ALBANY — The proposed New York Health Act, legislation that would offer a state-run, one-payer health insurance program, drew wide-ranging criticism at a recent discussion sponsored by the Empire Center.
Representatives of state government, health-care interest groups and academia convened to spar over the proposed legislation that proponents say would reduce the cost of health care while making quality, affordable insurance available to everyone.
Opponents politely scoffed at that notion during panel discussions at the city’s prestigious University Club. Expanding Medicaid within the state’s Affordable Care Act Exchange might be a better option, suggested Michael Sparer, chairman of Columbia University’s Mailman School of Public Health.
What follows is a synopsis of viewpoints by some of the panel’s participants, as well as details of the legislation that remain subject to tweaks by the state Legislature.
INTENT – To reduce overall health insurance costs while providing affordable coverage for the 1.1 million New Yorkers currently uninsured.
PERSONAL COST – The universal insurance would be financed by payroll taxes. The Rand Corporation projects that in 2022, taxable reportable income of $27,501 to $141,200 would be subject to a Health Act tax rate of about 12 percent. Above that, 18 percent.
At about 12 percent, the payroll tax for the insurance would be $12,000 on a $100,000 income.
WHAT’S COVERED – All medical bills for 20 million New Yorkers. There would be no co-payments or deductibles, issues that proponents say prevent even some insured people from seeking medical care.
PRESCRIPTION DRUGS – Also covered. Proponents expect the state can leverage its millions of users to extract lower costs from pharmaceutical companies.
TREATMENT AND PRE-AUTHORIZATION – expected to be reduced by the legislation. “With private insurers there’s the advantage of making sure the care is appropriate,” said Sean Doolan, general counsel for the NYS Conference of Blue Cross and Blue Shield Plans. Medicare recipients can already seek treatment providers without approval.
THE IMPACT – The state’s richest taxpayers might flee because of their high costs, drastically undermining the tax base, said Bill Hammond, health policy director for Empire Center, a non-partisan think tank. The plan could more than double state taxes, he said. Assemblyman Richard Gottfried, D-Manhattan, who first proposed the legislation in 1992, disagreed people would stampede out of the state. ”… A good number of these people will have their savings wiped out by long-term care costs. Under the New York Health Act that will never happen.”
SHIFTING COSTS – The bill, A05062, states it would replace local and state shares of Medicaid, as well as state and local payments for public employee health coverage. That in turn could reduce some state and local taxes.
PAYING PROVIDERS – The plan would develop alternative payment methods to replace fee-for-service, which the bill states rewards volume of care, not necessarily quality. Rates would be negotiated with health-care providers. To even the playing field, the bill would authorize the providers to form organizations to collectively negotiate with the state.
DROP MEDICARE – No one gives up Medicare membership or benefits. New York Health would pay the Part B premium, pick up or eliminate co-pays, and cover home care as well as other long-term care.
WHERE TAX DOLLARS GO – It’s proposed to establish a trust fund separate from the overall state budget.
PLAN OVERSIGHT – A 28-member board of trustees appointed by the governor upon recommendations of stake holders and the Legislature.
HOW SOON – A vote by the Legislature is not scheduled, but could occur this year. If approved, it will take several years for the plan to be fully implemented, said state Sen. Gustavo Rivera, D-the Bronx, chairman of the Senate’s Health Committee.
© 2019 Times Herald-Record