Rep. Chris Collins and Lt. Gov. Kathy Hochul sparred Friday over Medicaid. (Buffalo News file photos)

ALBANY – In shades of their bitter campaign, Lt. Gov. Kathy Hochul and Rep. Chris Collins on Friday dueled over a Medicaid plan that, for now, is far from certain to even become law.

Hochul, who lost her congressional seat to Collins in 2012, started things off on Friday by putting out a lengthy statement about a plan by the Republican congressman that she said would “wreak havoc on the state.’’

Hochul, a Democrat, went on from there, raising questions about Collins’ ethics, his understanding of government finances and his priorities.

“Mr. Collins, try practicing good government rather than partisan politics,’’ said Hochul, who as lieutenant governor usually leaves the aggressive attack-making to her boss, Gov. Andrew M. Cuomo.

Collins was quick to respond.

“Kathy Hochul has sold out Western New Yorkers to protect the Albany insiders she now serves,’’ said Michael McAdams, a spokesman for Collins. “Instead of putting the taxpayer first, she sided with Albany’s special interests and their wasteful spending.’’

At issue was a plan put forth by Collins that included the state assuming the costs of Medicaid, which provides health insurance in New York for low-income and disabled people, including seniors. New York’s Medicaid program will cost a total of $65 billion this year, providing some level of health insurance to more than 6 million New Yorkers.

Counties pay about 13 percent of Medicaid’s tab, and they have pushed for years for the state to take over the full costs of the program, in part because they say state-mandated coverage has driven up expenses the counties can’t control. The federal government pays 51 percent of the New York health insurance costs and the state pays the remainder.

Hochul made her attack against Collins in the aftermath of a controversial plan advanced by some House Republicans to replace the Affordable Care Act, or Obamacare. Cuomo’s health department Thursday said that plan could reduce health coverage for more than 1 million New Yorkers.

Collins had a plan to require an end to counties’ requirement to pay for Medicaid, but the plan was not formally advanced during markup of the broader health insurance proposal that came out of two House committees earlier this week.

Hochul said Collins’ proposal to shift county Medicaid expenses to Albany is “ill-conceived” and would cost the state $2.3 billion. Taken together with the House GOP Obamacare replacement plan and Hochul said Collins’ effort would be a $4.7 billion hit for the state.

Hochul also strongly defended the current system in which counties pay a portion of Medicaid.

“On the merits, the counties have no right to claim this is an undue burden. They paid a percentage of health care costs even before Medicaid – and in fact, currently have a more favorable agreement than in decades,’’ she wrote.

Hochul noted that the state more than 50 years ago gave counties the option to collect sales taxes to help pay for Medicaid when it was created by the federal government.

Hochul noted counties’ share of Medicaid costs over the years has dropped from 25 percent, and that the state for several years has funded the increases the counties would have otherwise paid from the sharply rising costs of the program. “If the Collins amendment passed, the state would need to raise income taxes or the counties would have to forego their share of sales tax in exchange for the state picking up the additional Medicaid costs,’’ Hochul said in her statement, adding that the Republican congressman should “stop prioritizing his wealthy friends.’’

Collins, his spokesman said, offered an amendment to bar federal reimbursements for state Medicaid funds that are raised from local governments. It would not, he said, apply to large municipalities, including New York City, or states that tap counties for the costs of administering the program.

“Hard working families are tired of footing the bill for New York’s out of control Medicaid system that is putting our counties on the brink of bankruptcy. The good news is that taxpayers can count on Congressman Collins to fight for them by refusing to feed Albany’s penchant for wasting our tax dollars,’’ McAdams said.

New York’s Medicaid program is the nation’s most expensive, and the New York State Association of Counties says that New York’s county taxpayers spend more than triple what all other county taxpayers in the nation pay combined.

Collins’ office said his plan would require the state to pick up about $2.2 billion now spent by counties outside New York on the Medicaid program. His office noted that Erie County spends $204 million on Medicaid, or 83% of its property tax levy.

Stephen Acquario, executive director of the association of counties, praised Collins for proposing the state Medicaid takeover.

"The federal legislation introduced by Congressman Collins attempts to do what the state has been unwilling or unable to do,'' he said. "It provides real mandate relief for counties, so that counties can begin to reduce property taxes in the state.''

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