New York State

How state Senate control will alter health policy

From single-payer to marijuana, top senators on the health committee discuss their top priorities.

Officials at City & State's Health and Wellness summit discussed issues including lead poisoning, legalized marijuana and Lyme disease.

Officials at City & State's Health and Wellness summit discussed issues including lead poisoning, legalized marijuana and Lyme disease. Ali Garber

As Republicans seek to win enough races to hold onto control of the state Senate, they’re quick to point to the policy ramifications of a state government controlled entirely by Democrats.

One key policy area that will hinge party control of the state Senate is health care. Perhaps most notably, Democrats are pushing for a state-based single-payer health system that would provide comprehensive coverage to all New Yorkers.

State Sen. Kemp Hannon, the Republican chairman of the Senate Health Committee, says the issue should be debated, but that single-payer isn’t the right path forward. His counterpart as ranking member, state Sen. Gustavo Rivera, says the proposal would be his top priority should he replace Hannon as committee chairman.

Here’s where the two lawmakers come down on those issues and others, including lead poisoning, legalized marijuana and Lyme disease.

Kemp Hannon

Chairman, state Senate Health Committee

Kemp Hannon, Chairman of the state Senate Health Committee.
Ali Garber

Why has the state been slow to take some of the steps you and others have laid out for preserving the state’s drinking water?

We created the (Drinking Water Quality Council) last year. They’ve had three meetings. The next meeting was due to set the levels of contaminants and I have already had a lengthy letter to the commissioner of health as well as the commissioner of environmental conservation. That was sent in June and I and two other senators, along with the Citizens Campaign for the Environment, had a press conference (recently) calling on the state to get on top of it.

I don’t know. I don’t have any insight to why. They have not responded and all I can do is use my bully pulpit to call attention to it. We have, along with the water council, enacted appropriations for $2.5 billion, which, I would say, even by New York standards, is a large appropriation to address a whole range of different water issues across the state, both in terms of supply and disposal.

Why is drinking water in New York such a pressing issue?

Because of two factors. We have more possible sources of contamination to our water than ever before because we have modern technology and we don’t necessarily have thorough testing before something is introduced into the commercial stream – such as the 1,4-dioxane, which is used for a whole host of different things and it’s even found in Tide. So that’s a pressing issue and there’s a lot more listed on the (Environmental Protection Agency) list of potential emerging contaminants. The second is it’s public health. The longer you wait, the more people’s health is put in jeopardy. And third, which was part of our $2.5 billion, is we’re an old state. We have lots of things that have happened that do not comply with our modern standards in terms of how we would dispose of wastewater or treated water as well as how we regulate how we put paint on buildings and all that and how we put paint on water lines. That’s why they’re pressing because we have those three things.

Gov. Andrew Cuomo recently signed legislation that expands the state’s medical marijuana program to cover treating opioid addictions. What are your thoughts on expanding New York’s medical marijuana program?

Well, we are just coming into the cycle where some of the actual research is being done and reported on … as to the efficacy of medical marijuana. And it has proven it can be used in cases of pediatric epilepsy. And I think more of that will be coming. So there has been a very careful, some would say too cautious, introduction of medical marijuana in the state. There is some legitimate concern that the people who need it under a recommendation of a physician are not able to be in a geographical location where it’s available. We’re starting to get real complaints about the high cost of medical marijuana. And while people who are using it for pain feel it’s effective, they just can’t afford it.

It’s been slow, just picking up. We have more dispensaries being approved. Some of the logistical problems have been addressed, such as secure delivery or moving from one dispensary to another. But we’ve found there are people (who) just didn’t know who to contact, which doctors were approved, etc. And I think the website information has improved. I would take a guess that there’s more improvement needed.

Is Albany moving toward legalizing recreational marijuana?

