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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.

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.

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


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