How to Fix a $6.1 Billion Budget Hole? Attack Health Care Spending

All I have to say is that my disabled and probably permanently unemployed mom (who lives in NY) has previously had to decide whether missing a few bills or eating less is worth the $700 per month for her medication.

Being a Democrat does not make you a progressive. Andrew Cuomo is living proof.

It's pretty well known that some of the worst actors in our system - think cabs and liquor stores before we get to the real villains here - could only "get away with what they do" because they know how govt and politics works. Some basically good people (and some rogues, both in NYC and in Albany) need to run for election every 4 years, and it's often "taxing" to fund a primary challenge and a general election. So they sell ... a tiny portion of their soul to entities like cab fleets (well, when they HAD money for these near-bribes) and liquor stores (ever wonder why that's one thing you CAN'T buy online? or did you connect the dots effortlessly?) But NOBODY works the system harder and "better" (we are talking STRICTLY in their own self-interest, of course) than nursing home operators and some of the other adversity leeches, like those dealing with populations unable to fend for themselves. Of course, some well-to-do New Yorkers can and will pay very big numbers for care, but the reality is that most people look at $10K per month for a family member ... and recognize that "impoverishment" is in the cards. Enter nursing homes that speed the impoverishment on its way by a combination of "key money" and extortionate "rents," ... and then everyone knows that Medicaid will kick in. NOT just as a "safety net" for taxpayers who got singularly unlucky at some point - but as PAYBACK for all those campaign contributions. Of course diBlasio personally was a big enabler. Now what?!

Ok. As a Self-Employed Private Duty LPN paid by Medicaid AND a former recipient of Medicaid Insurance with SNAP benefits when I needed them years ago, I feel like I have very strong opinions on this and I guess it’s time to write the “powers that be!” This is not rocket science folks, there are clearly major differences in the entire system and I firmly believe that we need separate budgets to clearly define the lines and change so many things to better the program. Patients like mine desperately need paid services for life, period. Then you have the people that expect their $2 bottle of Ibuprofen to be paid for and they are the ones milking the system. I did work previously in a “Medicaid Clinic” where I learned a lot about how people manipulate the system! IE: the patient begging for an electric w/c weeks after orthopedic surgery, in “so much pain” who was seen by the physical therapist out selling drugs on the corner, crutches & all! I don’t have enough characters here to elaborate but I think I have a decent solution to the problem and definitely we need to update requirements & parameters. My patients are never going to get better but way too many people like to stay in the system when they just don’t want to work at all. Then you have the chronic medical conditions that do need services as well. We need to tighten the circle! Just my opinion!

We can start repairing the state of the State by impeaching that whining Cuomo, one of the most incompetent politicians ever. What is New York City going to do next year for electricity when Cuomo shuts down Indian Point? How's that Buffalo billion doing? When the gas runs out will the nitwit reconsider his refusal to allow a new gas pipe under the Hudson? Do we like the new election laws which are designed to keep small political parties off the ballot so they don't split the Dem vote? Do we like getting letters from the State's Department of Taxation and Finance right after we file our income tax returns asking us to verify every deduction on the tax return and to show W-2 and 1099 forms if we've claimed State withholding? And let us never forget that it was Cuomo who caused the housing and banking crises of 2008 when he was head of HUD. Oh, and by the way, his new concrete version of the Tappan Zee Bridge is downright ugly.

We must have an honest discussion about religious organizations who don’t pay taxes and live on Medicaid and SSI generation after generation.

NYS/C have been raising the wages of everyone, including the home attendants, which is a good thing, I suppose. Now, all of a sudden, NYS has found itself with a 6.1 billion deficit. Surprise, surprise...!

It’s a nobrainer: Take it from the poor who cannot afford health insurance! Brilliant!

What incompetence. We have a booming economy but NY is billions short. Cuomo is a joke.

Step #1 in fixing the budget: get rid of Fredo. Impeachment or recall would be nice.

Evidence going 40 years, eg published in the New England Journal of Medicine, documents that reducing Medicaid and making people no longer eligible raises the morbidity and mortality rates for those firmer recipients. I’m amazed, frankly, that Gov Cuomo would light the way for Trump, and GOP governors, to do the same. Utterly cruel, especially he hasn’t begun to address administrative or bureaucratic fixes first. Is Coumo really that hard-hearted, just like Trump??!! Not being from New York like both of them, I really don’t know.

