Too Much Medicaid Messaging

Medicaid, Medicaid, Medicaid.

How the cost of this program plays on the minds of local government leaders as they try to make ends meet.

You can’t turn around without seeing some county legislator or executive lament how the local share of this vastly growing social service program beats down their budget.

Look at Monroe County. You’ve seen the stories about how county leaders want to deal with a gap in the budget. Republicans want a sales tax increase. Democrats want to charge towns that use the sheriff’s department directly for the service. Behind it all – Medicaid.

And, boy, if the county doesn’t remind you about it – over and over again. That bad state government, says the county leader. They push that Medicaid cost on the counties and won’t control the spending. Albany allows that runaway freight train to run right over us.

The message is so constant that you start believing we pay for nothing else in Monroe County but that health care program for the poor and the elderly.

Go back to the announcement by Brooks about the sales tax increase. She said with a dour look that day that the cost of Medicaid (now more than $160 million) has outstripped sales tax collected and kept by the county (about $110 million). As if the sales tax once paid off the program but now can not. In fact, that link between Medicaid spending and county sales taxes collected has been made time and again – in various ways – by the Brooks administration. This probably stems from the days back in the early 1990s when Republican Bob King made that connection. He sold his sales tax increase as a way to pay for growing social service costs like Medicaid.

Just when you get through with the sales tax connection… you open up your local property tax bill.

The bill reports a fairly detailed breakdown of where you property tax money is going. The biggest chunk – 36.1 percent of the tax payment – goes to something they list as a “Medicaid Tax.”

Wow. More than a third of every property tax dollar goes to Medicaid? Well, kind of. You see that number (and all the other numbers represented on that property tax bill) are actually the net cost of the program versus the total amount of revenue taken in locally by the county. In the case of the “Medicaid Tax” that’s the $160 million cost versus the county’s total take from property taxes, sales taxes and other smaller fees (which total roughly $447 million).

On some level it makes sense. You wouldn’t expect that a program in Monroe County’s general budget would be paid for by a dedicated tax.

And yet… it shows up on my property tax bill this way – without an explanation. It could leave one with the impression that the property tax was dedicated to the Medicaid cost.

And then you remember the rhetoric about how the amount collected in sales taxes has been surpassed by Medicaid. This link too might lead one to think a single tax source funds this expense program.

But no one tax is dedicated to Medicaid. So what’s the point? What’s going on here?

It shows that Monroe County is trying incredibly hard to send a message to us taxpayers – that Medicaid’s burden is crushing the county government.

So noted. But perhaps county government can keep clarity in mind when trying to pound home that Medicaid message.