Federal Medicaid Cuts To Throw 30,000 Off Health Insurance In NY-19, Cost State Billions
The House GOP budget bill would eliminate coverage for thousands in Tompkins County, shift billions in costs to New York, and threaten rural healthcare access statewide.
ITHACA, N.Y. — Tompkins County and New York State officials are warning about unprecedented federal budget cuts that would gut Medicaid and threaten healthcare access for thousands of local residents.
The proposed House Budget Reconciliation bill, dubbed the “Big Beautiful Bill” and supported entirely by Congressional Republicans, includes $698 billion in nationwide Medicaid cuts over the next ten years, according to the Congressional Budget Office (CBO). The plan would also cut the Supplemental Nutrition Assistance Program (SNAP) by $270 billion and permanently extend parts of President Trump’s 2017 Tax Cuts and Jobs Act (TCJA), with the CBO estimating that new tax cuts will add an estimated $3.8 trillion to the federal deficit over ten years.
The CBO has estimated that nationwide, the plan will cause more than 10 million people to lose access to their health care. In New York alone, more than 1.4 million people are expected to lose Medicaid coverage, and 730,000 will be cut off from the Essential Plan, a state health insurance program that provides affordable coverage to residents who do not qualify for Medicaid or the Child Health Plus program but still struggle to afford private insurance. The cuts would equate to a loss of $13.5 billion in annual federal funding for New York and its counties.
During a recent Tompkins County Legislature meeting, Legislator Shawna Black outlined data from the New York State Department of Health (DOH) that projected the local impact of the cuts on New York’s 19th Congressional District, which includes Tompkins County. According to the DOH, the district has 37,400 Essential Plan enrollees — 10,000 of whom would be shifted to state-only coverage. Another 4,589 would lose their health insurance entirely.
A report from the Congressional Joint Economic Committee provided by the office of Congressman Josh Riley (D-NY-19) paints an even more dire picture, showing that 33,011 people in NY-19 will lose access to insurance and 30,411 will lose Medicaid coverage.
While it remains uncertain exactly how many residents in Tompkins County will lose coverage, about 16,540 residents are enrolled in some form of Medicaid, which equates to roughly 20% of the county's population. According to Riley’s communications team, a maximum of 5,100 of those residents could be at risk of losing coverage.
Riley voted against the reconciliation bill, saying, “House Republicans are so hell-bent on giving big corporations and campaign donors another tax break that they blocked my amendment to lower the cost of prescription drugs for working families.” He added, “I don’t know a single person in Upstate New York who thinks our kids should go hungry, our rural hospitals should close, or that 33,000 people in NY-19 should lose their healthcare so that billionaires and the wealthy can get another tax break.”
The new tax cuts in the bill will disproportionately impact those with low incomes. According to a report from the Wharton School at the University of Pennsylvania, “The average household in the lowest quintile – with a household income between $0 and $16,999 – would lose about $820 under the House reconciliation bill. That figure represents a 14.6 percent loss in average income for that group and a 5.7 percent reduction in the median income for that group. Households with incomes between $17,000 and $50,999 would lose $430 on average. Lower-income households tend to fare worse as spending cuts deepen over time.”
The report continues outlining that households with incomes between $51,000 and $92,999 would save $840 on average, while households in the top 0.1% with incomes above $4.3 million would benefit the most, saving more than $390,000 annually.
The report added that the cost of these tax cuts is being funded by “cutting Medicaid spending by imposing work requirements for able-bodied adults without dependents, increasing eligibility checks to twice a year, reducing the Federal Medical Assistance Percentage (FMAP) for states covering undocumented immigrants.”
Black highlighted a phone call she recently received from a disabled constituent who expressed fear of losing their Medicaid coverage due to new federal work requirements included in the reconciliation bill. “They’re disabled and can’t work. They're concerned that they won’t have their Medicaid insurance in a few months,” she said.
