The Senate bill, as presently promulgated, would burden New York taxpayers in excess of $1 billion in extra Medicaid costs, while denying critical aid to city hospitals that serve the poor. The feds would pick up almost all the initial costs states would bear by providing Medicaid coverage to everyone up to 133 percent of the poverty level.

However, New York would be ineligible for this assistance because we already cover most people up to 150 percent - more than the basic requirement of providing health care for the poor. Consequently, we will lose out for having generously covered our poor in the past.

The New York House delegation, headed by Congressman Charlie Rangel, chairman of the Ways and Means Committee, must collectively demand equitable financing of the Medicaid expansion, which is due to take effect in 2015. To his credit, Rangel seems game, and is on public record as stating that he is very, very optimistic New York is going to come out certainly better than we are now. He also rightly categorized the provisions as “totally unfair.”

The daunting reality is that New Yorkers would be immensely burdened by the Senate's version of the national health plan. Governor David Paterson estimates that this unjust arrangement will cost us more than $1 billion a year as an additional million New Yorkers join the Medicaid rolls, and Mayor Mike Bloomberg has warned that cuts on the table could force closure of clinics. Both have looked out for us in this instance.

The House version of the health plan offers relief to all states and would save New York $4 billion a year. A clear priority should be protecting aid to city hospitals that serve the millions of uninsured. Clearly, New York needs, and deserves, more from the final health reform legislation.

In this imperfect plan, Congress must make sure that costs are covered for emergency care for uninsured patients. Unless the House-Senate conference committee finds common ground, health care costs will explode. We must be able to seek out the best care at the best price. If these and other reforms are not made, New York will suffer the most, a price we cannot afford to pay, and an additional burden we cannot carry.