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Maybe you've already seen the TV spots, which started Thursday night: "New York State's outrageous Medicaid system," the announcer says, in a voice of concern. "Almost as expensive as Texas' and California's combined."

She goes on to say that though state government makes the rules, you pay Medicaid's bill, "through higher property taxes, almost $2,000 a year for every man, woman and child in Erie County." (An overstatement, but more on that later.)

The ads are brought to you by Erie County Executive Joel A. Giambra in his latest salvo against Albany and the Medicaid program for the elderly and indigent. Medicaid serves about 130,000 people in Erie County, costing local taxpayers more than any other piece of the safety net.

More than $188 million will go out from county coffers this year, though the county expects to get $13 million back, for a total cost of $175 million. Next year's estimate: $204 million.

After displaying the spots airing on local TV, Giambra said he will probably spend more than $100,000 from his "Friends of Giambra" fund to show that the significant property tax increase expected in 2005 stems from Albany's failure to either reform the program or take on the Medicaid share that counties can no longer afford.

County officials from around New York argue that because state officials set the rules that make New York's Medicaid system the nation's most expensive, the state should pay all costs above the 50 percent share the federal government covers for New York.

Giambra wants taxpayers to pressure their state lawmakers to do something about Medicaid. But will his campaign work?

"I don't know what that accomplishes," said Assembly Majority Leader Paul A. Tokasz, D-Cheektowaga, who said Giambra instinctively resorts to politics and not policy. Tokasz said Gov. George E. Pataki proposes state budgets, and could propose in some future budget that the state take on county Medicaid costs. At the same time, President Bush could propose that the federal government pay a greater share.

"I suggest he give the president a call, his political kindred spirit," Tokasz said. Or he could have a similar conversation with Pataki, or make him the target of a campaign, Tokasz said.

Instead, Tokasz said, Giambra found it easier to go after the State Legislature.

Giambra has been deflecting criticisms that his past tax cuts are as much to blame as Medicaid for modern-day budget problems. But Giambra said he drew from the county's once-ample reserves to balance budgets during his first few years in office, figuring that state government would soon end its decades-old opposition to a Medicaid takeover.

As a lure, he proposed giving Albany the $120 million or so generated by a penny of the county sales tax if Albany paid Erie County's Medicaid share. He also proposed that Medicaid recipients make at least a $1 co-payment for prescription medicines, another idea that went nowhere.

If not for Medicaid, he said, he could eliminate the county property tax, which would attract businesses to Erie County.

"If we have to raise property taxes 70 percent to deal with this problem, it is going to make this community less competitive than it is today," he said. "If we have to cut services and gut the quality of life, by reducing library services, road patrols, cultural funding, this community is going to be a less desirable place to live, to work, and to raise your children."

While the ad implies that Medicaid costs each resident $2,000 a year in property taxes, it's actually far less. The Giambra team based that figure on the total amount of bills generated in Erie County -- $1.275 billion, according to Budget Director Joseph Passafiume. However, the federal and state governments pay the vast majority of that amount, and they don't collect property taxes.

Even when figuring the $1.275 billion, that's $1,400 for each of Erie County's 950,000 residents, Passafiume said, or $9,848 for each Medicaid recipient.


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