With Donald Trump returning to the presidency and Republicans set to control both houses of Congress, the incoming Administration’s promise to cut $2 trillion in federal spending does not seem far-fetched. Yet how? The President-elect has promised not to cut Social Security and Medicare; and during the campaign he vowed to bolster the military. He also promised to cut taxes.

For now, how that math works is anyone’s guess, but the nation will soon see his plans. One thing that is likely is that whatever the new Administration decides, federal support for the states will be reduced – perhaps dramatically.

One area that is expected to take a hit is the nation’s health care delivery system, most notably the Medicaid program, which provides health care for low-income and other vulnerable Americans. The federal government spends nationwide about $600 billion annually on Medicaid, helping to underwrite coverage for nearly 70 million Americans.

Medicaid is a joint program of the federal government and the states. States are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees. Because Medicaid is administered by states within broad federal rules, Medicaid programs and spending vary across states.

New York offers the most generous Medicaid benefits of any state, and it costs both a lot. Thus, if Medicaid is on the chopping block, it could be devastating to New York.

New York Medicaid provides coverage to 7 million of the state’s nearly 20 million residents. And that number is growing. Over the past decade, New York State has added 1 million individuals to its Medicaid program. The current state budget appropriated over $100 billion to the Medicaid program, with New York providing $37 billion – the difference is almost entirely covered by the federal government.

Thus, big cuts at the federal level could have big impacts on New York.

When it comes to health coverage, New York policymakers will do everything they can to avoid cutting benefits to needy residents. It will take creative measures to ensure that the state is getting everything it can out of its health-care system.

One step that must be taken is to tackle substandard hospital care.

Last week, a national think tank established by some of the nation’s largest employers and purchasers, released a report examining the quality of care in America’s hospitals. The Leapfrog Group has been issuing these analyses for over two decades. The Group relies on Medicare hospital quality data to make the best “apples-to-apples” comparisons of the nation’s hospital care. Over those two decades New York has been consistently ranked poorly.

In last week’s report, the analysis found that New York State ranked 34^th nationwide in terms of quality, well behind large diverse states like California (ranked 6^th), New Jersey (5^th), Florida (13^th), Massachusetts (23^rd), Pennsylvania (9^th), and Texas (15^th). The ranking is based on the percentage of a state’s hospitals that received an “A” grade. Only 22% of New York’s hospitals received an “A” grade. The report allows consumers to see the quality scores of individual hospitals as well as states’ averages.

Why do New York hospitals perform comparatively so much worse? In July 2019 the director of Leapfrog Group explained what she knew about New York’s hospital safety:

“The system as a whole didn’t seem to have emphasized safety. We’ve seen other states work together and look at what’s working well at other states and implement it. It just doesn’t seem to be happening in New York.”

So, what should be done? There is a vehicle for the Hochul Administration to demand higher quality. In 2023, the Hochul Administration established the Commission on the Future of Health Care. The Commission is charged with offering recommendations to transform the health care system in New York State.

Given the storm clouds gathering over the nation’s capital, the Commission should be preparing for how changes there can impact New York’s health care system.

Improving quality of care must be a top priority for New York. According to experts, higher quality care is less expensive care. Thus, developing recommendations to improve the quality of care will not only lessen unnecessary patient injuries and deaths, but it will also make the system more efficient in its use of public dollars.

There can be no doubt that New York policymakers have not made quality of care the priority it should be. Given the potential for dramatic changes at the federal level, not acting to improve care will hurt taxpayers, too. Here’s hoping that the Hochul Administration will make quality of care a top health priority.

While the vote tallies for the nation’s elections last week are not fully complete, it is clear that it was a decisive victory for Republicans, with Donald Trump handily taking the Electoral College and winning the national popular vote, a possibility that seemed unlikely in the run up to the vote. Republicans also regained control of the U.S. Senate, with the House of Representatives races still too close to call. Here in New York, however, it was a different story.

Incumbents largely prevailed in state Legislative races and Democrats appear to have won four of the five swing seats for Congress. In addition, New Yorkers solidly supported the constitutional question on the ballot that strengthened legal protections against discrimination.

The Congressional races and the constitutional question were top political priorities for Governor Hochul. From a Democrat’s point-of-view, her marshaling of political resources to achieve those victories must be considered feathers in her cap.

Heading into Election Day, the governor pledged to raise money and distribute resources on behalf of Democratic Congressional candidates and in support of the constitutional ballot question. She did and her efforts bore fruit.

