So what is the Faso-Collins amendment to the AHCA?

As debate over the American Health Care Act rages, New York officials have turned their attention to an amendment added to the bill Monday that would result in Medicaid costs currently shouldered by counties being shifted to the state.

The cost of such a shift would be $2.3 billion if and when it takes effect in 2020, assuming of course the legislation passes both houses of Congress in its current form.

They call it the Collins Amendment (or the Faso-Collins Amendment or the Collins-Faso Amendment or, if you like salacious names, the Buffalo Bribe). The name(s) comes from Reps. Chris Collins and John Faso, upstate Republicans who are behind this push. But what would it actually mean for New York?

Glad you asked:

As stated above, this amendment would require that the state picks up the tab it currently puts off on counties when it comes to paying for Medicaid.

Simple enough. Could I read the amendment?

Sure. The full package of amendments (known as the manager’s amendment) to the AHCA that were added Monday night is below. Page 9 is where where the Faso-Collins piece is.

Faso AHCA Amendment by Matthew Hamilton on Scribd

So, um, what does all that legalese mean?

In an interview, Faso told CapCon that the amendment would impact only New York. He contends it gives the state two-and-a-half years to plan for the cost shift. It also gives the state an ultimatum: Absorb the county costs or be penalized in terms of federal funding worth the same amount ($2.3 billion).

When would this take effect?

2020.

Why would this impact only New York, not other states?

It’s true that some other states require counties to help pay for Medicaid. But as written, the amendment would require that only New York pick up the county tab.

Faso has repeated this fact ad nauseam: Local costs in New York (that includes roughly $5 billion in New York City, which is not subject to the cost shifting in this amendment) are $7.2 billion. Estimates for local costs across the entire country are at just over $9 billion.

How much in terms of percentage do counties pay versus state and federal Medicaid payments?

According to the Cuomo administration, the breakdown is 13 percent from counties, 36 percent form the state and 51 percent from the federal government. The administration also is quick to point out that it has been absorbing county-level costs for some time now. The split used to be 25-25-50.

What’s the big deal in the first place? Is it really that costly for counties to pay for Medicaid? Thirteen percent seems like a small number.

The Empire Center, a fiscally conservative think tank in Albany, put out a spreadsheet on just how much in property taxes at the local level goes to Medicaid. That is here.

Statewide, Medicaid is funded by 41 percent of property tax revenues at just the county level, according to the Empire Center data. When all local property tax revenues are added in, Medicaid eats up about a 7 percent share.

In some counties, the costs are worse than others. In Fulton County in the greater Capital Region, Medicaid is funded by 15 percent of all local property tax revenues. Looking at Medicaid as a share of just county property tax revenues, it’s 50 percent.

Compare those numbers to Albany County. Per the Empire Center analysis, Medicaid is a 72 percent share of county-only property taxes. When all property taxes from other jurisdictions are factored in, it’s a 9 percent share.

What you’re saying is the local property tax bill goes down if the Medicaid costs shift?

That is the theory that upstate House Republicans are operating under. Faso’s office estimates that individual county property taxpayers would save $358.72 annually once the costs are shifted.

But wait, won’t the money have to come from somewhere? I mean, even if my county property tax bill goes down, how would the state make up the revenue?

And now you see why this is getting messy.

First, let’s look at Faso’s contention. He claims the state can look elsewhere in its budget for cost savings and continue to reform its Medicaid program (the Cuomo administration estimates the Medicaid redesign has saved $34 billion for the state and feds).

Next, here’s state Senate Majority Leader John Flanagan on WCNY’s “The Capitol Pressroom” Tuesday morning: “At the end of the day, we’re all talking about the same taxpayer. Village, town, county, state, federal, whatever it may be. So who’s footing the bill? Do I think it’s worthy of discussion to have really intense conversations about Medicaid? Yes.” He later told reporters he is skeptical of the amendment.

Then there are the human costs that Gov. Andrew Cuomo’s administration says could be incurred here. At a Tuesday press conference, Cuomo, state Medicaid Director Jason Helgerson and top health care union and hospital group heads spelled out a doom-and-gloom scenario in which New Yorkers lose health coverage because the Medicaid funding goes away. The administration says some 250,000 total in Collins’ and Faso’s districts are at risk of losing health care through Medicaid, as are some 7 million people statewide. They also point to hospitals and nursing homes facing dire financial straits that could lead to closures and service reductions.

Of course, that scenario assumes that the $2.3 billion in question here is never picked up.

“You tell me what kind of a representative takes an action that is adverse to their own district, adverse to their own constitutents,” Cuomo said. “Normally (as) an elected official, you fight for your constitutents. You try to deliver for your constituents. They are literally doing actions that will hurt the district because their politics come first. They have sworn allegiance to (House Speaker Paul) Ryan and the radical right.”

Right or wrong, this is just one piece of the AHCA. What’s the overall impact of that bill?

State officials have been expressing concern about the Affordable Care Act repeal and replace plan for some time. Per Cuomo’s Department of Health, more than 1 million New Yorkers would face a significant loss of health coverage, and $4.5 billion in costs would be shifted to the state, counties and hospitals over four years.

So, in 2020, overall state, county and hospital costs of the AHCA and the Faso-Collins amendment are projected at $4.7 billion ($2.4 billion in annual AHCA costs; $2.3 billion in costs to the state for shifting Medicaid).

All of that sounds like it’s making the state budgeting process difficult.

It sure seems that way. Assembly Speaker Carl Heastie previously has been open about the specter of a special session later this year, well after the April 1 beginning of the new fiscal year, to re-open the budget and adjust for financial impacts of the AHCA.

“We have a legislative calendar, we have a legislative schedule and we have due dates by law that we’re supposed to meet in terms of the budget,” Flanagan said Tuesday. “I want to be very clear in terms of how I’m going to say this because I don’t want to make it a complete direct analogy, but when September 11th transpired, we were called back into action, working with the federal government. Obviously you never want to see something like that happen, but if there are huge events that happen at the federal level that require us to come back into session, I’m very confident that the governor would not only calls us back that we would come back, both the Assembly and the Senate.”