cuomo_250x-239x300-9931912Governor Cuomo’s warnings about how repealing the Affordable Care Act would affect New York should be read with caution.

On Wednesday – as the U.S. Senate took its first step toward unwinding Obamacare – Cuomo’s office said ACA repeal would cause 2.7 million New Yorkers to lose coverage and cost the state budget $3.7 billion.

But those two numbers are based on conflicting assumptions about how the repeal process will play out – a nuance that his press release did not make clear, but which Health Department officials explained later.

The officials raised the possibility that repeal could have dramatic and unintended consequences for the state’s Medicaid program. Unlike most other states, New York expanded its version of Medicaid going back years before the ACA. It did so under a series of waivers granted by the federal Department of Health and Human Services, which were superseded when the new law took effect in 2014.

Thus, if Washington repeals Obamacare without reinstating a waiver, New York’s Medicaid eligibility rules could revert to the pre-waiver baseline, officials said.

Currently, New York’s program covers most adults with children up to 138 percent of the federal poverty level, and childless able-bodied adults up to 100 percent of FPL. Under a scenario in which the ACA is repealed and no waiver is granted, eligibility for adults with children could be limited to 94 percent of FPL, and able-bodied childless adults would no longer qualify at all.

That would end coverage for 1.9 million New Yorkers, officials said.

Another 220,000 people would lose access to private coverage they have purchased through New York’s ACA exchange, and 586,000 would lose coverage under the Essential Plan, a low-cost, government-funded health plan that was an optional benefit under Obamacare.

Other analyses of ACA repeal have assumed that Medicaid eligibility would revert to what it was in 2013.

Previous estimates by the Urban Institute and Charles Gaba of ACASignups.net have projected that 1.1 million New Yorkers would lose coverage under that scenario. [UPDATE: Charles Gaba has revised his estimate to 2.5 million.]

For its budget impact analysis, by contrast, the Cuomo administration assumed that New York would continue covering all or most of the people currently enrolled in Medicaid and the Essential Plan – without the benefit of extra federal aid that the ACA provided. In that case, the state would have to put up $3.7 billion or more of its own funds, officials said.

That number is roughly consistent with my own estimate and with that of state Comptroller Tom DiNapoli.

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

You may also like

Cuomo Administration Ducks Important Questions on Nursing Homes

A new report from the state Health Department tries to deflect blame for thousands of coronavirus deaths in the state's nursing homes – but undermines its own case by withholding data and engaging in tendentious analysis. Read More

Nursing Home Vacancy Rate Soars, Hinting at a Higher Coronavirus Toll

The vacancy rate in New York's nursing homes has more than doubled since the start of the coronavirus pandemic, suggesting that the death toll among residents may be thousands higher than officially reported. Read More

Unsure of COVID Impact, NY Insurers Roll Dice on Rate Hikes

The health insurance industry's rate applications for 2021, , reveal deep uncertainty about the long-term impact of the coronavirus pandemic on medical costs. Some companies anticip Read More

Hospitalization rising in some areas

Coronavirus hospitalizations are surging in parts of upstate, including three regions that the Cuomo administration authorized to begin reopening today. Read More

Uneven ‘relief’ for NY providers

A review of federal emergency payments to New York health-care providers reveals a striking disparity: Four of Manhattan's most prosperous private hospitals collected more individually than the 11 city-owned hospitals combined. Read More

Essential Plan surplus hits $3B

As Governor Cuomo pleads for financial help from Washington, one of his state's programs is sitting on $3 billion in unspent federal aid: the Essential Plan. Read More

A grim toll gets worse

The full toll of the coronavirus pandemic in New York is likely thousands higher than the official death tallies, according to newly released federal data. Read More

More fiscal turmoil for Medicaid

In a sign of pandemic-related strain on state finances, the Cuomo administration is postponing a series of multi-billion-dollar Medicaid payments over the next three months. Read More

Subscribe

Sign up to receive updates about Empire Center research, news and events in your email.

CONTACT INFORMATION

Empire Center for Public Policy
30 South Pearl St.
Suite 1210
Albany, NY 12207

Phone: 518-434-3100
Fax: 518-434-3130
E-Mail: info@empirecenter.org

About

The Empire Center is an independent, non-partisan, non-profit think tank located in Albany, New York. Our mission is to make New York a better place to live and work by promoting public policy reforms grounded in free-market principles, personal responsibility, and the ideals of effective and accountable government.