In the swing Congressional elections in Syracuse, the Hudson Valley and on Long Island, Democratic candidates won – or appeared to have won – in 4 races. The incumbent Republican representatives appear to have lost in Syracuse, the upper Hudson Valley and on the south shore of Nassau County. The one Democrat incumbent facing a tough race won. Only in the lower Hudson Valley did the Republican incumbent fend off a challenge.

The performance of New York Democrats stands in contrast to the party’s performance nationwide. But there are warning signs for state Democrats.

This is true because Kamala Harris received far fewer votes in New York than Joe Biden did in 2020 and Donald Trump fared better in New York than four years ago. Comparing the two Democrats’ performances shows that Biden received almost a million more votes than Harris did. Trump received 150,000 more votes last week than he did in 2020.

Harris received 4.3 million votes to Biden’s 5.2 million four years earlier. Yet, there are 6.5 million registered Democrats in New York. Trump received 3.4 million in 2024 – an increase over the 3.25 million he received in 2020. There are 3 million registered Republicans in New York State. It seems pretty clear that Republicans showed up for the Presidential race and Democrats did not.

Democrats’ warning signals don’t end there. Since 2020, there has been a drop in Democratic voter enrollment: There are nearly 300,000 fewer registered Democrats in New York than there were four years earlier. Republican party enrollment is up nearly 100,000. By the way, voters who are not registered in any political party have also seen growth and now outnumber the Republican total.

Why the shift in voter enrollment? It could be a shift in how voters feel about politics in New York. Polling on how New Yorkers feel about the direction of the state has been negative. In addition, it is likely that at least some of the shift in Democrats’ total has to do with the net outflow of people from the state. While the total number of registered voters is up from four years ago, the state’s population has declined. Perhaps one explanation can be that Democrats have been more likely to move out-of-state.

Lastly, Republicans in state legislative races seem to have survived in a Presidential election year. Typically, Presidential years bring out more voters than in off years and in a state as heavily dominated by Democrats as in New York, Republican candidates suffer.

Instead, Republicans appear to have been able to protect their incumbents and even solidify their gains in south Brooklyn – until recent years a Democratic bastion. And a look back at the governor’s race in 2022 – when a Republican candidate ran a strong race against Governor Hochul – underscores a potential longer term shift in the political fortunes of Republicans.

As with any election, who wins and loses matters most. In New York, Democratic gains in the Congressional races and the solid approval of the constitutional amendment are undoubtedly victories. Success by Republicans in maintaining their support in legislative races in a Presidential year must offer some solace.

The trends in voter enrollments and the Republican gains in New York City are encouraging signs for their party and flashing warning lights for Democrats. How they proceed going forward will plant the seeds for future election outcomes.

At long last, the tumultuous election of 2024 comes to an end this week. Of course, the most likely scenario is continued tension over vote counts in the battleground states. Here in Albany, the focus will be on governing.

While the Hochul Administration continues to develop a budget plan for next year, the most immediate task ahead for the governor is deciding what to do with the hundreds of pieces of legislation that have passed both houses, but not yet sent for her approval.

Let’s look first at the numbers. In 2024, the state Senate and state Assembly jointly approved a bit more than 800 identical bills. Of those, as of the morning of November 4^th, the governor had approved 443 bills and vetoed 3, leaving 360 bills to go.

New York’s Constitution has specific rules for how bills are to be handled. The Constitution requires that once an identical bill has passed both houses it should be sent to the governor for her approval. The courts have ruled that every bill approved by the Legislature must be sent to the governor by the end of the calendar year.

Here are the most important rules, buckle your seat belt.

Once a bill is sent to the governor for approval, she has ten days – excluding Sundays – to consider the legislation. If she approves it, it becomes law. If she vetoes it, then it does not. However, the Legislature can choose to override the veto if two-thirds of the members of each house act in that calendar year. In that case, the bill becomes law over the objections of the governor.

If the governor does nothing during that ten-day period, the bill automatically becomes law.

If lawmakers send the bill to the governor at the end of the calendar year, the Constitution provides that she has 30 days to consider the legislation. In that circumstance, she can approve, or veto as described earlier, but if she does nothing, then the bill is considered vetoed.

The Legislature technically controls when the bill goes to the governor – with the house that approved the bill first making the call. However, in order to manage the volume of bills that the governor considers at any one time, there has been an informal rule that the governor requests bills when she is ready. The Legislature rarely sends a bill unless the governor requests it, and since the three leaders are all in the same political party, there are few reasons to upset the current practice.

