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Cutting Medicaid ; Collins offers up a proposal to begin a needed discussion

Although Erie County Executive Chris Collins' recent observations on ways he might cut Medicaid may have been insufficiently considered, the fact is that it's always a good time to discuss this state/federal program that has become an albatross around the necks of local governments and taxpayers.

The program has become unsustainable, costing $53 billion in New York, which provides the nation's most generous benefits. It's a problem that has been 45 years in the making, dating back to Nelson Rockefeller. It has since mushroomed into a program serving one in four New Yorkers -- 5 million of us. New York comprises 9 percent of the country and approaching 15 percent of the total Medicaid dollar appropriation. Thus, Collins' proposal.

The county executive suggested that he would drop a number of benefits within the program, up to and including eyeglasses that he believes all families can well afford. Physical therapy, speech therapy, dentures, hearing aids, private-duty nursing, optometrist services and dental care are among the others.

While it may be difficult to judge what the individual family, especially one qualifying for Medicaid, could afford -- we're not at all sure that all families can afford glasses -- there is little doubt that this runaway program has placed local government finances on track for disaster.

Now is the time for creative thinking and there's opportunity through health care reform, assuming it doesn't get repealed, and the possibility of using an Erie County model as a pilot program. Both the state and federal governments should listen to counties. Medicaid is one of the nine mandated programs consuming more than $230 million of Erie County's property taxes.

Counties in New York have long been on the hook for a large share of the program's non-federal costs. It has been financially perilous, despite a 2005 cap of 3 percent on each county's annual cost increase.

In Rockland County, for example, the amount of property tax levy geared toward Medicaid is 115 percent. Last year, Erie County spent $201 million on Medicaid, or 96 percent of the property taxes that were raised for county operations, with the exception of the libraries.

The situation has caused businesses and homeowners to flee south, sometimes as close as Pennsylvania.

Collins wants to allow counties to opt out of offering certain benefits, estimating that it could cut the annual property tax bill by 40 percent, or $80 million.

His outcry echoes that of previous county leaders, including Collins' predecessor, Joel A. Giambra, and Assemblyman Robin L. Schimminger, D-Kenmore, who has tried numerous times to authorize counties to set their Medicaid options and their eligibility levels.

Any change on the level of what Collins is proposing would require a federal government waiver to exempt New York from the requirement that Medicaid programs be uniform throughout the state.

But these are different times and Erie County may qualify as a pilot program, which the federal health care reform act encourages. It also doesn't hurt that the executive director of the New York State Association of Counties, Stephen J. Acquario, sits on the governor's Medicaid Redesign Team.

Like his predecessors, Gov. Andrew M. Cuomo has made strong statements about Medicaid reform. Acquario's presence on the panel puts him in a position to represent local interests and offers cause for hope that Collins' proposal will get a fair hearing.

It's time for real reform.

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