Tag health care

Gotham Gazette: With Full Democratic Control, Sponsors of New York Single-Payer Health Care Hopeful About 2019

Victor Porcelli, November 14

Though Governor Andrew Cuomo has not expressed support for instituting a single-payer health care system in New York, his fellow Democrats campaigned on the issue as they flipped control of the state Senate, landing all of state government into Democratic hands and providing a significant boost of optimism to the lead sponsors of the New York Health Act, which would create a government-administered single-payer health care system.

The bill has passed the Democrat-dominated state Assembly several times and all the members of Senate Democratic conference signed on as co-sponsors at the end of last legislative session in a unified show of support for the program heading into the election season.

Cuomo has said he supports a Medicare for all-type system at the federal level, but cast doubts on the cost and complexity of doing it in New York, and since their resounding wins on Election Day, the incoming leaders of the Democratic Senate majority have indicated that the massive undertaking of single-payer is not at the top of the agenda.

Still, with Democratic control of the Senate and the Assembly by wide margins, single-payer healthcare could be passed as early as the 2019 session, according to Assemblymember Richard Gottfried, chair of the Assembly Health Committee and lead sponsor of the New York Health Act.

“It was clear in the country and New York that healthcare was the number one issue on voters’ minds,” Gottfried said, before pointing to his legislation. “A solid majority of the new state Senate has either been a cosigner, voted for it in the Assembly, or campaigned on it. So I think we’re on track to get it passed in the Assembly and state Senate.”

The New York Health Act would replace health insurance companies with New York state government as the payer of healthcare costs for all New Yorkers. It has been passed in the Assembly four years running but has yet to be voted on in the Senate, where Republicans have held control. All of the other 30 Democratic senators joined lead sponsor Senator Gustavo Rivera of the Bronx to co-sponsor the legislation, though the Senate Democratic conference is seeing significant turnover due to primary wins by insurgent challengers. But, those challengers have in general been even more vocally supportive of single-payer health care than their more moderate predecessors. These facts give Gottfried confidence that the New York Health Act will pass during the 2019 session, which begins in January.

But the bill still faces an uphill battle, in part because of the massive changes it would institute, and the fact that though it might reduce overall individual and business healthcare costs after implementation, for the state to run the system it would require raising taxes significantly, something many Democrats have promised not to do and Cuomo is vehemently opposed to. It would also drastically impact the state’s private and public hospitals, the health insurance industry, and more. Some of the changes would of course be beneficial to New Yorkers, but the undertaking is complex and the New York Health Act as currently written leaves a lot of detail undetermined, including funding.

The governor has repeatedly opposed single-payer healthcare at the state level, suggesting that it would be more rational and financially feasible if administered by the federal government. Cuomo questioned in the past how a single-payer system could be put in place without doubling the tax burden, and cited California’s and Vermont’s debates over single-payer — which both ended when supporters were not able to answer one question: where would the funding come from? — as paragons of the impracticality of state-level single-payer.

Gottfried, a Manhattan Democrat, is confident that with his fellow lead sponsor Senator Rivera, who is likely to be the Senate health committee chair come January, and other legislators, he will be able to sway Cuomo to support the legislation.

“He’s obviously not on board yet, but he and his staff are very open to working with the Legislature on the issue,” Gottfried said. “I’m convinced we can satisfy their concerns.”

And after a recent study by RAND Corporation concluded that the New York Health Act would result in a reduction of administrative costs, provide all New Yorkers with healthcare, and reduce healthcare costs for most, Gottfried says the financing of the bill will not be a problem.

“New Yorkers are all going to have to think about what they will do with the hundreds of thousands of dollars that will end up in their pockets, and that’s a nice problem to have,” Gottfried said.

The study has a caveat, however, stating in its conclusion that “the estimated effects depend heavily on the assumptions about provider payments, administrative costs and drug prices.” Politico highlighted these assumptions as well as the likely tax increases that have largely been brushed aside by Democrats supporting the legislation. Wealthy people leaving the state, companies restructuring, the cost of hospital expenses rising at a faster rate or the Trump administration not issuing a federal waiver to redirect all healthcare-related funds to the new state entity are all possible events that could result in RAND’s conclusion falling apart.

For it to work, while health care costs drop, taxes would undoubtedly increase significantly for many New Yorkers. As cited by Politico, “a household reporting $150,000 in income would see its state tax rate increase from 6.45 percent in 2017 to 18.3 percent,” under one model scenario. Additionally, those who receive Medicaid or fall under the state’s Essential Plan, which subsidizes health insurance for low-income New Yorkers, have less to gain from the expansion. According to RAND, though, 1.2 million New Yorkers would gain health coverage.

It is likely that funds for New York single-payer health care would partially come from a new payroll tax, which RAND projects to fall largely on employers. However, RAND suggests the health act payroll tax would cost less for businesses already contributing toward employee health insurance and the Medicare payroll tax, estimating decreases in employer costs fairly quickly.

Concerns about businesses and high-income individuals leaving the state persist, with a tax atmosphere in New York that many, including Cuomo, acknowledge is already burdensome and became more so for many taxpayers, especially top earners, under the new federal tax code.

Senator Rivera, aware that cost is the primary argument against single-payer health care, repeatedly emphasized the need to work towards a version of the bill that would reduce the financial strain.

“I will continue working diligently with Assembly Member Gottfried, Senate Majority Leader Stewart-Cousins and the Senate Democratic Conference to make the New York Health Act a bill that is not only fiscally responsible, but that provides comprehensive coverage to all New Yorkers,” Rivera wrote in an email to Gotham Gazette.

