Joseph Krist
Publisher
NEW YORK STATE BUDGET
It took a month after the start of the fiscal year but a roughly $254 billion state budget agreement was announced this week. The budget was delayed while the Legislature debated several non-financial issues. Primary among them was changes to New York State’s very strict limits on involuntary psychiatric commitment. Another was an all-day ban on students having cellphones in schools. The agreement also eases so-called discovery requirements on how prosecutors hand over evidence to criminal defendants in the pretrial phase.
The budget proposal called for New York to spend $17 billion more than last year, made possible in part after state officials disclosed that tax revenues and the state’s general fund closed the fiscal year with billions more dollars than expected. The framework agreement with the Legislature included the governor’s proposed child tax credit of up to $1,000 for families with a child under 4, but the refund was scaled back. Now about $2 billion will be devoted to the program, with New Yorkers receiving between $200 and $400, depending on their income. The budget agreement maintains the tax cut but includes an increased payroll levy on companies with more than $10 million in revenue.
The Metropolitan Transportation Authority will get $68.4 billion over the next five years as part of a state budget agreement. Full details on how the state intends to pay for the plan — largely with an increased rate on an unpopular business tax — are not yet clear. Some $30 billion of the capital plan will be paid for with an increase to the payroll mobility tax, an unpopular levy on businesses in New York City and surrounding counties that use mass transit. Companies with a payroll of over $10 million will shoulder a higher rate while the tax on smaller businesses will stay the same or decrease.
The M.T.A. expects to spend $10.9 billion to buy roughly 2,000 new rail cars, an order that will include 1,500 subway cars and more than 500 for the Metro-North and Long Island Rail Road. $3.3 billion will buy and support 2,261 new buses.
It will spend $1.1 billion to install modern fare gates at 150 stations to prevent fare evasion. The M.T.A. said it lost close to $800 million in fare and toll evasion last year.
About $1.2 billion that would have been used for the reconstruction of Pennsylvania Station will instead be applied to other transit projects, now that the Trump administration has declared it will take the responsibility to manage and finance the Pennsylvania Station project.
STATE OF THE STATES
The effort to enact a budget for Federal Fiscal Year 2026 is likely to hinge on one or two items which Congress will attempt to offload onto the states. Primary among them is Medicaid. There will be efforts to lower the federal share of Medicaid expansion under the ACA. If the cut is large enough, some 10 states would see participation in the expansion cut back as automatic triggers related to the size of the federal share would kick in.
The moves to cut Medicaid will not just seek to reduce fiscal pressures on states. In several cases, states where Medicaid expansion occurred did it pursuant to voter initiatives. It is a clear effort to override the popular will. If it succeeds, states will benefit in the narrow sense that fewer people will be covered requiring less expenditure. What it also brings is a return to a model that everyone acknowledges was broken in terms of healthcare for the uninsured. This will increase demand for more assistance to institutions for care of the indigent from the state to the healthcare system.
The federal drama will unfold just as most of the states begin a new fiscal year. The potential for difficulty is clear. NY Gov. Hochul acknowledged the uncertainty associated with ever changing federal policy in announcing the budget agreement. That is a factor that many states will have to anticipate. The key to state budgets in fiscal 2026 will be flexibility. If the federal cutbacks go through and the economy continues to underperform, midyear adjustments will be required.
NEW YORK CITY BUDGET
It takes a while to get past the campaign literature portion of Mayor Eric Adams’ proposed FY 2026 budget. The “biggest, best budget ever” is $115.1 billion, with gaps of $4.6 billion in FY27, $5.8 billion in FY28, and $5.7 billion in FY29. Tax revenue is expected to have increased by nearly 8 percent in FY 2025, driven by growth in income and business taxes. As the economy slows, growth is forecast to decline to around 1 percent in FY 2026. This results in an upward revision over the FY 2026 Preliminary Budget of $1.7 billion in FY 2025 and $1 billion in FY 2026.
The FY 2026 Executive Budget maintains $8.5 billion in reserves, including $1.2 billion in the General Reserve, $5 billion in the Retiree Health Benefits Trust Fund, $250 million in the Capital Stabilization Reserve, and a record level of $2 billion in the Rainy-Day Fund. This represents no increase in reserves to offset the potential impacts of federal funding reductions.
Given the erratic nature of federal policymaking observed over the first 100 days, the assumption that that process has reached a conclusion is a bit dangerous. “In addition to rising recession risk, the city has not changed its assumptions for the receipt of federal funding to reflect the potential impact of recent federal actions, as many of these actions are litigated, leaving it vulnerable to choices made in Washington,” said Thomas P. DiNapoli, the state comptroller.
PRIVATE EQUITY AND HOSPITALS
The role of private equity in the not for profit healthcare sector is receiving increasing negative attention as the impacts of its management of facilities, especially hospitals is resulting in financial turmoil. Last week, we discussed the end of operations of two hospitals in PA which were “turnaround situations”. They resulted in neither improvement nor asset sales.
Steward Health Care is another PE entity that thought it could build a better mousetrap and turnaround regional hospitals that did not offer all acute care services. They did it while also loading debt on to the balance sheets. Steward operates 31 hospitals across eight states — Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania and Texas. One of its Pennsylvania hospitals – Sharon Regional Medical Center closed in January and was only recently reopened by its new owners Tenor Health Partners.
