Tag single-payer

The Nation: “Richard Gottfried’s Health Care Crusade Is Paying Off”

Richard Gottfried’s Health Care Crusade Is Paying Off

The NY State Assembly member has spent 27 years advocating for statewide health care. Now, his colleagues in Albany are finally catching up.

By Raina Lipsitz

MARCH 1, 2019

New York Assemblyman Richard Gottfried speaks at a news conference at the Capitol in Albany on April 28, 2015. (AP Photo / Tim Roske)

Two posters hang on the door of New York State Assembly member Richard Gottfried’s Albany office. One has a picture of Dr. Martin Luther King Jr., underneath a quote: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” The other says “Healthcare is a Human Right!” and urges the reader to “Pass the New York Health Act.”

First elected at age 23, Gottfried is now 71 and one of the longest-serving legislators in New York history. He has sponsored the New York Health Act in the Assembly since 1992. The Assembly has passed the bill, which would establish single-payer health care in New York, in the last four legislative sessions; now that the State Senate is also under Democratic control, it has a real opportunity to become law.

Gottfried is optimistic. After all, his Senate colleagues not only support the bill; many of them actively campaigned on it. While granting that there would be “nervousness” to move forward on the part of Senate leadership, he believes that, given the level and consistency of support for single-payer health care “not only among self-identified Democrats, but particularly among independents” and the number of senators who cosponsored the Senate version of the bill, “there will be vocal and negative voter reaction” if the Senate fails to “fulfill its promises.”

Still, even for those who say they support it, the bill isn’t as easy to sell constituents on as you’d think. In a recent interview, Assembly member Catalina Cruz told me she is for the bill, but shares concerns raised by “union colleagues,” like whether it would negatively affect certain contracts and whether retirees who have paid into the system will continue to benefit if they move out of state.

“First of all, a large part of labor in New York very strongly and actively supports the bill and has for some time,” Gottfried said when presented with these concerns. “The New York State Nurses Association was part of a group that, 28 years ago, persuaded me that I should be for single payer.”

Major unions that support the bill, he said, include 1199, the health-care workers; 32BJ, the building service employees; and RWDSU, the retail workers, as well as “a large part of” the CWA and the UAW. Some union leaders, however, argue that they’ve ceded wages and benefits in exchange for union health plans and the New York Health Act would take away a key bargaining chip.

To Gottfried, that “misses the point.” Nearly all health-care plans now, union or otherwise, have deductibles, co-pays, restricted networks, and out-of-network charges, he pointed out. In fact, he said, “I’ve never heard of any union health plan that is as good as the New York Health package.”

In New York City, Gottfried added, municipal employees have had a deal for more than 30 years under which the city pays 100 percent of the premium. Under the New York Health Act, the employer has to pay at least 80 percent of the payroll tax that will fund the plan. Gottfried tells public-sector union members in New York that if they can get their employer to pay 100 percent of about $20,000 in premiums, they should be able to get the city to pay 100 percent of $6,000 to $8,000, and push for the savings to be used to increase wages and non–health care benefits.

“Their answer…is often something like, ‘We’ve already negotiated for 100 percent of the premium; why should we have to bargain again?’” In a tone of mild frustration, Gottfried answered the hypothetical question: “Because it would put more money in your members’ pockets…and get them better health coverage.” Furthermore, he said, “Public employees who retire and move out of state still get their retirement benefits, including retiree health coverage…. we put that explicitly in the bill.”

Gottfried has spent nearly 30 years making the case for the New York Health Act; he can recite the pros and counter the cons in his sleep. The insurance industry’s claim that only 5 percent of New Yorkers lack coverage, and the problem can be solved simply by getting those people on Medicaid “completely ignores the reality that 95 percent of New Yorkers who have health coverage are constantly being knocked around and shortchanged and abused by that coverage,” Gottfried said. There is no way to fix the current system without eliminating insurance companies, because the money New York would save by doing so is “absolutely essential to delivering the full benefits” of single payer, such as expanding coverage, including long-term care coverage, and protecting patients from deductibles and out-of-network charges.

“Anybody who tries to sell the snake oil that getting the last million New Yorkers into health insurance is all we need to do,” he said, “is deliberately or negligently missing the point.”

