grousing about -- they've been funding Medicaid forever,' " Gsell said. "She alluded to this one- or two-year-old piece of Federal legislation from the early '60s and says, ‘yeah, the counties volunteered to do it.’ No, even then, the state told the counties, 'you will fund this program.' "
New York's Medicaid bill is so high, Gsell said, because the state covers the full smorgasbord of coverage. Whereas the Federal government has only about 15 services that are mandated, New York offers the full slate of available options, more than 30 altogether.
At no time, Gsell said, have states been given any opportunity to have a say in who is covered, how they are covered or what is offered. Everything is mandated by the Federal government or the state.
When Gsell became county manager 23 years ago, the county share of coverage was about $4 million, but the expense started increasing at 5 to 10 percent per year until the county share was capped a few years ago.
The Collins amendment is designed, in part, to help secure support from New York's congressional delegation. That overt political maneuver prompted another statement from Hochul today:
"Mr. Collins has perpetuated a political scam on New York. As Mr. Trump’s bag man he has had to buy votes to pass the Affordable Care Act and did it by promising counties relief from their share of Medicaid. He now wants New York State to pay his $2.3 billion political IOU.
"The state cannot and should not. If Mr. Collins wants to buy votes let the federal government pick up the share rather that the people of New York. Local county taxes or state taxes New Yorkers still pay. One way or another, it is still coming out of New York taxpayers’ pockets. Let Mr. Collins help New York State and his district by having the federal government pay – that is why he is in Washington.
"He could easily help pay by reducing the $150 billion tax cut to the richest 1 percent of Americans or buying one less tank from Trump’s record defense budget. Why make the people of his district pay for his politics. We do know Mr. Collins is adept at corrupt financial schemes but this is the ultimate insider trading scam."
Ryancare/Trumpcare is by no means assured of passing. It will obviously receive Democratic opposition, but a number of House conservatives also oppose it. It will also face a tough fight in the Senate.
Still, if it does pass, Gsell is far from certain it will lift the burden from Genesee County for unfunded mandates. He believes, based on the stern opposition to the cost shift from Cuomo and Hochul, that Albany will just pull the purse strings tighter on other programs with county-state cost shares, such as indigent defense, Safety-Net, Pre-K early intervention and probation assistance. The state share of a total of nine state-mandated programs exceeds the potential $9.6 million in cost savings offered by Collins amendment.
"The money that the state has to start absorbing could turn on our budgets in these other areas with less state aid," Gsell said. "The state is not going to go quietly into the night."
Michael McAdams, a spokesman for Collins, rejected this contention outright.
"That's an unfounded hypothetical," McAdams said. "There's no basis for thinking that would actually occur."
The ironic piece of this fight between Collins and Hochul (who lost the congressional seat to Collins after one term) is Hochul has long been a strong proponent of local communities, making a point to shop local every holiday, for example, even stopping in Batavia stores.
Through the governor's press office and on Twitter, we reached out to Hochul to ask her to address the seeming contradiction of supporting local communities while backing an unfunded mandate, but we haven't received a response.
Gsell thinks Hochul's position may not be entirely her own.
"It struck me as she was being instructed," Gsell said. "This didn’t sound like a Kathy Hochul thing. It mirrored very much what the governor’s thing is, which is, ‘counties, shut up. You’ve got your Medicaid cap. We’ve given you pension reform with Tier 6. You’ve gotten enough. Go away. We’re not going to cost shift from counties to the state.' ’’
