How the latest Obamacare repeal bill would affect New York State

The legislation that Senate Republicans hope to pass next week in a last-ditch effort to dismantle Obamacare would strip away some of the federal funds sent to New York and other states for expanding Medicaid – and give them to the states that didn’t.

The conversion of Affordable Care Act funds into state block grants from 2020 to 2026 is one key part of the bill that Senate Republicans will bring up for a vote by the end of the month, before the expiration of special budget rules that allow passage by a simple majority.

How New York State would be affected

The bill would put the ACA’s financing for subsidized private health insurance and Medicaid expansion into a giant pot and redistribute it among states according to new formulas.

New York would lose $45 billion under the bill’s conversion of Affordable Care Act funds into state block grants from 2020 to 2026, the Avalere consulting firm said.

The Center for Budget and Policy Priorities, a think tank that favors the current health law, said New York State would lose $18.9 billion in 2026 alone.

Here’s a look at the 10 states that would lose the most in federal funding if the bill becomes law:


How New York leaders have responded

Supporters of the bill say governors and state legislatures would have broad leeway on how to spend the money, and could also seek federal waivers allowing them to modify insurance market safeguards for consumers. For example, states could let insurers charge higher premiums for older adults.

But with that flexibility also comes the challenge of fixing a broken health care system with less money, a task that New York Gov. Andrew M. Cuomo and at least 10 other governors have publicly rejected.

“I would not trade $19 billion for the flexibility. Because if they cut us $19 billion, if I was as flexible as a Gumby doll, we could not fund our healthcare system,” Cuomo said. “It also puts 2.7 million New Yorkers at risk of losing their health insurance.”

The bill also repeals requirements that individuals buy health insurance and employers offer it, ends subsidies to help people pay premiums, cuts off funding for Medicaid expansion, and makes significant cuts as its reshapes Medicaid.

“They are designed, these cuts, to hurt states that have expanded Medicaid,” Cuomo said. “To penalize us for doing a better job than other states is a gross unfairness.”

Residents of New York and California, which expanded Medicaid and set up insurance marketplaces, had fared better than people living in Texas and Florida, which opted out of both, according to a March 2017 study by the Commonwealth Fund, which studies health issues.

If the bill passes in the Senate, it faces a difficult path in the House, said Rep. Peter King (R-Seaford), who opposes the bill because of the funding cuts for New York.

To penalize us for doing a better job than other states is a gross unfairness.

– Gov.
Andrew Cuomo

How other states would be affected

The bill would lead to an overall $215 billion cut to states in federal funding for health insurance, through 2026. Reductions would grow over time.

A reduction in federal subsidies for health insurance likely would lead to more people being uninsured, said Caroline Pearson, a senior vice president at Avalere, which specializes in health industry research.

Thirty-four states would see cuts by 2026, while 16 would see increases. Among the losers are several states that were key for President Donald Trump’s election, including Florida, Pennsylvania, Michigan, and Ohio.

California would lose $78 billion, while Texas and Georgia would gain $35 billion and $10 billion, respectively.

“If you’re in a state which has not expanded Medicaid, you’re going to do great,” said Cassidy. “If you’re a state which has expanded Medicaid, we do our best to hold you harmless.”

What else would the bill do?

Named for the bill’s sponsors, Sens. Lindsey Graham (R-S.C.), and Bill Cassidy (R-La.), the bill would repeal much of the Obama-era Affordable Care Act and limit future federal funding for Medicaid. That federal-state health insurance program covers more than 70 million low-income people, ranging from newborns to elderly nursing home residents.

Independent analysts say the latest Senate Republican bill is likely to leave more people uninsured than the Affordable Care Act, and allow states to make changes that raise costs for people with health problems or pre-existing medical conditions.

The Congressional Budget Office has said it doesn’t have time to complete a full analysis of the impact on coverage before the deadline.

How would Medicaid spending be affected?

