New York Reps. Chris Collins (pictured) and John Faso brokered a change to transfer more of the burden of caring for Medicaid beneficiaries from counties to the state of New York Thursday. | AP Photo Health care bill's 'Buffalo Bribe' detonates across New York 'They've declared war on New York,' said Gov. Andrew Cuomo.

ALBANY — They call it the ‘Buffalo Bribe.’ Or the ‘Tammany Haul.’ Or the ‘Knickerbocker Kickback.’

However you refer to the ploy to change the way New York funds Medicaid, the maneuver has simultaneously provided political cover for a group of Upstate New York Republicans to vote for the House GOP’s Obamacare repeal and rattled state politics back home.


As part of the last-minute scramble to ensure the 216 votes needed to pass the measure in a vote planned for Thursday, New York Reps. Chris Collins and John Faso brokered a change to transfer more of the burden of caring for Medicaid beneficiaries from counties to the state of New York — a move that could ensure that the majority of Republicans in New York’s nine-member GOP House delegation ultimately back the bill.

But it also served to pull the pin on a grenade that landed in Democratic Gov. Andrew Cuomo’s office. During a Tuesday press conference with hospital executives and health care unions, the governor lashed out, asserting that the $2.3 billion shift envisioned by Collins and Faso would amount to a “cut” to Medicaid for New Yorkers — including 100,000 and 150,000 people in their respective districts. He said it would also hurt hospitals.

“They’ve declared war on New York,” Cuomo thundered, brushing aside any property tax reductions that would come from shifting Medicaid costs. “Do you have a special arrangement with an angel or a Medicaid fairy who’s going to come down with the $2.3 billion? … It’s all cheap politics.”

At the heart of the deal — reminiscent of the so-called “Cornhusker Kickback” for Nebraska that helped grease passage of Obamacare in 2010 — was a targeted change to Medicaid funding that supporters say could lower local property taxes for Upstate New Yorkers. Unlike other states, the cost of funding Medicaid in New York is shared between the state government and its 62 counties — including the five boroughs of New York City.

Since counties outside of the city are funded mostly by property taxes, they’ve long groused that the “unfunded mandate” from Albany has hurt homeowners and businesses. It’s a decades-old complaint, stretching to the days when Gov. Nelson Rockefeller set up the system.

Addressing it has been a talking point for Republicans in Upstate New York for just as long — and unfunded mandates were a major underpinning for Collins, formerly Erie County executive, which includes Buffalo, when he considered a run for governor in 2010.

Now, Collins, a stalwart ally and defender of the president, has more juice than the typical House Republican — he was the first member of Congress to endorse Trump.

Faso, who spent decades as a minority member in the New York State Assembly, likewise railed against the funding issue during his campaign last year. After staying quiet about the American Health Care Act — which he did vote to advance in a committee — Faso cited the amendment as a reason to support the legislation.

“It fixes a 51-year mistake,” he said Monday morning on WGDJ-AM, an Albany radio station. “The people in my district, I think, sent me here to legislate, sent me here to try to fix problems that are affecting them and their families and making it more difficult to live in Upstate New York. We have to restore the economy: a lot of that has to do with regulatory and tax changes, but a lot of it has to do with relieving the burden of the property tax.”

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The amendment, which excludes large municipalities such as New York City, would bar federal reimbursements for state Medicaid funds raised from local governments, effectively shifting around $2.3 billion in Medicaid spending from the counties to the state.

Republicans including Faso have been under pressure to oppose the AHCA from progressive groups like Citizen Action, who say it will increase the cost of health insurance for senior citizens, lead to eventual reductions in Medicaid spending and eventually result in fewer people having health insurance. And few New York Republicans represent districts conservative enough to easily dismiss such pressure.

"With or without this amendment, a vote for the American Health Care Act is a vote to take away quality, affordable health coverage from 24 million people nationwide - an average of 80,000 people in each New York Congressional district,” Karen Scharff, the group’s executive director, said in a statement. “It’s rural hospitals and health care providers that will get hit the hardest by gutting Medicaid, putting every individual in our Upstate communities at risk. This amendment can only exacerbate the already devastating impact that increasing the costs of health care and decreasing the number of people covered will have - all while boosting profits for the health industry executives and lobbyists.”

While New York is deeply blue in aggregate — Hillary Clinton carried Trump’s home state by more than 20 points — the 2012 round of redistricting saw House seats drawn by a federal court rather than subjected to normal partisan gerrymandering, which made several seats politically competitive.

Barack Obama carried Faso’s district, which includes the mid-Hudson Valley and Catskills. Its previous occupant, Rep. Chris Gibson, was ranked as the most liberal Republican in the House in 2013. GOP Reps. Claudia Tenney and Elise Stefanik, both of whom have districts occupied by Democrats as recently as 2009, also backed the AHCA as a result of the amendment.

“They’ve declared war on New York,” Gov. Andrew Cuomo thundered, brushing aside any property tax reductions that would come from shifting Medicaid costs. | AP Photo

New York Democrats, who hold 18 of the delegation’s 27 seats, reacted strongly against the deal. In a statement, Rep. Louise Slaughter (D-Rochester) said the amendment is “a gimmick, and nothing more than pure political cover for wavering New York Republicans that know the Republican healthcare plan would devastate our state, especially upstate rural areas.”

The amendment, which would take effect in the 2020 fiscal year, will squeeze Cuomo’s fiscal house. The governor is currently in the final weeks of negotiating a $150 billion-plus budget with the state legislature, and has been quietly lobbying the state’s congressional delegation along with its permanent healthcare interests. Cuomo had assumed there would be no major changes in federal Medicaid assistance in the coming fiscal year, which begins on April 1.

But the state would face enormous pressure to pick up the tab from the counties, which in turn would bolster arguments among liberal Democrats who dominate the New York State Assembly to increase income taxes. Cuomo, a centrist who has been laying down markers for a potential presidential run, has resisted those calls along with Republicans who control the New York State Senate.

Both the amendment and the AHCA face a series of hurdles before they become law. Faso’s amendment must be accepted by the Senate’s parliamentarian as part of reconciliation talks with whatever version of the bill advances in the upper chamber.

In Albany, where the budget-makers have done their best to ignore what is happening in Washington, the rising impacts of the AHCA may no longer be ignored.

“I don’t want to see New York get adversely affected,” state Senate Majority Leader John Flanagan, a Republican from Long Island, told reporters on Tuesday. “The timing of this, of course, is gonna make sure that this is going to be part of the budget discussion right now.”

Collins, in an interview with POLITICO, was less measured. The congressman said Cuomo’s budget was “piggish” and that he should be able to trim it to accommodate the counties’ Medicaid share.

"I know what he's saying, he's running around all chicken little, the sky is falling," Collins said. "Get a life, governor. If he's so incompetent and his staff is so incompetent that he can't cut 1.5% of his budget, he can call to ask for my help.”

Josh Dawsey contributed to this report.

