Today I am pleased to announce a first for RSSBinghamton–a guest viewpoint. And it’s from someone who is (cordially) taking me to task over my recent remarks about Medicaid. Long-term readers of this blog will know that I welcome dissenting opinions and views from my own.

Today’s guest viewpoint comes from Leigh Ann Scheider, Executive Assistant to Broome County Executive Barbara Fiala. In the article Medicaid is Bankrupting Broome County and All of New York State I encouraged Ms. Fiala to “show leadership” and “think outside the box.” Those comments prompted Leigh Ann to write me a detailed email about Ms. Fiala’s record to date in showing said leadership. She gently chided me that perhaps I did not share enough facts on the matter. I asked Leigh Ann for her permission to post her email in toto (nothing has been changed), and she agreed. And forthwith:

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By Leigh Ann Scheider

Dear Mr. Willis,

This morning I read your blog post on rssbinghamton.com titled “Medicaid is Bankrupting Broome County and All of New York State”.  While your points are valid and very astute, your continuous chant that Broome County Executive Barbara Fiala has not addressed the Medicaid burden is sorely incorrect. In fact, as an outspoken member of the New York State Association of Counties (NYSAC), Executive Fiala has continually called upon state leaders to address this state’s uncontrolled Medicaid costs.

What you seem to have avoided or did not take the time to research is the constant, persistent, identification of the Medicaid burden by Executive Fiala in almost all of her budget addresses. Before and even after the Medicaid cap went into effect, Executive Fiala has drawn attention to the ever increasing Medicaid costs, that as you noted, continue to balloon.

This burden does indeed put local governments and the state in a poor fiscal position. Prior to the Medicaid cap being instituted, counties were negotiating projected Medicaid figures as they would spreads between sports teams (let me be upfront in stating that comparison is purely my own opinion). Factually, it would be better described by any county Budget Director that had to go through the process using empirical data. While the cap has given local governments the ability to more soundly budget for such defined increases, costs continue to rise. As Executive Fiala has said publicly, “Broome County’s Medicaid problem is not fixed”.

In further contrast to your claim that Executive Fiala has not addressed the depicted elephant in the room, her advocacy has gone beyond calling for state leaders to take action. Under her leadership, the State awarded Broome County the ability to conduct an audit of nearly 35 million dollars worth of Medicaid claims. For the news release: Click here. This local action proves Broome County’s commitment to protecting taxpayer dollars and preventing fraudulent practices. More information will be released soon on a large settlement that will more than cover the costs of the audits.

I respect your interest and perception of the Medicaid problem. Provided with the information and public statements made by Executive Fiala, it is my hope you would consider including more factual information within your post. While your post draws attention to a very real problem, it would be more impactful if the information was factual regarding the actions taken by leaders within Broome County.

As with any freelance media, credibility always stirs criticism, however, that is not my intention. Below, I have included remarks from Executive Fiala where she has addressed the Medicaid burden that Broome County taxpayers are faced with. These remarks do not include transcriptions of her comments made to state leaders and or NYSAC. If you have any further questions or comments please feel free to contact me directly through the information provided below. I appreciate your time and willingness to correct information within the contents of your blog.

Best regards,
Leigh Ann Scheider

[County Executive Fiala's previous public comments]

2006 Budget Address

“Some might be wondering that now with the Medicaid Cap, why our taxes are not decreasing? What you have to understand is that the cap is just that. It only caps the amount Medicaid costs would have increased. Do not get me wrong, we are extremely grateful state leaders have finally tackled this tremendous burden that has rested on counties’ shoulders, far too long.

What the state has given us is a formula that allows for an orderly and predictable way to forecast Medicaid expenses instead of the skyrocketing costs we were forced to solely absorb in the past. While we do not know for sure what our Medicaid costs for 2006 will be until the final numbers are certified by New York State on June 30th of 2006, we anticipate our local share of these expenses to rise by $1.2 million dollars.

Medicaid is still the single largest item in the Broome County Budget comprising approximately 11% of the total budget. I will continue to pressure our state lawmakers to better manage Medicaid. Our state by far has the highest Medicaid expenses, including highest total amount, highest per recipient and highest per capita.”

