As legislators in Albany continue to parse through Gov. Andrew Cuomo's executive budget, a task force is scrambling to find ways to cut billions of dollars from New York's Medicaid program.
The state is currently facing a budget deficit in excess of $10 billion, and Gov. Cuomo argues that Medicaid accounts for some 25 percent of money spent by Albany.
But officials from hospitals and nursing homes in the North Country say that Cuomo's proposed health care cuts will have far-reaching consequences.
Some experts claim Cuomo's cuts would result in major cutbacks for critical services - others believe the proposed budget could cripple operations at nursing homes.
Chandler Ralph is president and CEO of the Adirondack Medical Center, a health care facility based in Saranac Lake that provides services at facilities across the Tri-Lakes region.
"When his budget came out, he challenged health care to take out $2.86 billion," she said. "Then, he created a Medicaid task force to say, 'okay, come up with the $2.86 billion.' That's their goal. Quite frankly, until we know what they recommend, it's very hard to estimate what the impact might be on our facilities."
Cuomo has called for similar spending decreases at the state Department of Correctional Services. In both instances, the governor has stated a dollar figure he'd like to see cut and left the details to lawmakers and task forces.
State Senator Betty Little has called that a "stealth approach" - one in which the governor scales back spending without providing specifics. Only after the spending plan is enacted would stakeholders have a firm grip on what sort of cuts were actually made.
Ralph says she likes that approach - so long as it remains fair.
"I like the fact that he is challenging the field to come up with ideas on the budget," she said. "If it turns out that the governor is going to ask for a $2.86 billion cut without any details, obviously I agree with Senator Little - I think she's right on. It would be terribly unfair."
Ralph says Cuomo's proposed cuts could be devastating for AMC, noting they could result in the end of nursing home care in the North Country and throughout upstate New York.
"Let's hope that it's not just that we're going to cut a certain percentage," she said. "Right now, you qualify for Medicaid at 400 percent of the federal poverty level, making it one of the richest programs in the country. Can we back that off to 200 percent? I'm not proposing anything, but I'm saying we have to make tough decisions now and we need fundamental reform with Medicaid."
Gov. Cuomo wants a budget in place by April 1. Ralph says that's not enough time to fundamentally change flawed programs like Medicaid.
Instead, she thinks it will result in simplistic and systematic cuts.
"I'm very worried about it and I think what the governor needs to really look at is beyond the short-term," Ralph said. "Long-term, he's going to see - if these draconian cuts go through as he has indicated they might if we don't come up with quicker solutions - hospitals and nursing homes fail."
Ralph wonders whether Cuomo is ready to deal with the repercussions if health care providers begin shuttering facilities.
"Maybe he is - I can't speculate what he's thinking," she said. "But communities need to understand that there comes a point of no return, when after you've cut you can do it no more and still provide quality services. I think all of us, looking at all of our institutions, say if it gets to the point where I can't have a staff present to provide a quality product, I'd rather shut the institution down. I'm not saying that is what AMC is going to be doing, but that decision will be made by a lot of providers."
Cuomo argues that special interests are crying wolf across the board, including health care, education lobbyists, and public employee unions. He adds that if legislators continue to cave to those groups, the budget situation will get exponentially worse.
But Ralph says that when it comes to Medicaid, there are basic solutions that could lead to savings. She notes that North Country nursing homes get $147 daily to take care of a resident, as opposed to nursing homes in New York City where they get between $300 and $400 per day through Medicaid.
"I think there's some room for savings there - substantial savings," she said. "I don't want to get into an upstate versus downstate argument - but what they're doing to us is immoral."
Ralph also says there's an opportunity for reform in the home-care program in New York City, where facilities get six times as much funding for home-care as patients do upstate.
Ralph says that a fundamental change in health care funding is necessary in New York. If that doesn't happen, officials will be having the same conversation every February following the release of the executive budget.