The Triumph of the Medicaid program

One big health care story in the wake of the failure to repeal Obamacare is the triumph of the Medicaid program, both in New York and the nation.  Quinnipiac released a poll a few days before the Republican setback showing broad public opposition to the repeal, and one question asked the American public if it supported or opposed cutting Federal funding for the Medicaid program: the answer -No-opposed- by a margin of 74-22. The breakouts by group were extraordinary- Whites opposed cutting 72-23, nonwhites,82-17. Republicans opposed cutting by 54-39. Non-college whites opposed cutting the program 66-29. The poll included over 1000 registered voters.

When Governor Cuomo announced in January that Obamacare repeal would result in the loss of health coverage for 2.7 million New Yorkers, there were already 6.3 million New Yorkers on the Medicaid and CHIP programs, according to HealthInsurance.org. The Kaiser Foundation reported that 2.5 million New Yorkers had acquired coverage from the Medicaid expansion, as well as the private insurance component, between 2013 and 2015. Now 30% of New York’s population is enrolled in the Medicaid and CHIP program, and 94% of New Yorkers have health insurance!!

The national figures are also extraordinary. Medicaid.gov reported that 74 million Americans were enrolled in Medicaid or CHIP in December 2016, nearly 23% of the population. That figure compares to 58 million enrolled in the July-September 2013 period, just before Obamacare began in January 2014, a gain of 16 million. These new enrollments included many people who had actually been eligible for Medicaid before the Affordable Care Act, but were pulled in, at least in part, by the broad national outreach effort to get more people to enroll. These figures don’t include the 11 million people enrolled in private insurance through the HealthCare Exchanges, most of whom are also subsidized. New York integrated the Medicaid program with its NYStateofHealth Exchange so that a person could enroll in the public program or a private program through the same exchange. But 90% of the coverage beneficiaries in New York enrolled in Medicaid, not the private insurance.

In 2007, the year before the Great Recession, 47 million Americans were enrolled in Medicaid and CHIP. Today it is 74 million. Tens of millions of Americans just above the poverty line got the help they needed and now the Republicans have figured out it is hard to cut a program that has broad national support.

The top priority in the State budget this year is the renewal of the multimillionaires’ tax.

Failure to renew the tax, which expires Dec.31 of this year, will result in a $3.3 billion revenue loss to the State in 2018. That revenue loss concern is compounded by another tax cut enacted last year, the second ” middle class income tax cut ” enacted during the Cuomo years. Advanced by the Republican Senate during the 2016 budget, Cuomo and the Assembly agreed to the proposal with a long phase-in until 2024. While its impact is negligible now, next year, in 2018, the ” middle-class income tax cut ” results in a $1.1 billion revenue loss to the State. The Republican Senate’s resistance to renewing the multimillionaire’s tax this year will have significant consequences: if you added the two reductions together for next year, the revenue losses grow to $4.4 billion and start forcing reductions in spending on school aid, health care, and transportation.  Revenue losses from the middle-class tax cut grow to $4 billion a year by 2024.