2006 State of the County

“Medicaid is a concern but our Medicaid situation is in much better shape than it was a few years ago, thanks to the state Medicaid cap. But I feel it is important to note that even with the cap in place our costs increased by $1.7 million from 2004 to 2005 and they will continue to increase this year by approximately $1.2 million dollars.

The cap has been a tremendous help in planning for the future but everyone needs to remember this does not make our Medicaid problem disappear. It is still quite a drain on our local resources, comprising about 11 percent of our overall budget or about $34 million dollars a year.

That is why we need to work on continuing to reduce the Medicaid burden that exists for property taxpayers across New York State. This is not to say that those in need will be sacrificed or ignored. I absolutely do not believe that should happen.

However, the system and how it is administered by New York State is broken. It seems there is complete incompetence, fraud or both.

The New York Times reported last year that our Medicaid system which is quote-the most expensive and most generous in the nation-has been misspending billions as a result of fraud, waste and profiteering. This has got to be stopped.

I strongly advocate an aggressive approach to cracking down on fraud. That is why I sought to have Broome County become one of the first counties in New York State to join the Verify New York Program.

This program will enable counties like Broome to flag inefficiencies and billing irregularities. The demonstration project makes counties partners in the effort to detect, investigate and prosecute Medicaid provider fraud.

By participating in this project, we are not assuming there is fraud on the local level, however, if we do nothing, we will never know and I would rather take steps to protect the taxpayers’ dollars than simply hope there is not a problem.

This is not costing Broome County a dime and if any money is recovered as a result of fraud, we will share in those recovered funds.

I want to assure you that Broome County Security Department efforts, to investigate user fraud, will continue as well.”

2007 Budget Address

“In the 2002 resolution, lawmakers resolved that they would review the sales tax distribution formula, “…if within the next 5 years, New York State should assume the County share of Medicaid costs…”

Today I tell you that Broome County Government’s share of Medicaid stands at $33.7 million dollars and climbing. In my opinion, a nearly $34 million dollar Medicaid bill proves that the state has not “assumed the County share of Medicaid costs” and Medicaid remains a huge tax burden.”

2008 Budget Address

“Let me again reiterate, Broome county’s Medicaid problem is not fixed.”

“For anyone to say that the Medicaid is fixed is not only incorrect, it is irresponsible and a dangerous message to send to Albany.”

For full remarks visit: http://www.gobroomecounty.com/files/countyexec/pdfs/2008BudgetFinal.pdf

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Thank you Leigh Ann, for taking the time to write and bring to light Ms. Fiala’s efforts to contain Medicaid costs. As a taxpayer in Broome County, I appreciate her efforts. – Jim

Technorati Tags: Medicaid, Barbara Fiala, Leigh Ann Scheider, Broome County

Each year when Broome County Executive Barbara Fiala releases the proposed budget my blood pressure goes through the roof. Not because of Barb or her proposals per se, but because the real story is so well hidden in the numbers. I believe politicians either do their best to hide from citizens the fact that we are quickly being bankrupted by Medicaid, or they are in denial, hoping the problem will magically go away.

For those not familiar with Medicaid, it is the immoral requirement that some citizens fork over money to pay for their fellow citizens’ health care. That is, the producers of society, those who work hard and contribute, are forcibly made to hand money to non-producers–those who can’t or (in most cases) won’t work, giving non-producers better health care than the producers themselves have. It is unfair.

Try to locate a single line item identifying total Medicaid payments by reading through the latest 526-page proposed budget for yourself: Broome County Budget – Recommended 2010 (PDF, 54MB). It’s not there. In and amongst the line items you will see something called Social Services, under which Medicaid transfer payments are hidden. Social Services is $113 million out of a proposed $353 million budget (or 32%), and that includes Medicaid, foster care, food stamps and other items.

In the proposed budget you’ll see columns for “expenses” and “revenues” for various line items, including Social Services. How can something like Social Services (and by extension Medicaid) actually generate revenue? It can’t. “Revenue” is a misleading label for what is, in most cases, taxpayer money coming from a different pocket. Instead of the money coming from the “county taxpayer pocket,” it may come from the “state taxpayer pocket” or the “federal taxpayer pocket.” If it comes from any pocket other than the county taxpayer pocket, Ms. Fiala labels it as “revenue.” It makes no difference how you label it–the only way for government to issue money (short of fiat printing it, which spikes inflation), is to take it away from some people (taxpayers) and give it to other people (non-taxpayers). It’s really pretty simple to understand, but completely obfuscated in the proposed 2010 Broome County Budget.

