June 10, 2025

According to a key staff at the Fiscal Policy Institute (here in NY), proposed changes to the Essential Plan are by far the single biggest threat to New York’s healthcare system in the House megabill that is now with the Senate; the bill as written would reduce federal funding to New York by $7.6B while forcing the state to shift 500,000 lawfully present immigrants (mostly green card holders) to state-funded Medicaid at an additional cost of $2.7B. These impacts would begin in January 2026. This gigantic $10B annual fiscal hit to New York would impact not only Essential Plan enrollees themselves but anyone who depends on Medicaid or hospital care in New York.

Note:  All seven New York Republicans have signed on to two separate letters asking Senate Republican leadership to delay implementation of EP changes until January 2029. (See attached.)  While this is very good news, it’s extremely disappointing that NY Republicans were not willing to ask for full elimination of these provisions. We need to keep the pressure up.

See the following announcement regarding an upcoming Webinar being hosted by Danille Holahan, Executive Director of the NYS of Health Marketplace:

As the federal budget reconciliation legislation moves through the process, we continue to grapple with the enormous impact it will have on New Yorkers and their access to public health insurance coverage, as well as the massive hole this will create in New York State’s budget.

Top staff of the NY State of Health Insurance Marketplace – Danielle Hollahan, Executive Director, and Sonia Sekhar, Deputy Director – will provide a briefing for advocates this Friday, June 13^th, 10:00-10:30.  Register today!

In the briefing, Danielle and Sonia will go over the state’s estimates on the number of people who will lose coverage in the Essential Plan and Medicaid, along with the financial burden this will cause.

Please register and plan to join the Zoom meeting Friday.  

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Another opportunity to plug in to what’s happening in D.C. from the Coalition on Human Needs:

So many critical issues are facing our nation now, and we stand with people nationwide to oppose despotic actions.  We must not forget that the “big brutal budget bill” in the Senate now includes billions of dollars for the Departments of Homeland Security and Defense for anti-immigrant actions, while taking health care and food assistance away from millions.

State of Play on Budget Reconciliation Bill in the Senate (with state-specific info)

Please join us,

Thursday, June 12, 1:00 p.m. ET (10:00 a.m. PT)

Register here!

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Message from the National Council today:

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Legal Action Center Briefing

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More on Senate movement re:  Budget Reconciliation:

Senate Finance Republicans are increasingly looking to dial back key items on President Donald Trump’s tax policy wish list. And it’s pitting them against the architect of the House-passed tax legislation, Ways and Means Chair Jason Smith — and potentially even the White House.

The rub is this: The House version of the megabill would restore tax incentives for research and development, business equipment and debt interest through 2029, which Trump has indicated he supports. But Senate Republicans are dead-set on making them permanent, a proposition that would likely add hundreds of billions in more red ink to the legislation.

To offset that cost, GOP senators are looking to water down other tax provisions they believe aren’t as “pro-growth.” Those policies include “no taxes on tips,” “no taxes on overtime” and tax relief for seniors — all proposals Trump touted on the campaign trail and collectively boast a price tag of roughly $230 billion, according to the Joint Committee on Taxation.

As Senate leaders consider ways to appease the differing factions weighing in on their bottom line requirements in order to support the House GOP megabill, we see the issue of ‘provider taxes’ has moved to the forefront (again).  

New York State collects billions in federal matching funds from Washington by utilizing (federal) loopholes to maximize revenue coming into the state from the feds by implementing ‘provider taxes’.  The MCO Tax is a ‘provider tax’ where health insurers are taxed based on the per member per month revenue they receive from the state for managing Medicaid benefits. Those funds are used by the state to increase hospital and other rates, and this triggers additional federal matching funds based on those increased rates.  In this deal, the state agrees to pay back the insurers for the ‘tax’ dollars they were required to pay initially.

Towards the end of the Biden administration, NYS sought and received approval to implement an MCO Tax.   The recently enacted state budget spends over $1B in proceeds from implementation of the tax to increase rates for hospitals, nursing homes and other long term care providers that the Hochul admin had promised them during the previous legislative session.  