Compared to current projected levels, Medicaid spending would be reduced by more than $1 trillion, or 12 percent, from 2020-2036, a study by consulting firm Avalere found. Earlier independent congressional budget analysts said such Medicaid cuts could leave millions more uninsured.

Here’s how else the bill compares

Medicaid expansion

Current: States have the option to expand Medicaid to cover more low-income adults, with the federal government picking up most of the cost.

Senate bill: Ends the federal match for Medicaid’s expansion; ends program’s status as an open-ended entitlement, replacing it with a per-person cap.

Health status-based rates

Current: People cannot be denied coverage due to pre-existing medical problems, nor can they be charged more because of poor health.

Senate bill: Prohibits denying coverage to those with pre-existing condition, but states can seek waivers to let insurers charge more based on health status in some cases.

Subsidies for insurance

Current: Provides income-based subsidies to help with premiums and out-of-pocket costs such as deductibles and copayments; subsidy benchmark tied to mid-level “silver” plans.

Senate bill: Replaces income-based subsidies with block grants to states for health care programs; ends cost-sharing subsidies in 2020.

Standard health benefits

Current: Requires insurers to cover 10 broad “essential services” such as hospitalization, prescriptions, substance abuse treatment, preventive services, maternity and childbirth.

Senate bill: Allows states to seek waivers from the benefits requirement as part of the block grant program.

Coverage mandate

Current: Requires those deemed able to afford coverage to carry a policy or risk fines from the IRS; requires larger employers to offer coverage to full-time workers.

Senate bill: Repeals coverage mandate by removing tax penalty beginning with the 2016 tax year.

Planned Parenthood

Current: Planned Parenthood is eligible for Medicaid reimbursements, but federal money cannot fund abortions.

Senate bill: Planned Parenthood would face a one-year Medicaid funding freeze.

Sources: Department of Health and Human Services, Kaiser Family Foundation

WITH WASHINGTON POST

What it’s like to be your borough’s top advocate

Millions of dollars in city funding is controlled by five borough presidents, who can allocate it to the projects of their choosing — like affordable housing complexes in the Bronx, a rehabilitation center on Staten Island or upgrades to a police precinct in Queens.

While the role of a borough president can seem ceremonial at times, these are the only politicians whose sole purpose is to advocate for a whole borough.

“The borough-wide perspective is an important one, and we work with the legislators in order to deliver that perspective,” Queens Borough President Melinda Katz says.

The borough presidents use that perspective to advise on issues like land use and the city budget. Their primary role isn’t to pass legislation, Katz notes, although they can sponsor legislation if they partner with a member of City Council. But in order to achieve their agendas, they must work with city agencies.

“In Borough Hall, what you do is interwoven in these agencies, and you need to figure out a way to get the mayor and the administration to work with you,” Staten Island Borough President James Oddo says, noting that it’s different from working in City Council, where there are ways to achieve agendas “not only without the administration’s help, but despite the administration’s help.”

The five borough presidents, who are all up for reelection in November, focus on issues that many city politicians speak on, including securing affordable housing and promoting healthy living.

Their days can include anything from mundane meetings to dancing with seniors at a local center. Here’s a snapshot of the lives of each of the borough presidents.

Bronx BP Ruben Diaz Jr.

“We’ve been so beaten down psychologically and spiritually.” Credit: Corey Sipkin

Ruben Diaz Jr. “can’t stand” that his son, in his 20s, moved to upper Manhattan when he graduated college, he says with a laugh over lunch at a Bronx pizzeria.

He wants young people, like his son, to stay in the Bronx, but that hasn’t always been the mindset. When the borough president grew up in the Bronx, the mindset was to get an education and get a job so you could “get the hell out.” Now, as the borough sees more and more development, there’s more reason to stay, he says.

In order for that “skilled, young workforce” to remain, however, there needs to be affordability — and not only for the lowest incomes, Diaz, who has been borough president since 2009, says. Affordable housing needs to have a mix of availability for low-income and middle-income.

“If you don’t have that balance, then you’re really not setting our professionals up for a place to stay here.”

