The House GOP plan to repeal and replace Obamacare could cost already cash-strapped city hospitals hundreds of millions of dollars and potentially blow a multi-billion dollar hole in future state budgets, officials said Wednesday.
The state would have time to prepare since the House plan wouldn’t go into effect until the end of 2019.
Even so, Mayor de Blasio warned it would have a “devastating” impact on 1.6 million city residents and pose a “tremendous danger” to the city’s hospital system.
“The discussions in Washington seem to leave out how devastating the impact would be on 1.6 million New Yorkers, and tens of millions of Americans,” the mayor said.
De Blasio projected that 200,000 people who use the city’s public hospitals would lose insurance under the bill, which would force taxpayers to pay those costs and result in hundreds of millions in additional deficits for the city hospital system.
The city has added 17,000 more people to the Obamacare rolls as part of a campaign to encourage sign-ups and is aiming for 50,000 this year, he said.
Local funds cannot be expected to make up for lost federal subsidies, de Blasio said. “We’re already looking at the first wave of budget cuts starting to come in … We’re bracing ourselves for a lot of challenges.”
“So I’m not going to speak at this point about any ways we would compensate. I don’t want to give Washington the easy out of saying localities will compensate, because at a certain point we literally will not be able to, because if we are cut on many, many fronts simultaneously, we’ll run out of options.”
The offices of Gov. Cuomo and state Controller Thomas DiNapoli on Wednesday continued to analyze the bill, but couldn’t give specifics on exactly how much it could cost the state if passed.
“The health care bill proposes deep cuts and changes that may leave more New Yorkers without health insurance and will shift more costs to the state,” DiNapoli said Wednesday. “This bill could cost New York dearly, especially in coming years.”
Cuomo had previously projected that a full repeal of Obamacare without a replacement would cost the state $3.7 billion. DiNapoli had pegged the cost at $5.7 billion.
Rep. Joseph Crowley (D-Queens) estimate the House bill could cost the state up to $6 billion. Rep. Louise Slaughter (D-Rochester) pegged the cost to the state at $3.7 billion.
“Long-term, it will have an effect in raising the cost for middle-aged and older people,” Crowley said. “The younger you are the less you pay, the older you are the more you pay.”
State Sen. Health Committee Chairman Kemp Hannon called the bill from his fellow Republicans in Washington “unacceptable” and “poor public policy.”
Hannon (R-Nassau County) cited several concerns. Among them was the curtailment of health care funding, and provisions freezing the Obamacare expansion of Medicaid.
He also pointed to the “questionable removal” of the Affordable Care Act mandate that everyone have coverage. He questioned “whether people would ever sign up again. They would maybe just wait until they got sick.”
Dr. William Streck, the chief medical officer at the Healthcare Association of New York State, which represents hospitals, said a repeal of the provision expanding the Medicaid program in New York could impact some 2 million people and cost the state potentially $4 billion.
One Affordable Care Act provision that could disappear provides massive federal funding to states that expanded their Medicaid eligibility up to up to 138% of the poverty level. New York benefitted from the policy more than all but one other state.
Under the bill, the state will be forced to decide whether to continue to provide the expanded Medicaid services, which would come with a huge cost shift from the feds to the state, or stop covering such people.
Streck also said the state could be hurt by a plan to place caps on Medicaid spending and make it more a block grant program that would likely reduce federal health care spending to the state.
New York hospitals will especially feel the pain, Streck said.
They will be forced to cover more costs if the uninsured rate goes up. And they will lose some of the offsets that helped them absorb some funding that had been eliminated under Obamacare. That could mean New York hospitals statewide could be out as much as $18 billion combined over the next decade, he said.
But Bill Hammond, director of health policy at the Empire Center for Public Policy, argues the bill could have been far worse for New York.
The bill, Hammond said, puts off the changes to the end of 2019, giving states time to prepare, and allows the Medicaid population expanded under Obamacare to decline through attrition.
He also said a cap that would be placed on Medicaid spending would not significantly affect New York’s future funding since the state spending has increased at a lower rate than what’s being proposed in recent years.
Sill, Assembly Speaker Carl Heastie (D-Bronx) said he is “very concerned” with the House GOP proposal. A new state budget is due by April 1, likely before the issue is resolved.
“I do believe in some form we’ll be back here, I’d say after (the June end of the legislative) session, to deal with whatever harmful things the Trump administration maybe proposing to New York,” Heastie said.
The state Senate Democratic minority conference responded to the House bill on Wednesday with a call to create a universal single-payer health plan for New York.
The Dem plan also includes safeguard provisions for the state Health Exchange created under Obamacare and other related insurance protections.
“Every hard working person and family in New York State has a right to affordable and quality health insurance,” Senate Democratic Leader Andrea Stewart-Cousins (D-Yoners) said. “That is why our Conference is taking action to advocate for a single payer plan while also ensuring that those currently covered thanks to the ACA here in New York State are protected from Trump’s immoral attempt to strip coverage from Americans and bring us backwards.”
The single-payer health plan legislation is sponsored in the Assembly by Health Committee Chairman Richard Gottfried (D-Manhattan).
“What they’re doing in Washington will damage Medicaid and health insurance for working people, and who knows what they’ll do to Medicare next,” Gottfried said. “It will ruin people’s health, their family finances, health care providers’ stability, and state budgets. The only way New York can afford to fill those gaps is with the savings produced by a single-payer system like the New York Health Act.”