Back to Medicaid in Broome…According to a slide show prepared by Barb Fiala (this slideshow being the only way we know how much Medicaid on its own costs), the county will need to raise and pay $36 million in 2010 for Medicaid. Since the county pays 25% of Medicaid costs (or $36 million for 2010), and New York State pays 25% of the cost, and the Federal government pays the other 50%, that means the total cost (to taxpayers, from all of our pockets) for health care to citizens who won’t pay for it for themselves in (just!) Broome County will be $154 million in 2010. This is obscene and immoral in the extreme. Nationalizing health care will not drive costs down–if anything, the costs will go up. People tend to use services more and scrutinize invoices less when they don’t pay for it themselves. Funny how that works. It’s called human nature.

The only solution to continued tax increases is to cut Medicaid benefits dramatically–not only for everyone in the US, but particularly in New York State. I’ve written about this endlessly over the past few years. Medicaid is the elephant in the room that must be dealt with. Not until New York cuts back on benefits (we have the Cadillac version of Medicaid in NY), will we start to reverse the trend of escalating taxes, with the result that people and jobs leave the state.

What can Barb Fiala do in the meantime? It’s time for bold action. Someone needs to challenge New York State and start reducing Medicaid spending. If taxpayers are footing the bill, we should start acting like an insurance company. Set up review committees to approve procedures and control costs in Broome County. Clamp down on charges from doctors, hospitals, pharmaceutical companies, etc. Make Medicaid recipients (gasp!) responsible for a co-pay–say $25 per doctor visit. Give them an incentive to NOT run to the doctor for every hang nail. Make them fill out paperwork every few months (like insurance companies force us to do) re-certifying they don’t have insurance of any other kind that will cover part or all of their medical expenses. In short, let them experience the same level of hassle that hard working, taxpaying people experience themselves in order to provide health care for their families. Let’s subtly (or not so subtly) encourage them to get a job and get covered.

Think outside the box Barb, and show leadership on the most important issue facing this county! One thing is for sure, if nothing is done about Medicaid, the elephant in the room will surely bankrupt us within a few years.

Technorati Tags: Medicaid, Broome County, Barbara Fiala, county budget, county taxes

I call the sewage plant Exhibit A in why government consolidation does not work. Weekly we hear the bleating of local politicians (in particular Barbara Fiala, County Executive) about the wonders of consolidating governments and services. Bunkum. I’ve written about this before, but thought it would be a good time to revisit the topic in light of the fact the local socialist Democrats are about to re-elect Fiala to another four years. What a shame.

But back to sewage as our topic. It certainly seems to make sense to share services like sewage so only one (or maybe two) plants, which are expensive to construct and maintain, are built. Makes sense to me! Except when politicians get involved. This plant was built in 1965 and is 55% owned by the City of Binghamton, and 45% owned by the neighboring Village of Johnson City. The plant serves not only those two municipalities, but also eight others in the county. There’s a lot of…waste…that flows through the plant.

When the plant was built, the politicians decided that both Binghamton and J.C. would each appoint three members to a six-member board. The board has complete power to control spending, hiring and daily operations at the plant. Such brillance! We not only see this kind of abdication of responsibility locally, it’s through every layer of government. Let the “experts” run it and make the decisions. Throw away your constitutional authority by giving it to someone else and let them make the decisions–because it’s “too hard to run it unless you’re an expert”. Bunkum. Meanwhile, the taxpayers are hosed and we can’t do anything about it. You can vote politicians out of office every few years. Not so with the board of the sewage plant. They are insulated from accountability for the decisions they make.

Yesterday the Johnson City Board of Trustees voted not to accept the sewage board’s latest budget. Each year for 43 years they have voted to accept it, which is largely ceremonial. Until now. So what happens, you may ask? Nothing. The sewage board still holds the power to raise the rates and they will. Which means J.C. rate payers will see about a 58.5% jump in their sewage bills, along with similar jumps in Binghamton and the other affected municipalities. Talk about adding insult to injury! Mayor Matt Ryan just raised water rates 43%. And now this! Hold on to your wallets Binghamtonians. The good Mayor Ryan and his merry band of socialists will be knocking on your door soon to relieve you of ALL your money.

