Andrew Cuomo is certainly having a moment. Almost daily, the nearly decade-long governor of New York State holds press conferences on how he is handling the raging COVID-19 crisis, of which New York City is currently the global epicenter, during which much of the city, state, and even country swoons over his presentation of competent and compassionate leadership—especially compared to the epic intellectual and moral failings of Donald Trump.
Men and women alike declare on social media that they want him to be their “daddy,” their strong-armed savior who pulls them out of a burning building. The media is titillated over whether he has a nipple ring underneath his white polo shirt. And the hashtag #PresidentCuomo has been soaring.
If you’re detecting a side-eye in my tone, you’re right. But it’s not because Cuomo, who is certainly legions smarter and more compassionate than Trump (low bar, however), has not indeed been handling many aspects of COVID-19 in his state with epic levels of competence and compassion. In many regards, he has been—and the Cuomo adulation is partly deserved.
It’s because, if you’re among the smaller subset of advocates for low-income New Yorkers who for a decade have watched Cuomo try to slash programs with his left hand while playing progressive hero with his right, you could not help but notice last week how he—with typical shrewdness—used his current untouchable hero status to shove through $2.5 billion in Medicaid cuts in the just-passed state budget, as the state faces arguably its biggest health crisis in history.
Ultimately, the cuts in the roughly $75 billion Medicaid budget—historically, it eats up a larger portion of state revenue than any state nationwide—which Cuomo had been pushing for months before the COVID-19 crisis, are not as bad as they could have been, and some of them won’t go into effect until next year.
An important salvage is $6.7 billion in emergency federal aid to Medicaid—a sum that Cuomo used as a bargaining chip, essentially telling legislators that if they did not give him his desired $2.5 billion in cuts, he would “have to” refuse the federal funding.
But advocates still call the budget a scandal, especially in that Cuomo and legislators did not seek a dollar in new tax revenue from the wealthy, casting aside a proposal for a small tax hike on those who earn more than $5 million a year. (New York, due largely to New York City’s finance hub, is among the states with the most millionaires and billionaires in the country.)
“For the needs and concerns of everyday New Yorkers, particularly with a pandemic raging, this budget fails all around,” says Mark Hannay, who heads the advocacy group Metro New York Health Care for All. “Rather than raising sufficient revenues to fund a robust budget that is absolutely needed right now to help everyday people out with jobs, housing, and health care, the governor refused to raise taxes on the ultra-rich.
“And now we have an austerity budget that he forced down the throats of legislators, who did not stand up to him,” Hannay continues, “because he threatened to shut down the state government if they didn’t go along with what he wanted. With his popularity sky-high, he likely suggested that if he’d blamed the legislature, the press and public would believe him over them.”
A Push Pre-Dating the Crisis
This story does not begin with the COVID-19 crisis, which exploded in early to mid-March. According to Reed Vreeland, an advocacy director with the large New York City HIV, health, and homelessness nonprofit Housing Works, as far back as last fall, Cuomo was secretly putting together a so-called “Medicaid Redesign Team” to identify cuts in the program, with no early community input. The initiative was not announced publicly until early February. “He was creating a rubber-stamp process instead of seeking true dialogue with the community,” says Vreeland.
That’s not to say, stresses Vreeland, that the state Medicaid system doesn’t need more money. Medicaid rolls have risen dramatically in the state ever since it expanded Medicaid eligibility under the Affordable Care Act (Obamacare) a decade ago—New Yorkers on Medicaid now include many living with HIV who once got their meds and care via the last-resort Ryan White AIDS Drug Assistance Program—and the state also has a considerable aging population that relies on Medicaid.
“There needs to be a genuine discussion about New York’s need to invest more in health care, with the answer being higher taxes on the very rich and more from the corporate sector,” says Vreeland. But in the instance of this year’s budget, he says, Cuomo’s team was doing everything possible to inhibit that discussion. “They were just so desperate to make the cuts. They came up with that $2.5 billion figure and back-engineered the whole thing, with no regard for its outcome on providers and patients.”
According to Vreeland, many community members and advocates did not hear about the first public Medicaid Redesign Team meeting, on Feb. 11, until the day before. “You can’t get a lot of people up to Albany that quickly, but luckily about 40 of us made it,” he says. “What was immediately clear was that our group of advocates, including many people actually covered by Medicaid, was far more diverse than the panel and the invited audience, nearly all of whom were white.”
Vreeland’s group disrupted the meeting by approaching the panel’s table up front and chanting, “MRT is a sham!” and “No Medicaid cuts!” Their main demands were to make the Medicaid Redesign Team process more open and more racially and economically inclusive. The meeting organizers shut down the live feed and had security escort the protesters out.
After that, says Vreeland, the Medicaid Redesign Team announced three public listening and comment sessions for the entire state—one in Albany, one in Rochester, and one on Valentine’s Day in New York City, the latter for which it gave fewer than 24 hours’ notice. For the New York City one, says Vreeland, “we had to scramble to get the testimonies ready. The room was half empty,” but activists staged another disruption.
