Gerald Benjamin, SUNY New Paltz, and Thomas Gais, Rockefeller Institute of Government


Republican Congressmen John Faso wants the federal government to require that New York State assume all of the nonfederal share of Medicaid costs incurred outside of New York City. He conditioned his support for the previous, failed efforts to repeal and replace Obamacare on inclusion of this requirement in the federal law; the Graham-Cassidy bill is said to include the requirement.[1] New York City and the counties now pick up 13 percent of the total state tab ($58.8 billion in Fiscal Year (FY) 2015). The cost for New York City is $5.2 billion.[2] The total at stake for counties outside the city is $2.3 billion.[3]  Not chump change.

The proposal outraged Governor Andrew Cuomo. He called it a “political Ponzi scheme,” evidence that the congressman violated “his oath of office to represent the interest of the people of the state of New York.…”

Neither Cuomo’s rage nor the failed GOP takedown of Obamacare has deterred Faso. He has vowed to find another path to force full state assumption of the nonfederal share of Medicaid costs in upstate New York. Indeed, the Sturm und Drang of zero-sum national partisan politics aside, the congressman’s idea may be good public policy, or at least a start towards good policy. But there remain a number of big, unanswered questions. If full state assumption is good for counties outside New York City, why not also for the city itself? Should the national government be dictating the financial relationships a state has with its local governments? And if so, why just for New York?

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