Medicaid: The Cure for What Ails You (part one)

It's rare in politics where one issue can clearly be recognized as one in need of action. In the case of Medicaid in New York state, the issue demands attention. The program's effects on the tax burden of New Yorkers is oppressive, and the sting is especially sharp here around Syracuse, Rochester, and Buffalo. Our areas' taxes are extremely high, which, when coupled with the economic doldrums our three areas face, paint an increasingly bleak future. Getting taxes down should be the number one priority, regardless of what end of the political spectrum you hail from. While some may favor reducing services, the first pass at reducing taxes should go to making the systems and programs more efficient. Which turns me back to Medicaid.

Currently, New York has the dubious distinction of having the highest per capita Medicaid costs (that means per person) of any state in the Union, more than doubling the national average. The Empire State also comes in first for overall Medicaid spending, beating out California by close to $10 billion dollars, with a grand total of $40.6 billion. State spending for Medicaid (separate from Federal and local spending) accounted for 25% of the New York State spending in 2003. I live in Monroe County, and we spent $831 million for Medicaid expenditures in 2003. This is more than the total spending of 8 other states!

The problem is compounded by the way the burden of costs are shouldered between the federal, state, and local governments. The Federal portion of Medicaid covers between 50% to 77% of the total bill, depending on the state in question. New York receives the lowest allowable percentage of 50%. The state also passes some of the costs onto the counties, one of 18 states that follows such a process. Again, our New York state leads the pack. Counties pay 18% of Medicaid costs, where in the next highest state, Iowa, counties pay only 11%. This "pass the buck" game also ends up saddling local governments with unfunded mandates over what care needs to be covered and what does not, regardless of the needs of the individual communities.

The problem is titanic, and it doesn't look any better from whichever side you consider it from. The growth of this program in New York state is far ahead of the per capita income growth. The unfunded mandates force us to cover optional services, which makes up 45% of the Medicaid budget.

The biggest problem of all is that this issue has not gotten any kind of attention. No taxpayer revolt. No profile raising event that forces it hard and strong on the radar of our representatives in Albany.

If there is one thing I do with my blogging, it will be to focus on this. There will be more posts to come.

Information for this entry has been gleaned from The Rump Group report Medicaid Inc. and The Democrat and Chronicle most recent Medicaid Reform Editorial Report