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Submission: On May 18 via manual from US — Scanned from US
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Toggle navigation * Research * Reports * Blog * Commentary * Data & Statistics * Press * Releases * Commentary * Testimony * Events * Podcast * About * Who We Are * Our Team * Board of Directors * Student Fellows * Careers * Donate * Donate Blog ALBANY LAWMAKERS PUSH A $4 BILLION TAX ON HEALTH INSURANCE * by Bill Hammond * March 13, 2024 Legislative leaders are proposing an additional $4 billion tax on health insurance plans in the upcoming state budget – but withholding specifics of how it would work. The concept emerged Tuesday in the Assembly’s draft of the state budget for fiscal 2025, which is due by the end of this month. The health-care portions of the Assembly’s so-called one-house budget called for raising $4 billion from a “tax on managed care organizations” – and using the money to increase Medicaid spending – but said nothing about how the tax would be collected. [The Senate did not specifically mention the proposal in its one-house budget, but Senate Finance Chairwoman Liz Krueger expressed support, calling it “an easy answer of how we pay for [undoing] the Medicaid cuts without it impacting other parts of the budget.”] UPDATE: The Senate budget resolution called for the Department of Health > to submit a federal waiver to impose a per member per month tax on all managed > care companies, with higher rates imposed on Medicaid Managed Care plans > compared to non-Medicaid plans. This tax is expected to yield approximately $4 > billion in additional federal financial participation per year for three > years. The lack of detail raises concern that legislative leaders intend to negotiate the plan in private talks with Governor Hochul and keep specifics secret until just before lawmakers vote on the final budget. Such a tax could theoretically be designed to generate federal matching funds through Medicaid while imposing only nominal costs on health plans and consumers. Without details, however, the risks and benefits are impossible to judge. Insiders said the idea for an MCO tax was floated by the Greater New York Hospital Association, mirroring a similar levy recently enacted in California. The GNYHA plan reportedly calls for health plans to pay $40.40 per month for each of their Medicaid enrollees, and $1 per month for each non-Medicaid enrollee. MCO taxes and other so-called provider taxes are a widely used strategy to exploit Medicaid's open-ended funding system, in which the federal government pays a fixed percentage of each state's costs. In New York, each dollar spent on Medicaid out of state funds is roughly matched by another dollar from Washington. Thus, if the state were to raise $4 billion from managed care plans, it could use that money to finance an $8 billion increase in premiums paid to the plans on behalf of Medicaid enrollees – with the federal government picking up half the cost. This would leave the MCOs with a net increase of $4 billion, which they would pass along in the form of higher fees for hospitals and other providers. This strategy is widely considered to be an abuse, and the federal Centers for Medicare & Medicaid Services has tried to restrict the practice by requiring that taxes used to finance Medicaid must be "broad-based" and "uniform" – that is, not disproportionately targeted to Medicaid-related spending. However, almost every state uses at least one provider tax, and at least 18 have MCO taxes. New York currently imposes two taxes of this type under its Health Care Reform Act: a surcharge on hospital services of 9.63 percent for commercial patients and 7.04 percent for Medicaid patients, and a per-enrollee "covered lives assessment" that varies by region, from $10.25 per year in the Utica-Watertown area to a high of $189 in New York City. These taxes raise about $5.7 billion a year, most of which flows into the Medicaid budget. Last year, California enacted an MCO tax that was meant to raise $19.5 billion over four years. In its first year, it charged the affected plans $182.50 per month for Medicaid enrollees and only $1.75 per month for non-Medicaid enrollees. Although it was clearly targeted, CMS granted its approval because the plan narrowly passed a statistical test showing a lack of correlation between amounts owed and Medicaid payments. In a side letter to state officials, however, CMS said it believed the California tax violated the spirit of its regulations and that the agency intended to update its statistical test – signaling that it would reject similar taxes in the future. This raises the possibility that an MCO tax enacted by New York this year would be rejected in Washington – or that it would be okayed on a temporary basis, leaving a multi-billion-dollar hole in the Medicaid budget when that approval expires. If that were to happen, legislators would likely feel pressure to impose the tax equally on non-Medicaid enrollees, adding to the already high cost of health insurance in New York. If New York enacts the proposed MCO tax, the Legislature intends to use the revenue to fuel a further increase in Medicaid spending, which has been rising at double-digit rates in the aftermath of the pandemic. While Hochul has proposed trimming state Medicaid