Hear more from Diaz by clicking on the video above.

Staten Island BP James Oddo

“Staten Islanders have an elevated expectation of their elected officials.” Credit: Yeong-Ung Yang

“I am hyper by nature. I like to bounce around the building,” Borough President James Oddo says as he tosses a rubber ball between his hands at his desk at Staten Island’s Borough Hall in St. George.

That energy also translates to his job, which he said is “to fight for Staten Island every day, all day,” and many days it is a fight – with city agencies.

“I’ve told the mayor in chapter and verse, in Technicolor language, about just how frustrating it is to deal with agencies like DDC [Department of Design and Construction], and at times DOT [Department of Transportation].”

Oddo, who was a council member for 15 years before becoming borough president in 2014, works with city agencies on quality of life issues like getting roads paved, which he says has been a long battle.

“For 15 years, we essentially underinvested in our roads in terms of resurfacing, and four years ago, just about any community in Staten Island, just about every other block was crumbling,” but in the last three years, more roads have been paved than ever before, Oddo says.

Hear more from Oddo by clicking on the video above.

Queens BP Melinda Katz

“People, right now, are trying to figure out all over the world how to bring their kids and their parents to the borough of Queens.” Credit: Raychel Brightman

When Melinda Katz introduced her then-6-year-old son to an assemblyman, young Carter was confused because he wasn’t a woman.

“Men can be elected officials, too,” she recalls telling him, adding that he “learned that on that day.”
“From my son’s perspective, women are very strong,” she says.

Katz, a single mom raising her two sons in her own childhood home in Forest Hills, served in City Council between 2002 and 2009 and became borough president in 2013. She often refers to Queens as the “borough of growth” or the “borough of families.”

“We have folks coming in from all over to bring up their kids here.”

But there are challenges that come with that growth, including a need for more jobs in the borough. “The economy is the key factor in moving forward here,” Katz says. “The creation of jobs as we grow is going to be the pivotal thing.”

Hear more from Katz by clicking on the video above.

Brooklyn BP Eric Adams

“There’s no building off limits.” Credit: Yeong-Ung Yang

Eric Adams is incredibly proud of his transformation after being diagnosed with Type 2 diabetes in 2016.

“I want to be a living example of how wellness matters, how you can reverse your condition by living a healthier lifestyle and making smarter choices,” he says in his Downtown Brooklyn office, which features a cooking station, exercise equipment and a standing desk. By becoming vegan and exercising every day, Adams, who took office in 2014, says he was able to reverse his diagnosis.

As borough president, he wants to give residents of Brooklyn – the second unhealthiest borough according to the 2017 County Health Rankings – the tools to “take power over their health.”

One way he does this is by investing in greenhouses, especially at NYCHA properties, “where you have some of the worst eating habits and access to healthy food,” and at schools, where healthy habits can be taught to children who can then teach their parents, he says.

Hear more from Adams by clicking on the video above.

Manhattan BP Gale Brewer

“The biggest challenge in Manhattan is the affordability crisis.” Credit: Yeong-Ung Yang

Even Gale Brewer can’t overcome Manhattan’s transit problems. “The traffic is an issue. Sometimes the subway’s faster, but not always,” she said, after deciding she won’t be able to make an event before a 2 p.m. meeting at her office near City Hall. “It’s too bad, I was trying to get to it.”

The borough president craves face-to-face meetings with her constituents, appearing at as many as 12 events, public meetings, rallies or other functions a day.

“You can only do so many things.”

In between events, though, Brewer — a college professor and mom of several foster kids — also tries to mentor younger generations. Her office accepts all intern applicants, who can range from high school students to graduate students, and she’s been known to have as many as 150 interns at one time.

Brewer, who was elected in 2013, said she likes to have as many as possible. “It gives us an excitement of young ideas in the office,” she said. “I love to see them grow.”

Hear more from Brewer by clicking on the video above.

