Blair Horner: Governor Cuomo's Budget For Health Care

Feb 3, 2014

One of the state’s most important public priorities is ensuring that New Yorkers have access to affordable and high quality medical care as well as providing health services to those who are poor or needy.  Tens of billions of dollars are spent to meet those demands and this week the governor’s health budget proposal was the subject of a legislative public hearing.

Two key issues under consideration are the implementation of the federal health care reform act and the state’s public health programs.

The number of New Yorkers who lack health insurance is considerable.  According to the US Census Bureau, in 2012 roughly 2.1 million New York residents were uninsured (11.3 percent of the population). While this percentage represents a lot of New Yorkers, it is both the lowest percentage and the lowest number of New Yorkers who lack health insurance since 1999.

What has happened to drive down the number of uninsured?  The drop in the percentage of the uninsured has followed the timeline of the implementation of the federal health care law.  Starting in the Fall of 2010, coverage under the law started to kick in.  It seems reasonable to conclude that the changes brought about by the Affordable Care Act (ACA) contributed to New York’s decline.

The governor’s budget calls for continued funding of New York’s implementation of the federal Affordable Care Act, given the state’s significant reduction in the percentage of New York’s uninsured, is worth supporting.

Regarding the state’s public health programs, the governor has once again proposed dramatic – and possibly harmful – changes.

Last year the governor’s budget called for the consolidation of 89 public health programs coupled with a cut in funding of 10 percent.  Thankfully, both houses rejected the governor’s plan in their one house budget bills.  Unfortunately, the governor’s insistence on cuts to those vital programs resulted in a 5.5 percent reduction in funding.

This year, the governor’s budget is more limited, but the impact could be the same.  The governor proposes to consolidate 36 separate public health programs into 10 new programs that the governor argues have similar functions. The aggregate funding for these programs stays the same.  However, there is no guarantee that every single program will be protected from budget cuts.

Instead of clearly disclosing his budget proposals in an item-by-item basis, the governor instead re-allocates those public health programs into ten areas and allows the Health Department to award grants from that pool.  There is no obvious standard that the Department will use to allocate funding.

While the governor argues that these 10 new programs have similar functions, in some areas that is not at all clear.  For example, in the “Local health department public protection” plan lead poisoning programs and tobacco enforcement are lumped together.  What’s the logic of combining these program?  Other than they are the activities of the local health departments, nothing much.   Tobacco enforcement addresses problems of illegal sales to minors and complaints about smoking in public places.  Lead poisoning programs investigate the problems associated with exposures usually in indoor settings.

Lumping those two programs into one makes little sense.  So why is the governor proposing this consolidation?

Since the governor’s plan does not guarantee that these programs will continue to get current funding levels, and given that if it did there would be no reason for the consolidation, it is reasonable to assume that at least some of these programs will face cuts.

Hopefully, the response from the legislature will be the same – rejection. 

The governor’s budget will be subject to scrutiny over the next couple of months.  It contains measures worth supporting and worth rejecting.  Hopefully, the governor and lawmakers get it right; the health of New Yorkers is at stake.

Blair Horner is the Legislative Director of the New York Public Interest Research Group.

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