ACA repeal would be costly for rural counties

Whether it’s now, or possibly in 2020, it looks like the repeal of the Affordable Care Act — commonly known as “Obamacare”, may have property tax consequences for Fulton County and other high-poverty rural counties in New York.

The ACA is a monstrous piece of legislation with many, many complex parts, one of which is the Medicaid expansion piece. As a participating state, New York state got about $476 million in extra federal Medicaid funding in 2016 as part of the expansion. The New York state Association of Counties recently created a chart illustrating the impact of the ACA repeal on county costs and found the loss of enhanced Medicaid savings for Fulton County could cost property taxpayers $703,918 in the first year of the pull back. For perspective, that increase alone would encompass 82 percent of the allowable property tax growth under the state cap.

For counties in the Adirondacks, it could cost $7.6 million in property tax increases. Hamilton County would face $55,040 in increases, Warren County would get hit with $630,000 and Saratoga County would take a walloping $1.5 million hit.

Gloversville 5th Ward Supervisor Greg Young’s guest column in last Sunday’s Leader-Herald tipped me off to this potential drawback of an abrupt cutoff of the Medicaid expansion. Young pointed out that the funding formula under the much- maligned ACA has helped Fulton County’s local share of the cost of Medicaid to fall by more than $1 million per year, each of the past two years, while simultaneously expanding the availability of health care to thousands of county residents.

I know many — and probably most — of the people in our area are against the ACA and are probably cheering for it to be repealed. But the law is so complicated, I suspect most will not be pleased with the results, particularly if it causes a dramatic spike in county property taxes.

I decided I needed more insight into what’s going on with the ACA repeal and replacement in Washington D.C., so I reached out to two of our local congressional representatives, Republican U.S. Rep. Elise Stefanik and Democratic U.S. Rep. Paul Tonko.

Stefanik recently came under some criticism from a town hall event held in Glens Falls Feb. 22 that invited her, but she was unable to attend due to another commitment. This was after she had authored a report urging lawmakers to be accessible to millennial voters, including using the town hall format.

This happened during the time period when many lawmakers were getting an ear-full from constituents about the potential drawbacks of repealing the ACA. Stefanik says she “sets the standard for accessibility and transparency in this office” and points to many events she has done to meet with constituents including “Coffee with your Congresswoman” and “tele-town halls” that allow people from her huge district to connect with her remotely.

I don’t have much of a history with Stefanik. She came to speak to the Leader-Herald’s editorial board once and she is without a doubt a very intelligent, articulate speaker, who also seems to be very hard — for me at least — to get in touch with.

Of all of the congress members I have interviewed in my 15 years of working in journalism, Stefanik, so far, has proven to be the most difficult to pin down for a interview.

She did have much to say, however, in the 15 minutes I got from her (I actually pushed it to about 20) including that her guiding principals for repealing the ACA include maintaining federal protections for people with pre-existing conditions and allowing children to stay on their parent’s plans until 26. She said she is advocating for the Medicaid expansion to be maintained until a freeze of funding increases at 2020 and wants New York state to stop mandating local property taxpayers fund Medicaid.

“This is a New York state problem. We put more down on the counties, there are more county mandates than any other state across the country and the New York delegation has been working specifically on this issue to get the entire portion of Medicaid off the backs of the counties,” she said. “Because of the budget problems in Albany, this has been punted to the counties. I’ve had a call with local elected officials, both county legislators, town supervisors and state elected officials [that have said] this is the No. 1 issue. We need to get the Medicaid mandate off of the backs of the counties and make sure we’re addressing it on the state level.”

I think Stefanik’s right that the state should pick up the local share of Medicaid, and I think nearly everyone in our area would benefit from that, but I’ve heard politicians talk about that for at least 10 years or more and it never seems to happen.

A long time ago, the counties preferred having that local aspect to the funding, out of fear that upstate counties might be forced to pay for downstate poverty –an absurd notion in retrospect — and perhaps a lesson about the unintended consequences of complex legislation. Stefanik explained her gradual freeze of the Medicaid expansion.

“I’ve been an advocate for a multiyear process, so we can make longer-term plans,” she said. “There are some Republicans who are advocating for an immediate stop of Medicaid expansion. The proposal on the table would be a freeze in 2020. It would also allow the state to continue its Medicaid expansion, the federal match would just go from 90 percent to 50 percent.”

I tried to get Stefanik to tell me whether she’d vote for an ACA repeal even if it included an abrupt Medicaid expansion pull back, but she wouldn’t say. She repeated she strongly supports a multi-year approach with a freeze until 2020.

I called Tonko’s office Friday afternoon after talking with Stefanik and he got back to me within two hours. Admittedly, he has a long standing relationship with this paper and I’ve interviewed him many times. He blasted the ACA repeal as a reform that will grant a $7 million tax cut each to 400 wealthy families in the U.S., while cutting back on funding for health care for the poor, hurting the finances of rural hospitals, like the ones in our area, and placing in jeopardy the lives and the finances of the sick and the elderly.

Tonko said he believes the House Republican reform bill currently delays most of the negative consequences of the reform until after the midterm election and then after the next presidential election, in 2020, as a means of confusing the public as to the ramifications of repealing the ACA.

“It does not improve the quality of care, it does not improve access, in fact 10 to 15 million people, according to one think-tank, will lose their insurance,” Tonko said. “I find this very vulgar. You’re asking my counties to pay more. You’re asking my people to have less availability, access and affordability for good insurance, but you’re giving millionaires and billionaires a tax break. When does that stop?

“If that’s not egregious enough, they are imposing an age tax that allows insurers to charge an older person five times that of a younger person, or more. I think that age tax is going to most poignantly affect 50 to 64 year-olds, who will be most impacted by this change and representing a lot of seniors, a rural territory and many people, I think 62,000 people, who went onto the [Medicaid] expansion in my district — I don’t want to risk that.”

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