Reprinted with permission from the Times Union
ALBANY–Congressman John Faso (R – 19th) will vote for the American Health Care Act when it comes to the House floor Thursday, he told the Times Union on Tuesday.
As the House GOP’s Affordable Care Act repeal and replace bill gathers steam, Mr. Faso moved into the Yes column with the addition of “manager’s amendments” on Monday night. Those tweaks to the original legislation include an amendment backed by Mr. Faso and introduced by Congressman Chris Collins (R-27th) that would give New York state–and New York state only–an ultimatum: Absorb $2.3 billion in Medicaid costs shouldered by counties outside New York City beginning in 2020 or risk losing federal funding of the same value.
His goal is to reduce county property tax burdens by getting rid of in some cases the most expensive cost for county governments.
But that amendment has drawn a sharp rebuke from Governor Andrew Cuomo’s administration, with the governor himself on Tuesday angrily charging that the “rabid conservative ideology” behind the amendment, the full AHCA and President Donald Trump’s budget is telling New York “to drop dead.”
Mr. Faso’s response, “It’s always easier to spend someone else’s money.”
Of the overall AHCA proposal, the congressman was nuanced. “There are a number of provisions in the bill that I don’t like,” Mr. Faso said when asked specifically about one piece that would freeze funding for reproductive health services and abortions for one year. “But on balance, I think it moves the process forward to fixing what is wrong with the (Affordable Care Act).”
He said he likes amendments to enhance an advanced refundable tax credit and per capita grants for the state that would go toward the disabled and elderly in nursing homes.
Still, Mr. Faso said there are things he would like to see improved as the bill moves through the Senate, assuming that it makes it through the House. The Kinderhook Republican also said he believes there is an opportunity for further adjustments through the federal budget process, such as re-implementing public health funding (should it be slashed) that is afforded under the current ACA.
It’s the Medicaid spending amendment that is Mr. Faso’s baby. He first proposed legislation shifting county costs to the state on the campaign trail last year and has been an advocate on this issue for decades as he toiled in the Assembly Republican Minority.
Now that he’s in the House Republican Majority, it took him just two-and-a-half months to get ground-shaking policy for New York to the floor.
While Mr. Faso may not like provisions such as the reproductive health service spending freeze, he sees huge positives for local property taxpayers. Voting for the freeze is potentially poisonous for him because he has held that Planned Parenthood funding shouldn’t be cut out of “political spite” as long as clinics provide services in a legal and licensed way. But his office estimates that individual county property taxpayers would save $358.72 annually once the costs are shifted.
By contrast, Governor Cuomo projected that if the amendment becomes law 250,000 residents in Mr. Collins’ and Mr. Faso’s districts are at risk of losing health care through Medicaid, a chunk of some 7 million people statewide. They also point to hospitals and nursing homes facing dire financial straits that could lead to closures and service reductions.
That scenario assumes that the $2.3 billion in question is never borne by the state.
“What happened to putting people before your politics?” Mr. Cuomo asked. “Rather than swearing allegiance to the (House Speaker Paul) Ryan radical right, why didn’t they think about representing the people in their district? Why didn’t they think about the oath that they took and put their politics aside? That’s what this is about. They have declared war on New York, and this is just the beginning.”
State Senate Majority Leader John Flanagan (R-2nd) told reporters that he is skeptical of the Faso-Collins amendment. The crux of his argument is this: Under the current Medicaid financing structure, counties pay 13% of costs, the state shoulders 36% of costs and the federal government picks up the remaining 51%. So if the county costs are pushed onto the state, who foots the bill? “It’s the same taxpayer at the end of the day,” he said.
“I would go back to some basic questions,” Mr. Flanagan aded. “Does that mean that if this happens, the counties’ are going to reduce their sales tax or their property tax? Or are they just going to continue to spend at different rates?”
Ultimately, Mr. Faso and House colleagues will also face criticism over more than just the Medicaid cost-shifting. According to the state Department of Health, more than a million New Yorkers would face a significant loss of health coverage, and $4.5 billion in costs would be shifted to the state, counties and hospitals over four years if the AHCA is approved.
In 2020, overall state, county and hospital costs of the GOP’s AHCA and the Faso-Collins amendment are projected at $4.7 billion ($2.4 billion in annual costs related to the original AHCA; $2.3 billion in costs to the state for shifting Medicaid). That has made for an uncertain opening to the state budget season. Legislative leaders already have raised the specter of a special session later this year to address losses in federal aid for health care.
The budget must be approved by April 1.
To contact reporter Matthew Hamilton email