Editorial Roundup: New York

Recent editorials of statewide and national interest from New York’s newspapers:

Cuomo’s Bad Medicine on Medicaid

The New York Times

Jan. 31

For years, New York State has operated one of the most generous Medicaid programs in the country, a point of pride in a state with a long tradition of investing in the social safety net.

The program provides health care and other services to more than six million people, largely low-income New Yorkers, and the costs are shared between the state and federal government.

But profligate spending has sent costs spiraling in recent years. The Medicaid program has become a driving force behind a $6.1 billion hole in New York’s budget next year, and a brewing political battle over what to do about it.

Though Medicaid costs are rising across the United States, in New York - among the country’s largest programs, and long one of its most expensive - spending has surged. From 2015 to 2019, annual spending grew by an average of 6 percent, according to a report last year by the Empire Center for Public Policy, a conservative nonprofit research organization. That’s roughly double the rate of growth in the previous several years, even as enrollment remained flat.

Health care and budget experts have said a variety of factors are behind the trend, including an increase in demand for personal care programs that provide nonmedical services to disabled New Yorkers, a minimum-wage increase and financial assistance that the state has provided to struggling hospitals.

New York’s share of its $75 billion annual Medicaid bill is now about $30 billion and growing, imposing an increasingly untenable burden on state and local budgets. The federal government pays the rest.

The good news is that Gov. Andrew Cuomo, who is in charge of administering the federal program, has moved to rein in costs.

The bad news is that he has said localities will have to pay for increases in local Medicaid spending above 3 percent. That’s unfair and unrealistic. Local governments in New York already pay more mandated Medicaid costs than local governments in any other state, a dynamic that’s been in place since the program began in the 1960s. That’s not unusual in New York, where Albany relies on New York City’s tax base to fund the bulk of state services from education to commuter rails.

In 2018, local governments in New York sent $7.6 billion to Albany for the program, according to a 2018 report from the Citizens Budget Commission. In Fulton County in upstate New York, for instance, the local Medicaid bill for 2016 amounted to more than 15 percent of the county budget. In New York City, the annual Medicaid tab is roughly $5 billion, or nearly 5 percent of the city’s budget.

If the spending increases continue, and the state forces local governments to pay for them, the de Blasio administration estimates the city would owe an additional $1.1 billion next year. The state says the figure would be much lower.

Mr. Cuomo has called on local governments to reduce costs. That’s fine: New York City and counties across the state, which oversee enrollment, should work to root out any fraud or abuse and ensure that those who sign up for the program are eligible and truly in need. “They are the on-the-ground administrator. We respond to them,” Mr. Cuomo said in a phone call Wednesday.

Really though, local governments have limited say over how the program is run. Most of that responsibility rests with the state.

When it comes to reducing Medicaid costs, that’s where the focus should remain. The most promising effort so far is Mr. Cuomo’s Medicaid Redesign Team, a working group assigned to find $2.5 billion in savings this year, preserving benefits while slashing waste.

The governor used a similar task force to successfully carry out cost-saving Medicaid reforms nearly a decade ago, aided by the Affordable Care Act.

The new group will be led by the same two men: Michael Dowling, the president and C.E.O. of Northwell Health, and by Dennis Rivera, the former head of 1199 S.E.I.U., the powerhouse health care union. They are set to make their recommendations ahead of the April 1 budget deadline.

It will be up to Mr. Cuomo to ensure the public good is top of mind. The redesign group should issue a thorough report, presenting its findings to the public and the Legislature. Right now, it’s not clear they plan to do so, and that’s a problem.

While not perfect, the approach is far better than simply forking over more and more taxpayer dollars and sticking local governments with an ever-growing tab, as the state has been doing.

To get New York’s Medicaid program back on track, the group will need to take a hard look at spending on nonmedical services like cooking and bathing for homebound New Yorkers. According to the Empire Center, New York’s Medicaid spending on such personal services was the highest in the country. That may be because of a program that has expanded in recent years in which Medicaid pays nonmedical providers like family members to care for clients. In 2016, personal spending in New York accounted for 40 percent of national Medicaid spending for the category overall, up from 23 percent in 2011, the Empire Center said.

