Protestors at Chris Collins's press event at Erie County Hall on March 18.
Protestors at Chris Collins's press event at Erie County Hall on March 18.

Politics and Stuff: Chris Collins and the Medicaid Trap

by / Mar. 22, 2017 1am EST

Is Collins recruiting Trumpcare supporters or just setting up a smokescreen?

Congressman Chris Collins seems to be in his glory these days. He occupies the safest Republican-majority House seat in New York State. His pivot from establishment presidential candidate Jeb Bush to anti-establishment candidate Donald Trump worked perfectly. As the first member of Congress to endorse Trump, Collins achieved some preeminence. Appearing on countless national television interviews, Collins has become the cheerleader-in-chief.

Attaching your political persona to another politician, however, usually comes at some cost. When the politician you latch onto says something that you know may negatively affect your own political viability, you need to find ways to get some separation. When your political sponsor’s public comments and actions raise all sorts of negative issues, you need to find ways to navigate the rapids like a pro.

The issue-dodging technique has been played to perfection by Donald Trump. Starting with the lies about inaugural crowd sizes, continuing without interruption through the fiction of the millions of illegal voters, and reaching the height of arrogance with the “wire tapping” attacks on President Obama, Donald Trump has spent the biggest portion of his two-month-old presidency dodging, lying, and making his political team look like fools.

To the extent that people can look past the diversionary tactics, there are several issues that are supposedly a priority for Trump. The GOP’s seven-year obsession with repealing and replacing Obamacare makes that legislation a must for both Trump and Congress. It’s not going so well at the moment. Speaker Paul Ryan’s Trumpcare bill is floundering. The far-right just wants outright repeal with no replacement. The less-far-right part of the party is concerned about the things that will do major damage to the healthcare of millions of Trump supporters. Higher deductibles, higher premiums, fewer services, and millions of people losing their coverage are making Republican officeholders nervous. Changes to the bill that were offered earlier this week to bring along additional House votes may not do the trick.

To help out with Trump’s and his own dilemma with legislation that will harm the people who put them in office, Chris Collins has jumped into the fray.

Collins worked with the Trumpcare bill drafters to include language that will require New York State (and New York State alone) to pay for the entire cost of Medicaid, thus relieving county governments outside of New York City of the responsibility for raising local taxes to cover a portion of the cost. Relieving local taxpayers of that burden is a time-honored issue among county governments in New York State, going back 50 years to when the Medicaid program was first created. (History buffs might recall that Medicaid came to be in New York State through the efforts of a Republican governor, Nelson Rockefeller, and a State Legislature controlled by Republicans.)

Collins is being consistent about wanting a state takeover of Medicaid costs, an issue he also complained about when he was Erie County executive—much like Joel Giambra, Dennis Gorski, Ed Rutkowski, and Ned Regan did. Over the years the state has picked up a greater share of the Medicaid costs, but Erie County still spends $203.8 million annually on Medicaid, representing 82 of total property taxes, or 46 percent of total county sales taxes. Sales taxes, last raised in the Giambra administration, are the largest revenue stream for Erie County and are at the highest level of any county in the state.

Collins this past Saturday convened a little rally of Republican officeholders at Erie County Hall to promote his plan to include requiring the total state takeover of Medicaid expenses in New York as part of the Trumpcare bill. He was joined by Erie County Comptroller Stefan Mychajliw and nine other officeholders from Erie and Niagara Counties. Collins’s congressional website does not mention the rally or name the others who joined him.

What Collins is attempting to do is to add something to what, in congressional language, is referred to as a “manager’s amendment” to the Ryan Trumpcare bill. The manager’s amendment is the vehicle that Ryan and others will use later this week to soften the damage that the original bill will inflict.

In New York State Collins’s proposal, if enacted, would theoretically transfer $2.3 billion of county government expenses to the state government, relieving county governments of a like amount. This certainly would be good news for county property or sales taxpayers (the counties could reduce either or both revenue streams). I guess the assumption is that there would be a dollar-for-dollar reduction in county taxes rather than spending money on other things.

Of course, there would be an opposite reaction from New York State government, which would be left with the options of raising taxes significantly or cutting other programs to cover the extra costs of Medicaid. The state could also reduce Medicaid benefits, choosing how to apportion such cuts between the elderly, who use the majority of the state’s Medicaid payments in nursing facilities, or children and the poor, who rely on Medicaid for their health care. Hospitals and nursing homes will be negatively impacted. The state, to compensate for their extra Medicaid expenses, might also simply reduce other non-Medicaid expenses that they pay the counties for. Collins, of course, is too busy ridding the country of Obamacare to be concerned about whether seniors, the poor or taxpayers should bear the brunt of the shifting responsibilities for Medicaid expenses.

A question raised by Collins’s Saturday rally: Were Mychajliw and the other Republicans who joined Collins doing so in support of the Trumpcare bill? Will the Republicans supporting the Collins Medicaid plan be happy to be labeled as deputy-cheerleaders for Trumpcare and all its negative results when the county elections come along this fall. It might be a little complicated to explain why they want to take away thousands of county residents’ medical insurance while sticking it to the elderly.

Perhaps those elected officials were merely supporting the stick-the-state Medicaid amendment to Trumpcare, but not the actual Trumpcare bill that would be needed to implement the Collins Medicaid cost transfer. That would mean that those folks were not being straight with their constituents. Which means they were also being used as a smokescreen and cover for Collins on a sticky issue that he can’t easily talk away.

Either way, it is not good.

After Congress deals with the Trumpcare bill they can dive into things like Trump’s 2018 budget proposals. I wonder how many fellow Republicans Collins can round up to support a Trump budget that hurts hungry seniors, destroys environmental protection and says goodbye to things like educational, cultural and transportation programs. It is early in the budget preparations and I know there are more important and timely matters for Trump and the Republicans to contend with such as the Obama “wire tapping” and damaging our country’s relations with our friends and allies. Let’s see how many of the Republican faithful Cheerleader Chris can round up in support of the president’s budget.

In days gone by, former Democratic Chairman Joe Crangle relished the opportunity to hang unpopular national or statewide issues around the necks of local Republican candidates. It looks like that opportunity is coming along again.

Ken Kruly writes about politics and stuff at politicsandstuff.com.