A Perspective on the Affordable Care Act

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent Gardner

Part 1: Health Insurance Coverage for the Poor

The Affordable Care Act’s initial enrollment period is over and Health & Human Services Secretary Kathleen Sibelius has resigned, having earned a jacket full of Purple Hearts from countless Congressional hearings. What have we wrought?

Make no mistake—this will revolutionize health care delivery in the United States. As the Arab Spring suggests, revolutions can be good or bad. Or both, as in this case.

In the first of a two-part column on the Patient Protection and Affordable Care Act (ACA), let’s focus on how coverage for the poor has changed. Read more »

Irreconcilable Differences: The Problem of Health Care

Posted by & filed under CGR Staff, Journal of the Monroe County (NY) Medical Society.

Kent GardnerHealth care is different from other goods and services.

  • As a wealthy society, we aren’t willing to limit access to care based on ability to pay (at least entirely).
  • Caveat emptor—let the buyer beware—fails in the face of complexity: The patient (the “buyer”) is often incapable of understanding what is appropriate or necessary and must rely on the provider (the “seller”) for essential advice.
  • The pace of technological change outstrips our capacity to set limits on what constitutes adequate care.
  • Public policy, operating through payment schema and regulation, is a blunt instrument, influencing the marketplace in both intended and unintended ways. Read more »

What Options are Open to Counties with Nursing Facilities?

Posted by & filed under CGR Staff.

Donald PryorHow’d you like to be a county executive, legislator or member of a board of supervisors and have to decide the future of a financially-troubled county-owned nursing home? Often one of the area’s major institutions and employers, it provides an important community service, even though typically costing the county taxpayers significant amounts of money.  No matter what you decide, you’re likely to be criticized from one or more directions.  That is the unpleasant reality currently being faced by public officials in counties throughout all regions of New York State.

As recently as 2005, more than 40 counties outside New York City owned and operated public nursing homes containing some 9,900 beds.  Now those numbers are closer to 35 counties and 8,100 beds, and those totals are likely to dwindle further over the next few years.  Why the sharp declines in such a short period of time?  Rising costs and declining revenues combine to force county taxpayers to plug steadily-rising deficits. Read more »

New York Wins Again

Posted by & filed under CGR Staff, Democrat & Chronicles.

Kent GardnerNew York swept the annual property tax competitions sponsored by the Census Bureau. Scored by the Tax Foundation, New York counties dominated the competition in the “property tax as a share of median home value” event, capturing all of the top ten places. Camden, New Jersey was pushed off the top ten after a spirited showing from New York’s Chemung County. Newcomer to the Top Ten, Chemung ranked #16 in 2007.

In the “property tax per dwelling” event, New York’s perennial champions, Nassau and Westchester counties, took the top two spots with Rockland and Putnam counties also placing. The remainder of the Top Ten was dominated by New Jersey, always a contender in the nation’s tax competition.

What a contest to win! Is there hope of ever losing this competition? What must we do to cut the cost of state and local government? Does it matter?

Read more »

Something’s Gotta Give: New York in Crisis

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerI’ve been in a funk since the 2009-10 state budget passed. The state’s elected leaders entered the budget negotiations confronting a potential $20 billion deficit, up from the $14 billion estimated when the Governor released his original budget proposal. That is, the state would have run a $20 billion deficit in 2009-10 if spending and revenue continued without changing anything structural (like tax rates or spending formulae). The faltering economy could no longer satisfy the state’s addiction to ever-greater spending.

Given such a dire forecast, we all wondered how the state would manage to find the money to avoid a major reduction in spending. Imagine our surprise when the Legislature and Governor pulled a rabbit out of the budgetary hat and increased budgeted spending by $12 billion, nearly 9% more than in 2008-09.

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The state’s deficit problem is political, not technical

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerThis week’s conference on the state’s budget crisis—sponsored by the Empire Center on State Policy and the Center for Governmental Research Inc.—was organized around a technical question: What can be cut from New York’s budget to fix a deficit estimated (today, at least) at $12.5 billion? Yet the overriding problem is not technical but political. My colleague Erika Rosenberg, moderator of one of the sessions, asked the panelists this question: “What’s it going to take for the Legislature to make the unpopular decisions that are needed to balance the budget?”

Gov. David Paterson made the correct technical decision in calling the Legislature back for a special session on Nov. 18. Yet the brutal reality of New York politics eliminated any possibility of progress. With control of the state Senate still in question and the political risks starkly clear, the session never convened.

Read more »