Democratic lawmakers’ big plans for health care

In January Governor Cuomo signed the Reproductive Health Act into law.
In January Governor Cuomo signed the Reproductive Health Act into law.
Office of Governor Andrew Cuomo
In January Governor Cuomo signed the Reproductive Health Act into law.

Democratic lawmakers’ big plans for health care

From single-payer to vaping to reproductive health.
December 9, 2019

This year has been a big one for health care in state government. The state Legislature finally passed the Reproductive Health Act and other legislation that had stalled in the state Senate when it was under GOP control. Gov. Andrew Cuomo led a successful effort to codify Obamacare in state law, just in case Republicans succeed in repealing the landmark health care law at the federal level. State lawmakers even got a chance to stage a statewide series of public hearings on single-payer health care – one of the most controversial proposals in state politics.

A new session of the state Legislature will begin in January, and it is likely that Democratic control of both houses of the Legislature will once again smooth the passage of numerous proposals affecting health care across the Empire State. Here’s a look at some issues coming up in the months ahead.

Single-payer health care

In the past year, proponents of implementing a single-payer health care system statewide have arguably come closer than they ever have since Assemblyman Richard Gottfried, chairman of the Health Committee, first proposed the New York Health Act nearly 30 years ago. While the bill did not pass this year, the state Senate and Assembly recently concluded a joint statewide series of hearings on the legislation on Nov. 25. While a common theme at the hearings has been the ongoing shortcomings of the existing health care system, Gottfried and state Senate Health Committee Chairman Gustavo Rivera still face significant obstacles to passing their bill. 

The New York Health Act aims to replace the current system of health insurance with a government-run system that would provide comprehensive health care without deductibles or premiums. Such a system would effectively double the size of state government and require hefty tax increases, but single-payer supporters say the cost to taxpayers would be offset by the savings they would get compared to their current health care costs. While the bill has significant support in the state Legislature among Democrats, it remains to be seen whether legislative leaders will bring it up for a vote next year.

Gov. Andrew Cuomo has expressed opposition to establishing a state-level single-payer system, though he supports the idea in theory at the federal level. A key reason why is that the Trump administration would likely not grant New York a waiver that would allow the state to redirect its federal Medicaid funding to a single-payer system. Proponents argue that there are ways to work around the waiver issue, but that view is not shared by some lawmakers who might be willing to vote for the New York Health Act under ideal conditions.

The upcoming presidential election will likely determine a way forward on the matter. Progressive U.S. Sens. Bernie Sanders and Elizabeth Warren have championed single-payer health care at the federal level. A victory for candidates like them would likely neutralize enthusiasm for a state-level program as proponents would focus on establishing a national program. The election of a more moderate candidate like Joe Biden or Pete Buttigieg, however, could mean a federal government that is unlikely to adopt such a system but may be friendly to states that want to set up their own systems. If Trump were reelected, supporters of the New York Health Act would have to focus on efforts to workaround federal opposition. Even if the bill does not pass next year, it will still play a significant role in state political discussions about the future of health care.

Vaping and tobacco

The recent vaping-related illness deaths across the country and the spike in nicotine addiction among teens has brought renewed scrutiny to vaping and tobacco products. A litany of bills before the state Legislature aims to confront the issue. Proposed laws would make it illegal for anyone under 21 years old to possess tobacco or vaping products. Online sales of vaping products could be subject to new ID requirements. New packaging requirements could come into play. And flavored vaping products could become a thing of the past.

Lawmakers, however, will likely follow the lead of Gov. Andrew Cuomo, who announced in November the implementation of a new law raising the minimum age to buy nicotine products to 21. The governor will likely include proposals on the issue in his upcoming state budget, which offers lawmakers some political cover from voters who might be upset by any limits on a product that has become increasingly popular in recent years. Testimony at a recent state Senate hearing showed that vaping supporters will not go quietly. Beyond simply arguing that adults should be able to buy the product as a matter of personal preference, opponents of new laws limiting sales of vaping products, including flavored products, argue that it will undermine efforts to reduce smoking rates among teens and adults. Representatives of the vaping industry also said new laws would harm small-business owners.

Reproductive health

An ongoing political battle over gestational surrogacy continues to divide Democrats. New York is one of just a few states that do not allow a gay or infertile couple to make a contract with a woman to bear their child. Supporters like Gov. Andrew Cuomo and state Sen. Brad Hoylman, who is gay, argue that it is a matter of civil rights for LGBTQ people. Feminists like activist Gloria Steinem and Assemblywoman Deborah Glick – the first openly gay woman elected to the chamber – argue that paid surrogacy commodifies women’s bodies, especially poor women. Cuomo could try to legalize the practice in his upcoming budget proposal.

Another issue is a proposal from Hoylman to ban “medically unnecessary” surgeries on intersex children (until they would be able to consent to it under an informed basis) that would remove reproductive organs in order to help them conform to the male or female genders. The bill was introduced in November, and it is unclear how much support it currently has among Democratic lawmakers.

Other legislative issues coming up include ongoing efforts to pass a bill that would mandate comprehensive sex education in public schools from grades one through 12, as well as another bill that would establish the crime of fertility fraud – the subject of an April story in The Atlantic about a doctor who had surreptitiously fathered dozens of children through his patients.

News that the rapper T.I. takes his daughter to the doctor for so-called virginity tests has also inspired new legislation to ban the medical practice.

Correction: This story originally linked to an outdated sex education bill.

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Zach Williams
is a staff reporter at City & State.
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