With the state Legislature firmly in Democratic hands, single-payer health care has never been closer to becoming a reality in New York state.
The New York Health Act would abolish private health insurance and replace it with a state-run system that would provide a health service to everyone in the state. While it has passed in the Assembly in previous years and has significant support in the state Senate, it is far from a done deal. Gov. Andrew Cuomo and lawmakers need more convincing that such a system could work at the state level. Lawmakers would also need to raise tens of billions of dollars to support such a program – and an unfriendly federal government cannot be counted on to help.
But if the New York Health Act were to become law, it would revolutionize health care in the United States. No state has ever successfully implemented a single-payer system at such a scale, but the chairs of the Assembly and state Senate health committees say it can be done. City & State caught up with Assemblyman Richard Gottfried and state Sen. Gustavo Rivera to discuss the bills they are sponsoring in their respective chambers and how they think the proposal can make its way through the Legislature. These interviews have been edited for length and clarity.
Richard Gottfried, Chairman, Assembly Health Committee
You’ve sponsored the New York Health Act for a long time, what’s different this year?
We’re trying to coordinate our action on the bill with the state Senate. I know they have talked about wanting to hold some hearings about the bill, because for them it’s a newer topic than it is for the Assembly. Hopefully, they will be able to do that early enough in the session that both houses will be able to take the bill up before we adjourn in June.
If the Legislature does not pass single-payer health care, do you think there would be a voter backlash against progressives who ran on passing it?
The bill has been scrutinized and picked at for many, many years. I haven’t heard anybody asking questions about it that I haven’t heard and answered for years, so it’s not like some new issue is being unearthed. I don’t see any reason why elected officials who told their voters they were for the bill wouldn’t bring it to the floor for a vote.
Does New York need help from the Trump administration to make a single-payer system happen?
It would be simpler to implement the system with federal cooperation. It would also save the federal government money. But there are mechanisms for essentially wrapping around the federally subsidized pieces of the health care system even if the feds won’t fully cooperate in merging it into one program. With Medicare, there are a variety of ways to handle the situation. One would be to have New York Health operate essentially as a wraparound program to traditional Medicare. Another mechanism would be for New York to create a giant Medicare Advantage plan, that unlike other Medicare Advantage plans, would have no cost sharing with patients, no restrictive provider network and would offer the full range of benefits under the New York Health Act. Similarly, with ACA subsidies, we may need to create a shell health plan that would be the vehicle.
The governor is proposing that a committee of experts figure out a universal health care plan. Would that help or hinder your own effort?
This proposal would create a commission made up of “health policy experts and representatives of the insurance industry” – notice no reference to representatives of health care providers or, more importantly, consumers. This commission is just a gimmick for kicking the issue down the road. There have been numerous studies and highly professional analysis of the New York Health Act and similar proposals in other states for years. We don’t need a commission. That’s the last thing we need.
Gustavo Rivera, Chairman, state Senate Health Committee
The Assembly got a fast start on the New York Health Act. What about the state Senate?
We’re going to be holding hearings on this bill. Our goal is to have them right after the budget in different parts of the state. Gottfried has had hearings before, but these would be bipartisan. I mean we will invite Republicans to come if they want to, but I really meant that it will be bicameral between the Assembly and the Senate. The commitment that I make to folks who are interested in seeing this become a reality is that there will definitely be some forward movement. I will make sure that people understand what the bill is and what it is not, but I’m not going to provide a timeline right now because I don’t have one.
The latest version of the New York Health Act includes a new provision to provide long-term care. How does this affect the overall size and cost of single-payer health care?
The disability community and the elderly community have been consistently telling us that it was something we needed to do, but it certainly adds to the cost of the overall plan. However, if I’ve said this once, I’ll say it a million times: When you think about the costs of health care right now, including long-term care, Medicare, Medicaid, private health insurance, etc., you have a system that already costs $150 billion to $160 billion. We believe if you put all these things together, it gives you a program that will provide better results than the one we have now, and it will cost less.
Could tax rates be set before passing the bill?
It’s one of the conversations that we are having. One of the things that we want to do is give give people some scenarios. Say “Bob” is a 62-year-old male self-employed accountant. How much is that person paying for health care now? What kind of benefits does he have? I was doing a panel just a couple of days ago in Riverdale and one woman said she had actually done the math herself about how single-payer would affect her. She was saying how much she had spent. She rolled out the math and I’m like, “Holy Jesus, this woman did the math.” I want to use her story and math to show the difference between what she has now and what she would be paying if the single-payer passes.
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