The bill and its potential ramifications have been studied closely by Bill Hammond, director of health policy at The Empire Center, a think tank. “Regardless of which party controls the state Senate, the New York Health Act remains a wildly unrealistic idea,” Hammond said by email. “It means putting New York’s entire health-care system — representing one-fifth of the economy — in the hands of the same state government that struggles to run the subways. It requires massive, draconian tax hikes, enough to roughly triple total state revenues.”

“Plus, a true single-payer plan would need federal waivers that the Trump administration has vowed to block,” Hammond continued, also noting a political angle — that if Democrats spend great sums of money and political capital on a health care overhaul of this magnitude, what will they ignore, like fighting climate change or improving mass transit.

“It was easy to cast a symbolic yes vote for a single-payer bill that had no chance of passing,” Hammond said. “Now that that it might actually happen, supporters are going to be forced to confront the practical realities. Then, hopefully, they’ll focus on helping the 6% of New Yorkers who still lack insurance, rather than disrupting coverage for those who already have it.”

Rivera acknowledged that moving to single-payer would not satisfy everyone, especially those who benefit from the current system, and that there are negotiations to come that will likely adjust the bill to make it more palatable to holdouts.

“The biggest challenge will be to reach a consensus among stakeholders that the NY Health Act is feasible [and] fiscally responsible,” Rivera wrote.

Citing “healthcare practitioners, prescription drug companies, healthcare providers, employers, unions and New Yorkers,” as the various groups involved, Rivera also mentioned courting Cuomo as an important step to take in the coming legislative session.

“Our main priority for the next legislative session is to continue shaping the bill so that it is feasible, affordable, that the Governor is willing to sign, and that primarily, provides quality healthcare for everybody,” Rivera wrote. “During the next legislative session, we will focus on making the necessary amendments to the bill so that it truly reflects the different healthcare needs affecting all New Yorkers.”

For now, it is very difficult to imagine Cuomo coming on board, especially given the pains he’s taken to keep state spending increases at around 2 percent per year and to lower taxes. Asked about single-payer health care during a Thursday appearance on The Capitol Pressroom with host Susan Arbetter, Cuomo painted it as unrealistic given budget constraints. He said Democrats are generally in agreement on the concept, but legislators will have to deal with reality in working with him on a state budget next year, while he also said he thinks it’s much more workable on the federal level. “Single-payer health plan, for example,” Cuomo said, “conceptually I think it’s the right way to go in. I believe it’s more feasible financially on the national level. No state has been able to finance the transition costs.”

A variety of factors, including the challenge of getting Cuomo’s support and not wanting to come into power quickly pursuing something as revolutionary as single-payer health care, may be why the likely next Senate majority leader, Andrea Stewart-Cousins, and her likely deputy, Senator Michael Gianaris, have not highlighted it as top priorities for the coming session.

Assemblymember Gottfried noted that state Senators’ public approval of the bill gives him no reason not to “take them at their word,” and said he expects the legislation to move through the Legislature. He knows that private health insurers are certain to vehemently oppose the continued push.

“The insurance industry will be fiercely lobbying against the bill and they have a lot of money, going up against their lobbying will take a lot of work,” Gottfried said. “but I’m convinced with so many senators on the record in support of the bill, we will prevail.”

Daily News: New York State bill to boost prisoner health care to be introduced following reports of treatment that led to 50 deaths

By Reuven Blau, November 12

Prisoner health care must be significantly improved and staffing levels should be regularly monitored, a state lawmaker said Monday following reports of horrific medical abuses that led to 50 deaths over the past five years.

State Assemblyman Richard Gottfried (D-Manhattan) will introduce legislation to give the state Department of Health more oversight power over prisoner medical treatment. Currently, medical treatment is largely handled internally by the Department of Corrections and Community Supervision.

“People in prison and jail, sort of by definition, are not looked at kindly by most New Yorkers,” Gottfried said. “We also have to realize they are human beings. They are in our custody, and we have a constitutional obligation to protect their health, whether they have done wrong or not.”

The Daily News on Monday reported that a state medical review board concluded 50 prisoner deaths may have been prevented had they gotten better health care.

Commission of Correction review panels repeatedly criticized prison medical staff for failing to complete basic checkups and mental health screenings. In multiple cases, doctors and nurses totally discounted prisoner complaints until they were too serious, according to the death probes.

Gottfried’s proposed legislation will also require state officials to study health care staffing in prisons and issue a report on the issue twice each year.

The number of health care practitioners employed by the department shrank by 3%, according to DOCCS. Some doctors are in charge of 500 or more prisoners.

Times-Union – Richard Brodsky: Single-payer health insurance will be Dems’ bellwether

By Richard Brodsky, November 12

The outlines of Albany 2019 are beginning to emerge from the election results. There’s plenty to think about, but nothing will be more important or more politically potent than the fate of single-payer health insurance legislation.

We won’t examine the merits. There are arguments on both sides and abundant disinformation about cost and consequences.

Put that aside and think about the politics. It’s a foundation commitment for Democrats in New York and nationally. When Republicans ran the state Senate, single-payer died at the hands of the wily, persistent and now-defeated chair of the Health Committee, Sen. Kemp Hannon, R-Garden City. Those days are over. The Assembly, led by the wily and persistent chair of its own Health Committee, Dick Gottfried, D-Manhattan, has passed its bill five times. Incumbent Senate Democrats and most newly elected ones support the concept. Gov. Andrew Cuomo’s been noncommittal, expressing support in principle and concern about details.

If progressives get their way, this could be the first initiative of the new session. Consider the consequences of a decision by the new Senate majority to make single-payer the first item of business in January, voted on before the governor’s executive budget is due on Feb. 1.

