On life support

The federal government shut down briefly on Feb. 9, although both houses of Congress voted on a two-year budget deal in the early morning, and President Donald Trump signed the legislation before most people got to work.

The spending agreement included a provision that directly affected health care in New York – funding for community health centers, which provide medical services for primarily low-income people. These health centers aren’t the only programs affected by actions – or lack thereof – taken in Washington since Trump became president. Here is a rundown of health programs in New York that have been on the chopping block.

New York State of Health

Despite the actions taken by congressional Republicans and the president to strip many of the provisions of the Affordable Care Act, enrollment in New York State of Health, the state’s health insurance exchange, increased in this year. The Trump administration slashed Obamacare advertising funding by 90 percent, cut the enrollment period in half – although New York extended its enrollment deadline to the end of January – and decreased funding to groups that helped people enroll. The Republican-controlled Congress tried and failed to fully repeal Obamacare last year. The Republican tax plan did remove the individual mandate, which fined people who were uninsured. Despite these actions, New York State of Health, reported this month that 4.3 million New Yorkers have received insurance coverage through the marketplace.

Basic Health Program

New York and Minnesota were the only two states to utilize the Basic Health Program under the Affordable Care Act, which provides an alternative coverage option for people with incomes up to 200 percent of the federal poverty level. In New York, this program, known as the Essential Plan, covers more than 700,000 people. In December, the Trump administration announced that it was cutting the cost-sharing reduction payments to states, which helps fund the Essential Plan. State Attorney General Eric Schneiderman and the Minnesota attorney general are suing the federal government to restore the funding, and Gov. Andrew Cuomo provided for enough funding for the program in his budget proposal this year.

Medicaid

In August, Gov. Andrew Cuomo decried a rule that shifted federal money from states that expanded Medicaid under Obamacare to states that did not. The threat to Medicaid funding is still looming, despite failed efforts to repeal the health care law. In January, the Trump administration announced that it would allow states to require able-bodied adults to work or participate in community activities in order to receive Medicaid.

Disproportionate share hospital payments

Cuts to disproportionate share hospital payments – federal funding that allows hospitals to treat low-income and uninsured patients – led to a possible loss of about $1 billion to hospitals around New York. It also spurred a spat last fall between the state and New York City governments. NYC Health + Hospitals, the city’s network of hospitals, said the state owed $380 million in funding for the hospital payments, which the state initially refused to pay due to the federal cuts. After escalating threats of a lawsuit, the state released around $360 million to NYC Health + Hospitals. The cuts remain in place without congressional action.

Community health centers

Funding for community health centers expired on Sept. 30, but it was then extended until March 31 by the government’s short-term spending bill in December. These centers treated around 2 million New Yorkers in 2016, according to the Kaiser Family Foundation. Federal funding accounted for around 20 percent of the centers’ budgets, and they provide services not covered by insurance. U.S. Senate Minority Leader Charles Schumer visited a Syracuse center last month to highlight the dilemma faced by centers that have turned to the state for loans, especially since demand for health services have increased along with the intensifying opioid crisis. The budget deal, which was negotiated in part by Schumer, includes $7 billion in funding for centers across the country over the next two years.

Children’s Health Insurance Program

The short-term bill that ended the government shutdown on Jan. 22 funded the Children’s Health Insurance Program for six years, which provides health care for 350,000 children in New York. The program was allotted another four years of funding under the latest budget deal that was passed on Feb. 9, extending the program for a total of 10 years.