How sea level rise could affect the New York area

The federal government in January released estimates of how rising sea levels could affect coastal areas in the United States. Based on water-level and ground-elevation data, the map shows what areas could become inundated with a sea level rise of one foot to six feet. The green areas could become low lying and susceptible to flooding if the sea level rose, although the government would need a more detailed analysis to determine if they actually would.

The National Oceanic and Atmospheric Administration, which produced the data behind the map, cautions that the flooded areas shown “are not as precise as they may appear.” Erosion, construction or natural evolution of the coast could alter the forecast. There is also no agreement about how fast the sea level is rising. You can type an address into the search box (magnifying glass), or zoom in to any area, and then select an amount of sea level rise. This map was posted on Aug. 18, 2017.

Select sea level rise:


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  • Sea level
  • Low lying areas

How rising sea levels could affect Long Island

The federal government in January released estimates of how rising sea levels could affect coastal areas in the United States. Based on water-level and ground-elevation data, the map shows what areas could become inundated with a sea level rise of from one foot to six feet. The green areas could become low lying and susceptible to flooding if the sea level rose, although the government would need a more detailed analysis to determine if they actually would.

The National Oceanic and Atmospheric Administration, which produced the data behind the map, cautions that the flooded areas shown “are not as precise as they may appear.” Erosion, construction or natural evolution of the coast could alter the forecast. There is also no agreement about how fast the sea level is rising. New York State’s Department of Environmental Conservation estimates that by the 2050s, levels on Long Island’s coast could be between eight to 30 inches higher.

You can type an address into the search box (magnifying glass), or zoom in to any area, and then select an amount of sea level rise. And you can read more about how developers are anticipating sea level rise, This map was posted on Aug. 11, 2017.

Select sea level rise:


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  • Sea level
  • Low lying areas

Karina Vetrano murder: Howard Beach, 1 year later

Jogger Karina Vetrano was found brutally murdered on Aug. 2, 2016, in her close-knit Howard Beach community. A year later, many residents say they still won’t set foot in Spring Creek Park, where the 30-year-old’s body was found.

The murder, in a neighborhood where violent crimes are rare, left the community reeling for nearly six months until police nabbed a suspect, 20-year-old Chanel Lewis of East New York, which borders Howard Beach in Queens.

Lewis is accused of strangling and sexually abusing Vetrano, a graduate of St. John’s University who worked part-time as a cocktail waitress at an Italian restaurant and lounge in Howard Beach, where she also lived with her parents.

The suspect is being held at the North Infirmary Command on Rikers Island, which houses high-profile inmates or prisoners who need medical care, while awaiting a pretrial hearing on Sept. 7.

He allegedly confessed to killing Vetrano in February, but pleaded not guilty in court in April. Whether or not his confession was voluntary will be the topic of a pretrial hearing, Queens State Supreme Court Justice Gregory Lasak said during another hearing on July 13.

His DNA, which Lewis gave voluntarily, matched samples taken from under Vetrano’s nails, on her neck and on her phone, according to authorities.

Even with the arrest, residents of the neighborhood have been noticeably more alert, said Capt. Brian J. Bohannon Jr., the commanding officer of the 106th Precinct, which covers Howard Beach, Ozone Park and South Ozone Park.

“People do call the police when they do see something down there. We have had calls of suspicious persons in the neighborhood,” said Bohannon, who noted that Howard Beach is a “very pro-police community.” Residents have called in when they don’t recognize someone from their block or neighborhood, he added.

“I haven’t seen any … ‘sky falling down’ sentiment like people assumed would happen,” he added. “I feel they’re very appreciative of the work that the police have done, especially closing this case and bringing her killer to justice.”

The park where Vetrano’s body was found, Spring Creek Park — a sprawling, federally protected green space at the southern end of the Howard Beach peninsula locals call “The Weeds” — is overgrown with thick common reeds that reached up to more than 5 feet high on a recent afternoon and lined both sides of the dirt walking paths inside.

The wildness of the park deterred most people from it even before the murder, but after, the more adventurous also stopped going in, some residents said.