The point, to Gottfried, is that single payer is a moral imperative, which is why he sees many of the questions skeptics raise as nitpicky or irrelevant. But he doesn’t dodge one of the biggest: Can the New York Health Act be funded without raising taxes? “To do it, you need to convert premiums and other out-of-pocket spending into a smaller number that is paid through taxes,” he acknowledged. “If you focus on whether we’re spending more money on taxes, then you’ll say we’re spending more money on taxes. If you focus on how much New Yorkers spend, and how much of what they spend actually goes for health care, and how much they get to keep in their pockets, then [you’ll see that] we’re saving New Yorkers money, and getting them better health care.”

As for the fears of Democratic leaders like Governor Andrew Cuomo and Senate majority leader Andrea Stewart-Cousins, both of whom have publicly signaled that they won’t raise taxes, Gottfried said, “A pledge not to raise taxes should not prevent you from lowering the cost burden on New Yorkers…. If you can save New Yorkers billions of dollars by converting spending to the public sector, that shouldn’t violate anybody’s pledge.”

Asked how serious Cuomo is about supporting single payer—the governor says he likes the idea, but has hardly been a full-throated proponent—Gottfried remains optimistic. “Unlike about 48 other governors. Governor Cuomo says single payer is the right thing to do,” he says. But what about the difficult, practical work of making it happen? “I’d be surprised if the governor’s thinking evolves in the next couple of months,” Gottfried allowed, “but if and when the bill is on the floor of the State Senate, ready to be passed, I think we will start having serious conversations with the governor.”

For the bill’s critics, another sticking point is the Trump administration’s likely refusal to approve state waivers for single-payer health care. But, although it would “certainly be simpler to run the New York Health plan with federal cooperation, and it would even save the federal government money,” Gottfried said, “we can still run the New York Health Act by various mechanisms around or through Medicaid and Medicare and the Affordable Care Act.” The bottom line: “We can do it legally without federal waivers.”

What can be done to help get the bill to a vote? Gottfried said that he and Senator Gustavo Rivera, the bill’s Senate sponsor, need to continue answering questions and “explaining the merits of the bill,” as well as aggressively reaching out to groups that have questions about it and encouraging them to “come tell us” if there’s anything they think needs to be nailed down or changed. Gottfried cited productive discussions with labor unions, physicians, and the hospital community. Community organizations and grassroots activists also need to “keep up their advocacy,” he said, and “keep the fires lit under legislators.”

Given the national political climate, Gottfried believes it’s especially critical for states that can “move aggressively forward with a progressive agenda” to do so, in part because of the difference it can make nationally. The Children’s Health Insurance Program began in Minnesota; several years later, it was adopted by New York. “And in almost no time,” he said, “every state in the union had a children’s health-insurance plan.” New York can now do the same for single payer. If a couple of states enact single-payer legislation, “I think it’s only a matter of time before it becomes nationwide.”

Raina Lipsitz has written about gender, politics, and pop culture for a variety of publications, including Al Jazeera America, Jewish Currents, and the online editions of The Atlantic, Cosmopolitan, and Glamour.

VICE News: This Brewing Healthcare Battle Is a Preview of the Medicare for All War

By Harry Cheadle, 12/13/18

Last month, Democrats achieved an historic win in New York, flipping control of the state senate and thus taking control of the entire government, upending a weird status quo during which a group of breakaway Democrats allowed the Republicans to control the legislature’s upper chamber. Now that they actually have the power to pass laws in one of the most Democratic states in the country, the possibilities seem intoxicating for the left: Abortion access could be codified into law, the subways could finally be fixed, the state’s byzantine election laws could be updated, and New York could commit to fighting climate change.

But right near the top of any progressive wish list is the New York Health Act, the state’s version of Medicare for all—which is to say universal, government-provided—health insurance. Single-payer healthcare, as such systems are also called, has been a left-wing lodestar for generations. If the NYHA passed, it would make New York the first state in the union to guarantee free access to healthcare (and freedom from fear of health-related bankruptcy) to all of its residents, including undocumented people. 