As mentioned earlier, Governor Hochul has requested and acted upon nearly 450 bills and has 360 to go. She will start requesting them and must have received them all by the end of the calendar year.

Some of the bills still to be acted on are generally considered less consequential – except, of course, to those pushing them. For example, there is a bill that allows the state’s economic development agency to give a preference to any tourist promotion agency that is promoting the sport of stickball. No offense to stickball, but there are some bills that potentially would have more of an impact, such as a bill that requires local governments to maintain municipal websites.

And some are hugely consequential. For example, the Climate Change Superfund Act’s fate in New York now turns to whether the governor approves the legislation. Governor Hochul is co-chair of the U.S. Climate Alliance – a bipartisan coalition of governors committed to fighting climate change. Among the commitments of the Alliance is the promise to build resilience to withstand the impacts of climate change. The Climate Superfund bill would further that goal. Unless the governor approves the legislation, the entire costs of climate change – which already total billions of dollars annually – will be borne solely by New York taxpayers. The bill shifts some of those costs to the companies most responsible for our worsening climate without those costs being passed on to the public. An independent economic paper published by the respected Institute for Policy Integrity at the NYU School of Law supports that view.

And New York’s climate costs are already significant and will mushroom over time. This year alone, with New Yorkers experiencing a record number of extreme weather events, Governor Hochul has pledged approximately $1.4 billion in taxpayer spending to cover climate damages. In addition, New York has already invested $15 billion solely for coastal resiliency projects along New York Harbor. 

That proposal is one of the big decisions for the governor. But only one. As New York heads into the last weeks of 2024, the governor and her staff will be rolling up their sleeves to figure out her position on 360 remaining bills. One of them could help save taxpayers big bucks in the coming years as well as build a safer infrastructure to better protect New Yorkers from a worsening climate.

It makes sense for her to approve it. Time will tell.

After years of lies and threats, and then the violence of January 2021, election 2024 is looking like the worst one yet. There have been two attempted assassinations of Republican candidate Donald Trump. Add to that the growing reports of threats of violence and actual attempts at harming poll workers.

These threats are the direct result of the toxic spewing that has marked the 2024 campaigns.

New York is considered a reliably “blue” state, one in which a Republican hasn’t won a statewide election in over two decades. Yet the threats are now brewing even here.

While few expect the presidential vote count to be close, the road to control of the House of Representatives may run through New York. It was, after all, the surprising performance of Republican Congressional candidates in New York that gave control of the House to the Republicans in 2022.

Thus, the House races in New York are considered top priorities for Democrats to win and Republicans to protect in 2024. That’s why New Yorkers – particularly those in the Hudson Valley, Long Island, and Syracuse – have been deluged with political ads, many of them incredibly negative.

As a result, New Yorkers now have to worry about their elections being the target of a plague of lies and threats.

Last week, the County Boards of Elections in Delaware and Schoharie stopped the use of outdoor ballot drop boxes by voters due to security concerns. According to the Times Union newspaper, Schoharie Board of Elections officials said it was because the drop box was not secured and was not under camera surveillance. The drop box was used in the 2022 general election and the June primary without issue. But the Board of Elections recently raised concerns about it and, after consulting with the state Board of Elections, placed the drop box into storage.

In Delaware County, the chair of the county Board of Supervisors directed the ballot drop box to be moved inside the Board of Elections “where it’s more secure. . . . And so people still use it.” Unfortunately, these moves make it a little bit harder to vote in those counties.

These actions may seem like relatively benign pranks, even though the freestanding ballot boxes had been used without incident in the past. However, going after ballot boxes has been a notable tactic nationwide for those looking to disrupt the election.

Threats cannot be ignored. The best response is to do all that can be done to protect poll workers and polling places. When these attacks occur, the rest of us have a duty to stand up for democracy, which means to vote.

The time to request a mail-in ballot has passed. If you have requested a mail in ballot, make sure you fill it out correctly and mail it in postmarked no later than November 5th. Return envelopes already include postage and the return address of your Board of Elections.

If you aren’t voting by mail, you have two options. The first is early voting and that period lasts through Nov. 3^rd. Polling hours may vary, and early voting sites may differ from Election Day voting sites. The best way to know the hours for early voting and the polling locations – which are often different from those used for the traditional Election Day – is to check with the State Board of Elections website.

