No matter what you think about the legislative maneuvers to get ObamaCare passed, you have to hand it to New York's representatives: At least they didn't engage in "Cornhusker Kickback" deals to get their constituents to bite on expanded Medicaid costs.
But New York taxpayers need to watch out: As things stand now, they're set to be blindsided by a Medicaid fiscal hand grenade on a five-year fuse.
Helping the state avoid the coming nightmare is the clear duty of New York's senior senator, Chuck Schumer -- one of the top Democrats in the Senate.
You see, the Senate this week takes up the "reconciliation" bill the House passed along with the main ObamaCare bill. Lurking in this measure is a requirement that state Medicaid programs pay primary-care doctors rates equal to those of Medicare. The rule goes into effect for 2013 through 2014, with the federal government paying all the extra costs.
What's not to like? For New York, this amounts to the start of a five-year countdown to a state budget battle in 2015 -- when the extra federal cash vanishes and state taxpayers are left holding the bag.
Other states, including New Jersey and California, will face the same problem, but New York is likely to get hit the hardest.
Here's why: The dirty little secret about Medicaid is that some states, such as New York and New Jersey, have "stretched" dollars by slashing payments to the doctors who provide the care. They use the cash this frees up to ease eligibility rules and sign up more people
Doctors in those states would go broke caring for just Medicaid patients, so many refuse to participate in the program or limit the number of Medicaid patients they see. The result: The states with the biggest shares of their populations in Medicaid offer these enrollees the worst access to care and the poorest quality of health services.
It's a classic liberal con job: Offer more people government health "benefits" that actually do nothing to increase their access to good medical care, and likely reduce access to care instead.
Of the 50 states, New York has one of the highest Medicaid coverage rates -- with over one-quarter of the population, or 5.1 million individuals, in the program. At the same time, New York's Medicaid payment rates for primary-care doctors are the lowest in the country -- at only 36 percent of the rates doctors get for providing the same care to Medicare patients. (And even Medicare pays less than what physicians would get from privately insured patients.)
So when this reconciliation bill provision kicks in at the start of 2013, New York's primary-care doctors will suddenly get nearly three times what they used to get for treating Medicaid patients -- great news for both doctors and patients.
The problem comes in 2015, when the extra federal money ends -- and New York taxpayers will have to start picking up the tab for half of the extra costs.
Does anyone think that New York physicians, after getting a 270 percent raise for two years, will simply let Albany repeal it? Are Medicaid patients going to be happy going back to limited access to care? Not likely.
Other states will face this same problem, but not to the same degree that the already overtaxed residents of New York will.
How big will the hit be? Budget expert E.J. McMahon at the Empire Center for New York State Policy estimates the extra cost to state and local taxpayers at about $300 million a year. But he's making conservative assumptions from the limited data on state Medicaid data payouts; the cost may come in much higher.
Of course, come 2015, Albany could always try to get more money out of Washington -- but how likely will it be that senators from states that got little to nothing in extra payments from this reconciliation bill are going to vote for such a "giveaway"?
New Yorkers had better hope Sen. Schumer is on the job now -- or they'll pay later.
Edmund Haislmaier is a senior re search fellow in health-policy studies at The Heritage Foundation.
First appeared in The New York Post