At a joint meeting on August 1, the New Paltz Town and Village Boards unanimously approved a resolution urging passage of the New York Health Act (NYHA), A.4738/S.4840. First introduced in 1992 by Manhattan assemblyman Richard Gottfried, the bill establishing a single-payer health care system in New York State has passed in the Assembly for the past four terms, but invariably stalled in the State Senate, where its primary sponsor is senator Gustavo Rivera of the Bronx.
Under NYHA, doctors and hospitals would be paid for their work by a single tax-supported fund, similar to Medicare, rather than through hundreds of insurance companies as under the current multi-payer system. Instead of the multitude of plans currently available, each with different networks of providers and different services covered, every resident, regardless of age, employment status or preexisting conditions, is automatically enrolled in the same comprehensive plan. NYHA fully covers all medically necessary services: comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, mental health, reproductive health, rehabilitation, dental, vision, hearing, medical supply costs and even long-term care.
Elimination of insurance paperwork, new leverage for bulk purchasing of pharmaceuticals and other efficiencies are projected to result in a net savings of 3.6 percent in the cost of health care statewide, according to a 2018 RAND Corporation study. While ultimately “the costs are going to depend on what’s negotiated between the government and the providers,” state senator Jen Metzger told the two boards, “the modeling is very positive. The current system is totally broken.”
Removing all financial barriers to care, the system is funded through “progressive” (income-based) taxation, and eliminates all premiums, co-pays, deductibles and out-of-network providers. All doctors within the state would be included in the network of approved providers. Employers would pay at least 80 percent of the tax on payroll, and employees up to 20 percent. The RAND study estimates that a New Yorker with a $50,000 annual income, taxed at an effective 6.9 percent rate, would lay out $690 a year for health coverage, while his or her employer would pay $2,760; a self-employed person would pay $3,450 for the year.
Public hearings on the bills are currently being held around the state, and the collection of endorsement letters from municipalities, such as New Paltz just approved, is part of that process. The legislation’s staunchest opponents are the insurance industry and some unions whose members argue that they traded away salary increases for enhanced health plans as part of labor negotiations. Governor Andrew Cuomo has expressed general support for the single-payer concept, but so far not specifically committed to signing NYHA as drafted.
The State Senate is not expected to vote on S.4840 until 2020, but the realignment of that body from red to blue in the 2018 elections has greatly increased its chances of passage. Actual implementation “will take years. This legislation is just a framework,” Metzger said.