The second option is to vote on the traditional Election Day, which is Tuesday November 5^th during the period 6 a.m. through 9 p.m. (remember if you have voted during the early voting period, or if you voted by mail, you cannot vote again during the General Election).

However, if any voter gets harassed at a polling place, or if there is some other difficulty, the New York State Attorney General runs an Election Protection Hotline that can help answer voters’ questions. The Attorney General’s hotline can be contacted at (866) 390-2992.

Voters being harassed or otherwise inconvenienced can also request election-related assistance at any time through the Attorney General’s online complaint form. The Election Protection Hotline is staffed during the early voting period from 9am until 6pm and on Election Day from 6am to 9pm.

It is beyond sad that Americans have to worry that a lunatic – sometimes violent – fringe amped up by campaign speeches and social media falsehoods have harmed our system of governance. There is no excuse for the hateful political speech and threats of violence that we are experiencing. But we can draw inspiration and comfort knowing that for hundreds of years the courage of prior generations has stood up to all sorts of evil – both foreign and domestic.

Now it’s our turn. Don’t let the haters win: vote.

While Election Day is still a couple of weeks away, voting has started here in New York. For those of you old enough to remember the days of the lever voting behind a “Wizard-of-Oz” curtain, casting your ballot in New York has changed a lot.

The lever machines are out, filling in the paper-ballot bubble is in. Nowadays scanning machines quickly tabulate the paper votes, leaving a physical document that has your vote, unlike the old days when no such record existed.

And that’s not the only thing that’s changed. Instead of only being able to vote on the first Tuesday in November, New Yorkers can vote during an early voting period and can now cast their choices through the mail.

As a result, New York votes are now more secure and casting a ballot is much easier. And New York has moved near the national average in the election participation.

This year, New Yorkers can choose one of three ways to vote:

• In person (during the early voting period or on Election Day);
• By requesting an absentee ballot (if you will be traveling or due to an illness); or
• New this year – by requesting an early voting mail-in ballot without needing to provide an excuse.

For those who are interested in voting through the mail, this is the last week to register to do so. The mail-in ballot (that does not require an excuse) is new, so if you would like to vote this way, here is how.

Request a mail-in ballot online or visit your local Board of Elections office.  Mail-in ballot applications must be received by the Board of Elections by this Saturday, October 26th.  Your ballot will be sent to you immediately after your application is received and processed.

If you are mailing in your ballot, when you have finished voting, fold the ballot and put it in the security envelope. Sign, date, and seal the security envelope. Put it in the return envelope and mail it, postmarked no later than November 5th. Return envelopes already include postage and the return address of your Board of Elections.

If you do not want to mail your ballot, you have a few options: Hand deliver it to your local county Board of Elections office by November 5th before 9 PM. Bring it to an early voting site in your county between October 26th and November 3rd (hours and locations vary by county). Or bring it to a poll site in your county on Election Day (November 5th before 9 PM).

Once you have mailed in your ballot, after a few days you can then track your early mail-in ballot online.

If you haven’t registered to vote, you still have time. This Saturday, October 26^th is also the voter registration deadline. If you are not sure if you are registered to vote, you can check your voter registration status online.  If you are not registered yet, you can register online or visit your local Board of Elections office to pick up a voter registration form. But don’t delay, as noted the voter registration deadline is October 26^th.

October 26^th is also the first day of early voting. Early voting lasts through Nov. 3^rd. Polling hours may vary, and early voting sites may differ from Election Day voting sites. The best way to know the hours of early voting and the polling locations – which are often different from those used for the traditional General Election Day – is to check with your local county board of elections.

Registered voters may cast ballots during early voting. In addition to checking their voter status, the State Board of Elections website will provide the location for early voting and Election Day polling places.

The General Election Day is Tuesday November 5^th during the period 6 a.m. through 9 p.m. (remember if you have voted during the early voting period, or if you voted by mail, you cannot vote again during the General Election).

However you choose to vote, when you have received your ballot, vote for the candidates of your choice on the front, and flip over your ballot to vote on the question(s) on the back (every voter will have a statewide ballot proposal, and your ballot may also include local ballot proposals from your municipal government).

Wherever you are along the partisan divide, over the next couple of weeks you have your opportunity to have your voice heard. You can vote by mail, cast a ballot early starting this Saturday, or vote on the traditional General Election Day, November 5^th. As the saying goes, not choosing is choosing. Vote.