spending by $700 million, the Senate is proposing a year-to-year increase of $2.8 billion, and the Assembly is proposing an increase of $4.3 billion (see table and chart). New York's per capita Medicaid spending is already the highest of any state's and 72 percent above the national average. Tags: Centers for Medicare and Medicaid Services Governor Hochul Medicaid New York State Assembly State Budget State Senate Taxes and Spending ABOUT THE AUTHOR BILL HAMMOND * * As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy. Read more by Bill Hammond YOU MAY ALSO LIKE BUDGET DEAL SLOWS MEDICAID GROWTH BUT PLANTS SEEDS FOR FUTURE SPENDING The growth of New York's Medicaid spending is projected to slow but not stop as Governor Hochul and the Legislature effectively split their differences over health care in the newly enacted state budget. Read More BUDGET DEAL SLOWS MEDICAID GROWTH BUT PLANTS SEEDS FOR FUTURE SPENDING The growth of New York's Medicaid spending is projected to slow but not stop as Governor Hochul and the Legislature effectively split their differences over health care in the newly enacted state budget. Read More ALBANY’S NEW HEALTH INSURANCE TAX COMES WITH FEW LIMITS The newly enacted state budget imposes a multibillion-dollar tax on health insurance without specifying who must pay how much – leaving those basic details to be decided later by the health commissioner in negotiation wit Read More ONE OF NEW YORK’S BIGGEST MEDICAID CONTRACTORS IS QUIETLY ACQUIRING A COMPETITOR Author's note: This post has been updated to correct an error in the second paragraph. As state lawmakers debate the future of Medicaid home care, one of the program's bigg Read More NEW YORK’S HOME HEALTH WORKFORCE JUMPED BY 12 PERCENT IN ONE YEAR New York's home health workforce has continued its pattern of extraordinary growth, increasing by 62,000 jobs or 12 percent in a single year, according to newly released data from the U.S. Bureau of Labor Statistics. Read More WHILE NEW YORK’S MEDICAID BUDGET SOARED, PUBLIC HEALTH FUNDING LANGUISHED Four years after a devastating pandemic, the state has made no major investment to repair or improve its public health defenses. While funding for Medicaid over the past four years Read More A MEDICAID GRANT RECIPIENT SPONSORS A PRO-HOCHUL PUBLICITY CAMPAIGN While much of the health-care industry is attacking Governor Hochul's Medicaid budget, at least one organization is rallying to her side: Somos Community Care, a politically active medical group in the Bronx that recently r Read More NEW JERSEY’S PANDEMIC REPORT SHINES HARSH LIGHT ON A NEW YORK SCANDAL A recently published independent review of New Jersey's pandemic response holds lessons for New York on at least two levels. First, it marked the only serious attempt by any state t Read More A POLITICALLY ACTIVE MEDICAL GROUP GETS $29 MILLION IN ‘DISTRESSED’ PROVIDER FUNDS State officials awarded $29 million in 'distressed' provider funding to a politically active medical group in the Bronx, state records confirm. a network of physicians and other he Read More BUDGET DEAL SLOWS MEDICAID GROWTH BUT PLANTS SEEDS FOR FUTURE SPENDING * April 29, 2024 BUDGET DEAL SLOWS MEDICAID GROWTH BUT PLANTS SEEDS FOR FUTURE SPENDING * April 29, 2024 ALBANY’S NEW HEALTH INSURANCE TAX COMES WITH FEW LIMITS * April 25, 2024 ONE OF NEW YORK’S BIGGEST MEDICAID CONTRACTORS IS QUIETLY ACQUIRING A COMPETITOR * April 11, 2024 NEW YORK’S HOME HEALTH WORKFORCE JUMPED BY 12 PERCENT IN ONE YEAR * April 5, 2024 WHILE NEW YORK’S MEDICAID BUDGET SOARED, PUBLIC HEALTH FUNDING LANGUISHED * March 28, 2024 A MEDICAID GRANT RECIPIENT SPONSORS A PRO-HOCHUL PUBLICITY CAMPAIGN * March 26, 2024 NEW JERSEY’S PANDEMIC REPORT SHINES HARSH LIGHT ON A NEW YORK SCANDAL * March 25, 2024 A POLITICALLY ACTIVE MEDICAL GROUP GETS $29 MILLION IN ‘DISTRESSED’ PROVIDER FUNDS * March 18, 2024 BUDGET DEAL SLOWS MEDICAID GROWTH BUT PLANTS SEEDS FOR FUTURE SPENDING * April 29, 2024 ALBANY’S NEW HEALTH INSURANCE TAX COMES WITH FEW LIMITS * April 25, 2024 ONE OF NEW YORK’S BIGGEST MEDICAID CONTRACTORS IS QUIETLY ACQUIRING A COMPETITOR * April 11, 2024 NEW YORK’S HOME HEALTH WORKFORCE JUMPED BY 12 PERCENT IN ONE YEAR * April 5, 2024 WHILE NEW YORK’S MEDICAID BUDGET SOARED, PUBLIC HEALTH FUNDING LANGUISHED * March 28, 2024 A MEDICAID GRANT RECIPIENT SPONSORS A PRO-HOCHUL PUBLICITY CAMPAIGN * March 26, 2024 NEW JERSEY’S PANDEMIC REPORT SHINES HARSH LIGHT ON A NEW YORK SCANDAL * March 25, 2024 A POLITICALLY ACTIVE MEDICAL GROUP GETS $29 MILLION IN ‘DISTRESSED’ PROVIDER FUNDS * March 18, 2024 BUDGET DEAL SLOWS MEDICAID GROWTH BUT PLANTS SEEDS FOR FUTURE SPENDING * April 29, 2024 ALBANY’S NEW HEALTH INSURANCE TAX COMES WITH FEW LIMITS * April 25, 2024 ONE OF NEW YORK’S BIGGEST MEDICAID CONTRACTORS IS QUIETLY ACQUIRING A COMPETITOR * April 11, 2024 NEW YORK’S HOME HEALTH WORKFORCE JUMPED BY 12 PERCENT IN ONE YEAR * April 5, 2024 WHILE NEW YORK’S MEDICAID BUDGET SOARED, PUBLIC HEALTH FUNDING LANGUISHED * March 28, 2024 A MEDICAID GRANT RECIPIENT SPONSORS A PRO-HOCHUL PUBLICITY CAMPAIGN * March 26, 2024 NEW JERSEY’S PANDEMIC REPORT SHINES HARSH LIGHT ON A NEW YORK SCANDAL * March 25, 2024 A POLITICALLY ACTIVE MEDICAL GROUP GETS $29 MILLION IN ‘DISTRESSED’ PROVIDER FUNDS * March 18, 2024 ADVANCED SEARCH * From Month... 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