GOP bill seeks to shift Medicaid costs to Albany

March 22--Orange, Ulster and Sullivan counties would shed tens of millions of dollars in annual Medicaid expenses in 2020 under an amendment to the Republican health-care bill racing through Congress.

The amendment, which would apply only to New York, was inserted to help secure the support of New York's Republican House members.

But whether the plan to eliminate the counties' share of the Medicaid expense would save taxpayers a bundle, merely shift the tax burden, or hurt hospitals and needy patients was a matter of intense political debate on Tuesday.

Rep. John Faso, a Kinderhook Republican who represents Ulster and Sullivan counties, helped push for the amendment, first proposed two weeks ago by Rep. Chris Collins, a Buffalo-area Republican and former Erie County executive. Attached to the House Republicans' bill to replace the 2010 Affordable Care Act, the proposal would satisfy a longstanding quest by some county leaders to unload what they regard as the ultimate unfunded mandate from Albany: the counties' cut of the giant Medicaid expense, which is borne mostly by the state and federal governments.

"High property taxes are crushing Upstate homeowners and businesses," Faso said in press release. "Medicaid costs passed on from Albany are the primary driver of these taxes."

County taxes make up only one portion of New Yorkers' property taxes, and Medicaid's impact on county budgets varies widely. Orange County will spend $70 million on Medicaid this year, the equivalent of about 58 percent of the total property taxes it collected. Medicaid costs Sullivan County $20 million, about 35 percent of its tax levy. Ulster County's Medicaid expense is $35 million, or 46 percent of its levy.

Ulster County Executive Mike Hein, a Democrat, called the plan to eliminate counties' Medicaid costs a "simplistic solution" that could force the state to make drastic cuts in Medicaid services or else recoup the $2.3 billion in lost revenue by withholding sales tax revenue or other funding it distributes to counties. He also said there was no guarantee that counties would use their Medicaid savings to lower taxes.

"The net effect of this isn't positive for taxpayers," he said.

Orange County Executive Steve Neuhaus, a Republican, said he supported ending the counties' contributions to Medicaid, but feared that the state would find another way to charge counties for the expense. He also had concerns about the potential impact on services, saying, "I don't want to see people using emergency rooms for their health care."

Gov. Andrew Cuomo, a Democrat, harshly criticized the amendment, saying it would slash funding for hospitals and Medicaid recipients and worsen legislation that already was bad for New York. That bill, known as the American Health Care Act, is expected to come to a vote in the House on Thursday.

The amendment would apply only to upstate New York and Long Island, not Democrat-controlled New York City. New York counties currently pay 13 percent of Medicaid costs, while the federal government covers 51 percent and the state pays 36 percent. The state and its counties used to pay 25 percent each, but the counties' share has steadily dropped since the state capped their contributions in 2011.

cmckenna@th-record.com

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