If passed and smoothly implemented, NYHA could be not just a way to improve the lives of New Yorkers but a model for the rest of the country as it debates the merits of Medicare for all, a policy backed by Bernie Sanders and many other potential 2020 presidential contenders. But now that Democrats can actually pass the NYHA, single-payer supporters are facing a fight that could pit them against not just the insurance industry but a host of Democratic constituencies and leaders—a preview of the contentious debate over healthcare that might follow victories in 2020.

The foremost obstacle is the powerful medical industry lobby, which will likely deploy the usual counterattacks—think the “death panels” of the Affordable Care Act debate, or the fear-mongering “Harry and Louise” ads that helped scuttle reform in the 90s. Then you have Democratic lawmakers who may hesitate to back a transformative proposal that would raise taxes on a lot of people, a governor who doesn’t seem particularly warm to the idea, a hostile federal government, and potential lawsuits from employers. While the coming NYHA battle represents a possible turning point in the history of healthcare politics, it won’t be a pretty sight.

Yet if single-payer advocates could get past all that, they’d have a roadmap to victory in other states—and a model that could be replicated in DC.

Richard Gottfried, the chair of the New York State Assembly’s Health Committee and the chief architect of the NYHA, recently explained what it would look like. “It would create universal complete health coverage for every New York resident without premiums, deductibles, copays, or restricted provider networks,” he said over the phone. The bill would pay for this by pooling the money the state gets from the federal government for programs like Medicaid and Medicare, and also by raising taxes. “There would be one tax on payroll income, predominantly paid by employers, and a parallel on unearned income like dividends, capital gains,” Gottfried explained.

This would transform the way New Yorkers pay for healthcare—instead of giving premiums to insurers, they’d be getting taxed—and according to a recent studyby the RAND Corporation, overall health spending would drop by $80 billion, or 2 percent, by 2031, even as the roughly 1.2 million currently uninsured New Yorkers gained access to care. Gottfried said he didn’t necessarily agree with RAND’s report (for one thing, his bill as currently written does not specify tax rates, so RAND analysts made assumptions about what those rates would be) but NYHA backers have trumpeted the finding that the bill could drive costs down.

The arguments against the NYHA are echoes of the normal arguments marshaled against single-payer healthcare. Realities of Single Payer, an anti-NYHA organization made up mostly of business and health insurance interests, warns of high taxes, long wait times for care under a government-run system, and job loss in the insurance industry. (Through a spokesperson, Realities of Single Payer said in a statement that “rather than throwing out a functioning system for a very uncertain future, there should be a greater focus on covering the remaining uninsured New Yorkers.”) Katie Robbins, the director of Campaign for New York Health, a coalition of unions, doctors, and left-leaning groups, called these warnings “talking points that are used to create fear” and noted that this year’s election proved single-payer was popular statewide.

“There’s been a longtime narrative, a false narrative in my opinion, that this is an issue that only New York City liberals care about,” Robbins said. “But what we saw reflected in the results is that Senate candidates outside of New York City—Long Island, Hudson Valley, upstate in Syracuse—who ran on the New York Health Act, not just standing on it, but making it a priority of their campaign… handily won their elections.”

Those election results create pressure on Democrats, according to Hank Sheinkopf, a longtime Democratic consultant in the state who has worked for everyone from Andrew Cuomo to Michael Bloomberg to Bill Clinton: “They have to do something.”

The NYHA—which Gottfried has introduced into the Assembly every year since 1992—has passed the lower legislative chamber in each of the past four years. But even with increased support in the Senate, its path to becoming law is tricky to say the least. The top Democrat in the State Senate, Andrea Stewart-Cousins, seemingly embraced the NYHA last year, but after the election said Democrats wouldn’t raise taxes. And while Governor Andrew Cuomo said the NYHA was a good idea “in theory” during a debate against his left-wing primary challenger Cynthia Nixon, he was also skeptical of the cost and said he’d like to see single-payer healthcare be implemented on a federal, rather than state, level. (Neither Stewart Cousins nor Cuomo responded to requests for comment left with their offices.)

