Social Security, Medicare and Medicaid accounted for more than $1 trillion of the $2.3 trillion the federal government spent in 2005, according to a report released by the U.S. Census Bureau earlier this month.
The report covers direct payments, grants, procurement awards, and salaries and wages by federal agency and program. The report does not include expenditures for selected intelligence agencies, international payments, foreign aid and interest on the federal debt.
New York and four other states ”“ California, Texas, Florida and Pennsylvania ”“ received one-third of all federal funds in 2005.
While Medicare and Social Security spending are determined at the federal level, Medicaid is a program that states have some control over.
About $45 billion of the state”™s annual budget is devoted to Medicaid, and some say one major reason for that is that New York allows more services to be covered than many other states under the program.
New York is also one of two states, along with South Carolina, where counties pay a portion of Medicaid.
Mark LaVigne, communications director for the New York State Association of Counties (NYSAC), said counties in New York have long complained about this, and for many smaller and rural counties Medicaid makes up a large portion of their budget.
He said counties saw significant relief two years ago when the state passed a law capping how much counties would pay for Medicaid at 3.5 percent the rate of growth for the program. Prior to that, counties paid a quarter of the total cost, with the state picking up a quarter and the federal government paying for half.
LaVigne said the local share of Medicaid was $400 million the first year of the cap, last year it was $200 million. The last year before the cap came into effect, the local share was $7 billion.
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LaVigne said NYSAC would like the state to take over the remaining local costs for Medicaid, but acknowledges that isn”™t likely.
“Can they afford to do it? Probably not,” he said.
Another problem: since New York allows so much to be covered under the program, that generosity might have to be reduced in order for Medicaid to be financially viable were the counties removed from the equation.
State Assemblyman Adam Bradley, D-White Plains, however, said that is a tricky ethical question to decide: what should and shouldn”™t be covered.
“Do we limit it at just emergencies, do we allow eyeglasses for children?” asked Bradley. “These are difficult questions to answer.”
Bradley said he is not sure if state taxpayers would ultimately save money if the state assumed control of paying for the counties”™ portion of Medicaid.
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“The only way the state could take it over is to raise more revenues, which means raising taxes,” he said.
Bradley said New York is also hurt because it is “shortchanged” by the federal government, which picks up half of the Medicaid spending for the state. In many other states, he said, that figure is 60 percent to 70 percent.
“That”™s where the problem begins,” he said.
He said it also may not make sense for a full state takeover of Medicaid because, “most areas Medicaid covers are administered by counties. In that case we should fully evaluate the role of county governments. It might not be a bad idea if it gets rid of county government.”
Jonathan Drapkin, president of the Mid-Hudson Pattern For Progress, agreed that New York does allow a lot of services to be covered under Medicaid, but, like Bradley, questioned where you draw the line.
“New York believes in providing a greater amount of services to its residents than other states,” he said. “Part of the criticism is we have a very generous menu of services; this debate happens all the time.”
Drapkin said the state has been attempting to crack down in recent years on Medicaid fraud, with reports placing those costs anywhere from $2 billion to $15 billion per year.
According to the state Medicaid Inspector General”™s Office, the state recovered $243 million in Medicaid fiscal year 2006.
The program cost every New Yorker an average of $2,112 in fiscal 2003, the latest year for which national data are available. That was 2.3 times the national average.
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