Tag single-payer

Gotham Gazette: As Broader Debate Intensifies, New York Nonprofits Consider Throwing Weight Behind Single-Payer

By Caroline Lewis, 9/21/18

Wendy Stark is ready to press the reset button on health care. The executive director of Callen-Lorde Community Health Center, based in Lower Manhattan, Stark is hopeful that an overhaul may be on the horizon in New York through controversial legislation gaining increasing attention as this fall’s elections determine the upcoming balance of power in state government, from the governor’s office through the state Legislature.

The New York Health Act — which has increasingly strong chances of passing the state Legislature but does not have the support of Democratic Governor Andrew Cuomo, who is favored to win a third term — would set the stage for New York to toss out the current health insurance system in favor of a single taxpayer-funded, government-administered health care program for everyone.

As the bill has been the subject of more debate in recent months, partially stemming from gubernatorial candidate Cynthia Nixon’s support for it, powerful lobbyist groups representing insurers, hospitals, and businesses have been vocal about their opposition. The Business Council of New York State took to Fox & Friends to denounce the legislation, while others have written op-eds in local publications. Republicans running for office, including gubernatorial nominee Marc Molinaro, are warning New Yorkers about a potential government takeover of health care.

But as the leader of a health care provider that serves mostly low-income members of the LGBT community through its clinics in Manhattan and the Bronx and employs more than 350 people, Stark has a very different take. She says in addition to allowing her organization to save on employee benefits and administrative costs — a projection generally backed up by the RAND Corp.’s recently-published analysis of the New York Health Act — a single-payer system would cut down on the red tape patients have to deal with.

“So many of the barriers to care people experience are rooted in the economics of health care,” Stark said. “We don’t believe health care can make adequate improvements without changing the foundational economics of how it works and is paid for.”

Under the proposed single-payer system, insurance premiums, deductibles and copays would all go out the window, and patients could visit any health care provider without having to worry about whether they were in their insurance network. Meanwhile, taxes would go up, with the wealthiest New Yorkers paying a greater portion of their income and employers paying a certain amount per employee. Under the sample tax model proposed by the RAND Corp., the state would have to collect an estimated $139 billion in new taxes in 2022 to pay for the single-payer system. Still, RAND projected that overall spending on health care would go down — barring a few caveats that that could stand in the way of the system being successful.

Callen-Lorde is one of 10 community-based health centers and 183 total nonprofit groups statewide that have publicly endorsed the campaign supporting the New York Health Act (in addition to a variety of mostly small for-profit businesses). But while it may seem like a natural fit, the bill still has a ways to go to become a widespread legislative priority for the large contingent of community-based organizations that help connect immigrants, people with behavioral health problems and housing insecurity, formerly incarcerated individuals, and members of other marginalized groups to needed health care and social services.

Many nonprofit health centers and other organizations, including those in the human services sector — which employ a growing workforce and have formed coalitions to represent their interests in Albany and Washington, D.C. — are still examining the implications of the New York Health Act before issuing full-throated endorsements. Others are directing their limited resources to what they see as more pressing policy and funding concerns.

But that may change as the policy conversation develops. Groups like the Federation of Protestant Welfare Agencies, FPWA, which represents 170 human-services and faith-based organizations, are hoping to help move things along.

“We believe the New York Health Act would strengthen nonprofits both for the communities they serve as well as their employees, and make the system more tenable long-term,” said Winn Periyasamy, policy analyst at FPWA.

FPWA, along with the Coalition for Asian American Children and Families and the New York Immigration Coalition, hosted a forum on single-payer for nonprofit representatives on the Lower East Side last month, where they heard about the New York Health Act directly from its lead sponsors in the Legislature, Assemblymember Richard Gottfried and Senator Gustavo Rivera, both Democrats who represent parts of New York City in their respective legislative houses.

New Yorkers in favor of a single-payer health system will know they’re winning, Rivera told the audience, when sinister images of him and Gottfried start appearing in insurance-industry funded attack ads.

