Legislative Column by Assemblyman Dave Townsend (R,WF- Sylvan Beach)
If we are not already at a health care tipping point in New York then we will be soon. This is due to New York’s unique place among states administering and funding health-related entitlement programs. In the Empire State this comes down to three programs: Family Health Plus, Child Health Plus, and Medicaid. Medicaid alone accounts for approximately 45 percent of our state’s budget; in the next decade that figure could rise past 50 percent, according to independent fiscal analysts.
Medicaid in the Empire State is by far the most generous in the country; New York’s government devotes ever-larger sums to the program’s nearly 4.5 million beneficiaries (23 percent) statewide. It spends more than California despite covering 55 percent fewer patients, and costs taxpayers 79 percent over the national average for each recipient.
New York is also only one of a handful of states that requires comparable Medicaid contribution levels between the counties and the state. This means that Washington pays around 50 percent, New York State covers approximately 25 percent of total costs, and local taxpayers get stuck with the remaining 25 percent. This cost-shift is a leading driver of high property taxes Upstate.
Now, with New York suffering a generational spike in joblessness, Medicaid is set to add patients to its pricey caseload, costing us even more in 2010 and beyond. Unemployment is typically a leading indicator of Medicaid growth. For example, a study conducted last April for the Kaiser Family Foundation projected that every increase of 1 percentage point in unemployment would generate 1.1 million more uninsured and 1 million more recipients of Medicaid and the State Children’s Health Insurance Program nationwide.
With statewide unemployment over 8 percent (9.5 percent of Oswego County’s residents are out of work), Medicaid caseload growth is increasing precisely when our state’s taxpayers can least afford to fund it. A $1 trillion federal health care bill, with its proposed Medicaid expansion of 15 to 20 million more enrollees nationwide, threatens to supersize New York’s projected 2011 state budget deficit of $7 billion if no cost controls are applied.
New York State cannot afford the federal government dictating eligibility while leaving hard-working Upstate families, already paying some of the highest health-insurance rates in the country, to cough up more money. Furthermore, the number of New Yorkers not covered by employer-sponsored health insurance, individual market health insurance, Medicaid or Medicare is lower than the national average. Our Medicaid program serves not only about a quarter of the population, but also covers dental, vision, and 33 other optional services that cost taxpayers millions each year.
If the federal government is so keen on expanding eligibility for Medicaid then it should pay for it. (Applying the same tax standards to these generously comprehensive Medicaid plans that the Congress wants to level on private policy holders would be a good start.) If not, then don’t pass along one more unfunded mandate to the states.
Let New York and others like it experiment with a state-based system, one that does not keep shifting financial burdens to counties and their taxpayers. In fact, let’s take Medicaid’s $23,060 per-capita cost and give each family a non-refundable credit to buy its own private health insurance. If we are to rein in the rapid growth of Medicaid spending in New York, we must contain exploding costs driven primarily by perverse federal incentives. Affordable health care is important to everyone, and with a New York-first plan we can make true reform a reality.