Tenor is owned by R2 Power Investments, a private equity firm headquartered in Pasadena, California. Tenor bills itself as a turnaround firm for financially struggling hospitals. Steward continued to work with Tenor to finalize a deal after the hospital shut its doors. The health system received court approval to purchase shuttered Sharon Regional Medical Center for $1.9 million on Jan. 10.
Steward had gained notoriety for the financial distress at Massachusetts hospitals purchased from the Catholic Church in Boston. Steward Health Care closed some facilities after what can only be described as a failed buyout strategy in acquiring hospitals. Other facilities are being sold. St. Elizabeth Medical Center in Brighton has been rebranded as Boston Medical Center — Brighton, while Good Samaritan Medical Center in Brockton is now Boston Medical Center — South. BMC Health System assumed operations of the two hospitals on October 1, 2024, after Steward Health Care sold the facilities.
CLIMATE LITIGATION
The Maryland Supreme Court will decide whether three climate change lawsuits are preempted by federal law. The Court will review Baltimore City, Annapolis and Anne Arundel County’s lawsuits against more than two dozen fossil fuel companies, agreeing to hear a host of issues in the consolidated appeal that previously had been rejected by federal courts. Primary among them is that some of the companies’ production occurred on federally regulated areas offshore which would preclude state regulation.
The Court is set to decide four issues from appellants’ petition. They are whether the U.S. Constitution and federal law preempt and preclude state law claims seeking redress for injuries allegedly caused by the effects of out-of-state and international greenhouse gas emissions on the global climate; whether Maryland law precludes nuisance claims based on injuries allegedly caused by the worldwide production, promotion and sale of a lawful consumer product.
It will also decide whether Maryland law precludes failure-to-warn claims premised on a duty to warn every person in the world whose use of a product may have contributed to a global phenomenon with effects that allegedly harmed the plaintiff; and whether Maryland law precludes trespass claims based on harms allegedly caused by global climate changes arising from the use of a product by billions of third parties around the world outside of a producer’s control.
In January, an Anne Arundel County Circuit judge dismissed a pair of lawsuits by Annapolis and Anne Arundel County, citing the reasoning presented in a July 2024 Baltimore City Circuit Court ruling that determined similar claims by Baltimore City are preempted by federal common law and therefore cannot survive. That decision is an outlier.
But federal courts have so far ruled there was no valid basis to remove the cases to federal court. In February 2024, a panel of 4th Circuit judges in the Annapolis and Anne Arundel County cases found federal removal was not proper; in April 2022, a 4th Circuit panel found the same in the Baltimore City case. In April 2023, the U.S. Supreme Court denied the city’s petition for certiorari.
The U.S. Department of Justice in a pair of lawsuits argued that recent laws New York and Vermont adopted requiring oil companies to contribute billions of dollars into funds to pay for damage caused by climate change were unconstitutional. The Justice Department filed those cases one day after it launched two preemptive cases seeking to stop Hawaii and Michigan from filing planned lawsuits against major oil companies over climate change, cases the administration said would imperil domestic energy production. DOJ cited an executive order that the President signed on his first day back in office on January 20, declaring a national energy emergency to speed permitting of energy projects
GRANT CUTS
The scale of the continuing effort by the Trump administration to dictate university conduct through the withholding of grant monies for research is becoming clearer. A recent analysis at the Kaiser Family Foundation (KFF) shows how significant and comprehensive the effort has been.
KFF Health News found that the NIH terminated about 780 grants or parts of grants between Feb. 28 and March 28 KFF Health News found that the NIH terminated about 780 grants or parts of grants between Feb. 28 and March 28 of this year. Some grants were canceled in full, while in other cases, only supplements — extra funding related to the main grant, usually for a shorter-term, related project — were terminated.
Among U.S. recipients, 96 of the institutions that lost grants in the first month are in politically conservative states including Florida, Ohio, and Indiana, where Republicans control the state government or voters reliably support the GOP in presidential campaigns, or in purple states such as North Carolina, Michigan, and Pennsylvania that were presidential battleground states. An additional 124 institutions are in blue states. Columbia University had more grants terminated than all organizations in politically red states combined.
Montana is one of 23 states, along with Puerto Rico, that are eligible for the NIH’s Institutional Development Award program, meant to bolster NIH funding in states that historically have received less investment. Congress established the program in 1993. The NIH’s grant terminations hit institutions in 15 of those states, more than half that qualify, plus Puerto Rico.
Disclaimer: The opinions and statements expressed in this column are solely those of the author, who is solely responsible for the accuracy and completeness of this column. The opinions and statements expressed on this website are for informational purposes only, and are not intended to provide investment advice or guidance in any way and do not represent a solicitation to buy, sell or hold any of the securities mentioned. Opinions and statements expressed reflect only the view or judgment of the author(s) at the time of publication, and are subject to change without notice. Information has been derived from sources deemed to be reliable, but the reliability of which is not guaranteed. Readers are encouraged to obtain official statements and other disclosure documents on their own and/or to consult with their own investment professional and advisors prior to making any investment decisions.