My take on this “mess” and how I would handle it if I were Mayor Harry Lewis from J.C.: Immediately fire the three members of the sewage board that J.C. appoints. There must be some provision to replace members of the board. You must get the current members out–now. And replace them with citizens who are not happy with the way things are being run at the plant. Second, sue the state and federal government over their unfunded and unfair regulations. If they are requiring obscenely strict new rules, you need to challenge them and tie it up in court to prevent it from busting this year’s budget. Third, work with Binghamton (if you can–they’re such dolts in Binghamton City government it will be a difficult task) to rewrite the agreement for governing the plant to make it more responsive to the rate payers (i.e. taxpayers).

One thing’s for sure: Status quo at the sewage plant is not an option. We must get a handle on it now to prevent this from happening again. Let this sad tale of sewage be a lesson to everyone on the folly of government consolidation.

Technorati Tags: Binghamton, Johnson City, sewage plant, government consolidation, municipal consolidation, Broome County, Mayor Harry Lewis, Mayor Matt Ryan

Broome County’s portion of the tobacco booty is $17 million. Some in the County Legislature wanted to spend the money in building a new communications building for Broome Community College to enhance the college’s budding communications program. I thought from the beginning building a new communications building was a much better use of the money–but no matter. The decision is now made.

The current holdup on renovations for the Harvey Building has to do with Ms. Fiala wanting to award 90% of the work to her labor union buddies. Political patronage is a great thing, eh? She no doubt has an eye on stocking her re-election campaign war chest. She’s being challenged in court by local contractors disputing the high union labor requirement.

Below was my response on the “story chat” for the P&SB article. I was feeling charitable, hence my complimentary tone.

I wouldn’t classify County Executive Barbara Fiala as a complete and utter disaster (like Binghamton Mayor Matt Ryan), but she’s certainly fiscally irresponsible. How about a commitment, Ms. Fiala, to freeze property tax increases for the next two years, as a starting place. Can you at least do that?

And how about showing leadership on the 800 pound gorilla of Medicaid spending? By my calculations, 80% of the property taxes we pay to the county fund the budget item called “Social Services”–the lion’s share of which is Medicaid ($34 million for Medicaid in the 2008 budget). THIS MUST STOP. How about suing New York State to allow Broome County to offer fewer Medicaid benefits instead of the “Cadillac version” offered now?

What we desperately need, Ms. Fiala, is leadership. Please stop attacking the Republican Sheriff and complaining that municipalities get to keep a full 50 percent of sales tax revenue, and start showing leadership on the issue of spending and taxes. If you do, both Republicans and Democrats will support you come re-election time.

http://rssbinghamton.com/analysis-of-proposed-2008-broome-county-budget/
http://rssbinghamton.com/the-high-cost-of-doing-business-in-new-york-and-medicaid/

Technorati Tags: Binghamton, Broome County, Barbara Fiala, George Harvey Justice Building, Broome Community College, tobacco settlement money, Medicaid

First, let’s set the record straight. For years, Sheriff Harder has gone hat-in-hand to the County Executive and County Legislature telling them he needed more manpower for the jail. And for years they have denied him. Since he operates a public institution that is regulated by strict state laws mandating how many officers must be on hand to run the place, he had no option but to use overtime. And a lot of it. The yearly budget has allowed some overtime, but often he would run over–way over the alloted budget. Fiala has been using this issue to try and smear Harder, I’m assuming because she’s a Democrat and he’s a Republican.

Harder finally had enough. He called in the big dogs (Commission of Corrections), and they have the full weight of New York State behind them. Apparently they can make Broome County hire these officers over an 18-month period to correct the situation. I’m a little concerned when the New York State comes in and orders us around, especially when they mandate we spend money, but if I were in Dave Harder’s shoes, I would have done the same thing. He had no choice.

So now, Ms. Fiala and the Legislators have to find some money. The P&SB incorrectly reports we will have to find the full $1.4 million extra. Actually, there’s already $1 million budgeted for overtime at the jail right now. If the overtime is eliminated, that means we only have to find another $400,000. True leaders would suck it up and find it without raising taxes. But then, we don’t seem to have true leaders in our county government. Broome taxpayers–be prepared for yet another tax increase by your Democrat county government.

