By Douglass Dowty
syracuse.com
SYRACUSE, NY 鈥� Historic changes to Medicaid championed by congressional Republicans and President Trump will kick thousands of Central New Yorkers off health insurance and push more uninsured into already overcrowded local emergency rooms, experts said.
New work requirements are expected to leave more than 30,000 Central New Yorkers without insurance in the next two years. That includes more than 14,500 former Medicaid patients at Syracuse鈥檚 three hospitals, according to state and projections.
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That means, over time, the hospitals will treat more people who can鈥檛 pay their bills, pushing that financial burden across the health care industry.
The effects will ripple far beyond those who lose coverage. Syracuse鈥檚 emergency rooms, already some of the most overcrowded in the nation, will still be required to treat thousands of newly uninsured patients after manageable illnesses become dire.
In addition, the changes from Washington will wipe out millions of dollars of income that the hospitals 鈥� which employ nearly 20,000 workers 鈥� rely on now.
The three local hospital systems could lose as much as $65 million annually, syracuse.com鈥檚 analysis shows. That鈥檚 about a 2% to 3% loss for Crouse, St. Joe鈥檚 and Upstate鈥檚 two hospitals.
鈥淭he impact goes far beyond those who lose coverage,鈥� said Dr. Steven Hanks, president and CEO of St. Joseph鈥檚 Hospital Health Center. 鈥淥ur entire health system and every community we serve will feel the effects: reduced services, longer wait times, staff reductions, and the potential closure of programs and facilities.鈥�
Perhaps the hardest-hit provider locally isn鈥檛 a hospital.
It鈥檚 Syracuse Community Health , which is federally mandated to care for the poor and uninsured and sees more than 17,000 Medicaid patients each year.
The South Side health center, which has several branch offices and provides care inside city schools, could see more than 3,000 patients lose their health insurance. That would cause a loss of $3 million a year, or 10% of the health center鈥檚 budget.
That leaves the community health center facing cuts that affect all of its patients, whether they are on Medicaid or not, said CEO Dr. Ofrona Reid.
Those cuts could include reducing the hours of the health center鈥檚 urgent care, called Quick Care, which was designed to take pressure off local ERs. Gone may be Saturday hours and evening hours during the week.
Instead, those people 鈥渨ill go straight to the ER, because they know they won鈥檛 be turned away鈥� when there鈥檚 a problem, Reid predicted.
That could increase complications and costs for people with manageable diseases, like diabetes, said local healthcare expert Tom Dennison, also a retired professor at Syracuse University鈥檚 Maxwell School of Citizenship and Public Affairs.
Upstate Medical University has, by far, the region鈥檚 biggest Medicaid patient population, with 70,000 patients a year on the joint state-federal program. That鈥檚 one-third of Upstate鈥檚 patient load.
The majority of those patients will keep their government health care insurance. But the public hospital also serves as a safety net for the hardest cases and those in dire need.
鈥淲e don鈥檛 discriminate based on our patient鈥檚 insurance status,鈥� said Upstate鈥檚 chief of staff Matthew Chadderdon . 鈥淪o the patients receiving care here today will receive the same care here whether they have insurance or not. We simply won鈥檛 get paid.鈥�
Long-term, that could mean cuts to hospital services without additional funding, Chadderdon said.
Crouse and St. Joseph鈥檚 combine for another 45,000 Medicaid patients, according to figures provided to . About 20% of their patients are on Medicaid.
Who is getting cut off Medicaid?
The local impact of the $1 trillion in federal Medicaid cuts over the next decade are based on patient and revenue data provided to by the three hospitals and the health center.
Specifically, the Medicaid cuts are the result of work requirements for able-bodied adults who gained Medicaid coverage under the Affordable Care Act.
The state estimates that almost 18% of the state鈥檚 nearly 7 million Medicaid recipients will lose coverage when the work requirements take effect in January 2027, many for failing to file the proper paperwork every six months.
It鈥檚 likely that the federal cuts will have a much wider impact than simply the pain of 1.25 million New York residents losing insurance.
That鈥檚 because the state designs the Medicaid program, which is then approved by federal officials. New York lawmakers could seek to protect some from losing insurance, spread out the pain across the program or even funnel more money into Medicaid鈥檚 $116 billion budget.
鈥淭here鈥檚 a lot up in the air right now,鈥� said Kevin Krawiecki, vice president of fiscal policy for the Healthcare Association of New York State, a hospitals trade group. 鈥淭he downstream effects are real. I鈥檓 just not sure how big they are.鈥�
The cuts target the so-called 鈥渆xpansion鈥� population of people who gained Medicaid coverage under the 2010 Affordable Care Act. New York was one of 41 states and Washington, D.C. , that accepted federal money to expand the safety-net healthcare program. The recent cuts do not target Medicaid鈥檚 traditional populations, including expectant moms, children and the disabled.
But the legislation does shift billions more in costs to the state. It鈥檚 expected that New York鈥檚 healthcare institutions will lose roughly $8 billion each year in Medicaid revenue. But, in the end, a series of changes will likely end up costing the state $13 billion more each year.
Who will be affected most?
Just how much impact the cuts will have remains to be seen.
Dennison, the retired hospital executive, warned that the cuts could have a major impact 鈥� especially on small, rural hospitals. Many don鈥檛 have the margin to absorb even a small drop-off in Medicaid revenue, he said.
鈥淥nce institutions are stripped to the bone, there鈥檚 no way to recover,鈥� said Dennison, also a retired Syracuse University professor. 鈥淭hey will be hand-in-mouth and that鈥檚 where they鈥檙e going to stay.鈥�
But William Hammond, of the conservative Empire Center for Public Policy, noted that Medicaid spending has grown so fast that he projected New York State could absorb $7 billion in lost federal revenue and still spend more in 2027 than it does now.
Still, Hammond noted, the federal changes meant to slash Medicaid spending also created a new big expense: the state will need to pay for a new bureaucracy to enforce the work requirements.
Those changes also create another budget headache for the state.
In addition to Medicaid, the changes also remove thousands from a state health insurance option called the Essential Plan, which covers people who don鈥檛 make enough to afford commercial insurance.
The Essential Plan is funded by federal tax credits funneled to the state. But more than 700,000 legal immigrants with visas will no longer be eligible for the plan. That will cost the state $7.5 billion in revenue from the federal tax credits.
A half-million legal immigrants will move to traditional Medicaid, costing the state $2.7 billion more each year, according to projections.
The other 225,000 legal immigrants will be without insurance, including about 4,500 in Central New York.
Put together, the changes will leave roughly 1.5 million people without insurance due to Medicaid work requirements and immigrants removed from the Essential Plan, the state projects.
The timing of the changes complicates the math on their impact. The Essential Plan changes go into effect next year, while the work requirements don鈥檛 take effect for another year and a half.
The state projects the new rules will cost $750 million this budget cycle, which runs until March 2026 . The state has signaled it can make up that gap, said Krawiecki, of the hospital association.
But next year鈥檚 budget will have to contend with the expected losses from the work requirements, which start Jan. 1, 2027.
鈥淲here are they going to cut?鈥� Dennison wondered aloud. 鈥淲e don鈥檛 know.鈥�
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