REGIONAL – Ulster County has a population of just under 180,000, with a poverty rate measured at 12.8 percent according to the most recent census. In 2014, 4,379 were listed as receiving Medicaid services.
How might a threat to that program play out here?
Some points about Medicaid Services: Ulster County is a mandatory managed care county. Most families must choose a health plan, and if they qualify they must sign up for Medicaid. Ulster County offers traditional fee-for-service Medicaid and Managed Care Medicaid for individuals and families aged 19 and up who meet the income guidelines.
Under the 2010 Affordable Care Act, or "Obamacare," the federal government and states shoulder the cost of insuring those with low incomes. Federal money is calculated by the amount of care received by a state's Medicaid patients.
That has meant the federal government is also paying for the cost of expanding Medicaid coverage to low income adults, even those without children, in the 30 states that chose to expand their programs which includes New York.
The thinking behind this is that providing Medicaid services, which includes doctor's visits and preventive care, is a lot less expensive overall than leaving millions without any care at all until they present at an emergency room. The average cost of a visit to an ER in New York seems to be between $1500 and $2000, and the costs of treating illness at an emergency room for someone who cannot pay are passed on to everyone else's cost of health insurance. In 1986, Congress mandated that hospitals and health providers must provide care to anyone who needs it, whether or not they can afford to pay for it. The alternative, patients dying in parking lots, was seen as uncivilized.
Ulster County also offers Prenatal Care Assistance, and a Family Planning Benefit Program, plus, of course, Chronic Care Medicaid, which provides nursing home and long term home health care for the elderly.
Here lies one of our society's biggest problems with very difficult political and fiscal fault lines. There are about 1.4 million people in nursing homes nationwide. and about 62 percent of the cost for their care is borne by Medicaid. It is assumed by experts that at least half of all those now 65 and older will need some kind of similar help as they age. This may be home healthcare, which tends to be much less expensive, or nursing home care. One estimate is that this will cost on average $91,000 for men, and $180,000 for women because they live longer. Many, unable to afford this care and lacking long term insurance to cover it, will turn instead to Medicaid.
However, the current Senate plan under discussion would replace the current federal payment with a fixed per capita cap or a block grant. Any increase would be pegged to inflation. The expansion of Obamacare's Medicaid benefits would be terminated by 2024.
At this point states are required to fund at least 40 percent of total Medicaid costs. There is considerable latitude in how they can obtain that funding, but it is typically a mix of state general expenditures and local taxes. A big cut back in Medicaid funding would be very difficult in New York State, as Governor Cuomo has already announced, and could put a $5 billion hole in the state budget. On top of that, New York congressmen John Faso and Chris Collins have pushed an amendment in the House bill that would end New York counties' responsibility to pay a share of Medicaid costs. That would add another $2.3 billion to the state's budget woes, something Cuomo has called "unconstitutional" and a "scam."
More on exact figures for our towns in future issues...