WASHINGTON – Rep. Chris Collins' proposal to relieve counties of their Medicaid costs has been added to the Obamacare repeal bill the House is likely to vote on later this week.
Collins' plan, which would force New York to pick up the $2.3 billion tab that upstate and Long Island counties now contribute to the health care plan for lower-income state residents, was included late Monday in the last-minute package of amendments that House Speaker Paul Ryan put together to build support for the controversial Republican health care legislation.
“This is a huge win for our constituents,” said Collins, a Clarence Republican who worked on the amendment with Rep. John Faso, R-Kinderhook. "Year after year, Albany’s leadership relies on counties to foot the bill for New York State’s out-of-control Medicaid costs. Enough is enough."
But Collins' proposal is controversial, too. Even before the idea made it into Ryan's final package of amendments, Gov. Andrew M. Cuomo lashed out at it, saying the state has no way to make up for the amount of money counties now contribute to Medicaid.
"The cut is so severe that the majority of hospitals, nursing homes and assisted living facilities located in Upstate New York and on Long Island would be devastated," Cuomo said.
Referring to Collins – a former Erie County executive – Cuomo said: "How a county executive could believe their county could prosper while losing hundreds if not thousands of jobs and seeing the decimation of their health care system is beyond me."
Collins' amendment bars states from shifting Medicaid costs onto the counties outside of New York City. If they did so, states could lose federal funding equal to the amount they charge counties.
Aides to Collins said he opted not to try to apply that provision to New York City because of the huge financial hit the state would take if it suddenly was forced to pick up the city's $5 billion in Medicaid costs.
The proposal also would not affect other states -- of which there are more than a dozen -- that force counties to pick up some Medicaid costs. Most of those states only charge their counties for Medicaid's administrative costs, but New York goes much farther than that, charging counties for a share of hospital costs for facilities that see a large number of Medicaid patients.
That being the case, Collins' amendment specifically bars states from charging counties for Medicaid the way that New York State does, but would allow other states to continue charging counties for some Medicaid costs.
The county share of Medicaid in New York had long been 25 percent, but under pressure from the counties, the state has winnowed down the county share to 13 percent.
Still, the program remains the most significant financial burden that New York counties face. In Erie County, for example, Medicaid costs ate up 82.8 percent of the revenue the county raised through property taxes in 2015, Faso's office reported.
That being the case, aides to Collins say that by transferring Medicaid costs to the state, the owner of a $200,000 home in Erie County would save $1,000 a year on property taxes.
Collins and Faso worked to include the amendment in the health bill not just to free counties of Medicaid costs, but also to win the support of Republican House members from New York who had concerns about the plan to repeal and replace Obamacare.
“Credit must be given to John Faso for his leadership role," said Rep. Tom Reed, R-Corning. "He brought this to us as a legacy issue from his time in Albany as an elected official ... We all came together as a delegation to get this done, but credit also goes to Collins as the New York representative of the committee of jurisdiction, Energy and Commerce.”
House leaders included the Collins amendment in their health bill revisions in part to win the votes of some New York Republicans who had not yet committed to voting for the measure when it comes before the House later this week.
It apparently worked. In addition to Reed and Faso, Rep. Elise Stefanik, R-Willsboro, and Rep. Claudia Tenney, R-New Hartford, praised Collins' amendment.
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