With the Trump administration having taken steps to weaken Obamacare, New York activists have stepped up demands for the state to have a single-payer healthcare system.
In three of the past four years, New York’s lower chamber has passed a bill introduced by Assemblyman Richard Gottfried (D-Manhattan) that would establish the system in the state. Twenty-seven of Albany’s 63 state senators — all of them Democrats — are also carrying the bill in their chamber.
The bill’s never been passed in the state Senate, which for all but a short time has been controlled by the GOP for decades. Its numbers are now split evenly between Republicans and Democrats, owing to one from the former camp going on naval duty.
Implementing Gottfried’s plan, the New York Health Act, would require waivers from the federal government.
Gov. Cuomo said last year that he would sign the bill if “it was not incongruous to what the federal government would do to us. I think it’s a very exciting possibility. But I think it’s going to be a federal play and we are, our funding system basically relies on Medicaid from the feds. And if they turn off that valve or slow that valve, there is no way we’re going to be able to make that up in this state no matter what.”
Proponents of the bill say the legislation is a great way to remedy inequities in healthcare outcomes and point to how medical costs have increased for patients in recent years.
Richard Friedman from the University of Massachusetts at Amherst conducted an analysis of what Gottfried’s proposal would cost the state. The economist’s study estimates it would require $91 billion per year in increased taxes to be carried out. But it also says state residents would save $45 billion annually in healthcare costs.
Critics say single-payer — government-provided insurance for all — is far too expensive for any single state to pay for and use California and Vermont as examples: The two states came close to implementing single-payer systems, but the governors in each backed out over how expensive it would be.
Adding to the chorus of calls for single-payer in New York is Cynthia Nixon, the actor and activist running a progressive primary challenge to Gov. Cuomo.
President Trump and congressional Republicans tried last year to repeal the Affordable Care Act in favor of a new healthcare law. Although their push failed, Trump has successfully taken steps to weaken Obamacare, like axing its individual mandate; the move will take effect in 2019.
In and beyond New York, Republicans have not been associated with support for single-payer. But according to Assemblyman Ron Kim (D-Flushing), the prospect of Washington dismantling the Affordable Care Act or making cuts to Medicare or Medicaid has made at least some of them a bit more open to the notion.
He admits there is no chance of the proposal passing this year. But the lawmaker also said he’d had private discussions with GOP senators who “are open to entertaining” and “at least discussing” single-payer “because of the crisis we might be facing.”
And according to state Sen. Toby Ann Stavisky (D-Flushing), who sits on her chamber’s Health Committee, more cuts to Obamacare are coming from Washington.
“I think our healthcare system is in trouble right now,” she said. “And I think it’s going to get worse, particularly when more cuts are initiated.”
The lawmaker also predicts that Republican cuts to the Affordable Care Act will “be felt more” next year and in future ones.
Stavisky concedes Gottfried’s bill has extremely slim chances of passage during the soon-to-end legislative session. And she admits that single-payer would certainly “be difficult at the state level.”
In terms of how to move state-level single-payer in New York forward, the senator says negotiations would be key and the bill’s backers should be open to compromise.
One of the most vocal analysts to criticize Gottfried’s plan is Bill Hammond of the Empire Center for Public Policy.
That’s because the bill would require “an unprecedented, huge tax increase,” Hammond said.
His analysis has led him to conclude that Friedman’s study seriously low-balls how much money would be needed to pay for state-wide single-payer. According to the Empire Center expert, the actual cost is closer to $200 billion.
With a grant it received from the New York State Health Foundation, the RAND Corp. is conducting a study of the bill’s potential economic effects. Hammond said he’s looking forward to what its results are, given RAND’s reputation for high-quality research and how it has no “axe to grind.”
According to the Empire Center expert, were the state Senate to turn blue and the bill’s backers were in power, they may not necessarily rush to pass the legislation.
“They’re supporting it because it’s a popular concept,” he said. “When push comes to shove, I think a lot of them are going to change their minds.”
Even a vocal advocate for Gottfried’s bill, Leonard Rodberg of the Physicians for a National Health Program, says the politics could get complicated.
“The politics is going to get difficult … once the political debate becomes really serious,” said the activist, who used to be the chairman of Queens College’s Urban Studies Department.
Business interests, he added, would lobby against the proposal.
But it’s unlikely that the obstacles will make Rodberg and his single-payer allies from keeping up their push.
“The benefits to the public are so overwhelming that it seems to me the time has come to get smart,” he said.