GOP senators zero in on Medicaid policy in Trump’s tax bill that has little impact on enrollment

The Senate is not expected to hold hearings on the legislation, instead working out changes in private

• Mana

By John Wilkerson

June 9, 2025

Washington Correspondent, STAT News

WASHINGTON — A handful of Republican senators want to dial back federal funding cuts to Medicaid in President Trump’s tax cut package, known as the One Big Beautiful Bill. But the changes that most of them are focused on would not help many people keep their insurance.

Republicans have faced pushback for their plans to pay for Trump’s tax cuts by reducing federal Medicaid funding and by making changes to Affordable Care Act marketplaces. States don’t like losing funding, hospitals don’t like losing business, and voters don’t like losing their insurance or paying more for it. 

Unlike the House, the Senate is not expected to hold hearings on the legislation, opting instead to work out their differences in private. Based on hallway interviews with reporters, there are a handful of Medicaid policies that seem to be getting the most attention ahead of the release of the Senate’s legislation, related to a mechanism that states use to boost their federal funding, known as provider taxes.

Republicans are using a budget process called reconciliation to avoid the need for support from Democrats to pass Trump’s domestic agenda. They hold a 53-47 majority in the Senate, meaning that if four Republican senators were to vote against the bill, it would fail. They’re aiming to pass the bill by July 4.  

Sens. Rand Paul (R-Ky.) and Ron Johnson (R-Wis.) are demanding steep federal spending cuts, meaning they may be impossible to win over. That would leave one more vote that Senate Majority Leader John Thune (R-S.D.) could lose, and a number of other senators have expressed concerns related to Medicaid.

And while Democrats and consumer advocates have focused their criticism on the number of people who would lose insurance, mostly due to the Medicaid work requirements in the bill, most Republican senators with concerns about Medicaid either aren’t opposed to work requirements or haven’t directly mentioned them as a concern.  

“Work requirements, I’m all for that,” Sen. Josh Hawley (R-Mo.), said last week. Hawley recently wrote an opinion piece in The New York Times arguing against Medicaid cuts. 

“But benefit cuts, I’m not for, and rural hospital closures, I’m not for,” he continued.

Medicaid enrollment would suffer the biggest hit from work requirements, leading to 5.2 million adults losing Medicaid coverage over a decade, for a reduction in federal spending of $344 billion, according to the nonpartisan Congressional Budget Office. The total loss of coverage is nearly 11 million from the bill. Another 5.1 million people would become uninsured from a combination of expiring ACA subsidies and new ACA rules that Trump’s health department proposed, the CBO said.

Republican senators seem to be mostly focused on a measure aimed at limiting states’ ability to increase federal funding of their Medicaid programs with a tactic called provider taxes. States pass a portion of the money raised from the taxes back to those providers, often hospitals and nursing homes, by boosting their pay rates. The federal government matches a percentage of the extra state spending, allowing states to direct even more money to those providers, typically more than they were taxed in the first place.

Yet the limit on provider taxes account for just 400,000 of the projected 11 million people who would lose insurance. The CBO expects that some states would respond to provider tax limitations by making enrollment more challenging.

Hawley warned that the measure would lead to rural hospital closures. 

“That’s the big one,” Hawley said last week in response to whether provider taxes are the main concerns for hospitals in his state.

Hawley said he also opposes a measure that would require Medicaid recipients to pay copays if they have incomes above the federal poverty level, which is about $15,500 for single beneficiaries. 

Other Republican senators have also highlighted provider taxes. Sen. Susan Collins (R-Maine) told The Washington Post last week that she’s “concerned about the impact on rural hospitals and how it all would work with a provider tax.”

Sen. Thom Tillis (R-N.C.) said states need time to deal with the impact of provider taxes because changes to the policy could help trigger an end to Medicaid expansion in his state.

Sen. Jerry Moran (R-Kan.) said in April that he’s worried that Medicaid cuts could lead to rural hospital closures. “Our ability to maintain those hospitals and keep their doors open is a major priority to me,” he said.

Sen. Jim Justice (R-W.Va.) said he supports the House bill’s provider tax measure, which prevents states from adding new provider taxes or raising existing ones. He just doesn’t want to make it more aggressive, which is a possibility that has come up as some Senate Republicans seek to further reduce government spending.  

