When a Republican congressman from Buffalo, Chris Collins, tried to save the shambolic effort to repeal Obamacare, he had a novel idea that just about everyone else hated: make the state government pay the full share of Medicaid expenses for upstate and suburban counties.
“Collins tried to play New Yorkers for fools, and while we know he is a financial fraudster, his latest insider trading scheme backfired and didn’t outsmart the people of this state,” fumed Lieutenant Governor Kathy Hochul.
Governor Andrew Cuomo, so enraged by the $2.3 billion the state would have to drum up if Donald Trump and Paul Ryan’s American Health Care Act ever passed with Collins’s amendment, threatened to sue, raise taxes, and close hospitals. Since New York City was excluded from the Collins proposal, the city’s sole GOP House member, Dan Donovan, also panned the amendment, and came out against the AHCA. Because Ryan and Trump concocted such an awful piece of legislation, it was never brought up for a vote, and Obamacare survived.
Since Collins is a staunch ally of Trump, Democrats and more moderate Republicans could easily dismiss his amendment as a cynical maneuver to secure passage of a flawed bill. In our ultra-partisan era, ideas that emerge from unexpected places are immediately taboo. If it reeks of Trump, the average liberals says, we just don’t go there.
But Collins and his upstate colleagues were actually talking a lot of sense. Counties have been sharing the costs of Medicaid for fifty years, thanks to legislative wrangling dating back to the Nelson Rockefeller era. To pay for expenses that a state would normally cover — New York is the only state in the country that forces localities to pay a large chunk of their Medicaid costs — counties must keep property taxes unusually high. In Collins’s Erie County, for example, about 84 percent of its property taxes are devoted to Medicaid expenses.
Collins’s ally in the fight was John Faso, a freshman congressman from the Hudson Valley who will be in a pitched battle to win reelection next year. Faso understood the amendment was a winning issue because if it ever passed, property taxes would dramatically decrease. The only real problem with the Collins amendment was the unfairness of exempting New York City.
Cuomo claimed it would be “impossible” for the state to close the gap in lost Medicaid funding, but $2.3 billion in a $150 billion budget represents a crumb that could be replaced in other ways. The tax-averse Cuomo could propose a more progressive state income tax or find savings elsewhere.
Rather than do the sensible thing and advocate for the state to take on the Medicaid costs, a few members of Congress from New York are doing Cuomo’s bidding by introducing a hopeless piece of legislation. The Democratic lawmakers, including Eliot Engel and Tom Suozzi, are seeking to adjust the formula that determines how federal matching dollars for Medicaid go to the states, potentially netting New York an extra $2.3 billion. The Republican-controlled Congress will never even consider this.
More importantly, Cuomo and these members of Congress could actually make New York a bulwark against Trump’s madness by supporting an assembly bill to bring single-payer healthcare to the state. Assemblyman Richard Gottfried’s proposal would install a Canadian-style health system statewide, which would amount to a beefed-up version of Medicare paid for by tax increases. Though the assembly passed his legislation before, the Republican-run state senate — in GOP hands thanks to Cuomo’s lackluster efforts to help senate Democrats and his empowering of a breakaway group of Republican-aligned Democrats — has never even given the bill a committee hearing.
Local governments deserve to be free of a Medicaid burden that should be paid for by the state. And New Yorkers deserve serious healthcare reform that looks nothing like what Trump and his right-wing enablers have dreamed up.