All families, no matter how poor, can afford eyeglasses, County Executive Chris Collins said Tuesday as he mentioned eye care as one of the Medicaid offerings he would drop as an option in Erie County if he could.
Dental care is another such option Collins might drop, he said, as he suggested that New York's county leaders be allowed to set the breadth of the Medicaid program that their taxpayers will help finance within their borders.
New York offers the most wide-ranging and expensive Medicaid menu of any state and offers all but two of the Medicaid options. Among the state's Medicaid offerings are physical therapy, speech therapy, dentures, hearing aids, private-duty nursing, eyeglasses, optometrist services and dental care.
Those offerings are decided at the state level. For years, state leaders expected counties to cover roughly 25 percent of many costs, though in recent years each county's annual cost increase was capped at about 3 percent per year.
During the early days of Medicaid in 1966, New York's counties contributed $112 million to the program. Today, they pay $7.3 billion, according to the New York State Association of Counties. In 2010, Erie County spent $201 million on Medicaid, or 96 percent of the property taxes that it raised for county operations, excluding the libraries.
"These numbers are staggering, and provide a clear example of why Erie County, and all of New York State, cannot continue on this course," Collins said at a news conference in which he called for state legislation to revise the program. "These optional services are why New York is well-known for having an infamous 'Cadillac' Medicaid program. In this era of tough fiscal times, taxpayers are demanding a Chevy, not a Cadillac."
The county executive estimated that in Erie County alone, taxpayers could see an overall decline of $80 million, or about 40 percent of their county property tax bill, if the county could drop out of many options. "When you factor in the entire state, the savings are enormous," he said.
Collins did not originate the idea of letting each county determine the Medicaid extras to be offered. Other county executives suggested it over the years to the Association of Counties as it lobbied to rein in the cost to taxpayers. But the association was focused on persuading state leaders to cap the cost for counties, spokesman Mark LaVigne said.
In 2005, when then-County Executive Joel A. Giambra was railing against Medicaid for its role in the county's financial crisis, Assemblyman Robin L. Schimminger, D-Kenmore, proposed letting counties set their Medicaid options and their eligibility levels as part of his package of reforms. The idea did not become law, though Schimminger said he reintroduces the legislation every year. "Not everybody sees the value of the legislation," Schimminger said. "There is a fear that if given a free hand, counties would race to the bottom and provide only the most bare-bones of coverage. To which I say they will be subject to all the same forces that apply in Albany. While they might eliminate or shrink some, they will not eliminate or shrink all. It will be their decision."
But there are other complications. Any such change requires a federal government waiver to exempt New York from the rule that Medicaid programs be uniform throughout any state. The Schimminger bill, if passed, only would direct the state health commissioner to request a waiver.
With Gov. Andrew M. Cuomo empaneling a group to redesign New York's Medicaid system, the suggestion to let each county determine its own program will probably be vetted by that panel, said Stephen J. Acquario, executive director of the Association of Counties and a panel member.
"I think that the observations by the Erie County executive reflect those of someone in a position to make a difference. He is seeing firsthand the inefficiencies of the system, and its corresponding impact on the property tax," Acquario said. " I think everything should be on the table. Everything. Including this suggestion."
Collins expects to trumpet his proposal over coming days and weeks, and he said he would like it to become a debate for this year's County Legislature campaigns, when voters for the first time will select an 11-member Legislature, down from 15.
The county executive, who also is up for re-election, will use the issue to connect with his conservative base. Aides said that in coming days, he will arrange a conference call potentially involving hundreds of county residents. They will be phoned by an automated dialer and asked whether they would like to join the call with Collins about his proposal.
"I think it's time to recognize the best decisions are made locally," Collins said Tuesday. When reporters asked whether families in need would be left without essentials, such as glasses, he said that not every state provides glasses under Medicaid.
"Families need to prioritize," Collins said. "There isn't a single family that can't provide eyeglasses."