Pay attention, all you Medicare-for-all devotees: this is what happens when the government gets involved in paying for health care. They either have to take over the whole system and regulate cost, delivery and payment or we’ll all go broke “fixing” health care.

"[program costs $75 billion] a figure that has increased in recent years as Mr. Cuomo and the Legislature approved increases in the minimum wage, enrollment has grown and the governor pushed through an increase in reimbursement rates to health care providers. So the program costs more because the minimum wage was raised? Reimbursement rates went up because of the minimum wage? I'd call that an unintended consequence. And isn't the Federal subsidy under the ACA to expire soon?What happens when the bill to NY goes from $20 Billion to the full amount of $75 billion(plus)? He's got to cut Medicaid. This is NOT sustainable. Also, eligibility needs to be re-analyzed. It was significantly increased in the first years of the ACA.

There is a shortfall in the proposed budget, so instead of spending $33 billion on ‘green initiatives’, use some of that funding for Medicaid.

Five years ago the federal government granted New York State $8.2 billion to implement what is called the Delivery System Reform Incentive Payment Program (DSRIP). It was supposed to reform health care delivery in the state by setting up networks that would 1. integrate care for Medicaid and uninsured patients 2. emphasize primary care, behavior health care, prenatal care and preventive medicine 3. improve care for chronically sick patients 4. implement a population health management strategy 5. reduce the number of unnecessary hospital admissions These initiatives, and others under the program were aimed at improving health outcomes while reducing total Medicaid cost. All are worthy goals, at least on paper. I doubt whether one in one hundred New Yorkers has even heard of DSRIP, let alone been apprised of its results. Surely the Department of Health will say the program is a howling success, but the state's Medicaid cost increases without abatement and if New Yorkers are healthier because of it, that would be news to me. Is DSRIP yet another multi-billion dollar government boondoggle? What does the governor say? Maybe the Times could look into it.

A relative’s baby had a stroke at birth. NY State paid for weekly in home private physical therapy for three years, plus other treatments. No means test, each parent had full health insurance and the child was fully insured (but didn’t need to file any insurance claims because the state paid for everything). It was nice to not have to pay for any of the treatments and file insurance claims, but they probably could have, or at least done so with private insurance. This is just to say that the state indiscriminately throws money at programs without really taking a hard look at the specifics. I’m sure everyone who benefits of the state’s generosity accepts it willingly. They have no moral obligation not to. Those to blame are the decision makers - legislators who time after time prove that they can’t move fast enough to enact some legislation that has a big political benefit to them, but fall short in doing their primary job, which is to manage the state in a responsible manner. If Medicaid spending is the problem, then Medicaid spending should be the focus of scrutiny and action.

This is a terrible sign for the nation. If New York can't cover medical costs in this current time of economic boom, what'll happen when we're in a recession? In both New York and California, the tax rates can't go up much further without risking massive flight of people and companies to other states that'll result in further erosion of the tax base. New York's fiscal crisis shows the limits of progressive policies at the state level. The truth of the matter is that states can't print money nor go into debt to finance costly programs--regardless of how worthy they are. In addition, states compete with each other economically and the temptation is to race to the bottom: lower taxes to attract wealthy individuals and corporations, deny poor people benefits to deflect them to other states, and cut spending on education and health care to balance the budget. The outcome of all this is that something as fundamental as health care should be a federal responsibility with a national set of standards and policy measures that can contain costs. Otherwise, states like New York and California that want to do the right thing are penalized for covering their poor on one hand and having to secure the care in our exorbitantly expensive private medical system on the other. This is a sure way to have more and more states either go bankrupt or deprive essential aid to the most vulnerable population.

LBJ knew the answer when he created Medicare. Congress will fund it adequately if their own relatives get care through it. Congress will control costs if they have to pay like anyone else. Medicaid in most states is controlled by politicians who do not care if poor people die, and even Medicare is being cannibalized by HMOs I call Medicare Disadvantage. HMOs can always increase their profits by denying the care you need. Every dollar of essential care they deny is pure profit in their pockets.