Complicating matters is a political dynamic friendly to the health care industry. In 2018, for example, the Greater New York Hospital Association gave more than $1 million in political contributions to the state’s Democratic Party. Not long afterward, the state increased Medicaid reimbursement rates for the first time since 2008, costing the state an estimated $140 million per year. Mr. Cuomo has denied that donations influence his policy decisions, and Cuomo administration officials said at the time that the increase was necessary, and simply long overdue. Health care experts disagree, and say hospital revenue had already been on the rise.

New York’s Medicaid bill is out of control. The first order of business is to understand more about why, and to be honest with the public about what needs to be done about it.

Online: https://nyti.ms/399jIBf

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The state of our union is deteriorating

Newsday

Feb. 4

There was little President Donald Trump could have said or done in his third State of the Union speech to surprise Americans. We have come to expect the unexpected, a fire hose of the unprecedented that has dulled the nation’s capacity for astonishment or outrage.

And the trappings of Tuesday night’s speech were indeed unprecedented. Trump’s remarks came amid an impeachment trial poised to deliver his acquittal by the Republican Senate majority on Wednesday, in the very chamber where the Democratic majority House voted to impeach him less than two months ago. And he was introduced by Speaker Nancy Pelosi, his principal congressional foil and the person who signed the impeachment papers, and with whom Trump has not spoken in months.

So perhaps it was not surprising that partisan combat was evident from the start, when Trump ignored Pelosi’s proffered hand after giving her a copy of his speech, when Pelosi omitted the traditional words “high privilege and distinct honor” when introducing him, when Republicans began chanting, “Four more years!” and when Pelosi tore up pages of his speech when it was over. The displays were unfortunate.

Nor was it unexpected that in touting his achievements - what he called “the great American comeback” - he cast them in full 2020 campaign mode, demonizing Democrats and attacking the previous administration. The speech was vintage Trump - a swirl of truths and falsehoods. He effectively listed his accomplishments - a strong economy with falling unemployment and rising wages, ramped-up energy production, a reduction in regulations, new trade deals.

But he also talked about building the world’s most inclusive society, at odds with his administration’s exclusionary policies. He lauded the recently signed trade deal with Mexico and Canada as an example of keeping his promise, without crediting House Democrats who forged the final deal by working with Trump’s trade representative to pull it off. And he said he would always protect patients with preexisting conditions, when his administration is in court right now arguing to dismantle the Affordable Care Act and its protection of preexisting conditions.

The contrasts in the chamber - one side repeatedly erupting in applause, the other mostly sitting in silence - mirrored divisions outside the Capitol. Trump’s approval rating has hit an all-time high at 49%, while the other half of the nation simmers at Trump’s conduct and assaults on the machinery of democracy. The circumstances were awkward, but Trump thrives on awkward. Giving the Presidential Medal of Freedom to conservative commentator Rush Limbaugh, one of the most notoriously partisan operatives in our nation’s history, was inappropriate. Acknowledging sacrifices made by Americans in service to the country was admirable, but the stagecraft veered into schmaltzy TV reality show territory. And he never even went through the pretense of asking Democrats to work with him for the nation’s benefit.

If you were seeking balm in Trump’s talk, you found it. If you were prepared to seethe, you did. That perhaps was the least surprising thing of all.

Online: https://nwsdy.li/2S0GYM7

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Prison closings need more than 90-day notice

Middletown Times Herald-Record

Feb. 2

In a cost-cutting mood and facing a $6 billion deficit, Gov. Andrew Cuomo has his eyes on prisons again. The governor has closed 17 correctional facilities in 10 years, at a reported savings of $193 million a year. His proposed 2020 budget seeks legislative permission to close an undetermined additional number of facilities. He’s also apparently a bit eager to do so, asking for authority to shut down a facility with only 90 days notice.