“I can’t wait for that gritty video, I can’t wait for it!” said Rivera, of the Bronx, exuding confidence that the debate over the state’s single-payer bill is on its way to reaching a fever pitch.

The New York Health Act passed the Assembly the last four years in a row, but was thwarted each time by the Republican-controlled Senate. Now the bill–which was already only one sponsor short of a majority in the Senate in the last session–is among a slew of progressive measures that have been infused with new hope following the dissolution of the Independent Democratic Conference, which allowed Senate Democrats to caucus with Republicans.

“This is real,” Gottfried insisted at the forum. “This is not a dream. And you and your people are really crucial to making sure it gets done.”

Those in attendance were particularly interested in how the bill would affect undocumented New Yorkers, who are generally not eligible for health insurance now but would be under the single-payer system. Undocumented New Yorkers currently often use public hospitals at great expense, having eschewed preventative care due to their documentation status and lack of insurance. Dr. Mitchell Katz, chief executive of the cash-strapped NYC Health + Hospitals system, praised the Assemblyon Twitter for passing the New York Health Act in June.

Attendees at the event also talked about the need to properly translate materials on single-payer into the languages of the communities they serve.

“We’re reaching into our Asian-American communities,” said Anita Gundanna, co-executive director of the Coalition for Asian American Children and Families. “A lot of people had never heard of the [single-payer] proposal before or thought through the impact of it, so for us the very beginning step is to expose our communities to what’s going on and how it might impact them.”

CACF and other groups serving Asian-Pacific Americans advocate for health care initiatives through Project CHARGE, the Coalition for Health Access to Reach Greater Equity. Gundanna said there’s a need to get more buy-in from individual organizations before single-payer can become an official part of the coalition’s policy agenda.

“We have to be strategic and patient,” she said. “We can’t move without having our coalition behind us.”

On the bright side, Gundanna pointed out, the nonprofit sector had to increase its capacity to share information about health policy a few years ago in order to help people understand and get insured through the federal Affordable Care Act, also known as Obamacare.

But more recently everyone has been on the defensive, using their resources to try to preserve the ACA and prevent a wide array of federal policies from taking effect. Lately, many organizations are preoccupied with changes the Trump administration is considering to the Public Charge Rule, which people in the social-services sector say are already discouraging some immigrants from using public benefits, including subsidized health insurance, for fear it could be used as a strike against them later.

Gundanna said she wants to present nonprofits with proactive solutions like single-payer but acknowledges that everyone must consider, “How many resources are there to explore these quote-unquote ideal options in this quote-unquote ideal world?”

Asked about the New York Health Act, the Community Healthcare Association of New York State, which spent much of 2017 and early 2018 consumed by a battle to secure endangered federal funding for its members, said in a statement, “CHCANYS supports innovations in health policy that improve access to high-quality health care for everyone. We continue to study the options for expanding coverage to all New Yorkers and are closely monitoring the current political discourse.”

Meanwhile, the Human Services Council, whose advocacy focuses on improving the government contracts its member organizations rely on for funding, is not likely to take a position on the New York Health Act, said Allison Sesso, the coalition’s executive director.

“Doing stuff on this is not why we exist and could eat up resources,” said Sesso, although she added, “I think this conversation is really important and I’m glad it’s being elevated.”

As advocates for the New York Health Act work to make the case that it’s worth the time and effort for would-be proponents to support the bill, they are also faced with the uphill battle of getting the governor on their side. A year ago, before the bill stood much of a chance of passing both houses of the state Legislature, Cuomo signaled some slight openness to the idea of implementing a single-payer system in New York. Asked about it again during his debate with Nixon, before he beat her in the gubernatorial primary this month, Cuomo came out against the idea. He said he thought it could work at the federal level but would be too costly an endeavor for the state to embark on alone.

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by Caroline Lewis for Gotham Gazette. On Twitter @clewisreports and @GothamGazette.