While congressional Republicans have insisted that cuts are being made to root out “waste fraud and abuse,” Black pointed to data that shows that mandating work requirements would “create a significant administrative burden for counties and could cause hundreds of thousands of people to lose their healthcare coverage,” according to the New York State Association of Counties (NYSAC).
Black continued saying that funding cuts would cause local hospitals to lose more than $24.8 million in reimbursements. She added that the state expense for NY-19 would increase by $55.9 million, and total statewide expenditures will increase by more than $2.7 billion.
“This budget proposal is a direct threat to the health and well-being of our residents,” said Benjamin Boykin II, President of NYSAC and Westchester County Legislator. “Stripping coverage from over 2 million people and shifting billions in costs to counties will devastate public health infrastructure and leave local governments with impossible choices. Congress must reject this unconscionable plan.”
NYSAC Executive Director Stephen Acquario warned that the impact would reverberate across the state. “The proposed federal cuts represent a triple threat—to county budgets, to the vulnerable people we serve, and to the stability of New York’s healthcare system,” Acquario said. “Counties simply cannot absorb the loss of billions in federal funding without massive service reductions or local tax increases.”
Tompkins County Legislator Deborah Dawson has warned that any federal Medicaid funding cuts would place significant strain on counties like Tompkins. Dawson said that the county is already under increased financial pressure due to New York State's decision to shift a portion of Medicaid costs to local governments by intercepting enhanced Federal Medical Assistance Percentage (eFMAP) funding. According to a 2024 county budget presentation, the state's decision to intercept federal Medicaid funding cost Tompkins County $1.6 million in 2024.
With the reconciliation bill set to reduce the percentage of eFMAP funding the federal government will cover from 90% to 50%, Dawson is concerned that county governments statewide will be forced to bear the burden of increased costs.
“While the state has put a limit on how much they’re going to make us pay towards Medicaid, my concern is that cuts at the federal level are going to hit Albany, and then it’s going to roll downhill,” Dawson said. “That’s what always happens.”
Dawson added that she was especially concerned since New York State’s 2026 budget, which passed five weeks late on May 8, did not provide extra funding for Medicaid to cover for federal cuts.
“From what I know about the state budget process, there was nothing in the governor’s proposed budget or in her amendments to the proposed budget that attempted to quantify how much more Medicaid might cost us and how the state planned to pay for it,” Dawson said.
New York State Assemblymember Anna Kelles responded to concerns that the state would transfer the costs of federal Medicaid cuts, saying that the cuts will negatively impact both state and local governments — but that the state would not disproportionately burden counties to make up for them.
“It’s not going to be a situation where the feds are going to go back on their contract with us, and we’re going to try to minimize the impact to the state and disproportionately pass along those cuts and create greater unfunded mandates for the counties,” Kelles said. “That is not what’s going to happen.” She added, “This is not counties versus the state. The problem is the Republican majority in Congress and the Trump administration.”
Kelles continued saying that the cuts also threaten the state's Medicaid Section 1115 waiver program, which is designed to address social determinants of health through targeted investments in housing, nutrition, and community-based care. Kelles said that these programs are vital for low-income families and people with disabilities.
“These are programs that we are implementing that are effectively attaining the goals that Medicaid was purposely established for,” Kelles said. “The whole point of Medicaid is to create equity—to stabilize our economy, to stabilize access and equity in access to education and health.”
Kelles criticized an April 10 letter from the Trump administration’s Centers for Medicare and Medicaid Services (CMS), saying that it mischaracterized the services provided through the waiver program to paint them as “frivolous” to justify rolling them back.
“They’ll define a service as housekeeping, but what they would be cutting is personal care assistance like dressing, grooming, helping people go to the bathroom, helping with meal preparation,” Kelles said. “They’re trying to minimize these services so it doesn’t sound like it’s actually essential.”
Kelles added that targeted programs include maternal health services, HIV/AIDS care, school-based public health programs, and behavioral health treatment.