Then, in early to mid-March, COVID-19 hit New York, swiftly shutting down more of the city every day as people self-quarantined in order to neither pass on nor get the virus. “We’d wanted to do more public actions raising attention about the Medicaid cuts,” says Vreeland, “but we couldn’t take the health risk. Most of the activism turned digital. But,” as Albany got down to the nitty-gritty of the budget in the second half of March, “not being able to confront legislators and the panel in person with people who actually rely on Medicaid” took its toll. “It was a major component in why I think some legislators felt it was OK to vote for these cuts.”
Cuomo’s Lesser-Known Side
Still, says Vreeland, “If advocates hadn’t been involved at all, I think the cuts would’ve been much worse. We were able to lessen some damage.”
Another major salvage is that nonprofit community health centers will still be able to collect much-needed revenues from their in-house so-called 340B pharmacies, referring to a federal program that lets them buy drugs at slashed rates but get reimbursed by insurers at the full rate. (Still, notes Vreeland, “In a thoughtful process, taking away something as crucial as 340B revenues wouldn’t have gotten so far along”—it was reversed at only the last minute.)
Also salvaged, says Hannay, was funding for various programs run by nonprofits that help people both enroll in and navigate their way through health plans, such as Medicaid Managed Care or Obamacare marketplace plans. (Hannay credits this to the advocacy of Community Service Society of New York, which provides such services.) Another good aspect of the budget, he says, is that the state will now negotiate with drug manufacturers directly for pharma benefits for the majority of state Medicaid recipients who are in a managed care program, rather than having the programs themselves do it. “That’ll generate payments for Medicaid,” he says.
But none of that offsets cuts across the board—including $400 million to hospitals, plus cuts to long-term care services for the elderly and people with disabilities. Such cuts won’t go into effect immediately, thankfully, in order for New York State Medicaid to qualify for that $6.7 billion of federal funding, but they are now law and will activate eventually. “You’ll feel the cuts in terms of who qualifies for what services, and how much of any given services you’ll get if you do qualify,” says Hannay.
And the cuts come at a time when the state’s health system may be burdened and strained indefinitely due to the repercussions of the COVID-19 crisis, which could billow forward for years.
According to Ricky Silver, who co-leads Empire State Indivisible, one of many groups in the coalition called New York Budget Justice, the cuts are all the more disappointing given that they were passed by both a state senate and assembly re-energized by a wave of progressive candidate wins in 2018, creating an all-blue Albany that has recently passed a welter of progressive reforms on everything from rent regulations to climate change to gun control.
According to Silver, New York Budget Justice, pre-COVID-19, had been urging legislators to mount a progressive alternative vision to the governor’s budget asks, “in a way that would build momentum to push back on Cuomo,” he says. “We even created a lot of the materials for them to use on our website.”
So why didn’t they push back when they could have? “The cynical point of view is that they’re more focused on getting re-elected this year than they are on uplifting the most vulnerable,” he says. (It’s important to remember that large swaths of New York State, from Long Island to the upstate regions, range politically from moderate to Trump-loving hard conservative—not all areas reflect the left-leaning, multiracial politics of New York City.) “Or they have too much fealty to Cuomo, which hinders them.”
Still, Silver urges those who are currently all starry-eyed over Cuomo to pull back and look at the big picture. “How is it that a so-called progressive state with a Democratic governor and two Democratic chambers was actually considering turning down $6.7 billion in federal Medicaid funding when we’re currently the epicenter of a global pandemic?”
But he notes that the budget fight isn’t an entirely done deal. “This legislative session runs through June, so we’re still calling on legislators to continue remotely and to pass legislation to improve this budget and to enact policies to help the state recovery and manage the pandemic.” New York Budget Justice, he says, “will also be involved in mobilizing the state’s delegates in U.S. Congress to push for a next wave of federal stimulus funding that impacts New York in a positive way.”
At a virtual press conference Friday, April 3, advocates and some state legislators (including Julia Salazar, Harvey Epstein, and Carmen De La Rosa) decried the budget. “We have no idea what we will need our health care system to look like” going forward in this pandemic, “and we just gutted it,” said Bryan O’Malley, who heads the advocacy group Consumer Directed Personal Assistance Association of New York State. “It’s ethically and morally wrong.”
Peggy Perkins, a member of New York Communities for Change, said that the budget will do “damage to low-income communities of color.” She added: “Andrew Cuomo is not a hero. He’s a Republican in sheep’s clothing. And this is a Republican budget.”
Of course, Cuomo and much of the legislature would likely differ. Cuomo’s office has touted the budget’s many investments and improvements to health care, education, infrastructure, and other services.
But at a time when much of the nation’s first major impression of Cuomo is largely glowing—especially when he is compared to Team Trump, which Hannay calls “a bumbling clown car of people who have no intention of doing the right thing”—advocates say that what Cuomo tried to do with the budget, especially with health cuts, shows his true colors.
“His entire decade of leadership suggests that he believes in austerity as the right form of leadership,” says Silver. “I’m not in the least surprised that he didn’t take his newfound popularity and use it to ask his rich friends to give more money to the state in a time of crisis.”