Several regional business associations in western New York have launched campaigns to encourage state lawmakers to enact reforms that would reduce the burden of Medicaid costs in New York State.

The Rochester Business Alliance (RBA), the Buffalo-Niagara Partnership (BNP), and the Metropolitan Development Authority (MDA) of Syracuse have met recently with county officials in Monroe, Erie, and Onondaga counties. Those three organizations are founding members of a group called Advance Upstate New York, which has identified Medicaid reform as its top legislative issue for 2004.

Specific reforms being promoted by these advocates include a cap on Medicaid expenses, expanded use of Medicaid care, and a limit on reimbursements for "personalized care," which includes such activities as shopping and cleaning, to 15 hours per week.

As part of their advocacy for Medicaid reform, western New York business leaders have been active in publishing opinion columns advancing the case for Medicaid reform.

• David Klein, CEO of Excellus BlueCross BlueShield and a member of The Business Council's board of directors, published an op-ed in the Rochester Democrat & Chronicle on March 28.
  
  "New York is in trouble. We live in the highest taxed state in the nation with an aging population and a slow growth economy, particularly upstate," Klein wrote. "It is critical for our state Legislature to act now on real reforms that offer short- and long-term solutions so that the economic climate promotes growth rather than simply a struggle for survival."
  
  Klein, who serves on the state Senate's Medicaid Task Force, outlined a number of specific reform proposals, including administrative centralization, a targeted extension of managed care to programs covering the elderly, and creation of incentives to encourage the purchase of private long-term health insurance.
  
  Klein also emphasized the importance of reducing costs, and not just shifting the burden from one set of taxpayers to another.
  
  "To achieve meaningful cost containment, we need to forego ideas that would achieve little savings or simply shift the cost burden to the private sector," he wrote. "And the focus for reform needs to go beyond which taxpayer base is used to finance the program."
  
  
• Maggie Brooks, Monroe County executive, and Thomas Mooney, RBA's president and CEO, urged Medicaid reform in an op-ed piece they published, also in the Rochester Democrat & Chronicle.
  
  "Our state and local taxes in New York are already among the highest in the nation, and Medicaid is a primary cause," they wrote. "More than any other item in the [state budget]," they added, Medicaid spending "threatens the economic survival of upstate New York."

The western New York business groups join The Council in this effort, which has long been the state's most prominent business voice in advocating Medicaid reform. For example, 2002 research by The Public Policy Institute, The Council's research affiliate, has showed that New York's per capita Medicaid spending is by far the nation's highest and about 155 percent above the national average.

Institute research has also shown that:

• New York spends 15 percent of the national total for Medicaid, even though we have only 7 percent of the population and 9 percent of all Medicaid recipients.
  
  
• New York collects some $1.4 billion in taxes on health care, virtually all of it from businesses. These are taxes that no other state even imposes-yet it costs business more than all other state taxes except the corporate franchise tax.
  
  
• New York spends more on Medicaid than any other state-by far. In fact, New York's Medicaid spending per capita more than Medicaid spending in Texas and California combined.

The Business Council is advocating a range of reforms, all of which emphasize that the root of New York's Medicaid problem is its far-above-average level of spending. The Council supports a state take-over of the local share of Medicaid, provided it comes with an ironclad requirement that county saves be returned to county taxpayers.

The Council also believes Medicaid care can be improved and costs reduced by an increased emphasis on managed care, especially in cases involving chronic illness, and a more sophisticated use of information and information technology to improve caregivers' decision-making.