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 It did so under a series of waivers granted by the federal Department of Health and Human Services, which were superseded when the new law took effect in 2014.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 Under a scenario in which the ACA is repealed and no waiver is granted, eligibility for adults with children could be limited to 94 percent of FPL, and able-bodied childless adults would no longer qualify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

Hochul’s CDPAP Overhaul Hands a Costly Win to 1199

Governor Hochul's overhaul of the Consumer Directed Personal Assistance Program reached a milestone Monday when she named a Georgia-based company as the winning bidder to be the program's statewide "fiscal intermediary" – Read More

New Yorkers’ Health Costs Spiral as Officials Take Credit for ‘Savings’

The latest round of health insurance premium hikes announced by New York regulators adds to evidence that state policies are drowning consumers instead of helping them. Late last mo Read More

What Paul Francis Got Wrong About the Empire Center’s Nursing Home Research

In February 2021, the Empire Center published the first independent analysis of the Cuomo's administration much-debated directive ordering Covid-positive patients into nursing homes. The report found that the directive was associated with a statistically significant increase in resident deaths in the homes that admitted the  infected patients. Read More

Internal Cuomo Administration Documents Showed Evidence of Harm from Nursing Home Order

State Health Department documents from June 2020, newly unearthed by congressional investigators, appear to show harmful effects from a controversial order requiring nursing homes to admit Covid-positive patients. Read More

On Covid in Nursing Homes, There’s No Comparison Between Cuomo and Walz

Former Governor Andrew Cuomo and his political critics have something in common: They're both trying to drag Minnesota Governor Tim Walz into Cuomo's nursing home scandal. Cuomo’s attempt to hide behind Walz, li Read More

How 1199 Earns its Reputation as Albany’s No. 1 Labor Power Broker

For the fourth time in six years, the president of New York's largest health-care union, George Gresham of 1199SEIU, has won the top spot on the "Labor Power 100" list from City &am Read More

New York Runs Away from the Pack on Medicaid Spending

New York's per capita Medicaid spending jumped 14 percent in 2023, moving it further ahead of the rest of the country, recently released nationwide data show. In the federal fiscal year that ended last September, New York spent $95.6 billion on Medicai Read More

State Offers Taxpayer-Funded Health Coverage to Unionized Home Care Workers

In a new subsidy for the health-care union 1199 SEIU, the Hochul administration is allowing the union's benefit fund for home care aides to shift some members into taxpayer-funded health coverage through the Essential Plan. Read More