Cuomo and the Assembly will immediately be on the spot. Should the Assembly follow through by again passing the bill? If not, there will be significant statewide and national anger, including from the Working Families Party, which emerged from the elections with real clout. Does Cuomo support, oppose, or play for time? Anything short of immediate support puts him under the same kind of statewide and national pressure, intensified by any presidential ambitions he may have. He does not want to start the 2020 scrutiny process by explaining why he’s not enthusiastic about a key part of the progressive platform.

Cuomo is likely to play for time and ask the Democrats to wait. That will trigger questions about what Cuomo will or won’t include in his budget, something the Senate Democrats will care about.

In other words, the timing of single-payer legislation is crucial. If the new Democratic majority decides to play hardball early, they create leverage they otherwise won’t have. If they don’t, Cuomo can finesse the issue and the Legislature is on the defensive.

These kind of machinations are a normal part of legislative politics and are not a bad thing. But they require both firmness and delicacy. It’s simply unclear whether the new majority will be up to the test as quickly as January.

The new Senate will also wrestle with ethics and election reform, school aid, the MTA, tax cuts and caps and much more as the dozen new members learn the ropes. The Assembly will have to decide whether to backtrack on its ambitious legislative agenda of the past few years. The governor will eventually have to declare on the progressive agenda, and find ways to pay for his big projects of the past two years. What happens in January with single-payer, or doesn’t happen, will tell a great deal about the rest of the year.

Richard Brodsky is a former state Assembly member.

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.

Times Union: Capital Region hospital ERs join pilot to reduce opioid use

By Bethany Bump, October 24

ALBANY — A group of 17 upstate New York hospitals, including nine in the Capital Region, are embarking on a pilot program to reduce the use of opioids in their emergency departments.

The Iroquois Healthcare Association is spearheading the $500,000 Opioid Alternative Project, which was funded in this year’s state budget as part of wider efforts to curb the state’s opioid epidemic. The regional trade organization representing upstate hospitals and health systems modeled the pilot after a successful program in Colorado.

“Emergency rooms are often the first contact patients have with opioid painkillers,” said Gary Fitzgerald, president of the association. “As such, upstate New York hospitals are in a strong position to reduce opioid use, particularly as their emergency departments provide care for increasing patient populations vulnerable and at risk for opioid abuse and addiction.”

The Colorado pilot was established last year, and involved training physicians, nurses and other staff at 10 separate emergency departments in treatments other than opioids for certain pain diagnoses, such as acetaminophen for urinary stones or ketamine for musculoskeletal pain. It didn’t prohibit the use of opioids where appropriate, but encouraged clinicians to instead try evidence-based alternatives when presented with certain conditions.

Results exceeded expectations. Participating hospitals were able to decrease opioid use in their emergency departments by 36 percent over a six-month period compared to the same period one year earlier, while simultaneously holding patient satisfaction scores steady, according to a report published this year by the Colorado Hospital Association. The goal had been to reduce opioid use by 15 percent.

In New York, clinicians from participating hospitals met last month to establish their own protocols for alternative treatments, said Jessica Morelli, vice president of the Iroquois Healthcare Alliance.

Details are still being finalized, she said, but they broadly agreed to use alternatives to opioids such as acetaminophen, ibuprofen, ketamine, lidocaine and even caffeine for diagnoses ranging from urinary stones, back pain, sprains, minor fractures and dislocations, tooth pain, headaches and abdominal pain.

The protocols will lay out a “menu” of first- and second-line therapies, she said. Second-line therapies are treatments for when first-line options don’t work.

Participating hospitals in the Capital Region include Albany Medical Center, Ellis Hospital in Schenectady, Glens Falls Hospital, Nathan Littauer Hospital in Gloversville, Saratoga Hospital, St. Mary’s Healthcare in Amsterdam, Albany Memorial Hospital, St. Peter’s Hospital in Albany, and Samaritan Hospital in Troy.

“I am excited to be part of a regional approach to curbing opioid use,” said Dr. Adam Rowden, an emergency medicine physician at Albany Medical Center. “One of the best ways to prevent opioid misuse and dependence is to decrease their use and minimize exposure to patients not currently taking them. These guidelines are evidence-based and treat pain while minimizing the risks for opioids.”

Funding for the project will go toward clinician training, as well as data collection for the duration of the pilot, Morelli said.

State lawmakers who helped secure the funding expressed hope that the pilot can eventually provide a model for other emergency departments.

“Emergency departments are on the front line of the opioid crisis,” said Assemblyman Richard Gottfried, a Democrat who chairs the Assembly health committee. “These 17 hospitals can be models for broader training of emergency physicians to utilize opioid alternatives when clinically appropriate.”

Morelli noted that the pilot applies strictly to opioid use within emergency departments, not to prescriptions that patients may leave the hospital with — though a number of hospitals have cut down on the dosage and duration of opioid prescriptions they hand out as the drug epidemic has worsened.

Marijuana Moment: New York Bill Would Require Medical Marijuana Be Covered By Public Health Insurance

By Tom Angell, October 23

Public heath insurance programs would be required to cover medical marijuana in New York if a new Assembly bill is enacted.

“Cost is the primary barrier to patient access in New York’s medical marijuana program,” reads a memo attached to the legislation. “Medicaid, other public health plans, and commercial health insurance plans do not cover medical marijuana, forcing patients to pay out of pocket. Some patients begin treatment only to stop due to inability to pay, while others turn to the black market.”

“For thousands of patients, medical marijuana is a safer and more effective medication than other drugs, especially opioids.”