360 video: “The Weeds”

Note: On mobile devices, the 360-degree video experience can be viewed only in the YouTube app.

Maxomiliano Lopez Gomez said he used to kayak, fish and ride his motorcycle in Spring Creek Park, but he didn’t return after the NYPD and National Park Service police swarmed it following Vetrano’s death.

While Spring Creek Park is part of the Gateway National Recreation Area, owned and operated by the National Park Service, the NYPD is responsible for the surrounding area. City police are not currently targeting the area for more patrols, Bohannon said.

The exterior of the park is patrolled daily by a U.S. Parks police officer in a marked vehicle and the interior is patrolled several times a week, said Sgt. David Somma of the U.S. Parks police, though he wouldn’t provide the exact number of patrols inside The Weeds.

Immediately after Vetrano’s body was found, the weeds in the park were trimmed down so people could finally see into it, and police in cars, on horses and on foot patrolled the area for months. But as soon as Lewis was arrested in February, the police disappeared and the weeds grew back in full force, residents said.

“You’re basically in a forest and you never know what’s going to come out of there,” Lopez Gomez said. “I’m not really worried about people in there, but more the animals, like raccoons. They could be rabid. You see people go in there, mostly people who enjoy the wildlife. But I don’t go in there anymore.”

James Debari, 46, father of two young children and resident of Howard Beach for 11 years, said he used to go into the park “out of curiosity,” but hasn’t been back since the murder.

“I would never take my kids in there,” he said. “I’m more worried about the ticks than anything else. A lot of people don’t go in there. Nobody really knows why [Vetrano] was in there.”

Some community advocates have urged residents to stay out of the park, while others hoped the tragedy would push the National Park Service to rejuvenate the space into a safe place for visitors by removing weeds and adding cameras and lighting, Somma said.

Howard Beach, Queens


Howard Beach Murder Map
VIEW MAP

“If you’re going to be walking at night, make sure you go with a buddy,” said Joann Ariola, president of the Howard Beach-Lindenwood Civic Association. “We also urge people not to go to Spring Creek Park. Although it’s patrolled, it’s not as patrolled as we would like it.”

On Feb. 2, just before Lewis’ arrest on Feb. 5, the National Park Service and the state Department of Environmental Conservation approached Queens Community Board 10 – which covers Howard Beach, Ozone Park and South Ozone Park – with an update to its resiliency plan for the park that was proposed in 2015, after superstorm Sandy.

The plan originally focused on reducing storm damage and flooding around Spring Creek Park, but now features a “crime prevention” component, including permanently ripping out the weeds there, replacing them with shorter native plants and installing benches, according to Gateway.

“We wouldn’t want anything to grow high like [the weeds],” explained Gateway spokeswoman Daphne Yun. “It maximizes safety and security through sight lines and access points.”

I would never take my kids in [The Weeds].
… A lot of people don’t go in there.

Howard Beach resident James Debari

Construction on the nearly $70 million, FEMA-funded project is expected to start in the summer of 2019 and wrap up by the summer of 2021, according to the DEC.

But infrastructure in the park currently doesn’t support cameras and lighting, Somma said.

Gateway has hired a security expert to figure out whether adding cameras and lighting would be possible, according to Yun.

“Lighting is part of the conversation, but there might not be any lighting so people can know when it’s open and when it’s closed,” Yun said, noting that the park is only open from dawn to dusk. There’s a small sign listing park rules and hours at the intersection of 83rd Street and 161st Avenue.

The community’s concerns over safety in the park came to a head after Vetrano’s death. As the NYPD investigated, the only footage obtained of her running outside the park was captured from a CCTV camera attached to a house on 83rd Street near 164th Avenue.

“If there’s a really safe area, you don’t want the resources to be used, but then something happens, and you wished they were there,” Queens Borough President Melinda Katz said.

The NYPD installed eight cameras along the edge of Spring Creek Park on Aug. 24, 2016, about three weeks after Vetrano was killed. The cameras were funded by Katz’s office as part of a Queens-wide camera installation project costing $1.2 million.

