Will New York state, led by a Democratic governor, expand its Medicaid program to ensure hundreds of thousands of its poorest receive health care?
Although a majority of President Obama's signature health care law was upheld, the Supreme Court said in its ruling that states will have the option to expand Medicaid.
According to Obama, expanding the program would cover 17 million Americans without insurance by expanding coverage to all adults with earnings up to 133 percent of the federal poverty line.
If states agree to opt-in, the federal government would fully fund the expansion from 2014 to 2019; from there on out, states would need to pick up approximately 10 percent of the costs - which could equate to millions of dollars in additional expenditures.
Medicaid is joint-funded by the federal government and the state, and is determined by a federal matching formula known as Federal Medical Assistance Percentages. The county pays the state over $32 million a year for the assistance program.
State Sen. Cathy Young, R-Olean, said nearly a million New York state residents may be forced to apply for government-assisted health insurance as a result of the Supreme Court ruling.
With the possibility of paying a tax for not obtaining coverage, the state's Medicaid rolls could see a major influx.
Therefore, Young said, Medicaid may expand with or without the state opting into the program.
"... Although no one knows the exact numbers, it is estimated that there are about a million additional people who currently qualify for Medicaid in New York state but are not enrolled," Young said in a statement to The Post-Journal. "These people will be forced to either buy their own health insurance or sign up for government-funded health care, or they will face paying a tax.
"As a result, there will be a huge influx of these individuals who will sign up for Medicaid to avoid paying the tax, enormously expanding our state's current Medicaid rolls, which in turn will hit state and local taxpayers hard."
Young pointed to a CATO Institute study, which shows Medicaid costs rising by as much as $65.5 billion over the next decade as the result of Obamacare. The Washington-based think tank attributes the cost explosion to higher rates of "old-eligibles" (those entitled to assistance but not enrolled) who will will hop onto Medicaid in lieu of paying a tax.
The CATO report notes that federal funding to expand assistance will not cover old eligibles.
"New York already has the most expensive Medicaid program in the country, and it only will grow because of the Supreme Court ruling," she said. "It significantly will drive up state and local spending."
She continued, "I am extremely concerned about how much this is going to cost us. We have been working hard to streamline Medicaid and reduce costs, and this ruling definitely pushes the state in the direction of higher spending and taxes. It will hurt the taxpayers and our economy."
However, another report, by the non-profit Kaiser Family Foundation, shows government assistance costs associated to Obamacare will rise by as little as 1.2 percent in New York through 2019.
State Assemblyman Andy Goodell, R-Chautauqua County, also noted costs associated with expanding Medicaid, but said savings incurred over the short-term should be used to shift health care expenditures over the long-term.
Goodell said with New York offering the second highest welfare cash benefits in the nation, many residents may migrate to the state to receive higher assistance - crippling an already over-burdened system.
"The solution is not for New York state to be the welfare capital of the nation, but the business capital of the nation," Goodell said. "Short-term, this bill will get federal funding and we'll see savings.
"My recommendation to the governor would be to use those savings in the short-term and change the structure of the health industry with all the taxes, fees and assessments."
Governor Cuomo, in reaction to the Supreme Court ruling, said he looks forward to establishing a health care exchange, which - according to the president - will provide competitive insurance coverage plans. Cuomo, in an executive order in April, established the online exchange.
Under Obamacare, states will be required to establish the exchanges or be forced to use a federally back system.
"... We will continue to move forward with implementing the health exchange that will lower coverage costs for New York's businesses and help ensure that uninsured New Yorkers have access to health care," Cuomo said in a news release. "We look forward to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers."
Some elected officials, including governors Rick Perry, R-Texas, and Rick Scott, R-Florida, have already denounced expanding Medicaid and establishing an online exchange. Overall support for the expansion has followed party lines.