ALBANY, N.Y. (AP) — There's a debate in New York over the effects of an amendment to the Republican federal health care overhaul that only applies to the state.
House Republican leaders seeking to lock down votes from New York lawmakers have proposed shifting $2.3 billion in Medicaid costs from the state's counties to the state.
The amendment was a response to complaints that New York unfairly burdens its counties with a share of the nearly $60 billion health care program for the poor and disabled.
Critics are taking rhetorical flamethrowers to the last-minute amendment, calling it the "Buffalo Bribe," ''Poughkeepsie Payola" and worse. Democratic Gov. Andrew Cuomo on Wednesday called it an "absurd" measure that would devastate New York's health care system. A Buffalo-area congressman behind the amendment accused Cuomo of trafficking in "doomsday predictions."
Beyond the rhetoric, here's a guide to what's at stake and what could happen.
Total Medicaid spending in New York in 2015 was $59.8 billion, second only to California, according to the Kaiser Family Foundation. New York also has been measured among the top spenders per-enrollee. Analysts note that costs for many services tends to be higher in New York, which has one of country's more generous Medicaid programs.
In New York, the federal government covers 51 percent of Medicaid costs, the state pays 36 percent, while New York City and counties pay 13 percent. Many county officials dislike that breakdown, claiming the mandate is a reason property taxes tend to be high in New York.
The proposal championed by Republican U.S. Reps. Chris Collins of the Buffalo area and John Faso of the Hudson Valley would alleviate local governments in New York from paying a portion of the state's Medicaid charges. Faso, who developed the language, said the amendment excludes New York City's $5 billion in Medicaid expense because the Democratic stronghold relies on local income taxes instead of property taxes to support the program.
Rensselaer County Executive Kathleen Jimino said that if the amendment proposed by her fellow Republicans passes, her Hudson Valley county would be able to reduce county property taxes by 56 percent. That would translate into more than $500 saved for average county homeowner, she said.
"This is a unique opportunity to say, 'We're going to actually address property taxes," she said.
WHAT WOULD HAPPEN?
The proposal would leave a state with an already tight budget looking at more than $2 billion in additional Medicaid costs by 2020. That could mean cutting spending or raising state taxes.
"The amendment would make an even bigger hole in the state budget, specifically in the area that serves low-income kids and families, and disabled people and low-income seniors," said Kathy Breslin, president and CEO of the Albany-based Schuyler Center for Analysis.
As an expected Thursday vote on the bill neared, Cuomo projected how the "devastating" cuts would play out for hospitals in the districts of the Republican New York representatives.
Proponents of the switch, echoing the national Republican arguments, suggest cutting program costs and eliminating fraud. Faso's office said a state government that can come up with a "Buffalo Billion" for economic development projects can surely find the resources to manage its Medicaid finances.
But taxpayers' still could be left footing a sizable portion of the bill.
Lt. Gov. Kathy Hochul said this week the amendment would force the state to either raise income taxes or have the counties give back the share of sales tax they get in exchange for the state picking up the additional Medicaid costs.
"One way or another, it is still coming out of New York tax payers' pockets," Hochul said.