Meanwhile, unions remain a powerful force in state politics—especially in New York City—and some might oppose the NYHA because members generally have good insurance they won through negotiations and may not want to replace that with government-provided plans. Other barriers include the Trump administration potentially refusing to grant waivers to New York that some say would be necessary for the plan to be implemented (Gottfried disputed that such waivers would be needed) and potential lawsuits from employers under a federal statute called ERISA that protects employers who choose to pay insurance claims themselves.

It’s also not even clear the NYHA will pass the Assembly when the legislature goes back into session in January. “It’s like starting from scratch because the political dynamics changed so much,” Robbins said. In other words, now that everyone knows the NYHA may actually become law, some Democrats may have second thoughts about voting for it.

Gottfried, for one, seemed confident of the bill’s chances. “I fully expect the Assembly to pass the bill again,” he said. He added that he and NYHA Senate sponsor Gustavo Rivera were talking to stakeholders to flesh out the details of the bill and add “additional provisions” to speed its passage through the Senate. They were also “working to convince” Cuomo that the NYHA was the way to go, Gottfried said.

If Gottfried and his allies can pass the legislation quickly in early 2019, it will put Cuomo on the spot, former Assembly member Richard Brodsky—a frequent Cuomo critic—argued in a recent Albany Times-Union column: “Anything short of immediate support puts him under the same kind of statewide and national pressure, intensified by any presidential ambitions he may have.” It’s safe to say that reticence on Cuomo’s part will spark widespread progressive anger. “If Andrew Cuomo’s first appearance in 2019 is to put a bullet through the head of single-payer, it will have political consequences,” Brodsky said in an interview.

If the dynamics of passing the NYHA seem complicated, welcome to a preview of what national politics may look like in 2021. If Democrats can retake control of the federal government in the 2020 elections, they will have likely done so while promising single-payer healthcare, just as New York Democrats did. But passing a bill through Congress will require selling it to voters in the face of intense opposition from insurance companies and the medical industry, and also navigating the push and pull of other priorities like climate change. Medicare for all can seem like a common-sense solution to the country’s patchwork, inhumane, and overpriced healthcare system when advocates talk about it, and it’s popular in many polls. But history suggests the politics turn thorny when government-provided health insurance becomes a real possibility.

“You’re treading into unknown territory here. There’s no map for how to get this down the road.”
–Richard Brodsky

Recent single-payer pushes have come tantalizingly close in other states, only to fail, sometimes in dramatic fashion. In 2014, Vermont Governor Peter Shumlin pulled the plug on a single-payer bill, saying his state couldn’t pay for it. Two years later, a Colorado ballot measure that would have created a single-payer system was rejected by voters after a confusing election-season scrum—abortion-rights groups opposed the measure because the new system wouldn’t have covered such procedures. Last year, a California single-payer bill was effectively axed by Assembly Speaker Anthony Rendon, who said it was “woefully incomplete” and didn’t describe how the system would be paid for. (Single-payer advocates were so incensed they subsequently attempted to remove Rendon from office.)

Gottfried said that unlike the California bill, the NYHA clearly describes where the funding would come from, and unlike Vermont, New York has enough wealth to make paying for a single-system more practical. But other Democratic factions, including some unions and the governor, may not be persuaded by those arguments, setting up a fight between single-payer advocates and the rest of the party, with lawmakers caught in the middle.

As Robbins pointed out, six of the eight former members of the Independent Democratic Caucus—the rogue Democrats who gave control of the Senate to Republicans—lost primaries to grassroots opponents earlier this year, indicating the same base that is demanding single-payer has some teeth. “I would think that the folks who are in elected office now should really figure out how to deliver what they promised in their campaigns,” she said, “because clearly there is a motivated base with high expectations and now the electoral muscle to make them pay at the polls if they don’t deliver.”

That said, Robbins added that “there’s absolutely no guarantee” the bill will pass, and a lot could depend on pressure from activists. Brodsky suggested NYHA sponsors consider a “toned down” bill that is less costly and helps manage the transition so as to address criticisms about job losses in healthcare. He also said Gottfried had the “political shrewdness” to get it done.

“You’re treading into unknown territory here. There’s no map for how to get this down the road. It’s an enormous challenge,” Brodsky said, adding, “the political climate has changed from roughly unfavorable to roughly favorable. That’s not chopped liver.”