He might want to slow down just a bit.

While the savings may be necessary to help balance the budget and the closings may be justified by a 37 percent reduction in the state’s prison population this century, experience has shown that closing a prison is about more than numbers on a spread sheet. It’s about people and communities - and promises. It’s not something to be done hastily.

Many of the prisons are located in rural, upstate counties with small populations and not much in the way of job opportunities. The prison is often the chief employer and economic engine, supporting its staff and the businesses that crop up to serve, not only prison employees, but visitors to the prison. The previous prison closings came with an initial legislative pledge of $50 million to figure out a new use for the closed prisons or to create new jobs in the communities. Another $32 million was added to that fund in 2014, but $20 million has gone uncommitted and most of the investment has gone to one project in Utica.

The closed Mid-Orange Correctional Facility in Warwick is one that has seen that change of purpose happen, but Warwick is relatively close to New York City and Orange County has seen - and promoted - considerable economic growth due to its location and access to major interstate highways.

Cuomo, who says prisons should not be a primary source of economic development, wants additional funds for the redevelopment of closed prisons. In principle, he has a point. A society shouldn’t depend on prisons for its economic well-being. But the state’s track record on enticing new business, especially in rural areas which are sparsely populated, have few tourist attractions and are often far from convenient transportation, is less than stellar.

Rural counties like Sullivan, home to two prisons, could be seriously affected by a closing. For that matter, so could Ulster County, with four, and even Otisville in western Orange County. And closing a prison with just 90 days notice puts a tremendous burden on staff, which has to decide on how or whether to move families to keep a job.

There is no doubt the state, with the end of Rockefeller-era drug laws and a drop in violent crime, has too many prisons. Closing some would seem to be cost-effective. But communities need a more serious commitment from the state to help repurpose those prisons and stimulate new jobs. In addition, guards and other staff need to be assured that moving inmates to other prisons will not create unsafe, overcrowded conditions that could cause violence. And they need more than 90 days notice to deal with such a major change.

Online: https://bit.ly/2udilTB

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Cuomo’s Lack Of Action May Come Back With A Bite

The Post-Journal

Feb. 4

President Theodore Roosevelt, who served as governor of New York in 1899 and 1900, spoke often of the need to speak softly and carry a big stick.

It may be said of Gov. Andrew Cuomo that he speaks loudly and carries a limp noodle.

New York state finds itself facing a $6 billion budget deficit in part because the state hasn’t taken action over the past two years to confront a gap between the Medicaid budget and Medicaid spending that has left the program in dire financial straits. Over the past two years, Cuomo has ordered that Medicaid expenses from one state fiscal year be pushed into the next fiscal year so that the program could remain within its budget. Of course, such action is a short-term Band-Aid.

Medicaid isn’t the only area where the governor’s lack of action is coming back to bite him, however.

Public school officials in Chautauqua County are right to be frustrated with Cuomo’s 2020-21 education aid proposal. Cuomo was quick to say quite loudly on Jan. 21 that his budget proposal increased state aid to schools by 3%, with most of the increase in Foundation Aid. But most schools in Chautauqua County aren’t seeing anywhere close to a 3% increase in state aid. As area superintendents began looking at their proposed aid runs more closely, they found that categories for BOCES; hardware and technology; and software, library and textbook are no longer listed as line items for 2020-21 state aid reports. Instead, those three categories were included in the Foundation Aid category. At first glance, Foundation Aid went up. A closer inspection shows a fiscal shell game.

Those who called for billions of dollars more in education as part of this year’s state budget should have known that wasn’t going to happen. Much like the Medicaid budget is a mess because the state has put off making changes to bring the program into financial balance, this year’s disappointment over education aid is the byproduct of complacency over the past several years in education policy.

Billions more dollars in state aid is probably needed for state schools because the state refuses to change the status quo. Regional high school legislation has been bandied about the state Legislature for years but has never been approved. The state could be proactive and force mergers of small schools that are struggling to provide the courses their students need because they don’t have the money to provide electives as their school populations decline.