The bill, filed on Monday by Assemblyman Richard Gottfried and 17 cosponsors, would add medical cannabis coverage to four publicly funded health programs—Medicaid, Child Health Plus, workers compensation and EPIC, as well as the largely publicly funded Essential Plan.

“For Medicaid and Child Health Plus, there would presumably not be federal matching funds until the federal government changes its policies, but New York’s Medicaid and Child Health Plus programs have always covered people and services for which we do not receive federal match,” the Assembly memo says.

The bill also clarifies that while commercial health insurance programs are not required to cover medical marijuana, they are free to do so. And it would allow state regulators to certify medical marijuana dispensaries as Medicaid providers solely for the purpose of dispensing cannabis.

If enacted, it would be the latest in a series of steady expansions to the the state’s medical cannabis program. Earlier this year, for example, regulators moved to allow medical marijuana to be recommended for any condition for which opioids would normally be prescribed.

Meanwhile, the administration of Gov. Andrew Cuomo (D) is considering more broadly legalizing marijuana. Officials are conducting a series of listening sessions around the state on the topic, and the governor created a task force to draft legalization legislation that lawmakers can consider in 2019.

Fortune: The Justice Department Approved the CVS-Aetna Merger, But It’s Still Not a Done Deal. Here’s Why

Bloomberg News, October 19

New York state officials are considering blocking parts of the $68 billion mergerof drugstore store chain CVS Health Corp. and Aetna Inc., jeopardizing billions of dollars in insurance premiums for Aetna.

CVS (CVS, +0.38%) and Aetna won approval from the U.S. Justice Department on Oct. 10, contingent on Aetna (AET, +0.00%) divesting its Medicare Part D business, which covers prescription drugs for seniors. But the deal still needs to pass through state regulatory bodies.

At a public hearing in Manhattan on Thursday, Maria Vullo, superintendent of the state Department of Financial Services, said her agency might block CVS’s merger with Aetna’s New York unit. She called U.S. approval of the overall deal “myopic” and repeatedly asked CVS and Aetna representatives for written evidence that they would deliver on promises to lower prices.

Several groups, including the Pharmacists Society of the State of New York and the Medical Society of the State of New York, urged the state to block the deal. They said the merger would limit competition and drive up the cost of prescription drugs. Assemblyman Richard Gottfried, chairman of the Health Committee, said the deal introduces “dangerous trends” in consumer access.

Elizabeth Ferguson, deputy general counsel for CVS, said there wasn’t a plan to lower prices.

CVS and Aetna announced the deal in December 2017 but continue to face regulatory hurdles. Connecticut approved the deal Oct. 17, and the New York will reach a decision after Oct. 25.

Shares of CVS and Aetna were little changed in New York Thursday.

Gotham Gazette: Democrats in Swing Districts Run On, Not From, Single-Payer Health Care

By Dave Colon, October 16

Since the Affordable Care Act has failed to tame the beast that is America’s private health insurance system, and a new presidential administration is actively hostile to even that modest attempt at near-universal coverage, activists and many Democrats in New York have recently come to embrace a way forward. Single-payer, state-government-administered health care coverage has become something of a rallying cry for progressive activists in New York even as Governor Andrew Cuomo has argued it’s a program better-suited for the federal government to tackle.

While often thought of as a politically risky issue to embrace outside of solidly progressive areas, candidates in swing districts across the state are carrying the torch for single-payer and calling it a morally correct thing to do that will also save the state money. And with criticism of the proposal from Republicans, the issue has become a flashpoint in the battle for control of the New York State Senate, the GOP’s only source of power at the state level and the key for Democrats hoping to enact a long list of progressive goals.

The New York Health Act, the proposed law that would set up single-payer health insurance in New York, has gained momentum in the state Senate after years as an Assembly-focused effort. Every Democrat in the upper chamber of the state Legislature, where the party is in the minority by one seat, signed on to the bill last session.

The push saw added attention as Democratic gubernatorial candidate Cynthia Nixon made passing the bill a centerpiece of her campaign, although unlike on other issues like legalizing marijuana, Nixon didn’t appear to push Cuomo left on healthcare. But while Nixon and New York City Democrats — the lead sponsors of the NYHA are Manhattan Assembly Member Dick Gottfried and Bronx Senator Gustavo Rivera — have received the most attention for their embrace of the plan, Democratic state Senate candidates in the Hudson Valley and Long Island are also running on the passage of the bill despite the risk that an embrace of big government socialism could be a liability in their swing districts.

Conventional wisdom about the relative conservatism in many areas outside of New York City, and Cuomo’s own reluctance to embrace statewide single-payer (during his debate with Nixon he said it is a good idea “in theory,” but that it would double the state’s tax burden and he supports single-payer at the federal level), would suggest that Democrats in tight races would avoid the New York Health Act. Prominent Cuomo-led events where he’s endorsed suburban Democrats haven’t included mention the bill at all, instead focusing on issues like the continuation of the two percent property tax cap, the passage of the Reproductive Health Act and a “red flag” gun control law, and funding an effort to fight the MS-13 gang.

As Cuomo avoided the issue, Senate Majority Leader John Flanagan brought up the specter of socialism and high taxes in an op-ed column arguing for the GOP’s continued control of the state Senate. “The Democrat Conference vows to enact single payer health care, and so do all the candidates they are running. Medicaid for All would double the state’s budget while taking away Medicare from our seniors. You cannot support a cap on spending and a permanent cap on property taxes, while supporting budget-doubling policies like socialized medicine.”

But for some suburban Democrats, single-payer is as much of a winning issue as any other. “There’s definite support [for the New York Health Act],” said candidate Pete Harckham, running to unseat Republican Terrence Murphy in the Senate’s 40th District, in the Hudson Valley. “People are tired of fighting with insurance companies, hospitals are tired of fighting with insurance companies, doctors are tired of fighting with insurance companies. So I think there’s a very high appetite for the discussion and the dialogue with the New York Health Act as the starting place.”