Testimony on the New York Health Act before the New York City Council

Testifying before the NYC Council in support of its resolution endorsing the New York Health Act, December 6, 2018

Testimony of Assembly Member Richard N. Gottfried

in Support of the New York Health Act

Public Hearing: City Council Committee on Health

New York City Hall

December 6, 2018

I am Assembly Member Richard N. Gottfried.  I chair the Assembly Health Committee and I am the introducer, along with Senator Gustavo Rivera, of the New York Health Act, to create single-payer health coverage for every New Yorker.  I appreciate the Council Health Committee holding this hearing on Speaker Corey Johnson’s resolution endorsing the bill.  I support the resolution.

In both houses of the State Legislature, we now have solid majorities who have co-sponsored, voted for, or campaigned supporting the NY Health Act.  And Governor Cuomo supports single-payer health coverage, although he says he has questions about whether it can be done at the state level.

Every New Yorker should have access to the health care they need, without financial obstacles or hardship.  No one says they disagree with that.  And the New York Health Act is the only proposal that can achieve that goal.

In NY State, we spend $300 billion – federal, state, and non-governmental – on health coverage.  Nationally, we spend far more than any industrial democracy as a percentage of GDP.  But 18 cents of the insurance premium dollar goes for insurance company bureaucracy and profit.  Our doctors and hospitals spend twice what Canadian doctors and hospitals do on administrative costs, because they have to fight with insurance companies.  We pay exorbitant prescription drug prices because no one has the bargaining leverage to negotiate effectively with drug companies.

Just about every New Yorker – patients, employees, employers, and taxpayers – is burdened by a combination of rising premiums, skyrocketing deductibles, co-pays, restrictive provider networks, out-of-network charges, coverage gaps, and unjustified denials of coverage.  I know I am, and I bet everyone in this room is.

And those financial burdens are not based on ability to pay.  The premium, the deductibles – the insurance company doesn’t care if you’re a multi-millionaire CEO or a receptionist.

In a given year, a third of households with insurance has someone go without needed health care because they can’t afford it – and usually for a serious condition.

The number one cause of personal bankruptcy is health care — even for those who have commercial health coverage.

We’ve put control of our health care in the hands of unaccountable insurance company bureaucrats. Nobody wants insurance company bureaucrats deciding what doctor you or your family can see and when.

The health insurance system means massive cost increases for most everyone and better health care for hardly anyone. It’s a disaster.

But it doesn’t have to be that way.

The NY Health Act will save billions of dollars for patients, employees, employers, health care providers and taxpayers – while providing complete health coverage to every New Yorker.

Everyone would be able to receive any service or product covered by any of the following:  NY Medicaid, Medicare, state insurance law mandates, and the current state public employee benefit, plus anything the plan decides to add.

And there will be no premiums, no deductibles, no co-pays, no restricted provider network, and no out-of-network charges.

We’ll actually save billions of dollars because we get rid of insurance company bureaucracy and profit, doctors and hospitals will be able to slash their administrative costs, and New York Health will be able to negotiate much lower drug prices by bargaining for 20 million patients.

And this lower cost will be shared fairly, based on ability to pay.  NY Health will be funded by broad-based progressively graduate taxes.

There will be one tax on payroll.  At least 80% of it must be paid by the employer.

There will be a similar tax on currently taxable “unearned” income – like capital gains and dividends.

Because of the savings and the progressively graduated tax mechanism, 90% or more of New Yorkers will spend less and have more in their pocket.

Pumping this money back into our economy will create 200,000 new jobs in New York.

And there will be money to completely cover everyone, and make sure doctors, hospitals and other providers are paid fairly – and today, most of the time, they are not.

The vast majority of our hospitals get most of their revenue from Medicaid, Medicare, and uncompensated care pools – none of which fully cover the cost of care.  The NY Health Act requires full funding for all hospital care, and hospitals will save billions in reduced administrative costs.

Here are 3 basic numbers:  The savings from insurance company bureaucracy and profit, provider administrative costs, and drug prices will total $55 billion.  The increased spending for covering everyone; eliminating deductibles, co-pays and out-of-network charges; and paying providers more fairly will cost $26 billion.  So the net savings to New Yorkers is $29 billion.

