The 2013-2014 state budget was approved last week, marking the third on-time budget in a row. Three on-time budgets haven’t occurred in a generation, so there was a lot of back-slapping and “at-a-boys” at the Capitol.
What about the substance of the newly-approved budget? Every budget has its good points and its bad points; the final product is, after all, the product of compromise and negotiation. Sometimes those compromises make for good policy, sometimes they don’t.
In the health arena, the budget brought its own good news and bad news.
First the good news. When it comes to implementing the federal health care reform law, the Affordable Care Act, New York stays on track.
The Affordable Care Act is designed to offer health insurance to many Americans who lack coverage. Under the law, these individuals will start signing up for coverage this October and virtually everyone in America is required to have some form of coverage – either from the government, their employer, or purchased on their own – by January 1, 2014.
The budget implements the Affordable Care Act in New York State. It expands Medicaid coverage to individuals whose income is up to 133% of the poverty level. The government's definition of poverty is based on total income received. For example, the poverty level for 2012 was set at $23,050 (total yearly income) for a family of four.
The budget required that all health insurance companies which offer individual coverage must offer an out-of-network option in their policies offered in the health exchange. The health exchange is the place where people can go to buy affordable health insurance. The original budget proposal would have allowed plans to only offer in-network coverage to potential health exchange enrollees. The final budget will ensure that individuals who purchase their coverage will be able to get an out-of-network option if they need to do so.
The final budget also included state assistance for premiums for those families whose incomes are too high to qualify for Medicaid and yet who make up to 150% of the poverty level. The families currently get state support under the Family Health Plus program. As that program gets phased out, the final budget ensures that these families will continue to pay the same amount for their health exchange coverage that they now pay.
Then there was the bad news. Under the final budget, the state’s public health programs get pounded.
In announcing his 2013-2014 budget proposal in January, Governor Cuomo proposed a major change in the way the state funds 89 public health programs, including the state’s premier programs for fighting cancer, the Tobacco Control Program (TCP) and Cancer Services Program (CSP).
In addition to cancer, these programs also offered help for families with Alzheimer’s, lead poisoning, programs to improve nutrition and reduce obesity, among other things. The governor proposed to cut the combined appropriations of these programs by about $40 million or 10% of previous appropriations.
After an intense public outcry, both the Assembly and Senate in their own budgets rejected both the consolidation proposal and the programs’ cut in the governor’s budget.
However, final budget reduced by 5% the state’s public health funding, including money for things like breast cancer screening for the uninsured and monies to pay for educational and advertising efforts to keep kids from smoking.
That agreement will just mean more devastation caused by cancer and other health illnesses.
But the final chapter is not yet written. These agreements are only for one year and soon the governor will be developing his budget for next year – an election year.
As the governor and state lawmakers crank up their re-election bids remember to ask them: “Why did you cut funding for the state’s public health programs?” And for the governor, the additional question, “Why did you insist on it?”
Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.
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