Governor Cuomo's response to New York's big Medicaid deficit, as laid out in his budget presentation on Tuesday, was a disappointing mix of delay, deflection and delegation.
The cash flow of New York’s Medicaid program has become increasingly volatile in recent years, a byproduct of questionable fiscal maneuvers that spawned the current $4 billion deficit.
The ball in Times Square isn't the only thing dropping on New Year's Eve: The state Health Department also announced a 1 percent reduction in most Medicaid payments.
Governor Cuomo says that controlling the cost of prescription drugs will be part of his agenda in 2020. Four bills currently awaiting his signature or veto give him a chance to get started on that promise in 2019.
The remarkable thing about state's multi-billion-dollar Medicaid crisis is that it is almost entirely the result of the Cuomo administration's own actions. There is no economic downturn or change in federal policy that explains the program's current $4 billion deficit, or its $3 billion projected gap in the next fiscal year, as confirmed in Friday's mid-year update to the state financial plan.
The 1199 SEIU contract that the Cuomo administration subsidized with Medicaid money last year included a potentially nine-figure payment to the union's lobbying arm, which has spent millions on TV ads praising Governor Cuomo's health policies.
At the midway point of the fiscal year, New York's Medicaid health plan has already spent 61 percent of its state-funded budget, according to the latest cash report from the comptroller's office – putting the program on track to end the year with a $2.9 billion shortfall.
The budget crisis in New York’s Medicaid program stems from the failure of a key cost-control measure adopted during Governor Cuomo’s first term. In 2011, Cuomo and the Legislature imposed a “global cap” on state Medicaid spending that was tied to the medical inflation rate. The measure showed signs of working at first, but lost its effectiveness as circumstances changed, loopholes multiplied and compliance faltered.
Federal officials are reviewing the state's expropriation of $2 billion from the sale of Fidelis Care health plan, potentially throwing a wrench into the Cuomo administration's plans for using the money.
A little-discussed hazard of creating a state-run single-payer health plan in New York would be its vulnerability to the business cycle. It would depend heavily on taxes collected from high-income New Yorkers, a source of revenue that's especially prone to booms and busts. A recession – or a downturn in the stock market – could easily open a budget hole not just in the billions of dollars, but in the tens of billions of dollars.
Bucking the national trend, New York's uninsured rate dropped for the eighth consecutive year, new data from the Census Bureau show. The share of New Yorkers lacking health coverage in 2018 was 5.4 percent in 2018, down from 5.7 percent the year before. The number of people lacking health coverage dropped by about 72,000, to just over 1 million. Both the rate and the number are roughly half what they were in 2013, the year before the Affordable Care Act went into effect.
Sen. Chuck Schumer raised the alarm Tuesday about a pending reduction in Medicaid funding for safety-net hospitals, which he said would have "devastating" effect in New York. His warning was misleading in several ways, not least because it left out an important bit of context: Schumer himself voted for the cuts he was deploring. In effect, he was taking credit for trying to clean up a mess he had helped to create.