The way our society deals with long-term care – meaning home health care and nursing home care – for the elderly and people with disabilities is a moral outrage.  NY’s Medicaid does a much better job than other states.  But today, New Yorkers spend $11 billion a year out-of-pocket for long-term care.  And family members – usually women – provide unpaid home care worth $19 billion.

In January, Senator Rivera and I will be announcing that the NY Health Act will cover long-term care.

Now, that will use up $19 billion of the net savings.  But it means no NY family will have to wipe out lifetime savings, and no family member will have to give up a career, to provide long-term care for a loved one.  That’s profoundly important.

How much tax revenue will we need?  With the net savings, we’ll need $129 billion from the NY Health taxes.  When we add home care and nursing home care, we’ll need $159 billion.

How do we know the NY Health program will treat us – and our doctors and hospitals – fairly?  Two ways.

First, the legislation explicitly requires that provider payments be reasonable, related to the cost of providing the care, and assure an adequate supply of the care.  No coverage today has that guarantee.

Second, we’ll all be in the same boat; rich and poor.  Every New Yorker – every voter – will benefit from the program.  And every voter will have a stake in making sure our elected officials keep it as good as possible.

Remember where we started:  Every New Yorker should have access to needed health care, without financial obstacles or hardship.  We’re not there today.  The NY Health Act will get us there.  If anyone doesn’t like the NY Health Act, they should either put on the table another plan that will get us there, or admit that they’re OK with depriving millions of New Yorkers of health care or family financial stability.

Concerns have been raised by many of NY City’s municipal labor unions.  They are justifiably proud of the good deal they have won for their members over the years.  Good scope of coverage.  The City pays the full premium.  And the contract says that if there are savings in the health benefit, the savings go into a stabilization fund to pay for salaries and benefits.  As they remind us: at the bargaining table they have given up wages and benefits to protect this deal.

Under NY Health, by law, every municipal employee, like every New Yorker, would have an even broader scope of benefits, and without deductibles, co-pays and restricted provider networks and out-of-network charges.

Under the bill now, collective bargaining could continue to have the City pick up the whole tab for the payroll tax and pass on the savings to the stabilization fund.  But Sen. Rivera and I have offered to add bill language that by law would require the City to do that, without the need to bargain for it.

Our parents didn’t raise us to screw workers.  Period.  Sen. Rivera and I are determined to make sure that labor’s concerns are protected under the NY Health Act.  We are continuing the dialogue with them.

Thank you for letting me testify.

Gothamist: Can NY Make The Leap To Universal, Government-Run Healthcare?

By Caroline Lewis, August 22

Since it was first introduced in 1992, a bill that would provide New Yorkers with universal health care has passed the state Assembly five times, including the last four years in a row, but it has always died in the Republican-controlled State Senate. Now, the New York Health Act—which aims to replace all existing forms of health insurance with one state-run, tax-funded health plan for everyone—is just one sponsor short of a majority in the Senate. With elections coming up for state lawmakers, the Senate could be poised to flip, giving the bill a chance of making it as far as Governor Andrew Cuomo’s desk.

Some 59 percent of Americans now support a Medicare for all model under which everyone would qualify for a government health plan, according to a recent Kaiser Family Foundation poll. Cuomo’s Democratic challenger Cynthia Nixon, candidates vying for state Senate seats, and some members of the New York City Council—including Speaker Corey Johnson—are framing support for single-payer as both a moral imperative and a progressive badge of honor.

The New York Health Act has reached the level of political viability for people on both sides of the ideological divide to start taking it seriously enough to get into the details of what it would entail.

Press wrap-up: RAND study confirms NY Health expands coverage, net savings

A new report by the RAND Corporation finds that the New York Health Act single-payer bill would cover all New Yorkers while generating a net savings.  More information can be found here; the full report here; and a summary here.

