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.