Jen Metzger, running against Ann Rabbit in the 42nd District for the retiring Senator John Bonancic’s Hudson Valley seat, also said that she’s heard support for the bill out on the trail. “I come right out and say I’m a supporter of the New York Health Act and no one has said yet that it’s a terrible idea or a scary idea,” Metzger told Gotham Gazette. “People understand that this system is not working and that major change is needed.”

“We’ve got to put every option on the table, because we’re coming to a breaking point,” John Mannion, running against Bob Antonacci in the race to replace retiring Senator John DeFrancisco in western New York’s 50th District, told Gotham Gazette.

Both Metzger and Harckham don’t hedge their support either; each candidate told Gotham Gazette that they view healthcare as a human right and believe in a single-payer insurance system. It’s a view that’s become common enough among Democrats that Andrew Gounardes, running against state Senator Marty Golden in a relatively conservative district in southern Brooklyn, said, “frankly I don’t think it’s out of the mainstream to talk about universal health care in the year 2018,” during a previous interview with Gotham Gazette. Cuomo has also endorsed Gounardes, at a rally in Brooklyn where there was no mention of single-payer healthcare.

Support for the bill, even in districts currently held by Republicans, may not be as much of a liability in a wave year for the candidates who’ve expressed their support for it. The 40th and 50th Districts went for Hillary Clinton in 2016 by more than 5 points each, though the 42nd District went for Donald Trump by 5 points.

Gounardes and his primary opponent Ross Barkan were hardly the only New York City Democrats banging the drum for the New York Health Act this primary season. It was one of a slew of issues that challengers to the former members of the Senate’s Independent Democratic Conference (IDC) regularly used to explain how the incumbents had not represented progressive values while forming a power-sharing agreement with the Republican conference.

Jessica Ramos promoted single-payer on her website, Alessandra Biaggi explained her support for it using her own father’s Parkinson’s Disease as an example of how the current healthcare system was failing, and Zellnor Myrie promoted a recently-released RAND Corporation study that suggested the New York Health Act would save the state money over time — all three of them defeated former IDC members in the primary.

Even John Brooks, a Long Island Democrat running a tough re-election campaign for his seat on Long Island states on his website that he supports the New York Health Act, and has called affordable health insurance “a right, not a privilege.” Harckham though, said that the bill has appeal outside of the city because “the economic and the healthcare hardship is the same in the suburbs as it is in the city.”

Just under 5 percent of New Yorkers lack health insurance, according to a recent report by Comptroller Tom DiNapoli, and 7 million New Yorkers are receiving Medicaid, the federal program administered by the state with localities. Beyond the rhetoric of health insurance as a right and not a privilege, these Democratic candidates are also insisting the move to a single-payer system would actually save taxpayers and businesses money in the long run. “Shifting to a single-payer system would actually reduce property taxes, because it would reduce the cost of local taxes and government costs from how they pay for their employees’ health insurance,” Metzger, a member of the Rosendale Town Council, told Gotham Gazette.

This is of course disputed by state Senate Republicans, who have cast the possible change to a single-payer system as a big government takeover of the healthcare sector. “You can’t hold the line on taxes and spending when you’re calling for creation of a new government-run health care system that would double the size of the state budget and cost taxpayers hundreds of billions of dollars more than they already pay,” Senate GOP spokesperson Scott Reif said in response to a Democratic pledge — signed by Cuomo and Long Island Democratic Senate candidates — that included a promise to keep property taxes low, but made no mention of single-payer health care.

The RAND Corporation study concluded the change to a single-payer system in New York could (if certain assumptions were made true) save the state money in the long run, as even the bill’s primary sponsor in the Assembly, Gottfried, has said, that payroll and other taxes would need to increase to pay for the new system. The New York Health Act legislation itself doesn’t provide an exact way to pay for the single-payer system, instead authorizing a commission to figure out how to fund the plan should the bill pass. But Mannion posited that it’s not as if health insurance costs are affordable or helpful at the moment.

“I spoke to someone, a small business owner in my district, who said the entire health insurance premium he paid was $300,000 for his employees six years ago, and this year alone it increased by $300,000,” Mannion said, in response to a question on whether he’s prepared to explain tax increases necessary for a single-payer system.

Still, some Democrats are wary to discuss their views on the issue, even if they list it as an issue they’re running on. Jim Gaughran, running against Republican Senator Carl Marcellino in Long Island’s 5th District, called healthcare a right and not a privilege on his website, but did not respond to a request for comment, even after he was reached on his cell phone and promised a return call that did not materialize. The same situation came up with candidates Karen Smythe, whose website calls for universal single-payer, and Pat Strong, who said she would pass the New York Health Act. In the case of Assembly Member James Skoufis, running to represent the 39th Senate District, he’s already voted for the bill more than once in his time in the Assembly, but doesn’t list is as one of his main issues on his campaign website. Skoufis released a campaign ad touting his a fight with insurance companies on behalf of a constituent, but his campaign did not respond to multiple requests for comment on whether or not he would support the New York Health Act in the Senate the way he did in the Assembly.

The candidates who spoke to Gotham Gazette did insist that even if they won and Democrats capture a majority in the state Senate, voters shouldn’t expect an immediate passage of the bill in the first budget session.