Sen. Lisa Murkowski (R-Alaska) is the rare Republican to express concern about Medicaid work requirements but not about provider taxes. Alaska is the only state that doesn’t use provider taxes. She is scheduled early this week to talk about work requirements with Centers for Medicare and Medicaid Services Administrator Mehmet Oz. 

“It’s one of the things we’re trying to work through,” she said of work requirements to STAT. 

She’s also worried about the affordability of ACA marketplaces plans.  

“We may see those who graduate off of Medicaid, if the response is that we want to allow for the opportunity to pick up on the individual market, we want to make sure that that individual market is affordable. And what we’re seeing in a place like Alaska is that affordability is a challenge. The tax credits can help us,” she said.

Republicans have good reason to worry about a potential backlash to federal funding cuts to Medicaid and reforms to the Affordable Care Act marketplaces. 

About a quarter of Medicaid enrollees and 45% of people with marketplace coverage are Republican, according to a poll that KFF released Friday. More than 4 in 10 Republicans and 85% of independents worry that significant cuts to Medicaid would lead to people losing insurance and hurt health care providers in their communities. Health care providers in rural communities are especially dependent on funding from the Medicaid program. 

In general, Republicans say adults without dependents or disabilities should be required to work at least 20 hours a week to be covered by Medicaid. They could also maintain coverage if they perform community service or are enrolled in educational programs. They’d need to document twice annually that they meet those requirements.

“The disabled and pregnant women and seniors that are in nursing homes and all those people, there isn’t one of them who’s going to lose Medicaid,” Sen. Chuck Grassley (R-Iowa) told reporters last week.

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DOH Releases SOI for $15.8 Million in Funding for Physician Loan Repayment and Support Programs
On June 4^th, the New York State (NYS) Department of Health (DOH) issued a Solicitation of Interest (SOI) for the eleventh cycle of the Doctors Across New York (DANY) Physician Loan Repayment and Physician Practice Support Programs. Both programs provide up to $40,000 in annual funding for three years (not to exceed $120,000 in total funding) to or on behalf of a physician who agrees to practice in an underserved area for the three-year service obligation period. DOH will provide up to $15.8 million in total funding under this SOI, which is expected to result in approximately 132 three-year awards.

Funding may be awarded to:

• A physician to pay qualified educational debt;
• A physician to submit the costs of establishing or joining medical practices; or
• A health care facility to recruit or retain a physician through sign-on bonuses, loan repayment, or enhanced compensation (100% of the funds must ultimately be distributed to the physician or physician’s practice).

One-third of funding awarded under this SOI will be allocated to physicians practicing in New York City. At least 50% of available funding will be awarded to physicians working in general hospitals. The start date of the physician’s employment contract must be no later than October 1, 2025.

Eligible health care facility applicants include:

• General hospitals, D&TCs, or nursing homes;
• Office of Mental Health (OMH) Article 31-licensed facilities;
• Office of Addiction Services and Supports (OASAS) Article 32-licensed facilities; or
• Medical practices registered with NYS as a PC, PLLC, or LLP.

Health care facilities must be located in an underserved area, as defined in Attachment 6 of the SOI.

The SOI is available here. Applications will be reviewed on a first-come, first-serve basis through August 20^th. Questions may be submitted to DANYProgram@health.ny.gov with the subject line “DANY Cycle 11 Question” through June 18^th. Answers to questions will be posted on July 2^nd.

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The Department of Health and Human Services is dismissing all 17 members of the Advisory Committee on Immunization Practices (ACIP), a key panel that advises the CDC on vaccine safety and policy. Health Secretary Robert F. Kennedy Jr. called the move a “clean sweep” to restore public confidence, citing alleged—but unproven—conflicts of interest due to members’ ties to pharmaceutical companies. The dismissal has drawn sharp criticism from public health experts, who view it as a politically motivated decision that could further erode trust in vaccine policy. Kennedy had previously assured lawmakers he would not make changes to the ACIP. His recent unilateral decision to stop recommending COVID-19 vaccines for healthy children and pregnant women, bypassing a planned ACIP meeting, has added to concerns about politicization of public health guidance. (Articles here, here, here, and here)