New York Is Still A Long Way From Universal Health Care

In 2018, progressive Democrats in New York City and moderates in the suburbs and upstate campaigned, with near-equal fervor, on realizing the dream of single-payer healthcare in New York. When Senate Democrats took control of the chamber in 2019, there were high hopes that the New York Health Act, at last, would come to the floor for a vote.

It never did. Now, in 2020, with activists gearing up for a new fight and legislators readying, once more, to tangle with Governor Andrew Cuomo, the New York Health Act appears no closer to a floor vote, let alone passage. State lawmakers are not highlighting it as part of their legislative agenda push, which includes big ticket items like legalizing marijuana.

The New York Health Act has sailed through the Assembly in the past, though it was not brought up for a vote in the lower chamber last year. In the Senate, it has 31 co-sponsors, one short of a majority. Two Democratic senators, Long Island’s James Gaughran and the Hudson Valley’s James Skoufis, are past supporters—Gaughran campaigned on it 2018 and Skoufis voted for it when he was an assemblyman—but both have declined to sponsor the current bill.

Last year, the Senate held a series of hearings on the legislation, and activists with the Campaign for New York Health, the umbrella organization fighting for single-payer in New York, are planning to distribute a sign-on letter to lawmakers on Wednesday, the start of the new legislative session.

“2020 is going to be a critical year for healthcare,” said Katie Robbins, the Campaign for New York Health’s campaign director.

The New York Health Act, however, is not being emphasized this year like it was two years ago. Progressive insurgents hoping to unseat more moderate incumbents are not name-checking the bill on their websites anymore.

Only one candidate backed by the Democratic Socialists of America, Jabari Brisport, specifies the passage of the single-payer bill in Albany as one of his key priorities. Other non-DSA progressive challengers don’t mention the bill, either.

All DSA candidates, however, must state their support for the New York Health Act to win an endorsement from the organization. The lone DSA member in the legislature is not optimistic the bill will move anytime soon.

“The legislature would only really be able to do it in the budget, and Cuomo would never allow something with that large of a fiscal impact to pass, even if the revenue were 100 percent accounted for,” said State Senator Julia Salazar, a Brooklyn Democrat who campaigned aggressively on passing the New York Health Act when she first ran in 2018. “I hope I’m wrong. But it’s hard to imagine passing single-payer healthcare with a governor who’s this committed to austerity.”

Salazar, who insisted she did not want to speak for DSA, said the socialist group’s focus right now is passing universal healthcare on the federal level through their advocacy for Medicare for All, the signature policy priority of Senator Bernie Sanders, their endorsed presidential candidate.

“Just to be clear, NYC-DSA still fully supports the NYHA, as do I,” Salazar added. “I just think that the realistic assessment is that the governor who imposes an arbitrary spending cap every budget cycle, and who doesn’t seem to support single-payer healthcare, is going to continue to be an obstacle.”

Even with Democrats in control of all branches of government, single-payer faces significant headwinds in New York. Cuomo is not a supporter of the New York Health Act, though he has said he would back Medicare for All on the federal level.

The New York Health Act, which would create a universal, comprehensive program—dental, vision, and long-term are covered—eliminating all co-pays, deductibles, and premiums, would need $139 billion in new tax revenue, 156 percent more than the state currently collects, according to a RAND Corporation study. The single-payer program would create dramatically lower administrative costs, though this wouldn’t offset the need for new taxes.

New York State is currently facing a $6 billion budget hole fueled by rising Medicaid costs. Most energy and advocacy around healthcare is expected to take place around that gap, with progressives arguing against Medicaid cuts while Cuomo seeks reductions. Both Cuomo and Andrea Stewart-Cousins, the Senate majority leader, have resisted calls to raise taxes to close the $6 billion gap, let alone create a new healthcare system in New York. Critics of the push for universal healthcare have contended that the state’s failure to contain Medicaid costs demonstrates it can’t be trusted to be reasonable stewards of a new healthcare system.

Medicare for All advocacy, built around the Sanders campaign, has worked in tandem with activism around New York Health Act, but now appears to be occupying more activist energy. Matthew Thomas, a member of the DSA’s electoral group in Queens, said the organization remains committed to the New York Health Act.

Citywide, however, there are two policies DSA has voted explicitly to put its money and volunteer muscle behind: passing Medicare for All and a Green New Deal, along with putting energy companies under public ownership.

“It’s not Medicare for All versus the NY Health Act,” Thomas said. “DSA has a nationwide effort for Medicare for All connected around advocacy for Bernie Sanders. It’s an organic national movement operationalized in the New York City chapter.”

Though several major labor unions, including the healthcare workers union 1199 SEIU and the New York State Nurses Association, have expressed support for the New York Health Act, many municipal unions have not, fearing the healthcare plans won through collective bargaining would be lost with a single, statewide program. Union members who live out of state and commute to New York to work could lose health coverage if in-state members, covered by single-payer, stop contributing to the union’s healthcare fund.

In addition, the state would need a federal waiver to redirect Obamacare funds for Medicare, Medicaid, and tax credits to a new single-payer system, an unlikely event as long as Donald Trump is president.

Bronx State Senator Gustavo Rivera, the chairman of the Senate’s Health Committee, argued that the Medicaid-driven budget hole creates an opportunity for the New York Health Act because, in his view, it’s the only way to control healthcare costs in the coming decade and beyond.

“The fact is, moving to single-payer, as complicated and difficult as it might be, is the only way to guarantee long-term we can control costs,” he said. “The type of savings that are possible with single-payer are never going to be possible, regardless of what kind of reforms we make on this side, if we don’t move to a single-payer system.”

Manhattan Assemblymember Richard Gottfried, the sponsor of the New York Health Act and the architect of the policy, added that the Medicaid shortfall wouldn’t affect implementation of a single-payer system because it would come with new revenue raisers—higher income and employer taxes—to pay for itself. He is still optimistic that his bill, which has passed the Assembly four times but never reached the floor of the Senate, would get to Cuomo’s desk and be signed into law.

“As Mel Allen used to say, they do actually have to play the ball game. We are making progress,” Gottfried said.