“During the gubernatorial primary, Cynthia Nixon said ‘Oh just pass [the bill] and pay for it,’ but that’s not how you pass and craft legislation,” Harckham said, referring to when Nixon told the Daily News editorial board “Pass it and then figure out how to fund it” when its members asked her about the New York Health Act. “My starting point is New York Health, and let’s sit down with the experts. The Assembly has passed this version, so it’s pretty far along, but that doesn’t mean the Senate can’t alter it,” she continued. “Let’s do our due diligence, with the goal of providing universal single-payer coverage for all New Yorkers.”

Harckham did say, though, that he felt “two years of legislative time” is long enough to debate and pass a bill, which he called a first-term priority on his website (state legislative terms are two years long).

“The Assembly bill has to be revamped, and we have get it right,” Mannion said. A spokesperson for Mannion later told Gotham Gazette that “getting it right” meant that Mannion believed “a transition from the current system to universal coverage as per the bill would likely require a transitional period in which purchasing into a Medicare-for-all like system would be a possible step, including offering that option on the NY State of Health exchange website.” That website is currently where New Yorkers can purchase health insurance plans under the Affordable Care Act.

And even though the governor has said he prefers single-payer on a federal level, Metzger said there might be hope of convincing him to embrace the New York Health Act by playing to his love of New York being first. “I think we can show that [single-payer] can be done, I think there’s a lot of value in demonstration value,” Metzger said. “It’s been these academic debates in this country for a long time. If anyone can do it, I think New York can do it.”

City and State: If New York legalizes pot, what happens to its medical marijuana program?

By Rebecca Lewis, October 14

On a rainy night in September, hundreds of people packed into the Kumble Theater at Long Island University Brooklyn to talk about pot. The event was one of 15 listening sessions Gov. Andrew Cuomo set up around the state for input to draft legislation that would legalize and regulate recreational marijuana. Each attendee had two minutes to speak, and many spoke passionately about the medical benefits of the drug. New Yorker Tom Hilgardner argued that the distinction between medical and recreational cannabis should no longer exist. “It’s really of no use,” he said. “All use, even self-medication – people think they’re using it recreationally. It’s probably the body telling you there’s a medical benefit.”

Shortly afterward, Michael Zaytsev, a cannabis entrepreneur and founder of the Meetup group High NY, offered a different take. “I won’t go too far into the medical program, or my criticism, but we need to regulate that separately from adult use, I believe,” he said.

The remarks sum up a key question regarding the future of New York’s existing medical marijuana program: What impact would a recreational market have on the current medical one?

One key factor is price. Dr. Kenneth Weinberg with Cannabis Doctors of New York, a group of doctors who certify patients and offer consultations, said he hopes that legalizing recreational marijuana will bring down the cost of medical marijuana – presumably by expanding the supply. Marijuana and medicines derived from it are not covered by any insurer, private or public, because the federal government still recognizes marijuana as a Schedule I drug, which means the government considers it extremely dangerous and without any medical purpose. So patients still need to pay for it out of pocket, even with a certified medical marijuana card. “One of the major roadblocks is that people can’t get the cannabis,” Weinberg said. “I have a number of patients who I will certify and then will call back and they’ll say … ‘I went in and it was so expensive, I couldn’t keep doing it.’”

But for many patients, recreational marijuana would not be a replacement. Weinberg said that many patients would still benefit from consultations with doctors who can recommend the best course of action for people, many of whom have exhausted other treatment options. Most of the patients he sees have no interest in the recreational products they could buy if New York legalizes recreational marijuana. “The majority of the people who come in specifically ask me – they want to make sure they don’t get high,” Weinberg said.

Then there are the potential inconsistencies that could arise. Other states have faced challenges in reconciling recreational marijuana with medical marijuana programs in recent years, and may serve as a cautionary tale. Over the summer, Vermont became the most recent state to legalize cannabis, and it did not make changes to its medical marijuana program, leading to confusion about the two conflicting sets of regulations. There were questions about how much cannabis one can legally carry, how many plants one can grow and how much can be harvested from homegrown plants. Different rules apply for those with medical cards and those who obtain the newly legalized substance for recreational purposes.

Under the New York state’s existing medical marijuana program, patients are not allowed to grow their own cannabis, but new regulations could still come into conflict with existing ones. Perhaps the most immediate issue would be the type of cannabis one can buy and use. Medical marijuana is limited to nonflowering cannabis – that is, it cannot be smoked. Patients must consume it through vaporization, oil, pills or other nonsmoking methods. Under legislationpreviously introduced in the state Legislature to legalize and tax cannabis, there would be no restrictions on the method of use. Plus, the governor has not drafted the legislation he plans to introduce.

Additionally, patients as young as 18 can now use medical marijuana if they are certified. Most proposals for recreational marijuana set the age floor at 21, the same as with alcohol. This raises the question about the legality of 18- to 20-year-olds who possess medical marijuana, and which law would apply – an issue that arose in Vermont.

Of course, the introduction of a recreational marijuana market alongside the medical marijuana program can go smoothly. Colorado established its medical marijuana program in 2000 and legalized recreational use in 2014. According to Michael Van Dyke, who oversees the marijuana programs at the Colorado Department of Public Health and Environment, the state did not make any changes to its medical marijuana program in 2014, largely because it was created through a constitutional amendment and changes could not be made easily. (New York’s medical marijuana program was created through state legislation.) Van Dyke said the new recreational market had little effect on the medical marijuana program, and the state did not see a significant drop in medical marijuana cardholders. Those certified with the program were able to continue buying their products, which are set at a lower tax ratethan recreational products.