The battle over the NYHA will be a state-level political knife fight, but the stakes could be even higher than the future of healthcare in New York. The hope among advocates is that once a single-payer system gets a foothold in one state, it can be exported around the country. The passage of the NYHA would not be the end point of the movement, but the beginning of a new chapter.

“Social progress in this country historically, usually begins at the state level,” Gottfried said. “Our labor laws, a lot of our consumer protection laws, public support for healthcare for poor people, the child health insurance program—all began at the state level.”

City & State: Has single-payer health care’s time finally come?

By Rebecca Lewis, 12/9/18

With their new majority in the state Senate, Democrats are finally preparing to pass long-stalled progressive legislation. Perhaps the most expansive and expensive item on the agenda – and among the most controversial – is the New York Health Act, which would establish a single-payer health care system in the state, and one study estimated it would cost $139 billion in 2022. Many incoming lawmakers campaigned on the promise that they would get it done, but even if it does pass, it likely won’t be implemented right away.

The Democratic-controlled Assembly has passed the legislation every year since 2015, but in that time it never came up for a vote in the state Senate thanks to the Republican majority. Now that the chamber will be in Democratic hands, the legislation seems far more likely to pass.

A single-payer health care system means that a single entity covers the cost of all health care, which is still delivered by private or nonprofit providers. Everyone pays into a single plan run by the government, which in turn is the only provider of coverage paying claims. Assemblyman Richard Gottfried’s single-payer bill has proposed one public option and a ban on the sale of private insurance unless it offers additional coverage not included in the state plan.

One major obstacle the New York Health Act must overcome is a less than enthusiastic governor. Although Gov. Andrew Cuomo has expressed support for single-payer health care as a concept, he has repeatedly said that it would be better implemented at the national level. In a recent interview on WCNY, he expressed doubt that the state would be able to finance the $150 billion program, since that would nearly double the state’s budget. “There will be rhetorical desire to do things,” Cuomo said. “Governmentally there will have to be a reality test to get all things to fit in the budget.”

Although this sounds like it could put a serious damper on the future of the legislation, Gottfried called the governor’s stance “a perfectly reasonable position for a governor,” noting that Cuomo is already far more progressive than other governors by simply supporting the concept of single-payer health care. Gottfried said he has been in talks with the administration and expects those conversations to accelerate now that passage is more realistic.

Gottfried said that stakeholders who have remained quiet in the past are coming forward to voice their concerns. Most recently, Gottfried and state Sen. Gustavo Rivera, the bill’s Senate sponsor, have been negotiating with New York City public unions over concerns that union members would pay more or have fewer benefits. “What we’re talking about is modifications just to accommodate concerns that people are raising now that it looks like it can easily pass both chambers this session,” Gottfried told City & State. “People who we haven’t heard from are starting to come forward and say, ‘Gee, could you add this nuts and bolts?’ or ‘Tighten it up here.’’”

Gottfried said making tweaks to the bill will continue at least a couple weeks into the session, which begins in early January. However, Gottfried said that he and Rivera will not make any major structural changes to the bill and said the Assembly is “well positioned” to pass the bill this upcoming session.

People who we haven’t heard from are starting to come forward and say, ‘Gee, could you add this nuts and bolts?’ or ‘Tighten it up here.’ – Assemblyman Richard Gottfried

Rivera expressed more caution, telling City & State that he feels confident that the chamber will engage in meaningful conversations about the bill, which it has never done before, but did not want to make any promises about a timeline for passage. “This is not a simple thing that we’re trying to do,” Rivera said. “We want to make sure that we don’t put anything up for a vote, to be signed by the governor, unless it’s ready to go.”

Bill Hammond, a health policy expert at the right-leaning Empire Center for Public Policy, argued that no amount of change to the New York Health Act would actually make the legislation viable. “I think (Gottfried and Rivera’s) posture right now is not to acknowledge the sacrifice, it’s to make it even more attractive to whatever interest group thinks they’re going to lose,” Hammond told City & State. He added that any changes would likely add to the already astronomical cost of the bill.

