On Monday, Governor Andrew Cuomo and Mayor Bill de Blasio held an Albany press conference pleading for $10 billion in federal funding to salvage New York’s teetering hospitals. Last night, Senator Chuck Schumer got into the act, cornering Kathleen Sebelius on the House floor after the president’s State of the Union speech. It’s been eighteen months since New York applied for the required “Medicaid waiver” that would deliver the cash; Schumer says that on Tuesday night, the Health and Human Services secretary promised him she’d have a decision within 30 days. Yet one of the biggest players in this medical drama may be a right-wing Republican.
There are legitimate reasons things have taken a while: $10 billion is a lot of money, even to the federal government. Some of the haggling has been about how New York might spend the funds. “The original proposal wanted to use some of the money on housing,” says Chuck Brecher, a health care expert at the Citizens Budget Commission. “You can come up with ways that housing can be medically beneficial, but the feds are very leery of letting states use the money for purposes not normally within the scope of Medicaid.” Vern Smith, a consultant with Health Management Associates, says a waiver granted to Michigan ran 66 pages—and was relatively simple compared to what’s being contemplated in New York. “HHS wants to make sure the money is properly spent,” Smith says. “And the department has people looking over its shoulder, too.”
Ah, now we’re getting somewhere. In February, 2013, a committee chaired by California congressman Darrell Issa issued a blistering report accusing New York of wasting Medicaid money. Since then, the botched rollout of Obamacare has given Issa and his fellow Republicans more fuel with which to roast Sebelius. Some in Albany believe she is moving extra carefully before awarding New York any new Medicaid money to avoid Issa’s wrath.
The governor and the mayor have ample reason for urgency, besides the prospect of shuttered emergency rooms. If the delay drags on, or Sebelius grants New York significantly less than the $10 billion, Cuomo may need to reconsider the tax cuts he’s included in this year’s state budget. De Blasio campaigned on saving hospitals and creating new clinics in underserved neighborhoods — a good idea that will nevertheless take time. For the moment, though, Cuomo has done himself and De Blasio a favor: If New York’s hospital crisis worsens, the governor has deflected some of the blame to Washington.