Tag Archives: Medicaid spending

Health Care: 2017 Census of Governments Data

Many New Yorkers were stunned when Mayor Bill DeBlasio announced that the New York City Health and Hospitals Corporation, which runs public hospitals in the city, rather than the legendary New York City Health Department, would take the lead on testing and contact tracing as the city attempts to emerge from the COVID-19 pandemic.

“It makes absolutely no sense to move a function that has been done well by a great health department for decades to an organization that does not have the legal, epidemiologic, administrative or technical experience to manage it,” said Dr. Tom Frieden, a former city health commissioner and former director of the Centers for Disease Control and Prevention.

Perhaps Mayor DeBlasio knows something that the Times and Dr. Frieden do not.  That when measured per $1,000 of the personal income of all city residents, the Department of Health doesn’t have as much funding as it did back when former Mayor Bloomberg was nagging us about our health. That is one of the findings of an analysis of state and local government Health, Hospitals and Medicaid Vendor Payment expenditures, and the jointly funded federal and state (and in NY local) government Medicaid program that is used to pay for most of them.

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Federal Expenditures: A Government Transformed

Just based on the news, it would be easy to believe that not much had changed for the federal government during the Obama Administration, other than Obamacare. After that program passed, barely, the Republicans took Congress, and there has been a stalemate – with shutdowns, possible defaults, and a sequester that was meant to force compromise by taking both sides hostage, but turned out to be the actual public policy.

Now that I’m looking at the data, however, I see things completely differently. Obamacare is nothing but a blip in the relentless increase of health care as a percent of the federal budget, mirroring its ongoing increase in the economy as a percent of GDP. The sequester actually did shrink federal spending in the limited areas to which it applied, something people don’t realize because the limited federal government operations people actually see have continued to stagger on the for the moment. Meanwhile, demographic and economic changes have completely re-shaped federal expenditures based on programs that were enacted before Obama and the Tea Party were even elected. Notably the increase in the share of the population that is age 65 or over, and the share of the workforce that is working poor rather than lower middle or middle class. The result is a government completely transformed in a way that is in once sense alarming, but in another sense hopeful.

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Aid for the Needy: Census of Government Data

It was only a couple of decades ago that aid for the needy, and resentment of that burden by everyone else, seemed to be the biggest issue in public policy. It was an issue that swept the Republicans into control of the U.S. House of Representatives in 1994. With New York City widely believed to be America’s welfare capital, it helped to make Republican George Pataki Governor of New York State that year, one year after Republican Rudy Giuliani became the Mayor of New York City. This anti-welfare reaction followed by three decades the “welfare rights” revolution, a brief period during which the needs and problems of the poor placed a greater claim on America’s then-growing public resources.

Today, however, public discussion of the needs, problems and costs of the poor seems to have essentially disappeared. So what is being spent on the needy, in New York City and other parts of New York State, when compared with other places today? This post uses Census of Governments data to find out.

Note:  this post, based on data from the 2012 Census of Governments, has been superceded by two posts based on data from the 2017 Census of Governments.  The new posts should be read instead.



The older post continues below.

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