But Gottfried maintained that a single-payer system will lead to lower overall health care spending despite the introduction of a new payroll tax because the average New Yorker would no longer pay insurance premiums and copays. He cited the Rand Corp. study, commissioned by the New York State Health Foundation, which found total health care spending could be lower under the New York Health Act than under the status quo. “To me, the issue is not about where your check goes,” Gottfried said. “What people really care about is how much are they going to have to spend, and how much they will be able to keep under the New York Health Act.”

However, Hammond pointed out that since there is no precedent for the system in the country, the details of the new tax plan have not been worked out yet and it is hard to accurately predict the cost of the program, so the Rand study could be wrong. He added that it also hinges on the federal government providing waivers to in order to divert Affordable Care Act, Medicare and Medicaid funding into the single-payer system, an unlikely prospect with the current administration. “There’s all kind of doubt and uncertainty about who’s going to pay more and who’s going to pay less,” Hammond said.

Rivera dismissed the idea that the New York Health Act depends on receiving those federal waivers, saying they would be helpful, but not necessary. “We believe, both my colleague and myself, believe that there are ways within the system that we could actually extend the New York Health Act as a wraparound service that would ultimately not require waivers,” Rivera said. He added that since the single-payer system would take years to put into place, he remained hopeful that a different, more sympathetic administration would be in the White House by then.

Another sticking point in evaluating and passing the New York Health Act is the fact that the previous legislation contained no specific language on tax rates for the proposed payroll tax, forcing Rand to use a hypothetical tax schedule. Gottfried said no language about tax brackets will be added to the legislation that he and Rivera will introduce and that it will be worked out after the bill’s passage since the program will take years to implement. He added the absence of this information will not pose an impediment to passage and that it could be easily added in if it becomes necessary.

Despite the many obstacles the legislation appears to face, Gottfried said that he and Rivera have learned from their previous mistakes, such as not including a revenue stream, and they remain confident New York will lead the country in single-payer health care. “Anything has to start with somebody,” Gottfried said. “And New York is ideally suited to be the state that begins single-payer coverage.”

Crain’s: At hearing, City Council gives warm reception to single-payer

By Jonathan Lamantia, 12/7/18

The City Council seems likely to pass a resolution endorsing a state single-payer health care bill after a hearing Thursday in which health committee chair Mark Levine fervently supported such a system and criticized its detractors.

Levine derided the status quo in health care, which costs more per capita in the U.S. than in other developed countries without better outcomes. He said that while he supports a national approach, it is unlikely to be taken up by the Trump administration.

“New York need not and must not stand still in the face of inaction at the federal level,” he said.

The bill would create a statewide public fund to cover all New Yorkers with no out-of-pocket costs. It received broad support at the hearing from nurses, physicians, social workers, immigrant advocates, disability rights activists and community groups.

The New York Health Act has passed the Assembly four consecutive years, and with the Democrats taking control of the Senate in January, there is an increased chance of the bill’s passage next year. Gov. Andrew Cuomo has said he believes the federal government is best positioned to take up the issue.

Assemblyman Richard Gottfried and state Sen. Gustavo Rivera plan to reintroduce the bill in January to address fiscal concerns. One new wrinkle, which Gottfried previewed Thursday, is that it will incorporate long-term care, such as nursing home and home care.

“No New York family will have to wipe out their savings, and no family member will have to give up a career to provide long-term care for a loved one,” he said at the hearing.

A coalition called Realities of Single Payer, which includes the state Health Plan Association, state Conference of Blue Cross and Blue Shield Plans, and the Business Council, said in a statement that the hearing was “nothing more than political theater” and a single-payer system would result in higher taxes and decreased access to care.

An analysis in August by Rand Corp. estimated that the state would need to raise $139 billion more in taxes by 2022 to fund the program, an 156% increase above expected levels. The research organization proposed one possible tax structure, as the current bill lacks one. Under its proposal, households earning up to $290,000 would pay a smaller percentage of their income toward health payments, including the new taxes.

The analysis assumed the state would receive a waiver from the federal government to deliver Medicare and Medicaid benefits through its own program while still receiving federal funds. Centers for Medicare and Medicaid Services Administrator Seema Verma has said she wouldn’t approve such a waiver.

