If Republicans Kill Obamacare, New York is in for a World of Hurt


It’s Day Three of our brand new 115th Congress. With the G.O.P. now in control of both chambers and Trump soon to take control of the executive, Republicans are furiously spinning up their top legislative priority (besides gutting congressional ethics oversight), repealing Obamacare.

If they follow through on their commitment to “repeal and replace,” the Affordable Care Act, it will be a financial and public health disaster for the state of New York, according to new numbers released yesterday by Governor Andrew Cuomo’s office and the state Health Department.

“The cost of a repeal of the Affordable Care Act, to state and local budgets and to the New Yorkers who depend on its health care coverage, is simply too high to justify,” Cuomo said in the press release announcing the analysis.

By the Health Department’s estimation, gutting the Affordable Care Act would carve a $3.7 billion hole in the state budget and yank $600 million in federal funding that goes straight to New York’s counties. The overwhelming majority of that money — more than $433 million — goes to New York City. The Department of Health estimates that repealing Obamacare wouldn’t just hit state and local governments’ pocketbooks; it would eliminate health coverage for some 2.7 million New Yorkers, nearly half of them in the five counties of New York City.

Since New York, unlike many states, runs much of its healthcare through county government, the end of Obamacare could hit especially hard at the local level, not least of all because the state’s disbursement of federal Obamacare funds to counties has helped them in recent years to stay within their 2 percent property tax cap. “All of a sudden, without the Affordable Care Act counties all across the state are going to face a very difficult decision about whether to raise taxes above the cap or to basically significantly cut back on local government spending as they try to absorb that lack of ACA money,” state Medicaid director Jason Helgerson said. “It’s not an inconsequential impact.”

Of course, these are just the Health Department’s best guesses at what would happen. “Estimating the impact of repeal without knowing what ‘replace’ means or even what ‘repeal’ means at the moment is a little challenging,” Helgerson noted yesterday. Still, “We can look back at previous reconciliation bills to get some sense.”

Today’s press release was calculated to help inform federal legislators about the consequences of their quest to end Obamacare, Helgerson said, but it’s not clear that they’re listening. “We have had no interaction with anyone in leadership in congress, not that they’re calling us on a regular basis to ask our opinion.”

So what will Governor Cuomo do if the Affordable Care Act does get repealed? When we asked, the Health Department was short on specifics: “NY State of Health will review details of the incoming administration’s policies regarding health insurance,” the Department responded in an email. “In the interim, we will continue to focus on ensuring that all New Yorkers have the best possible healthcare and insurance options.”