George Pataki’s proposed budget for health care is a devastating package that
is especially cruel and insensitive to working people and their families and takes
funds away from patient care. It would cut health care spending in the state
by more than $1.45 billion, including direct cuts to Medicaid and increased taxes
on nursing homes, hospitals, and home care agencies. The New York City health
care system alone would lose over $875 million.
Many think of Medicaid as a program for poor adults.
But 70 percent of Medicaid spending pays for care for
the elderly and disabled, and half of the rest is for
children. Medicaid reimbursements keep our hospitals,
nursing homes, home care agencies, and community
health centers afloat.
In previous budgets, the governor mainly tried to cut
funding to health care providers, making it harder for
them to serve all of us. But this year, his cuts would take
coverage and services away from hundreds of thousands
of less politically powerful people -- working people, the elderly and disabled adults.
TARGETTING LOW-WAGE WORKERS
Plus, the Medicaid expansion that covers low-income
working adults (e.g. a family of three with a gross
income under $23,000 a year) , is targeted for cuts. Governor Pataki proposes
that anyone who works for a company with more than 50
employees, or who has had health coverage within the
last 12 months, would be ineligible for Family Health Plus.
So, an under-paid Wal-Mart worker who
cannot afford health benefits would be barred.
The administration says it is doing this because large
companies should provide coverage for their workers.
And they should. But why penalize the workers? Does the governor think
that people with low-wage jobs at big companies have
the leverage to make their employers provide
The budget would require people covered by
Family Health Plus to pay part of the cost for doctor
visits, hospital stays and even ambulance services,
increasing costs for taxpaying New Yorkers who are
barely above poverty. And people on Family Health Plus
would no longer be covered for going to the eye
doctor or dentist.
HARDER TO GET LONG-TERM CARE
The budget would make it harder for senior citizens to
qualify for Medicaid coverage for long-term care
(nursing home or home care). People needing such care
must spend any assets they have above a certain amount on their care before Medicaid steps in. If the person transferred assets to someone else
(e.g. a family member) before applying, Medicaid counts the value of those assets as if the person still had them for three years after the transfer.
The governor would extend the look-back to five years
back from the date of application (not the date when the asset had been transferred). So,
if an elderly person pays for a grandchild’s college
education and four years later goes into a nursing home this
year, the governor would deny that person Medicaid for five years.
Supposedly this would keep people who can afford their
own care from taking advantage of Medicaid. Actually,
it would require people of modest means to impoverish
themselves to pay for care or would pressure family
members to give up their careers to care for an
elderly relative. People who can afford lawyers can
use trusts and other arrangements to get around these
It is ironic. If you are very wealthy and die,
Republicans want you to be able to leave your entire
fortune to your family without any estate tax. But if
you are middle class and frail, they want you to spend
your life savings on health care, leaving you with
little or nothing to pass on to your family.
COST OVER QUALITY IN DRUGS
The governor is in the right ballpark in proposing a preferred drug list for Medicaid. The only Medicaid providers whose rates of payment are
virtually unregulated by New York’s Medicaid program
are the drug companies. Now, the governor has proposed
a preferred drug list for Medicaid. A preferred drug
list/prior authorization program â€“ if done right â€“ can
dramatically reduce what we pay to drug companies. It
can encourage doctors to focus on effectiveness and
cost, without restricting their patients’ access to
needed drugs. But the Pataki proposal gives too much
weight to cost rather than quality in determining what
drugs would go on the preferred list and would allow
state bureaucrats to override a physician’s judgment
on what drug to prescribe a patient. In upcoming budget talks, the Assembly will
work to negotiate a good system.
The budget refers vaguely to promoting "case
management" of "high-cost cases." Effective
management can mean better care and lower cost, but it can only be done if a patient is covered by a plan over an extended period of time.
Today, people are constantly dropped from Medicaid
only to re-enroll months later, because of outdated
bureaucratic requirements. The Assembly has fought to cut red tape to promote stable coverage and better management of care. The governor
opposes these reforms.
THE CALIFORNIA QUESTION
often, for example, ask why New York spends so much
more than California per Medicaid recipient. The
implication is that we must be spending money we don’t
need to. But there are good and important reasons for
For one, New York has shifted most of its mental
health spending into Medicaid. We are smart to do
that, because the federal government helps us pay for
Medicaid. California does not do that, so its state and
local governments end up paying the whole bill.
We provide good care for elderly and disabled
patients, including much more home health care than
California. If we did not, many New Yorkers
would receive no care, become impoverished paying for
care, or their family members would have to disrupt
careers to care for them.
New York’s payments to hospitals, nursing homes, home
care agencies, and health centers are more closely
related to the real cost of providing care than
California. That supports the health care system that
we all depend on. If funding is cut -â€“ whether by
Medicaid cuts or more patients being uninsured â€“- then
staffs will be reduced and services stretched thinner.
Even the wealthiest patient will get poorer quality
care, and lives will be in jeopardy.
California’s Medicaid program is actually one of the
worst in the country â€“- spending less per recipient
than any state, including Mississippi. New York’s
Medicaid spending is not much different from
neighboring states like Connecticut, New Jersey and
In health care, as in education and other human
services, cutting is not reform. The real solution to
the inefficiencies and inequities in health care and
health care financing is to move
toward universal coverage with broad-based public
financing. Governor Pataki’s proposed budget is a
major step in the opposite direction.
Richard Gottfried is a member of the New York State
Assembly. A Democrat from Manhattan, he is chair of
the Assembly’s Committee on Health.
The comments section is provided as a free service to our readers. Gotham Gazette's editors reserve the right to delete any comments. Some reasons why comments might get deleted: inappropriate or offensive content, off-topic remarks or spam.