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The number of New Yorkers who rely on Medicaid and other publicly funded health plans has grown sharply over the past decade, but proposals by President Trump and some members of Congress could cut federal funding for those programs by billions of dollars and jeopardize health care coverage for many residents, according to a report released Wednesday by State Comptroller Thomas P. DiNapoli.

"There are disturbing calls in Washington to repeal the Affordable Care Act (ACA) and make radical changes to Medicaid," DiNapoli said. "We cannot go backwards on health care and force people to choose between buying groceries or seeing a doctor. We need more people to have access to quality health care, not fewer. These cuts would also impact the state budget and require difficult decisions to cover shortfalls."

DiNapoli's report, "7 Million and Counting: More New Yorkers Benefit from State Health Coverage," examines the expansion of Medicaid and other state health care programs over the last 10 years that now cover more than a third of the state's estimated 19.8 million residents. The report found that the number of people covered by Medicaid and other major state programs rose by 57 percent over the past decade, to more than 7 million, largely due to enactment of the federal ACA and other changes in federal and state health care policies.

Medicaid, Child Health Plus (CHP), the Essential Plan and subsidized coverage through the state's health insurance marketplace, New York State of Health (NYSOH), cost a total of more than $75 billion in state fiscal year (SFY) 2017-18.

Medicaid, established in New York in 1966, covered a monthly average of nearly 6.2 million people in SFY 2017-18. Medicaid enrollment in the state historically has been concentrated in New York City, where enrollment rose 28.6 percent over the past decade. However, growth across the rest of the state over the same period was almost triple the increase in the city, on a percentage basis.

Statewide Medicaid enrollment jumped by nearly 2 million individuals, or 46.3 percent, over the past decade, with increases in every county. In six counties – Dutchess, Nassau, Putnam, Rockland, Schenectady and Suffolk – the number of Medicaid enrollees more than doubled over the decade. Eleven other counties across the state saw enrollment growth of more than 75 percent, specifically Columbia, Ontario, Orange, Saratoga, Seneca, Sullivan, Ulster, Warren, Wayne, Westchester and Wyoming.

In medical inflation-adjusted dollars, spending per Medicaid enrollee in New York decreased by 18.5 percent from SFY 2008-09 to SFY 2017-18. Some of this decline resulted from the addition of large numbers of non-disabled adults and children, for whom Medicaid costs are lower than for certain other enrollment categories.

Spending for New York's Medicaid program totaled $69.4 billion in SFY 2017-18, an increase of nearly $24 billion, or 52.4 percent, since SFY 2008-09. Federal funding paid for 54 percent of state Medicaid costs in the last fiscal year and represented the majority of the spending growth in the previous decade. Federal resources support even higher percentages of the spending for the other major health coverage programs funded through the state budget.

In 2015, New York joined Minnesota as one of only two states in the nation to establish a Basic Health Program (known in New York as the Essential Plan), a low-cost health insurance option authorized by the ACA and largely funded by the federal government. The Essential Plan is available to New Yorkers under age 65 who meet certain income requirements and are not eligible for Medicaid, CHP or affordable employer-sponsored coverage. Over the first three years of operation, enrollment in the Essential Plan rose to nearly 729,000 individuals. That number is projected by the Division of the Budget to grow to about 742,000 by 2022.

CHP provides subsidized coverage for uninsured children under age 19 who are not eligible for Medicaid and live in homes with incomes up to 400 percent of the federal poverty level. CHP provided coverage to 350,495 children in SFY 2017-18. The program was initially funded only by the state, but in 1997 New York began receiving federal funding to support a portion of the program costs, which the ACA subsequently increased. As a result, the federal share of spending on New York's CHP program has grown to approximately $1.7 billion out of the $2 billion in total program costs.

Broader coverage options created by the ACA, and other changes in federal and state health care policies, have helped reduce the percentage of people lacking health insurance in New York. Estimates reported by the National Center for Health Statistics found that the percentage of New Yorkers without health insurance fell from 10.9 percent in 2008 to 4.9 percent in 2017.

The percentage of New Yorkers without health insurance has also been consistently and significantly lower than the nation over the last decade. In 2017, New York's uninsured rate was lower than the national rate by almost 50 percent.

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