David Rich, executive vice president of the Greater New York Hospital Association, spoke in opposition to the bill at the hearing. He noted the coverage gains New York has made to lower its uninsured rate to 5% from 10% in 2013 and said there were other ways to insure the remaining 5%. He said he worried a single-payer system would provide lower reimbursement to hospitals than the current system.

“Yes, we must cover the remaining 5% of New Yorkers who are uninsured. Yes, we should make health care affordable,” he said. “We can do this without the disruption we think would be caused by a single-payer system.” 

New York Times: 2 New Yorkers Erased $1.5 Million in Medical Debt for Hundreds of Strangers

By Sharon Otterman, December 5, 2018

Carolyn Kenyon, left, and Judith Jones, both of Ithaca, N.Y., raised $12,500 and sent it to a debt-forgiveness charity, which then purchased a portfolio of $1.5 million of medical debts on their behalf. Credit Heather Ainsworth for The New York Times

If a slim, yellow envelope with a Rye, N.Y., return address lands in your mailbox this holiday season, don’t throw it out. It’s not junk.

Some 1,300 such envelopes have been sent to New Yorkers around the state, containing the good news that R.I.P. Medical Debt, a New York-based nonprofit organization, has purchased their medical debt — and forgiven it.

Last spring, Judith Jones and Carolyn Kenyon, both of Ithaca, N.Y., heard about R.I.P. Medical Debt, which purchases bundles of past-due medical bills and forgives them to help those in need. So the women decided to start a fund-raising campaign of their own to assist people with medical debt in New York.

Over the summer months, the women raised $12,500 and sent it to the debt-forgiveness charity, which then purchased a portfolio of $1.5 million of medical debts on their behalf, for about half a penny on the dollar.

Ms. Jones, 80, a retired chemist, and Ms. Kenyon, 70, a psychoanalyst, are members of the Finger Lakes chapter of the Campaign for New York Health, which supports universal health coverage through passage of the New York Health Act.

“The way sort of opened,” Ms. Jones said. They cast a wide net for donations, she said, explaining to people that the campaign was only a short-term fix for the larger problem of out-of-control medical costs.

Many people take on extra jobs or hours to afford health care, and 11 percent of Americans have turned to charity for relief from medical debts, according to a 2016 poll conducted by The Times and the Kaiser Family Foundation.

The 1,284 New Yorkers who had their debts forgiven live in 40 of the state’s 62 counties, from Westchester to Chautauqua. The sources of the debt were some 130 hospitals and branches that had provided medical services, R.I.P. Medical Debt said.

“I like doing this much more than I liked doing collecting,” Mr. Antico said.

R.I.P. Medical Debt had its first star turn in 2016, when John Oliver did a segment on his HBO show “Last Week Tonight,” in which he paid $60,000 to forgive $14.9 million in medical debts through the charity. About 9,000 people received the yellow forgiveness envelopes as a result.

Since then, other high-profile efforts to forgive debts through the charity include fund-raisers sponsored by NBC and Telemundo affiliates.

In all, the organization says its donations have forgiven $434 million in medical debt so far, assisting some 250,000 people. That remains only a fraction, though, of the more than $750 billion in past-due medical debt that it says Americans owe.

“It is a drop in the bucket,” Mr. Antico said.

R.I.P. Medical Debt specifically seeks to buy the debts of people who earn less than two times the federal poverty level, those in financial hardship and people facing insolvency.

It purchases the portfolios at a steep discount, a penny or less on the dollar. These bills have typically passed through several collection agencies and months or years of collections. The people, who do not know they have been selected, receive the debt relief as a tax-free gift, and it comes off their credit reports.

Mr. Antico said he thought of his charity as a “resolutionary, not a revolutionary” effort, one that offers people relief, but that cannot solve underlying issues like high medical costs. Through personal data associated with the debt accounts, they are able to target specific classes of people, such as veterans, to relieve their debts.

“I do like the idea that people do not have to ask for help,” he said. “The random act of kindness is kind of a cool thing.”

The envelopes from Ms. Jones and Ms. Kenyon’s gift went out in November, but new letters are going out all the time. And don’t worry. Even if you throw your yellow letter out, your debt is still forgiven. You just might not know about it until the next time you run your credit.

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.”

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.

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.”

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.