Crain’s: What a Democrat-led state Senate means for single-payer

By Jonathan Lamatia, November 7

Democrats captured a majority in the state Senate Tuesday night. The party’s control of both houses of the Legislature offers a potential path to passage for the New York Health Act, which calls for a single-payer health plan.

But the reticence of Gov. Andrew Cuomo, who was elected to his third term, and opposition from the Trump administration could stall efforts to enact such a system.

The win for Democrats will likely make Andrea Stewart-Cousins the state Senate majority leader, giving her the power to name the senators who will lead committees. State Sen. Kemp Hannon, the Republican chair of the health committee who has held his seat since 1989, trailed attorney Kevin Thomas by about 1,300 votes after all precincts had reported in his Nassau County district Tuesday night. Hannon is known for his health care expertise and had received campaign contributions from trade groups representing hospitals and doctors. He had opposed the single-payer plan, as had the Republican conference as a whole.

In Hannon’s absence, the chairmanship could shift to Sen. Gustavo Rivera, the Bronx Democrat who has sponsored the New York Health Act in the Senate. Rivera is the ranking Democrat on the committee.

The shift in power could move the Senate toward a vote on the bill. The legislation has passed in the Assembly five times, including the past four years. Rivera said in an interview with City & State that he would be introducing a new version of the bill in January and would seek input from the governor’s office.

All 31 Democratic senators who caucus with the party had co-sponsored the New York Health Act. But the positions of some moderate Democrats could change if the legislation were poised to become law, said Lev Ginsburg, director of government affairs at the Business Council, which opposes the single-payer plan.

“It’s easy to co-sponsor it when there’s no chance of it going somewhere,” he said. “The minute it has a chance, at the very least as a responsible legislator, you must look at the fiscal impacts of it.” Ginsburg said that impact would be “terribly destructive.”

Assemblyman Richard Gottfried, D-Manhattan, who has championed the bill since 1992, said he doesn’t believe Democrats in the Senate will retreat on the issue. He was re-elected without an opponent Tuesday.

“When people have been so public on an issue that has had so much public discussion, I think that creates real momentum,” Gottfried said. “It becomes very hard for an elected official to say ‘I’ve been a co-sponsor of this bill, but I didn’t really mean it.'”

The New York Health Act would lead to slightly lower health spending but require an additional $139 billion in tax revenue in 2022 to finance the program, an analysis found. That would represent a 156% increase over projected tax revenue, according to an August report from Rand Corp. and the New York State Health Foundation. The analysis proposed its own tax structure for raising funds in the absence of one in the bill, except for language indicating the tax would be progressive.

The report surmised that most households earning up to $290,000 would pay a smaller percentage of their income toward health payments, such as premiums and copays, than they do now.

That analysis assumes the federal government would allow the state to deliver Medicare and Medicaid benefits using federal funds. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has said her agency would deny such waivers to states.

If the bill were to pass the Senate, it would put Cuomo in the difficult position of choosing between a progressive Holy Grail and holding down state spending. 

In an August primary debate against Cynthia Nixon, Cuomo noted the experience of California and Vermont, which tried unsuccessfully to implement a single-payer system.

“Nobody has done it successfully. It is the right idea. It should be explored. It is hard to do,” Cuomo said. “It has to be done on the federal level, and let’s elect a Democratic Congress, and let’s force this president to do it.”

Democrats captured a majority of House of Representatives seats in Tuesday’s election but Republicans increased their majority in the U.S. Senate.