Here's the elephant in the room that no one cares to talk about. Sure, Medicaid provides medical care for the poor. It also pays for nursing home stays for the elderly who have exhausted their savings. Some of these elderly exhausted their savings by giving it away to heirs five years or more before entering the nursing home. The current system gives the elderly a major incentive to impoverish themselves. This is wrong. I would like to see the breakdown--how much Medicaid goes to the elderly in nursing homes, how much to the working poor, how much to the indigent. Strategies for controlling spending should be different for these three groups. Simple-minded spending caps won't do it.

NY spends more money on Medicaid than TX and FL COMBINED! Clearly this expense can be reduced substantially. Failure to do so will only result in more taxpayers fleeing the state and these confiscatory taxes.

Why do we always try to balance our budgets on the backs of the people most in need??? Just horrible

I guess Margaret Thatcher was right... you eventually do run out of other people's money.

The Times has pointed out many times over the years that New York spends more on Medicaid than any other state, including the states with larger low-income and senior skilled nursing populations, so... ...where's the money been going? How do other states, including other progressive states, manage to provide the same care at a lower cost to taxpayers? The Times ran an excellent series on the issue of Medicaid fraud in New York, back in 2005 or thereabouts, wherein it was estimated that 10 percent of the Medicaid budget was straight-up stolen, either by shady providers padding their bills, or by criminal organizations that had obtained provider credentials. Whether or not the estimate included well-executed fraud that went undetected, I am unsure. And then...nothing. No sign the crooked providers were held to account. And the stolen money? I think we all know that money is long gone. About ten years ago, the Poughkeepsie Journal picked up on an unusual phenomenon: for about two decades, New York had been claiming and receiving far more in Medicaid reimbursements for care for the profoundly disabled than any other states. It came to about $15 billion over 20 years, under governors going back at least to Pataki. And then...nothing, other than some harrumphing in Congress about New York being a little less obvious in its chicanery from then on. We have a medical-industrial-state-legislative complex, just as sure as we have a military-industrial-congressional complex.

I'm a 69 year old man who recently came face-to face with the severe limitations of our health care system. I was diagnosed with lymphoma last spring and spent 8 weeks in Westchester Medical Center, where I received excellent care. I went into remission quickly and other than some minor issues with damage caused by the chemo I'm doing well and feel great. The bad new is the amount of money I owe for my cancer care. I have a Medicare HMO plan, under which I'm responsible for $15,000 in deductibles for a major illness like my cancer. I've worked hard my whole life, the last 42 years as a resident of NY. I or anyone should not have to face this crushing debt. Fortunately, I trade the markets and do well but what of other people? We need to fix this. Medicare for all may work but I'm not 100% sold on it. I get sick to my stomach reading an article like this. It's just plain wrong.

Usually, the lowest cost care is for routine check-ups, etc. Longer term and in-home care tends to be the most expensive. I'm sure the Governor will try to restructure things to not detract from care. Curious how much of these costs are prescription drugs? It would be interesting to see a Medicaid cost breakdown for NY State.

I heard Cuomo on NPR about two years ago touting NY’s apparent commitment to the poor and the elderly. What struck me about the interview was that he seemed disapproving of other states that do not share this view and nonchalant about the high costs associated with social programs, under the belief that most people in N.Y. care about the poor and are willing to pay for their care. Now, to read about his huge proposed cuts causes me to view him as rather naive, especially compared to when he was much younger.

How to fix a situation where you have to fix a budget shortfall by cutting folks' medical care? Medicare for All. That's how. Many will probably blame Cuomo but it's not his fault our medical care system is so dysfunctional. Look at the bigger picture.

He knows how to give away millions where he thinks it will buy him votes so he ought to be able to figure this out. One step at a time and right off the cliff we go!

This is a great idea. By cutting Medicare there will be less people using other services since they will be deceased. Maybe we can start the culling early? Another idea is to encourage smoking, since that leads to lower overall lifetime medical bills. What is this world coming to?

How about we stop giving unnecessary tax breaks to billionaires? AOC was right on point, and saved the city billions of dollars. If Bezos wants to move to the greatest city in the world, he'll have to pay his share, just as if he was a middle class business owner. And lo and behold, Bezos came here anyway. No free rides, even if you are a billionaire.