ALBANY – The congressional Republicans' attempt to force the state to assume counties’ expenses for Medicaid placed five New York county executives in an awkward position.
The five are the only Democratic county executives in New York, and for years they have called on Albany to relieve them of the obligation to pay for part of Medicaid, the insurance program for elderly, disabled and poor New Yorkers.
Now they have powerful allies in Washington joining their cause, while their Democratic governor is furiously fighting the bid.
“I have not heard any county leader criticize it,’’ Erie County Executive Mark Poloncarz said of the Medicaid cost-shifting amendment authored by Republican U.S. Reps. Chris Collins of Erie County and John Faso of Columbia County.
“On the amendment alone, I’m 100 percent behind it,’’ Albany County Executive Daniel McCoy added.
The chance to reverse a decision made in Albany more than 50 years ago might be music to the ears of county leaders like Poloncarz. His budget this year will spend $200 million on Medicaid.
But a huge asterisk is attached to the amendment: the Affordable Health Care Act. It cuts health programs in New York and critics say that means millions of Americans would lose health insurance.
“Clearly, removing mandates from county government, as a county executive, if I only look at the world through a hyper-simplistic lens, it would be fantastic. But I live in the real world and so do my taxpayers,’’ said Ulster County Executive Mike Hein.
Still, their support for the Collins/Faso amendment – as a stand-alone idea only – broke with the sharp rhetoric coming from Gov. Andrew Cuomo.
Cuomo spent all week lambasting the cost-shifting idea as a gimmick with fiscally dire consequences for the state budget and as the work of two “rabid” conservatives in the form of Collins and Faso. Cuomo also said it was another mandate from Washington foisted upon Albany without money.
That sounded familiar to a lot of county executives.
"I will say to the state government, ‘Welcome to our world.’ This is what they do every year to counties in unfunded mandates,’’ McCoy said. “Now they feel how we feel and it’s not fun.”
Three of the five Democratic county executives who spoke to The Buffalo News for this story all condemned the broader “repeal and replace” efforts aimed at undoing Obamacare. The other two Democratic county executives, Broome County’s Jason Garnar, and Suffolk’s Steve Bellone, whose county last year had to pay $242 million for its Medicaid share, declined comment.
Among the many bad features in the health plan out of Washington this week, Poloncarz said, is its likely effect on thousands of people who would lose health insurance coverage in Erie County. That would lead many of those to head to the county’s public hospital, Erie County Medical Center, to receive care. The county pays for such indigent services.
"I cannot criticize Chris Collins’ amendment as a county executive because I know it would have a positive impact regarding our expenses, but that doesn’t stop the rest of the bill from being a bad bill,’’ Poloncarz said.
“If it makes the pig look prettier but it’s still a bad bill, that has negative connotations,’’ he added.
Medicaid is the largest expense for counties across New York, totaling $2.3 billion for the 57 counties outside New York City. The Collins/Faso plan does not include New York City. The 57 counties now pay about 13 percent of the annual costs of the program in New York, with the federal government paying 51 percent and the state picking up the rest.
McCoy, the Albany county leader, is also first vice president of the County Executives of America, which a few months ago passed a resolution urging Congress to put New York State in line with the other states, which pay for Medicaid.
The county executives say the Collins/Faso amendment would represent an avenue for counties to reduce their property tax levies if they were relieved of the costs of Medicaid.
But the county executives also worried about Albany’s reaction if a Collins-Faso kind of measure ever did become law.
“I could easily see the state forcing more sharing (of services) or passing on more mandates … Would they go after sales taxes? Possibly,’’ Poloncarz said.
Cuomo on Thursday ruled out raising state taxes to pay for any impact of the health care measures that might come out of Washington.
Hein, the Ulster county executive, hosted a packed public hearing this week where “100 percent of the people who spoke were wildly opposed to the repeal of the Affordable Care Act.”
As pleased as he was that someone in Washington is listening to the plight of counties when it comes to Medicaid, McCoy said the effects of the overall health care plan from President Trump and the U.S. House “would represent a huge step backwards.’’
“I can’t, in good conscience, go along with it,’’ he said.
Republican county executives felt sympathy for the five Democratic county executives on the Collins/Faso amendment and the broader health bill.
“I understand their concerns,’’ said Rob Astorino, the Westchester county executive and Republican Party candidate against Cuomo in the governor’s successful 2014 re-election. He said 40 percent of county property tax revenues go to pay for Medicaid expenses over which the counties have little to no leverage to control.
He had the exact reaction as Democrat McCoy to the governor's railing against Washington for seeking, through the Collins/Faso amendment, to drive unfunded mandates on the state.
“Welcome to our world,’’ Astorino said of the perennial complaint by counties over their fiscal treatment by the state.
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