The report has generated widespread press coverage including:

PRESS RELEASE: RAND study confirms NY Health expands coverage, net savings

RAND CORPORATION STUDY CONFIRMS: NEW YORK HEALTH ACT “COULD EXPAND COVERAGE WHILE REDUCING TOTAL HEALTH SPENDING”

Think tank concludes: New York Health would cover all New Yorkers with net health care savings

Bill sponsors Senator Rivera and Assembly Member Gottfried will continue to push for the passage during the next legislative session

            State Senator Gustavo Rivera and Assembly Health Committee Chair Richard Gottfried, sponsors of the New York Health Act in the New York State Legislature, welcomed the findings of a study of the bill by the highly-regarded, independent, non-profit RAND Corporation. The study confirms that New York Health would reduce total health care costs, while increasing spending on actual care rather than administration and insurance company profit; provide full health coverage to every New Yorker; save substantial money for almost all New Yorkers; and generate a net increase in employment due to increases in disposable income.

Young Turks: Single-Payer Health Care Advances in New York

Associated Press: NY Assembly OKs universal health care; bill halted in Senate

June 17

ALBANY, N.Y. (AP) — The New York state Assembly has again endorsed a single-payer universal health care system.

The Democrat-led chamber passed the measure last week for the fourth year in a row.

Passage of the legislation is largely symbolic, however. The Republican-led Senate is not expected to take up the measure before lawmakers adjourn for the year next year.

Assembly Speaker Carl Heastie says Democrats in his chamber believe all Americans deserve a health care system that guarantees coverage for all.

The proposal would allow all New Yorkers to enroll for health coverage that comes with no network restrictions, deductibles or co-pays. The system would use state and local funds that now go to Medicaid and other health care programs.

New Rochelle Patch: NY Assembly Passes Single-Payer Healthcare

By Michael Woyton, June 16

Albany has taken the first step toward giving New Yorkers a single-payer healthcare system. On Thursday, the state Assembly passed bill A4738, The New York Health Act would establish a program that would create a system of access to health insurance for New York residents.

The bill, which was sponsored by Assemblyman Richard Gottfried, D-75th Assembly District, is now going to be considered by the Senate. The Senate version, sponsored by Sen. Gustavo Rivera, D-33rd Senate District, is currently being considered by the Senate Health Committee.

If it comes to the floor of the Senate, it’s a toss up whether it could pass because, even though the Democrats have a one-seat majority in the 63-seat body, one Democrat — Brooklyn Sen. Simcha Felder — caucuses with the Republicans.

Under the bill, according to a press release from Assembly Speaker Carl Heastie and Gottfried, every New York resident would be eligible to enroll, regardless of age, income, wealth or employment, in the healthcare plan.

Video – Spectrum News: Will single-payer healthcare ever come to New York?

June 14 – Video here.

SPECTRUM NEWS VIDEO: The state assembly has again passed the bill to create a single-payer health care system in New York. And again, the Senate has no plans to vote on it. But in the time since Assemblyman Dick Gottfried first began sponsoring the measure, both the health insurance system and national opinion have changed a lot. He discusses where the issue stands now.

Queens Chronicle: A look at the fight for single-payer in New York

By Ryan Brady, June 14

With the Trump administration having taken steps to weaken Obamacare, New York activists have stepped up demands for the state to have a single-payer healthcare system.

In three of the past four years, New York’s lower chamber has passed a bill introduced by Assemblyman Richard Gottfried (D-Manhattan) that would establish the system in the state. Twenty-seven of Albany’s 63 state senators — all of them Democrats — are also carrying the bill in their chamber.

The bill’s never been passed in the state Senate, which for all but a short time has been controlled by the GOP for decades. Its numbers are now split evenly between Republicans and Democrats, owing to one from the former camp going on naval duty.

Implementing Gottfried’s plan, the New York Health Act, would require waivers from the federal government.

Gov. Cuomo said last year that he would sign the bill if “it was not incongruous to what the federal government would do to us. I think it’s a very exciting possibility. But I think it’s going to be a federal play and we are, our funding system basically relies on Medicaid from the feds. And if they turn off that valve or slow that valve, there is no way we’re going to be able to make that up in this state no matter what.”