New York needs honest representation, especially when Medicaid is at risk

By KEVIN MCAVEY

On Feb. 25, the House of Representatives passed a 10-year federal budget blueprint that would structurally reshape America in deep and meaningful ways. The bill proposed up to $4.5 trillion in tax cuts — most of which would go to the top 10 percent of income earners — and program cuts of up to $2 trillion, including up to $880 billion in cuts to Medicaid, our nation’s health insurance program for low-income Americans. While Congressman Mike Lawler’s vote on the bill, which passed 217 to 215, was determinative, it is not the last word he will have on the matter.

Around 212,000 of our neighbors in Congressional District (NY-17), which spans Rockland, northern Westchester, Putnam, and Southern Dutchess counties, rely on Medicaid to access health care; and they join seven million other low-income New Yorkers, and 80 million Americans, who could be harmed by rushed cuts. 

Medicaid’s importance cannot be understated. It covers four in 10 births, two in five kids (half of kids with special needs and four in five kids in poverty), and, since the Affordable Care Act, one in six low-income adults.  

The ACA extended Medicaid to people making less than 138 percent of the Federal Poverty Level ($21,597 for an adult, $44,367 for a family of four), halving states’ uninsured rates. 

Medicaid covers one in five Medicare beneficiaries, covering premiums or services not covered by Medicare, like long-term care. Five in eight people living in nursing homes receive Medicaid. Half of Medicaid spending is for seniors and people with disabilities. 

The federal government matches eligible Medicaid spending at least dollar for dollar in New York, but contributes more to poorer states (e.g., Mississippi receives a 3:1 match).

Proposed Medicaid cuts 

The House Committee on Energy and Commerce, which oversees much of our nation’s health care spending, was tasked with finding up to $880 billion in savings. While Lawler initially deflected early constituent concerns that cuts would impact Medicaid, stating that “not one line” in the bill referenced Medicaid, and anyone who said otherwise, including this author, was “lying,” his statement has since been proven disingenuous. Per the Congressional Budget Office, it is mathematically impossible for the committee not to cut Medicaid: it comprises 93 percent of the committee’s non-Medicare spending. 

Further, House Republicans have been actively and publicly considering Medicaid budget cuts since January, including increasing costs for states like New York by lowering the minimum federal match rate; increasing state costs to cover ACA-eligible adults; capping federal spending on specific populations; and mandating that states impose work reporting requirements for ACA-eligible adults, despite most enrollees already working in low-wage jobs.

While Lawler has since revised his position, noting that he would not cut Medicaid “benefits,” he has not commented on whether he would otherwise make it financially impossible for states, including New York, to avoid cutting eligibility and benefits, as would be true in any of the above proposals. It is a slick, but important, distinction from a savvy communicator.

In response to a “Save Medicaid” rally in Mount Kisco, where I spoke, Lawler quickly pointed to “illegal immigrant[s]” and “scammers” as savings targets, and “fiscal responsibility” as his motivator — phrases that poll well, though have tenuous factual grounding.  

Medicaid does not provide federally funded health insurance for undocumented immigrants. However, as confirmed by the courts, New York’s Constitution requires that it provide coverage for legal immigrants (e.g., green card holders, refugees), which make us particularly vulnerable to federal prohibitions or penalties. Medicaid does reimburse hospitals for unreimbursed emergency care they provide to low-income people (regardless of immigration status) to sustain our local facilities. These expenditures totaled $3.8 billion in 2023 — too much, in candor — though not close to the $880 billion target.

Fraud, waste, and abuse exists in Medicaid, and we should root it out. In 2024, states achieved 1,151 convictions for Medicaid fraud and patient abuse or neglect and recovered $1.4 billion. The Government Accountability Office has recommendations to strengthen Medicaid fraud detection programs, which should be implemented. However, experts are skeptical about the magnitude of additional savings and are concerned that politicians may use the Medicaid “improper payment” statistic as a misleading talking point. Improper payments include under- and over-payments, and payments without necessary documentation; they are not necessarily fraudulent.

As to Lawler’s statement that he is merely looking after our nation’s financial future in his vote to cut Medicaid, this author is at a loss — his bill offers more than $2 dollars in tax breaks for every dollar of program cuts, increasing deficits by at least $2.8 trillion over the next 10 years.

Impact of Medicaid cuts

The proposals currently under rushed Congressional consideration would terminate health care for millions of Americans, and would disproportionately impact New York. The Kaiser Family Foundation, a health policy organization, estimates that if “per capita caps” are pursued and ACA match rates eliminated, and New York cannot finance the difference, state Medicaid enrollment would fall by three million (40 percent) and total Medicaid spending — and health system revenue — by $257 billion. The Urban Institute concurs: Eliminating ACA match rates (alone) would result in taking away Medicaid coverage for 1.8 million New Yorkers, including 42,000 in NY-17; our district’s uninsurance rate would double.

The loss of health insurance does not only impact the health and financial security of enrollees, but also the financial sustainability of our health care facilities. As Bea Grause, president of the Healthcare Association of New York State, notes, Medicaid cuts “would force institutions to make difficult choices, likely reducing services for mental health care and obstetric care.”  

The path ahead

While House Speaker Mike Johnson originally sought to have a final budget by Easter, as Politico reported, uneasiness among vulnerable and at-risk members, including Lawler, have pushed timelines into summer.  

This budget blueprint for America’s future, as initially endorsed by Lawler, would take dollars from programs that support our lowest income Americans to provide our wealthiest more take-home pay. At a moment when the wealth of billionaires in our country has doubled and corporate health care profits continue to soar, our district — and the person representing us in Congress — will be determinative in whether this further redistribution of wealth reflects our values and vision for our country. 

This is a conversation that requires honesty and candor from our congressman, and a willingness to engage with those he serves.  If Lawler is not able or unwilling to lead with these ideals, I promise, whether he continues to have the privilege of representing the residents of NY-17 will be the next issue we seek to resolve. 

Kevin McAvey, a Bedford resident, is a health system transformation leader who works with states, foundations and consumer groups nationally to improve the effectiveness of health care delivery.