While Rep. Elise Stefanik remains uncommitted about her vote on the American Health Care Act, she fully supports an amendment that would ease the Medicaid burden on local counties.

House Speaker Paul Ryan tried to woo upstate New York Republicans, including Stefanik, R-Willsboro, with an amendment to the GOP health bill that would exclude rural counties from having to contribute to the state’s Medicaid expenses.

The federal government covers half of Medicaid expenses, and New York is one of the few states that requires counties to pay part of its share.

The state used to split its share evenly with counties. But after years of protection by counties, their portion was capped several years ago, with the state now picking up the annual increases.

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Costs to counties

Rural counties have complained they are strapped for cash and that requiring them to help pay New York’s Medicaid expenses forces them to raise property taxes.

An analysis by Rep. John Katko, R-N.Y., said counties outside New York City contributed $2.2 billion, including $17 million from Clinton County and $6.9 million from Essex County.

In some counties, the program accounts for as much as 80 percent of the tax levy.

In Clinton County, Medicaid makes up 62 percent of the tax levy. In Essex County, it is 32 percent.

Taking responsibility

The change, if approved, would alleviate major costs for counties, allowing them the opportunity to lower property taxes if they choose, advocates say.

“Counties across my district, and across New York, are being unfairly subjected to massive financial liabilities being imposed by the state that can have severe impact on our local property taxes,” Stefanik said in a statement.

“This amendment would make New York state take responsibility for their own budgeting, freeing up needed funds at the county level for local government to use in our communities.”

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Counties cautious

Essex County Manager Dan Palmer pointed out that Medicaid is far from the only service counties are mandated to partly pay for, although it is the single biggest.

From probation to preschool to foster care to public health, Palmer said roughly 85 percent of Essex County’s tax levy is mandated by the state and, to a lesser degree, federal governments.

If the state is forced to pay for all of Medicaid, Palmer, like McManus, worried it might compensate by cutting in those other areas.

“We don’t know where the other shoe would drop,” he said.

Clinton County Legislator Mark Dame, R-Area 8, City and town of Plattsburgh, who chairs the county’s Finance Committee, said the proposed amendment to the federal health-care bill would be a significant transformation for county government.

“It (Medicaid) is an unfair program, and it needs to be changed, and if this health-care bill fixes it, then I’m all for it,” Dame said.

Dame said forcing the state to take over the program without the aid of county dollars might make New York run it more efficiently.

“There is way too much fraud and waste in this program, and the state would have to come up with a much more efficient way of running it,” he said.

Clinton County Legislature Chairman Harry McManus, D-Area 1, Champlain, said counties have been asking for a state takeover of Medicaid for years.

“In a vacuum, that would be great,” McManus said. “But I find it hard to believe that this would be a realistic and sustainable benefit.”

McManus said he would be concerned that the state would have to seek funds from counties in other areas in order to fully pay for Medicaid.

“The state has a lot of discretion, and I would hate to see something like sales-tax re-trenchment,” he said.

Despite missing their mark the past two years, Clinton County has historically benefited from healthy sales-tax revenue, which has helped keep tax levies down.

Clinton County Administrator Michael Zurlo said they are paying close attention to the Medicaid amendment.

“This is an intriguing proposal, and the county is taking a hard look at it,” he said.

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‘Deathtrap’

Democrat Gov. Andrew Cuomo criticized the Republican amendment to exempt counties that have fewer than 5 million residents. He called it a “deathtrap” that would cost the state $2.3 billion annually.

“The cut is so severe that the majority of hospitals, nursing homes and assisted-living facilities located in Upstate New York and on Long Island would be devastated,” Cuomo said.

Cuomo also warned that the GOP health-care plan with the Medicaid amendment could cost Upstate hospitals millions in funding cuts, including about $20.2 million at hospitals in Stefanik’s district.

The Governor’s Office gave these estimates for funding losses: University of Vermont Health Network, Champlain Valley Physicians Hospital in Plattsburgh $3.4 million; UVM Alice Hyde Medical Center in Malone, $1.3 million; UVM Elizabethtown Community Hospital, $336,450; Adirondack Medical Center in Saranac Lake, $1.2 million; and Moses-Ludington Hospital in Ticonderoga, $185,000.

“These massive cuts will cripple our hospitals and ravage the health-care services on which New Yorkers rely,” Cuomo said.

“I urge members of the community to call their member of Congress and demand that they vote ‘no’ on this unconscionable piece of legislation.”

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Enterprise Managing Editor Peter Crowley contributed to this report.

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(Editor’s note: Four daily newspapers in the North Country — the Enterprise, Post-Star of Glens Falls, Watertown Daily Times and Press-Republican of Plattsburgh — are sharing content to better cover New York’s 21st Congressional District.)