Who knew he was so sensitive to this issue? Seeing how the state burdens counties with its own financial obligations, one is inclined to believe the governor would welcome such tactics from federal lawmakers.

But a Washington proposal calling for the state to absorb what counties pay for Medicaid really got under Mr. Cuomo’s skin last week. This irked him so much, in fact, that he threatened to sue the federal government if it approved the plan.

Congressional Republicans have been debating how to replace the Patient Protection and Affordable Care Act, passed seven years ago this month. Repealing the law and implementing a better plan have since been advocated by many GOP legislators, including U.S. Rep. Elise M. Stefanik, R-Willsboro.

The American Health Care Act, the reform bill under consideration on Capitol Hill, includes an amendment from two New York legislators: U.S. Reps. Christopher C. Collins, R-Lancaster, and John J. Faso, R-Kinderhook. This provision would cut off federal Medicaid funding to the state if counties outside of New York City continued paying a share of the expenses.

Mr. Cuomo questioned the constitutionality of the amendment. He said legal action against the federal government may be brought if this provision is enacted.

According to the Kaiser Family Foundation, federal and state spending on Medicaid in New York totaled $59.8 billion in 2015. The federal government covered about 51 percent of these costs.

State law mandates that counties cover 13 percent of these total expenses while Albany pays the remaining 36 percent. County officials have long pointed out how this strains their budgets and have pressed the state to take over these costs.

Of the $27 billion to $29 billion the state spends on Medicaid, Albany collects about $7 billion from municipal governments; about $2.3 billion of this is paid by county governments outside of New York City.

The Collins/Faso amendment would give the state until 2020 to take on these expenses. Mr. Cuomo said this merely shifts the burden of paying for Medicaid.

In a conference call with journalists Wednesday, he said this was an old Republican tactic of “passing the buck without passing the bucks.” He claimed that medical facilities could end up closing if the state can’t come up this amount of funding, or Albany may have to raise income taxes to cover it.

The governor is correct that this plan would shift the burden of these Medicaid costs from the counties to the state. New York taxpayers would continue paying this bill — both to the state and federal government.

But the idea of having the state relieve counties of this financial burden has been debated for years, and it’s a discussion worth having. Increasing costs for Medicaid have prevented counties from appropriately prioritizing their budgets; counties must pay their share of Medicaid and adhere to the tax cap mandated by the state. They could use these funds to focus on infrastructure projects or reduce property taxes, for example.

Jefferson County would save about $20.5 million, according to a report prepared by the Empire Center for Public Policy. Lewis County would save about $5.2 million, Oswego County about $25.6 million and St. Lawrence County about $25 million. These costs chew up more than 30 percent of property tax levy for Jefferson and Lewis counties, and more than 50 percent of the property tax levy for Oswego and St. Lawrence counties — that’s a huge chunk of money for these counties.

New York’s Medicaid program is one of the largest in the country and is known to be plagued with abuse. At least several government agencies and private organizations have analyzed how the state could curb rising expenses by clamping down on fraud.

The AHCA has numerous problems in its current form and wouldn’t serve Americans well. Whether it will be turned into law remains unclear, but legislators on Capitol Hill must do a better job on retaining the most popular aspects of the ACA while revising its glaring flaws.

Regardless of the bill’s outcome, shifting Medicaid expenses from the counties to the state is an idea whose time has come. Officials in Albany must finally embrace a plan to remove the burden from the counties.

The $2.3 billion is within the state’s grasp. Legislators need to curb their overall spending and squeeze as much savings out of the state’s Medicaid program as possible by curtailing waste and fraud.

Mr. Cuomo is correct that unfunded mandates don’t feel good. So he should recognize how the state has been hurting counties with Medicaid expenses and agree to move in another direction.

© 2017 Watertown Daily Times