Although New York is looking to other states for guidance, no one knows yet whether the medical program will be changed in any way if recreational marijuana becomes legal. Assemblyman Richard Gottfried, who sponsored the bill that created the state’s medical marijuana program in 2014, said that he has had conversations with the governor’s office about the issue, but that they have not come to any conclusions. “Several of us in the Legislature are in close consultation with the governor’s people,” said Gottfried, who chairs the Assembly Health Committee. “So how we do that, I don’t know yet. But I know there is a lot of concern and brainpower being focused on it.”

Gottfried said while there is still no clear picture about how the medical marijuana program may evolve, he hopes the state can make it less restrictive. Currently, patients only qualify for medical marijuana if they have one of about a dozen qualifying conditions. Gottfried has been advocating to expand the list of qualifying conditions independently from the recreational marijuana debate, but he hopesthose changes come about in tandem with legalizing recreational marijuana.

Although other states have navigated this issue, each state has its own rules and regulations that were introduced in different ways at different times. Legalization is happening piecemeal across the country rather than uniformly at a national level.

More broadly, regulating both medical and recreational marijuana poses a novel policy question. There is little precedent for a substance approved for medical use that may also be widely used recreationally in a legal setting, while still being a controlled substance at the federal level.

Yet Gottfried did draw an analogy to foods with positive health benefits that people consume on a daily basis. He said that the problem lies in that fact that marijuana is not actually viewed this way in general. “The things that we consume that are very healthy for us, like oranges and milk, you would never think of them being pharmaceutical,” Gottfried said. “But if you extract the vitamin C from it, or produce it artificially, then the (U.S. Food and Drug Administration) supervises the production it. The FDA doesn’t supervise the production of oranges.”

This suggests that the future of medical marijuana may lie in the extraction of individual compounds found within cannabis that have medical benefits, which can be regulated separately from the growth of the plant itself. However, that largely depends on the federal government’s categorization of cannabis as a Schedule I substance.

As it stands, the question of legalizing recreational marijuana in New York still largely relies on the outcome of the November election. Even as the governor holds his listening sessions and convenes policymakers and experts to craft legislation, legalizing recreational marijuana may largely depend on Democrats winning control of the state Senate. Without that, the questions about the future of the medical marijuana program in the new environment could become moot.

Truthout: With Primaries Over, Advocates Fight to Keep Single-Payer in the Spotlight

By Michael Corcoran, October 5

The 2018 primary was a historic election for the movement for Medicare for All, which continues to ascend into heights that seemed unimaginable just a few years ago. Advocates of the policy face a challenge as they pivot to the general election: How to keep the issue central to the midterms.

In the last few years the momentum for Medicare for All, a “single-payer,” publicly financed plan for universal coverage, has been undeniable. In 2016, the Bernie Sanders presidential campaign helped bring the policy into the national debate. In 2017, RoseAnn DeMoro of National Nurses United said 2017 was “the summer for single-payer.” She was pointing to the record-setting support for the House version of Medicare for All (H.R.676) and the introduction of Sanders’s Medicare for All bill (S.1804) in the Senate.

As important as those two years were, however, the 2018 primary has also been a pivotal moment in the fight for single-payer. More candidates who supported single-payer ran (and won) for office — up and down the ballots — than they have in at least a generation.

“This has been an unprecedented election season for the single-payer movement, and it definitely shows that the ground has shifted on this issue,” said Benjamin Day, director of the single-payer advocacy group Healthcare-NOW, in an interview with Truthout. “The country is already there … the role of grassroots organizations like ours is just to close the democracy gap at this point and get Congress moving.”

The momentum is serious enough for the major industry stakeholders (pharma, the insurance industry, medical associations, hospitals, device manufacturers) to create an entire organization, the Partnership for America’s Health Care Future, devoted to keeping the issue from becoming the consensus among Democrats.

But a consensus appears to be forming — at least in the House, where 123of 194 Democrats support Medicare for All, as well as among voters of all ideological stripes. As the primary season was winding down, a Reuters/Ipsos poll was released showing record support for Medicare for All: 70 percent of the public, 85 percent of Democrats and a stunning 52 percent of Republicans. Even 60 percent of industry executives think single-payer would have a positive effect.

Other events have also galvanized the movement. Advocates hope that the Medicare for All Caucus, a coalition of House members whose purpose is to pursue and study the policy that was formed this summer, can be a vehicle to move H.R.676 through the House. The new caucus, Day says, is “already one of the largest caucuses in the House, is a major development, and will be the group bringing pressure from the inside.”

There are also important new leaders who have yet to get national attention in the campaign, Day said. “To me, the more emblematic (but less publicized) primary campaign was Michigan’s 9th Congressional district,” said Day. In this race Andy Levin is expected to win the general election on a campaign supporting single-payer. His father, Rep. Sandy Levin, who has a powerful perch on the Ways and Means committee, has never supported this kind of reform in more than 30 years in Congress. Young people are far more supportive of Medicare for All than their elders, so this reflects a generational shift in more ways than one.

Indeed, Levin’s likely victory in the general election (his district is extremely blue) counters a flawed media narrative that single-payer can only win on the coasts. “I feel like we’re really trying to launch a whole response to 2016, a new politics of solidarity,” Levin said, after winning his primary on August 6. “People are so sick of all the fussing, and they want a strong vision of America where we have health care for everybody.”

The dominant media in the United States have long been hostile to single-payer, treating it as a pipe dream and often citing its costs and not its savings. This has not changed since the issue has penetrated mainstream debate. For instance, media outlets would highlight supporters of single-payer who lost state-wide races — such as Cynthia Nixon in New York, or Abdul El-Sayed in Michigan — and portray their losses as evidence that Medicare for All is a losing issue.

These reports overlooked many successes further down the ballot. In fact, the New York Primary may turn out to be an extremely important development for single-payer. In New York, the chair of the health committee in the Democratic-controlled State Assembly, Richard Gottfried, has passed a single-payer bill many times in the Assembly over the years (the New York Health Act, or A05062).