The governor has appointed a task force of so-called experts. What will happen? I don’t know. New York’s not a state where you can do this by referendum. In a large number of states where there’s been a referendum, it’s passed. I tend to look at it with a very suspicious, not approving view. One of the major preoccupations in terms of policy creation and funding has been the problems of the opioid crisis, which has morphed into and includes now opioids and heroin, dealing with people dying from that. So the whole community where we’re trying to stop people getting addicted, that whole community, I believe, feels totally suspicious of recreational use. That being said, I am not ignorant of the fact that neighboring states and nations – Canada will soon have it, though we have a pretty secure border, but Massachusetts has approved it. It supposedly took effect in July of this year, 2018, and it’s now Oct. 1. I don’t think they’re actually selling it. But right there, there’s a border state and part of the problem people have with recreational use is the effect on drivers, and we’ll be facing that soon because there’s no borders really between New York and Massachusetts.

Can the state block New York City from legalizing safe injection sites?

You’re asking me a question on a day when the governor of California has vetoed injection sites. Can the state stop it? I don’t know that the state will stop it. They need permission I believe to change state laws. So that’s not stopping anything. The second part of it is I would think you would have to break into the policy debate the stance of the federal government – which when New Jersey said we’re thinking of doing this, the federal government said we do not approve of it and we will take action against you because it’s illegal.

And by the way, I don’t agree with the premise. The last I read, the city is not moving there. The last question was put to the mayor and he said “still thinking” about the whole issue.

Lyme disease is an issue you take very seriously. Do you think state resources are being allocated to fighting the disease are enough?

No. Specifically the Senate, with Sen. Sue Serino heading the (Task Force on Lyme and Tick-Borne Diseases), has spearheaded a wide range of approaches in terms of public health, in terms of resources, notification, prevention. We put nearly a million dollars in the budget this year just for Lyme.

More importantly, we called upon the governor to have the health department have an action plan so that specific steps will be taken as to how to address the Lyme and the different types of ticks – we’ve now discovered a whole new tick and a whole new type of infection that can come from that tick without necessarily knowing the import of that because it’s brand new to New York state. So we wanted an action plan. This was done with West Nile virus. The state came up with a comprehensive action plan, and then had the good sense not to totally stick with it, but after two years, amended the action plan so that they could take into account what had worked and what was the best possible steps to take. So we think there’s a lot that needs to be done. We’re about to issue our annual report for 2017-2018, so there’s an enormous amount of information in that.

Looking at the state of health in the state as a whole, what is an overarching theme?

While each of the issues you’ve raised are important issues, the overall policy issue facing our state is the fiscal stability of the health care system. The ability of hospitals and nursing homes and especially home care agencies to carry out their mission. The ability, and just as important, is how many people have health insurance in this state? With not only just health insurance, but how many people are facing a large deductible in their insurance? So whether it’s in a private plan or if it’s in Obamacare, if you have to pay the first $4,000 or $5,000 of your bills yourself before your insurance kicks in, that’s a $6,000 deductible, that $500 a month, that may be more than the premium per month. So those are the very essential things we have to figure out. How do we deliver health care well and in a quality way? And how can people afford health care?

Single-payer health care is being talked about a lot. Do you think New Yorkers deserve a debate in the Senate on the New York Health Act?

Well, we deserve a debate. Whether you bring the bill forward, I don’t believe the bill is workable. Not on the state level. If you do it on the federal level, then you have a chance. The reason that it’s not workable on the state level is you have so many federal laws impeding. However, I do believe it’s worthy of public discussion because it’s a sharp indication to people who are in the health care system that there is a general dissatisfaction with the way that the system is both delivering care and then the way that the paperwork accompanying all that care is carried out. So at the end of the day, just by talking about, “Oh, we’ll enact single-payer,” does not mean it all gets better. Government-run institutions are not all that great. I would just point anybody to the current system of getting your enhanced driver’s license, the real ID from the motor vehicle bureau. It’s a real chore to do that, so the same thing with health care. But does it need to be debated? Yes. People are not happy with the health care system, and instead of spending $200 billion on a single-payer system, think of all the improvements that could be made to New York’s health care for even half that money.

