The addition was crafted by Collins, a close Trump ally and the first House member to endorse his presidential bid, to help bring aboard four moderate upstate Republicans who had expressed reservations about the bill. It was added to the Obamacare repeal Tuesday after back-room negotiations. It could save county governments $2.3 billion a year — but shift that amount to the state, forcing Albany lawmakers to either cut Medicaid services statewide or find other ways to raise revenue and cut spending.