The problem for advocates is that in the State Senate, a group of conservative Democrats, calling themselves the Independent Democratic Caucus (IDC), created a majority government by caucusing with Republicans. As a result, the Republicans have not put the issue up for a vote, even though a majority of the Senate has cosponsored the senate version of Gottfried’s bill.

But due to pressure from the left, the Independent Democratic Caucus dissolved in April. Six of their eight incumbents lost last week to progressive challengers and Democrats are widely expected to control both chambers after the election. If they do, and if current supporters don’t back out, the math suggests the bill should be able to pass both houses and at least make it to Cuomo’s desk.

“Support is growing with the public. In the State Senate, we now have 31 cosponsors – one vote shy of a majority. The Democratic Primary results will raise the energy level, and I expect even more support after the November election,” Assemblyman Gottfried told Truthout. “I look forward to working with a progressive, Democratic Senate majority – including bill sponsor Senator Gustavo Rivera, ranking member on the Senate Health Committee – to pass the bill in both Houses.”

Senator Rivera tells Truthout he is excited at the possibility of a Democratic-controlled State House, so they can pass the NY Health Act. He said he would meet with Gottfried to update and improve the bill prior to the next session.

“If we do the work, there is a good chance we can control the Senate and I will be chair of the health committee. It being my bill, you can bet I would work with [Gottfried] to pass a bill and get it signed by the governor,” Senator Rivera told Truthout in an interview.

Meanwhile this year, a much-anticipated RAND study was released on the law and found it to be viable — as did a 2015 study from liberal economist Gerald Friedman, which showed it would result in considerable savings in overall health spending in New York, especially those with lower incomes.

“The authors estimate that total health care spending under the New York Health Act (NYHA) could be slightly lower than spending under the status quo,” the RAND study, titled “An Assessment of the New York Health Act,” concluded. “Spending would be similar in 2022 and 3 percent lower by 2031, with the ten-year cumulative net savings being about 2 percent, if administrative costs and growth in provider payment rates are reduced,” the report found.

Cuomo only grudgingly offered qualified support for single-payer for the first time in 2017. He supports the concept on the federal level but has not given a public statement on the NY Health Act.

The prospect of the Senate changing hands, as well as the release of the RAND study, has led to a flurry of activity by opponents of single-payer in the state, in both the health and finance industries. These interests formed a coalition and a website called “Realities of Single-Payer.” devoted to trying to counter the NY Health Act and spin the RAND study, organizers tell Truthout.

“The insurance industry seems to know that it is possible to flip the Senate, and that’s why they have launched an opposition group spouting lies and misinformation about the impact of single-payer health care in New York,” Robbins said.

This is not unlike the approach of the Partnership for America’s Health Care Future, but it differs in that it is aimed at stopping single-payer at the state level.

“Until political power shifts in D.C., New York has the opportunity to lead the way by pursuing universal, public health care, which will protect residents from the assault on health care from the Trump administration,” Robbins said.

Robbins’s framing of single-payer as an antidote to GOP attacks is one that could help keep the single-payer discussion alive in the coming months. Trumpcare scared America to its core. At one point, a Senate version of Trumpcare that would throw 23 million off insurance polled at 12 percent support. Further, Trump’s director of the Center for Medicare and Medicaid Services, has said the Trump administration won’t approve any state single-payer plans.

Contempt for Trump is, like support for the single-payer movement itself, moving to new heights, and single-payer is the kind of policy that would most protect the public from GOP ideologues and industry power brokers who are constantly trying to put their hands in the public’s pocket. If advocates can successfully portray the policy as a direct antidote to Trump’s attacks on the public’s health care, it could intensify or widen its level of support.

Many have cited the Trumpcare efforts as a potential watershed moment in the push for a national health system. As Sarah Jones wrote in The New Republic:

This latest example of its resilience represents a turning point, if Democrats choose to seize the opportunity…. Now is the time for the Democratic Party to begin building a proposal for a single-payer health care system.

Jones is right to qualify her assessment with “If Democrats choose to seize the opportunity.” Democrats have a long history of squandering, not seizing, opportunities. But while some Democrats are wary of running on single-payer, Republicans are raising the issue to try and portray the party as being in favor of socialized medicine. For instance, Ohio gubernatorial candidate Richard Cordray refused to support single-payer in his successful campaign against Dennis Kucinich, a long-time supporter of the policy. This has not stopped Cordray’s GOP opponents, however, from being attacked for it. “He owes voters a clear answer: does he support imposing a Single-Payer healthcare system on Ohio?” asks an attack ad from the Republican Governors Association.

This is where the party is very much divided. Cordray is following the Third Way/DCCC playbook and avoiding the issue. Others want to have this debate — and this includes several gubernatorial candidates who are seeking reform at the state level as well.

“Governors who enthusiastically support single-payer health care are the key for Medicare for All legislation to ever advance at the state level, but they’ve been like unicorns in recent decades — more rumor than reality,” Day said. “This year we saw high-profile gubernatorial candidates running on Medicare for All across the country, and quite a few of them winning their primaries in California, Colorado, Maryland and Massachusetts. There is no question that the window for state single-payer legislation is opening wider, just as momentum is building in Congress.”

It is all part of a stunning revival of a policy that could save thousands of lives and incalculable suffering each year. Organizers are acting with purpose, sensing this could be an early stage of the fight for health care as a human right.

“I believe we have a duty to create a world in which health care [is] accessible to everyone, and with the political will created by a grassroots movement making the demand, it is immensely possible,” Robbins said.