“There always should have been some sort of cameras there,” Katz said. “[Now] if you enter or leave the park, you’ll be filmed.”

“Small-town values”

Howard Beach is mostly residential with a beachside, suburban feel and a population of roughly 30,000 people, 82.4 percent of whom are white non-Hispanic, and the majority of whom are homeowners, according to the most recent U.S. Census data, from 2015. Only about 11 percent of residents rented during 2015, the data shows.

The neighborhood is bound by water on three sides and borders Ozone Park and South Ozone Park to the north and East New York to the west.

John Spinelli, 47, moved to Howard Beach in 2000. The former engineer, who is no longer working and is on disability, said he moved to the area for some peace and quiet and for the Italian community.

“I lived in South Ozone Park, but I moved here because the neighborhood was getting bad — noisy,” Spinelli said. “It’s quiet here. No one plays the music really loud. It’s a nice neighborhood. It’s predominantly Italian. That’s why my mom wanted to live here.”

With a median household income of more than $85,000, Howard Beach is easily the wealthiest of the communities surrounding it. By comparison, the median income of neighboring Ozone Park is $62,057 and in East New York it’s $35,698, census data shows.

Howard Beach also has the lowest major crime numbers out of those neighborhoods.

Complaints about noise and a woman selling ices on the roadside made up the majority of residents’ grievances during a July 12 session of a community meeting, held monthly at the 106th Precinct.

“It’s a community where violent crime is not regular,” said Betty Braton, chairperson of Community Board 10 and a resident of Howard Beach for more than 60 years.

“A murder is far from common. That’s what made it a horrendous thing to the community. It certainly disturbed the community greatly, made people very mindful that there is danger in this world you live in.”

Howard Beach hasn’t seen any murders or rapes in 2017, as of July 23, though there were eight robberies and nine felony assaults. Precinct-wide, there were three murders, four rapes, 109 robberies and 126 felony assaults for that time period.

By comparison, on the other side of the Belt Parkway in the 75th Precinct, which covers East New York and Cypress Hills, there were five murders, 32 rapes, 352 robberies and 478 felony assaults reported for that period.

Single-family houses and manicured lawns make up most of the tight-knit Howard Beach community, with Italian eateries, cafes and chain stores concentrated along Cross Bay Boulevard, the neighborhood’s commercial strip, including Vetro Restaurant and Lounge, where Vetrano worked as a cocktail waitress.

Residents have been more wary since the murder and it’s made them band together, Bohannon said.

“It increased awareness,” he said. “For the family, that grief is never going to go away. As far as the community in general, the businesses doors aren’t shuttered and no one is sleeping behind closed doors. I think we have rebounded pretty well.”

Residents of Howard Beach will hold a vigil for Karina Vetrano on Wednesday, Aug. 2, the one-year anniversary of her death. They will meet at 165th Avenue and 85th Street at 7 p.m. and walk to St. Helen’s Church on 83rd Street. Borough President Melinda Katz and the 106th Precinct’s Commanding Officer Brian J. Bohannon Jr. will be among those in attendance.

Reported by: Heather Holland, Nicole Brown, Lauren Cook, Alison Fox, Alex Bazeley & Sarina Trangle | Copy editor: Martha Guevara | Designer: Matthew Cassella | Interactive editor: Polly Higgins |

360 View: Inside cat room at Animal Rescue Fund of the Hamptons

Pets

360 View: Inside the cat room at Animal Rescue Fund of the Hamptons

These adoptable cats got up close and personal with our 360-degree camera.

Alt Video TextPlay 360° Video

The cats available for adoption at the Animal Rescue Fund of the Hamptons got up close and personal with a 360-degree camera on Wednesday, March 8, 2017. To find out how you can take home one of these furry friends, please call 631-537-0400 or click on www.arfhamptons.org.(Credit: Newsday / Megan Miller)

Note: On mobile devices, the 360-degree video experience can be viewed only in the YouTube app.