Whither Medicaid, or wither Medicaid?

By Joe Paduda

Contributing Columnist

Anxious, scared, frightened, concerned – those are the words people use when they talk about possible changes to Medicaid in Onondaga County. Those concerns are understandable; many have parents in nursing homes paid for by Medicaid, others have friends with kids insured under Medicaid, property owners are afraid their tax bills will increase, and more than a few folks know families that had no health insurance until Medicaid expanded.

I’ve been walking the neighborhoods of Skaneateles, talking with people to better understand their take on what’s going on in Washington. Two quick takeaways: First, while our older neighbors are usually more aware of and anxious about the Better Care Reconciliation Act (BCRA), Republican Senators’ name for their version of the ACA repeal bill, younger people are by no means ignorant or unconcerned.

Second, about half of the people I spoke with know that a big chunk of their County property taxes goes to fund Medicaid; that’s a lot more awareness than just a couple of months ago.  On average, 70 percent of your County property tax bill is for Medicaid – that’s over $100 million in total.

There’s also a growing acknowledgement that if Congress does slash Medicaid funding (the BCRA cuts Medicaid by about $900 billion over the next ten years) we will be forced to make some very tough decisions.  Does New York cut back on Medicaid coverage, tighten eligibility requirements and/or reduce benefits, or perhaps further reduce provider reimbursement? If the Federal government reduces its contribution to New York, what will happen to County taxes? Will there be a larger unfunded State mandate added to property owners’ tax bills?

All this won’t be resolved by the passage or defeat of the Republicans’ health care reform bills.  While there’s no doubt the current political leadership in Washington is bound and determined to slash Medicaid, it is by no means certain they have the votes to do that.  If the two “repeal and redo” bills in the House and Senate don’t pass, there are other efforts underway to add language restricting Medicaid coverage and funding in separate legislation before Congress.

Since 2014, the expansion of Medicaid has helped thousands more of our neighbors get health insurance. Today, about 70,000 people in Onondaga County – one out of six of us – are now enrolled in Medicaid.

Today, the cost of that Medicaid expansion is almost entirely borne by federal taxpayers. Congressional Republicans are seeking to push more of the cost down to the state level; it is entirely possible New York State will decide to go back on a previous commitment to cap county tax payments for Medicaid. This would likely result in higher County property taxes.

For individuals and families the Republican House bill known as the American Health Care Act or AHCA includes a provision requiring New York – and other states – to include home equity values above $560,000 when determining Medicaid eligibility.

When you put together people’s concerns about cost with fears about our neediest neighbors losing access to care, the reasons Skaneateleans are stressed are pretty obvious. New York’s healthcare costs per person are the sixth-highest in the nation while the State’s personal tax burden is, if not the heaviest, than certainly quite close. Yet we also have one of the older populations among the 50 states, and thus have more people who will be relying on Medicaid for more and more of their healthcare.

I recently joined the board of directors of a large Medicaid/Medicare healthplan in Boston and have seen just how effective innovations in healthcare delivery can be. There are a lot of ways we can make Medicaid dollars more effective, including better and earlier preventive care, incentives and dis-incentives to increase healthy behaviors, more intelligent and outcome-linked reimbursement, and better ways to bring care to the neediest.

What we don’t have is time; these changes take a lot of it, and we’ve got a lot to do.

Joe Paduda is Principal, Health Strategy Associates, LLC, Skaneateles, NY and Member, Board of Directors, Community Care Alliance, Boston Massachusetts.