Gustavo Rivera

Ranking member, state Senate Health Committee

Gustavo Rivera, Ranking member of the state Senate Health Committee.
Ali Garber

Are you hoping to be the next chairman of the state Senate Health Committee?

Absolutely. Let’s be clear. A few things need to happen. Obviously we need to pick up enough seats to be in the majority in November, and then the leader has to appoint who the chairpeople will be. So you expect nothing, but I’m hoping that based on the fact that over the last six years I’ve done work as the ranking member, and in all honesty I’ve prepared for this role. Hopefully I will appointed chair of the health committee – that is my hope, and I’m willing to work to make sure that’s the case.

Are you optimistic that Democrats will win a majority?

Absolutely, yes.

If the Democrats were to win the majority, what would be your top priorities?

There are a lot of them. The most important legislative priority, and this is I think true for everyone in the Democratic conference regardless of what committee we might potentially lead, is that we all recognize that the most important thing we can do next year is, that we must do next year, is govern effectively. This is not 2009, no matter how many times Republicans want to say it. We are a different group of people. We are prepared for the responsibility, we want the responsibility, and we want to govern effectively.

Now, some of the things I think are incredibly important: the New York Health Act is a bill to create a health care for all system in the state of New York. That is my bill. I picked it up last year. I have been gaining support on it since then. I have been working along with my colleague in the Assembly, Dick Gottfried, and with all stakeholders. Because look, up until this point, there are many people who have engaged – there’s a reason it has become a centerpiece of a lot of political discussions. But there’s a lot of folks who haven’t really engaged because it was always going to pass in the Assembly but it wasn’t going to move in the Senate. Now we’re talking about a different situation. We are engaging in real conversations with all stakeholders, including the Second Floor. We’re going to be introducing a different bill in January. It’s going to be tweaked in some ways, and we’re going to continue to work because we want to make sure that we have a bill that is workable, that the governor is going to sign, that we can afford, and that’s actually going to help us address the concerns of providing health care for everybody.

Where does the governor stands on the New York Health Act?

He’s stated publicly that it’s something he wants to look at, and we appreciate that. There have been ongoing discussions with people on his staff who are knowledgeable about this, and we’re going to get deep into the weeds. My colleague in the Assembly, Dick Gottfried, and I understand, this is not a bill that you can just pass overnight and see what happens. It is a bill that will fundamentally change the way that we deliver care to 20 million New Yorkers. That is not something simple, that is not something small, that is not something insignificant. The governor recognizes that. The goal is, how do we get to a bill that they can find acceptable. There are all sorts of technicalities that need to be worked out, some that have already changed with the bill, some that will change with the bill we introduce in January. But even the bill we introduce in January will likely have to be amended further. We’re not going to pass something that is not throught through, we’re not going to pass something that we cannot afford, and we’re not going to pass something that is just some crazy lefty thing.

What about the costs?

The Rand Corporation study that just came out a couple months ago – and you couldn’t call them a left-wing think tank – they found that it is the most fiscally responsible option for the state. That’s the direction we’re going to move in. Even the governor agress with us in principle about that, and we’re going to get him a bill that he can actually sign.

What else is on your agenda?

There’s a bill called Dakota’s Law, which I think is a much easier lift. It’s a bill that I introduced a few months ago. It has the name of a woman named Dakota who was the daughter of a constituent of mine. Sadly, she was poisoned by lead, so it’s a bill related to lead poisoning. Among other things, it lowers the threshold from 10 micrograms to 5 micrograms in the blood of a child. It would create a hotline so doctors have a place to report for in the state. It would extend it to 18 years old, I believe the requirement is currently 10 years old. It would create a mechanism by which localities could get state money or ask for state money for remediation or investigation of lead. It’s a very comprehensive bill, but it’s not a heavy lift.