Loud criticism of the American Health Care Act from politicians and health care groups increased on Wednesday, with the Obamacare replacement plan expected to come to a vote in the House of Representatives on Thursday.
Deriding the proposal as "Trumpcare," Sen. Charles Schumer, D-NY, and Gov. Andrew Cuomo said the bill's Medicaid cuts and insurance changes could force deep job cuts in the health care industry, as well as causing millions of people to lose insurance coverage.
"I am doing all I can to oppose Trumpcare because it hurts upstate maybe more than anywhere else, because we have generous Medicaid," Schumer said in a conference call Wednesday from Washington, D.C., on Wednesday.
The New York Times reported that the bill, which has the support of the House's Republican leadership and President Donald Trump, appears about 25 votes short of passage. It has been criticized from both the left and the right.
A key part of the legislation would convert Medicaid into a program of capped block grants for the states to administer, distributed regardless of actual need, AHCA opponents contend. The state spends about $60 billion a year on Medicaid, with federal, state and county money all going into the program.
Schumer said 60 percent of Medicaid payments go to nursing homes, and the Medicaid expansion under current law -- which would be eliminated -- is also paying for opioid addiction treatment programs. Medicaid also pays the long-term care costs for many disabled individuals.
"Thirty years ago Medicaid was a program for the poor," Schumer said. "It's become a program for the middle class, nursing homes and opioid care."
Cuomo said the bill's Collins-Faso amendment -- which would require the state to take over $2.3 billion in Medicaid costs now paid by New York counties -- would require the state to raise income taxes as much as 10 percent or make dramatic cuts that he said could even force the closure of hospitals and nursing homes. The amendment is named for co-sponsors U.S. Reps. Chris Collins, R-Lancaster, and John Faso, R-Kinderhook. Faso represents the 19th Congressional District, which includes Schoharie County and most of Montgomery County.
Cuomo said the state can't afford to spend another $2.3 billion on Medicaid without a tax increase.
"Either we could pass on the devastating cuts to our hospitals, nursing homes and the 40 percent of New Yorkers who currently receive Medicaid and health benefits, or we would be forced to raise state income taxes," Cuomo said Wednesday.
An analysis by the state Department of Health showed that if the money were cut from Medicaid, hospitals in Faso's 19th Congressional District would lose $13.7 million in funding. Among them, Cobleskill Regional Hospital in Schoharie County would lose $270,000, according to Cuomo. The 21st Congressional District, where U.S. Rep. Elise Stefanik, R-Willsboro, has also endorsed the amendment, would see $20.2 million in hospital cuts, including $4.5 million at Glens Falls Hospital and $1.6 million at Nathan Littauer Hospital in Gloversville.
"To devastate our health-care industry will not only affect millions of lives, but disrupt one of the state’s main economic engines," Cuomo said. "Health care is a pillar of the New York economy."
Faso late Wednesday defended the amendment, which he said would save property taxpayers money and force the state to reform its Medicaid spending.
“Governor Cuomo’s falsely represents the choices the state will face if the AHCA legislation is enacted," he said. "The vast majority of states in the nation don’t force property taxpayers to pay a portion of the state’s cost of Medicaid.
"After 51 years of poor public policy in New York state, the Faso/Collins amendment will finally force Albany and Mr. Cuomo to fix this situation," Faso added.
Republicans in the state Assembly seized on Cuomo's reference to a tax increase and accused him of making threats.
"The New York state budget is made up of $152 billion. I’m certain that there is funding in there for Medicaid, however, the governor would rather hike taxes to pay for it," said Assemblywoman Mary Beth Walsh, R-Ballston.
Capital Region health care providers didn't say they'd close, but they acknowledged deep concerns about the Republican bill, which will face stiff opposition in the U.S. Senate even if the House approves it.
"Given the projections about the number of people who may lose insurance coverage and the potential negative fiscal impact, Albany Medical Center has serious concerns about the repeal of the ACA and the current replacement legislation," said James Barba, president and CEO of Albany Medical Center, the region's largest hospital.
Officials at Ellis Hospital in Schenectady referred a request for comment to the Healthcare Association of New York State, which represents hospitals and nursing homes across the state and has been outspokenly against the bill.
"It would threaten health care for millions of New Yorkers, create a fiscal crisis for the state, and burden hospitals and health systems with fewer resources and more uninsured and under-insured patients," Bea Grause, president of HANYS, said in a statement.
A group called the Protect Our Care coalition estimated 579,000 New Yorkers would lose their insurance coverage.
In an interview, HANYS medical director Dr. William Streck, a former 30-year CEO of Bassett Healthcare Network in Cooperstown, said the basic bill would harm New York state, even without the Collins-Faso amendment.
"It would cost the state billions of dollars, and how that would be made up is not clear," Streck said. "People still get sick. The need for care is still there. Something would have to give ... Some hospitals may not be able to handle that stress."
Hospitals already operate on thin margins, he said, and rural hospitals like those in Cobleskill and Cooperstown operate on even thinner margins. Those hospitals also generally serve higher percentages of the poor and elderly than larger hospital, Streck said.
"If you look historically at the way cuts were handled in the past, programs are reduced and growth is constricted," Streck said. "The last thing anyone wants to do is eliminate jobs, but in the long term jobs are threatened."
Republican lawmakers noted that New York's Medicaid program is the second most expensive in the nation.
"New York state has one of the most expensive Medicaid programs in the country," Faso said. "This is because state government is not required to pay for the full cost of the program, instead raising revenue from county taxpayers to subsidize it."
“Counties across my district and across New York are being unfairly subjected to massive financial liabilities being imposed by the state that can have severe impact on our local property taxes,” said U.S. Rep. Elise Stefanik, R-Willsboro, who is another co-sponsor of the Collins-Faso amendment. “This amendment would make New York state take responsibility for their own budgeting, freeing up needed funds at the county level for local governments to use in our communities."
Last week Faso said in an interview that predictions that millions of people will lose their insurance coverage don't consider administrative changes to be made at the Department of Health and Human Services that he believes will increase choices for insurance customers, giving them options less expensive than the premiums they pay now under Obamacare.
Stefanik has co-sponsored a separate bill that would allow small businesses to band together to buy health insurance for their employees.