Candidates for governor offer different views on state’s role in medical care

ALBANY — The federal changes to Medicaid enrollment rules are expected to push thousands of New Yorkers off of their health insurance in the coming years, which the state's hospitals are expecting to lead to cuts to revenues that could threaten their ability to stay open.

And while those decisions were made by Congress, the two people running to be the next governor of New York have different ideas for how they want to see the future of Medicaid and health care in New York play out.

Incumbent Democrat Gov. Kathleen C. Hochul, running for her second full term, is regularly critical of the federal changes that are aimed at driving down the number of people covered by Medicaid. Those changes, passed last year in the ‘One Big Beautiful Bill Act,' include new work requirements for adults of working age without a valid exemption, restricts retroactive coverage for new enrollees, as well as revenue-collection restrictions like a ban on new provider taxes and a cap on existing ones.

When the bill was passed last year, Hochul put out a statement warning that it could lead to loss of health care for up to 2 million New Yorkers; 730,000 on the Essential Plan and 1.3 million from Medicaid. The Essential Plan is New York's implementation of the Medicaid expansion authorized by the Affordable Care Act, making health insurance available to more moderate-income households.

"No state can fully undo the damage in this bill of backfill cuts of this scale," she said at the time. "I'm working with the legislature to brace for the impact and protect as many New Yorkers as possible."

Since then, New York lost the federal funding necessary to keep the Essential Plan running, and Hochul's administration moved to roll back to an earlier version of the program. That will keep it running for about 1.3 million enrollees, but by July between 450,000 and 470,000 people will be disenrolled from the program.

There doesn't appear to be anything in the works to assist those hundreds of thousands of New Yorkers who will find themselves uninsured come July; notices started going out to those affected in April directing them to their employers for coverage or to the state's health insurance marketplace.

Between the Essential Plan rollback and the Medicaid enrollment cuts, almost 2 million New Yorkers are expected to fall off their health insurance coverage in the next year or so. That's projected to stress hospitals all across the state; the Healthcare Association of New York State and the Greater New York Hospital Association, which represent the health care systems of upstate New York and the city respectively, project that the total impact of these cuts will balloon up to as much as $10 billion annually by 2033, with a majority of that being driven by uncompensated care hospitals will still have to provide to the now-uninsured patients.

And now in the race for New York Governor, Democrats are using the issue to bash Bruce R. Blakeman, the Nassau County executive who is the presumptive Republican nominee for Governor against Hochul. They're pointing to a new report from Public Citizen, the Ralph Nader-founded public research and lobbying organization, which found that 45 hospitals across New York state are at higher risk of closure due to the Medicaid changes.

"Bruce Blakeman agrees with everything Donald Trump does, even when he slashes Medicaid and puts two hospitals in Nassau County and 43 other hospitals statewide at risk," said Addison Dick, spokesperson for the state Democratic Party. "Blakeman will put Trump ahead of New Yorkers no matter the cost – that's why he is vowing to take Trump's Medicaid cuts even further and rip away families' health care."

The methodology in that report looked for hospitals that had negative profit margins on average between 2022 and 2024, and also had more than 20% of paying patients covered by Medicaid or other low-income health coverage programs.

The report lists three north country hospitals as at-risk, including Claxton-Hepburn Medical Center in Ogdensburg, Clifton-Fine Hospital in Star Lake and Carthage Area Hospital.

At least for Clifton-Fine Hospital, which is owned by the Watertown-based Samaritan Health network, hospital officials say the report is no longer accurate.

"In 2024, Clifton-Fine Hospital proactively looked at switching to a rural emergency hospital designation, they were one of the first if not the first in New York to get that designation, so that helped them a lot with their financial footing," said Leslie DiStefano, Samaritan Health's spokesperson. "So they, really in many ways, should not be on that list. That data is fairly old."

Claxton-Hepburn and Carthage Area Hospital are both owned by the North Star Health Alliance, which has been going through a Chapter 11 bankruptcy proceeding and restructuring due to financial stressors that long-predate the H.R. 1 Medicaid cuts.

The state has furnished over $170 million to North Star to help the system maintain operations through a transition that saw the Ogdensburg hospital split into two separate entities within one facility, although relations between the state Health Department and the company's executives have not always been smooth.

When asked about his position on the Medicaid cuts and the state's continued support for North Star Health Alliance, Blakeman declined to answer the specific questions and instead criticized Hochul for her record on the issue.

"Kathy Hochul turned her back on the north country when she blocked emergency funds from local hospitals while allowing $2 billion in taxpayer dollars meant for health care to be stolen through fraud," he said. "As your governor, I'll claw back every stolen cent and invest in rural health care — because no family should have to drive hours for an emergency room."

The emergency funds Blakeman is accusing Hochul of blocking is the emergency funding that North Star was asking for before their bankruptcy filings; after a brief fracas over whether the company was sharing sufficient information about their top-paid executives and a subsequent leadership shakeup, that money has since started flowing again.

And that allegation of $2 billion in fraud comes from a letter sent to the state's Health Department from the federal Centers for Medicare and Medicaid Services, which alleged that nearly 75% of the state's 6.8 million Medicaid enrollees were getting it to cover some level of personal care services. In reality, at most 7% of state Medicaid enrollees get personal care services covered through the program.

But Blakeman has sketched an image of how he would like to approach managing the state's health care programs if elected; he broadly supports President Donald J. Trump and has declined to voice any opposition to the President's policies, including the H.R. 1 Medicaid cuts.

He's pledged to create a Department of Government Efficiency-like team to review the state's own Medicaid spending; New York has one of the largest and most expensive Medicaid programs in the nation, with over $100 billion in combined state and federal spending on it last year.

Blakeman, speaking on TALK! 100.7 F.M. in early February, said he'd like to see how New York's program can be whittled down to be more realistic compared to other state's spending on health care.

"I don't want to cut back treatments for people that are effective in keeping them healthy, because in the long run if you have a healthy community it costs government less and costs taxpayers less," he said. "I would look at it on a case-by-case basis."

And historically, Blakeman has opposed the Affordable Care Act. In 2010, when he was running for U.S. Senate against Sen. Kirsten E. Gillibrand, D-N.Y., he called for the program to be fully repealed. When he ran for Congress in 2014, he again called for the ACA to be repealed.

A spokesperson for Hochul said Blakeman's past stance on health care aligns with his current positions, and is evidence that the GOP nominee for Governor isn't aligned with the state's needs. That spokesperson also referenced the Public Citizen report that suggests 45 New York hospitals could close under the terms of H.R. 1.

"After Donald Trump gutted Medicaid and put 45 New York hospitals on the chopping block, Bruce Blakeman said he was doing an ‘amazing job' – and there's no question why: this is the Trump wannabe who spent his career fighting to repeal the Affordable Care Act and who tried to force higher costs and less coverage on his own employees," said Sarafina Chitika, spokesperson for the Hochul campaign. Hochul and Blakeman have gone toe-to-toe over hospitals in his own Nassau County as recently as last summer; the Nassau University Medical Center, which is a public-benefit corporation that Blakeman has the power to appoint members to the board for, has been facing flagging finances and a state-led takeover. At Hochul's behest, more than $110 million has been dedicated to righting the ship at the hospital, while Blakeman and those aligned with him have blamed the state for trying to close the hospital down or dramatically cut services.