Cuomo has now, two years too late, decided to take action by reinstating his Medicaid Redesign Team to find ways to bring the state Medicaid budget back into line. Perhaps he should consider the same approach with schools.

Of course, knowing our governor, he’d talk loudly when announcing such a School Redesign Team and then carry a limp noodle when it came to implementing its recommendations.

Online: https://bit.ly/2UrTeqL

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We can’t skimp when it comes to city parking

Utica Observer-Dispatch

Feb. 4

Anyone who has ever attended an event at the Adirondack Bank Center at the Utica Memorial Auditorium knows that finding a place to park can be a challenge.

The construction of the neighboring Nexus Center and downtown hospital certainly won’t make things any easier.

That’s why parking must be a priority.

We can build whatever we want downtown, but if people can’t find a place to park, they’re not likely to come.

Downtown parking has always been a problem in one way or another - not just in Utica, but in most cities. In Utica’s heydey, downtown visitors frequently found themselves circling blocks in search of a place to park. That problem was later solved by a business exodus to suburban shopping plazas and malls, where parking places were not only plentiful, but free.

Now with the city on the rebound, parking once again has become an issue.

Garages that once helped alleviate lack of on-street parking have deteriorated. The city has begun to address the problem, but it’s a costly venture. Kennedy Garage - north of City Hall, bound by Broadway, Columbia and Cornelia streets - was built in 1969 and needs extensive work, including electrical and plumbing improvements, expansion joint repairs and waterproofing, according to Stantec, an engineering firm that contracts with the city for repair estimates and annual inspections on its garages.

Stantec estimates it will cost between $15.5 million to $20.5 million to repair the city’s four parking garages - Kennedy, Washington Street, Utica Place and City Hall.

In addition, the city is part of a cooperative agreement with the county to build a $40.5 million parking garage with approximately 1,550 new parking stalls. Of those new spots, 1,150 stalls would be used for hospital use and public use such as outpatient services and 400 stalls for general public use.

The city would also need to make repairs to the Kennedy garage to comply with a 2017 memorandum of agreement with Mohawk Valley Health System. It dedicates at least 200 of the 450 parking stalls in the Kennedy parking garage for hospital use.

Repairs are underway, and that’s good. The Utica Common Council has approved $4 million in bonding for repairs in the Washington parking garage. The plan is to add that to $2.9 million from Utica’s $10 million Downtown Revitalization Initiative award to repair the garage.

Parking in some parts of the city - the government district, for instance - has been improved in recent years. The Oneida County Court House has a visitor lot off Elizabeth Street with limited spaces; the County Office Building likewise has a public parking lot off Park Avenue. Many visitors to the State Office Building park on Blandina Street and surrounding streets.

Other areas are getting some attention. In the growing Bagg’s Square area, the residential Doyle (soon to house a craft brewery), the Children’s Museum, the Oneida County Public Market, Union Station (housing county offices including the Department of Motor Vehicles), all require adequate parking. The county’s planned razing of the vacant Brown Building at 417-421 Main St. will open some some parking on Main Street, but more will be needed to accommodate the growth.

Likewise, the popularity of the 100 block of Genesee Street - home to places like Utica Roasters and Jonny’s Pizza - has very limited parking. The Oriskany Street/5S redevelopment project will address that, providing parking spots and a walkway all the way around the corner to Gerber’s at Seneca Street. It will improve the walkability of that Bagg’s Square West neighborhood - one of the goals of developers and city officials.

To be sure, adequate parking is an investment we need to make as the city moves forward. But with that investment must come a long-term plan for continued maintenance to make sure that parking garages don’t deteriorate to the point where they require millions of dollars’ worth of repairs. The hospital, auditorium and Nexus Center will put a great demand on the garages, and leaders must make certain that continued maintenance keeps them cost-effective in our growing community.

Online: https://bit.ly/371YRP0