Technorati Tags: Binghamton, Broome County, David Harder, Barbara Fiala, New York Commission of Corrections, Broome Legislature

On to the budget analysis. I don’t pretend to be an accountant and understand the very complicated 571-page document that is the 2008 Proposed Budget. Perhaps there are some accountants out there who can chime in and enlighten us. Here’s my rather basic understanding (feel free to correct me):

First, here’s where we’ll spend $328,881,986 in 2008 (yes, that’s 328 MILLION dollars):

The above does not tell the whole story. Some of the items, like Central Food, the County Library, Golf and the Arena will actually bring in money. That is, we not only pay out, but the “asset” will generate revenue that comes back in. So some of those items will in essence be “self funding.” Also, many of the items above are funded by sales tax revenue and revenue from New York State. Yes! I know…that’s also money from our pockets too. But for the sake of argument, let’s save that discussion for another day. Assuming that many of the items above are “funded” by other sources, here is what we are left having to pay out of our collective pockets using property taxes:

And if you were to break it down by how much of each $1 of the property tax you pay goes to fund the above, it breaks down like this:

*due to rounding it adds up to 99 cents

You can see that 80 cents of each dollar is used to fund Social Services. That includes Medicaid, foster care, and a host of social programs. The lion’s share is Medicaid–approximately $34 million in the 2008 budget. Folks, this is nuts. This is socialism run amok. Our government, both New York State and Broome County, points the gun of the state at our heads and forces us to open our pockets and pay for our neighbors. It is immoral and it is unfair. We need local leadership that will challenge New York State and think creatively about reducing the budget.

How about this for a simple but effective strategy: Don’t raise the budget for the next five years. Cap it where it is and figure out how to keep reducing line items year by year. The cost of living will go up, state mandates will increase, etc. So what!? Figure it out. Cap it and start, little by little, living on LESS. Become known as the one county in New York State where it’s actually costing LESS in property taxes to live. And watch this area start to attract more people, new jobs and new businesses.

Agree or disagree? Have a question? Want to vent? Leave a message in the comments below.

Technorati Tags: Binghamton, Broome County budget, Broome County, New York State, property tax, Barbara Fiala

Political party affiliation does matter because a party’s philosophy will ultimately affect the laws that are made and the policies that are implemented. Yes, party affiliation matters. But on the local level, it matters less–far less. You see, party affiliation doesn’t have much to do with wooing prospective businesses to an area, or keeping them there. Or fixing roads and bridges. Or attracting talented workers. Or any of the dozens of other things local governments do. With local government, it’s almost all economics. Less taxes and more jobs equals more population equals good policy. It doesn’t matter if you’re Democrat or Republican.

Why this rant? A few weeks ago Darcy Fauci was named Broome County’s new director of economic development. Prior to that she was the county’s chief public relations person. Her boss, County Executive Barbara Fiala (a Democrat), gave her the promotion. The complaints from the Republican side of the isle didn’t take long to surface, primarily taking the form “she has no economic experience.” As Darcy herself said, “what kind of experience is economic experience anyway?” She’s worked in the county executive’s office for two years, and previous to that she was in the news business. She’s lived and worked in this area for some 20 years. Seems to her (and me) that she knows quite a bit about the economics of this region, and she likely knows how to promote this region to those considering relocation or establishing a new venture.

Here’s the bottom line: I have no idea how she will do in this position. But you know what, let’s give her a chance. I extend my hand across the isle, and say “Congratulations!” I don’t know about you, but I love it when someone works hard and gets ahead. This is not a case of favoritism or cronyism, but a case of someone working hard and getting a deserved promotion from the boss. We owe it to Darcy to give her a chance, and to help her succeed. For you see, when she, and Fiala, and everyone else in local government succeeds, we all succeed. That’s statesmenship. We need more of it in Greater Binghamton.

What do you think? Have I lost my mind and gone wimpy lib? Did Barbara Fiala make a mistake? Does Darcy deserve the benefit of the doubt? Do we need more statesmenship around Greater Binghamton? Leave me a comment.

Technorati Tags: Binghamton, statesmenship, county government