A long-shot push to get New York to adopt a single-payer health care system persists despite a federal landscape far less amenable to government health spending than at any point in the proposal’s yearslong history.
The New York Health Act would establish government-backed health coverage for every resident in the state, an idea popular among progressives that has failed for decades to gain the political steam needed to advance in Albany. The proposal, which its architects have long said would require a federal waiver, does not seem likely to succeed in Washington’s current climate. But despite Republicans’ efforts to slash health spending nationally, a group backed by labor unions and current and former lawmakers insist New York could cover the program without federal approval and has renewed a push for the measure precisely, they say, as a way to cover federal gaps.
On Monday, the bill’s sponsor, state Senator Gustavo Rivera, a Bronx Democrat and chair of the health committee, along with the New York State Nurses Association, United Auto Workers, 1199SEIU and the Committee for Interns & Residents continued their push for the law with a rally at the State Capitol. The event followed a day of lobbying organized by Physicians for a National Health Program and the Campaign for New York Health, an advocacy group formed to back the bill, the week before.
The timing of the push, approaching the end of state budget negotiations, when much of the major spending decisions of the legislative session are made, is unusual, but the group is hoping to seize momentum for a longer game, said Melanie D’Arrigo, executive director of Campaign for New York Health. She wants to see the bill advance out of the Health Committees by the end of session and into the next phase of deliberations in the Legislature. Gov. Kathy Hochul recently suggested that a special session could be called later this year, and the group wants to be ready to seize any momentum brewing against federal austerity measures, D’Arrigo said.
Under the proposal, the state would cover health care for all residents, including out of pocket expenses, through Medicaid. In past years, the vision included waivers to spend federal dollars on the expansion, but those funds are likely to shrink, not grow, under the Trump Administration. Some, including Rivera and the bill’s longtime sponsor, former Assembly Health Chair Dick Gottfried, are now saying the state could work around that. There is some precedent for that; the state has historically covered parts of Medicare Part D and prescriptions for the elderly that weren’t part of federal coverage, Gottfried argued in an op-ed in City & State that coincided with the rally in Albany (Gottfried didn’t know which day the piece would be published, he said).
The bill would cost an estimated $40 billion dollars to extend coverage to the uninsured, bring every provider within network and cover long term care, Gottfried said. But those costs would be offset by an estimated $60 billion in savings on administration and prescription drug costs, which could be negotiated using the 20 million-person customer base that would be created, he said.
The plan would require a progressively graduated income tax, with the highest earners paying the most and middle- and low-income New Yorkers paying the least, Gottfried said. Hochul has made affordability a key plank of her agenda this year and included an extension on a 5% millionaire’s tax in her executive budget, but has never supported the bill. The state’s powerful insurance industry, which would take a major hit under the proposal, has long opposed the measure, arguing it could limit consumer choice while raising taxes.
Rivera and others have acknowledged that without a federal waiver the uphill battle would be steeper and the savings less. Regardless of a state tax, it is unlikely that New York’s tax base would be able to support the entire program alone if existing federal funding disappeared, said 1199’s interim political director Helen Schuab.
With Medicaid dollars nationally expected to be slashed to the bone under Republicans’ spending plan, New York should step in to protect the millions of people who could lose coverage and services, said Gottfried, who first introduced the bill in 1991. But there are no illusions that the measure could pass in the next few weeks.
“This has been and will be a long-term effort,” he told Crain’s.
