Obamacare had the Cornhusker Kickback.
Now, it looks like Trumpcare will have the Buffalo Buyout.
As House Republicans prepare this week to vote on the American Health Care Act ― the legislation that would repeal the Affordable Care Act ― congressional leadership is doing what leadership often does when scrambling to secure votes: offering legislative goodies.
Among the sweeteners leadership is handing out is a seemingly arcane change to a Medicaid funding formula that appears to be an attempt to help rural districts in New York. Those districts count among their representatives four GOP members who have shown at least some reluctance to passing the health care legislation: John Faso, Claudia Tenney, Elise Stefanik and John Katko.
Rep. Chris Collins (R-N.Y.), the Buffalo-area Republican who was the first lawmaker to endorse Trump’s 2016 bid for the presidency, has taken the lead on the proposal. But the amendment, which has been attracting attention in the local press, appears tailored to win over those three or four moderate GOP votes.
An aide to a New York GOP member with knowledge of the situation told The Huffington Post on Monday that the inclusion of the amendment would have a “large impact” on those members voting for the final product, with all but Katko thought to be leaning toward support. And, the aide said, New York GOP offices were “confident” the language would be included in a manager’s amendment.
New York is one of at least 16 states that call upon local governments to contribute money for Medicaid, the program that provides health insurance to low-income people and that the Affordable Care Act expanded dramatically.
Partly as a result of that expansion, the percentage of New York adults without insurance fell from 12.6 in 2013 to 7.0 in 2016, according to the Gallup Healthways Well-Being Index.
But politicians in New York’s rural counties have complained frequently about the burden, saying that it drives up their property taxes. During the 2016 campaign, Faso proposed amending Medicaid law so that states could no longer demand counties contribute.
The amendment would attempt to accomplish the same thing. And it would apply only to local jurisdictions with less than 5 million residents ― thereby excluding residents of New York City, whose city income taxes also contribute to state Medicaid funds and where the population exceeds 5 million.
According to a background document on the amendment obtained by HuffPost, New York counties contribute $7 billion to New York’s roughly $27 billion annual Medicaid liability, with $2.2 billion of those coming from outside New York City. By shifting those costs onto the state, in theory, counties could either lower property taxes that help pay for Medicaid, or spend the money on other programs.
Proponents of the amendment argued that, by forcing the state to make do without county contributions, the state would have to think twice about how much it is spending ― and to find ways of economizing.
“New York State is not realizing the financial impact of its out-of-control Medicaid policy,” the background document from Collins’ office reads. (New York spends 44 percent more per Medicaid beneficiary than the national average ― in part because health care in New York, like pretty much everything in New York, is unusually expensive.)
But New York Democrats were quick to blast the proposal. In a prepared statement, Lt. Gov. Kathy Hochul warned that the shift of Medicaid costs over to the state government would take place at the same time the federal government was cutting its own contribution, as part of the GOP repeal effort.
The result of this “one-two punch,” she warned, would be some combination of higher taxes and benefit cuts. “New Yorkers will be at risk of losing their healthcare, hospitals will be forced to lay off workers, and our vulnerable elderly will find it much harder to afford nursing home care,” she said.
Other critics wondered whether the effort could boomerang, by prompting Albany to cut other funds that benefit the counties.
“Rather than providing relief for county taxpayers, the State would surely respond to the lack of Federal revenue through huge spending cuts, including, potentially, cuts to county aid,” Kenneth E. Raske, president of the Greater New York Hospital Association, wrote in an open letter to the group’s members.
At this point, Republicans are trying to pick off individual moderate votes for their health care bill, with the expectation that President Donald Trump will have to win over conservatives. The Buffalo Buyout ― or the Tammany Haul, or the Empire State Earmark, or whatever you may want to call it ― is a recognition that leaders are close, but can’t afford to lose votes from moderates.
Democrats made similar deals while writing the Affordable Care Act in 2009 and 2010, with the so-called Cornhusker Kickback ― a promise to increase Medicaid funding to Nebraska, supposedly in exchange for the vote of then-Sen. Ben Nelson (D-Neb.), who was the 60th vote Democrats needed to overcome a Senate filibuster.
Nelson defended the arrangement, saying that he was a longtime opponent of Washington demanding that states pay for programs ― and that he had intended the provision as a “marker” that would inspire other states to demand similar deals.
That drew scorn from Republicans, who said it was proof that Democrats were using shady deals to get an unpopular bill through the legislative process.