ALBANY — Push-back from labor unions and lack of support from the governor could stymie the NY Health Act, which last year was one vote shy of passage in the state Legislature.

In his 2019 “Justice Agenda,” unveiled in Manhattan last week, Gov. Andrew M. Cuomo did not mention the proposed state-run single payer insurance program as part of his healthcare platform.

Cuomo, while previously calling single-payer healthcare a good idea “in theory,” has been a critic of the legislation that has been introduced in New York by veteran Assemblyman Richard Gottfried every year since 1992.

“California has tried to do it, Vermont has tried to do it, nobody has been successful,” Cuomo, a Democrat entering his third term, said in August.

He suggested that universal healthcare would be easier to implement on a federal level.

Cuomo’s skepticism places him at odds with the majority of Democratic state legislators, who seem more emboldened to challenge New York’s centrist governor in the wake of their November election wins, and members of the New York City Council, who earlier this month approved a resolution calling for passage of the bill.

The NY Health Act has passed the Assembly five times and nearly every member of the incoming Democratic majority in the Senate has voted in favor of the bill or expressed support for a statewide single-payer system during this year’s election cycle.

The bill would provide complete health coverage to all New Yorkers without deductibles, co-pays, restricted provider networks, or out-of-network charges. It relies primarily on a steep payroll tax, 80 percent of which will be covered by employers, while the remaining 20 percent would be paid by employees.

At a recent New York City Council hearing, Gottfried, D-Manhattan, announced that he and the bill’s Senate sponsor, Sen. Gustavo Rivera, D-Bronx, will amend the bill next month to add full coverage of long-term care for all New Yorkers during the legislative session that begins next month.

The bills sponsors have said they would consider amending the bill further to address some concerns from the state’s powerful labor unions, who are divided over the NY Health Act and question how it will impact their bargaining power.

Healthcare unions like 1199-SEIU and the New York State Nurses Association have been major advocates for universal health coverage, while unions such as United Federation of Teachers and New York State United Teachers have not taken a position.

The Municipal Labor Committee, which represents New York City employees, are critical of the bill, noting that city workers would face new taxes, only to receive a benefit that is currently covered in full by the city.

Gottfried and Gustavo, after meeting with MLC members, said they would consider modifying the plan’s 20 percent tax requirement for individuals, enabling employers — including government — to voluntarily pick up the full payroll tax burden.

“City workers have given up wages and benefits to achieve (100 percent healthcare premium coverage), so it’s not outrageous that they would ask to continue that arrangement,” Gottfried said. “However, they have not responded to our suggestion that we could amend the bill.”

Harry Nespoli, head of the Municipal Labor Committee, said he wasn’t aware of the proposed amendment and is skeptical about how it would work.

From MLC’s perspective, Nespoli said, city workers would be taxed for a benefit they already receive and unions would lose healthcare as a critical bargaining chip.

“New York City gets taxed for everything, and now you’re going to tax us again and turn around and use it to give everyone free health?” Nespoli said.

Empire Center for Public Policy’s Bill Hammond, a longtime critic of the NY Health Act, argued in NY Torch, a public policy blog, that that the proposal to accommodate municipal workers “would seem to create a two-tiered system, with one set of rules for city employees, and another set for everyone else.” He said that the proposed amendment would also undermine any projected healthcare savings for New York City.

It is unclear if other municipalities will seek similar carve-outs.

A major logistical hurdle remaining for the NY Health Act is the need to obtain a federal waiver to redirect all federal and state healthcare funding streams towards a single-payer system. That seems unlikely with a Republican president in office. The bill’s proponents have proposed creating a supplementary “wrap-around” Medicare coverage for the uninsured until the NY Health Act is fully implementable.

The expense of implementation and the specifics of the tax structure to finance the plan each year have yet to be decided. The state would need to secure $139 billion a year in tax revenue to finance the plan, according to a RAND Corporation reportreleased earlier this year.

Gottfried said he expects more stakeholders and interest groups to participate in the discussion”now that we have both houses of the Legislature on the record supporting the bill.”

One group of critics Gottfried said he does not expect to engage with is the Realities of Single Payer, a coalition of insurance providers and other business interests.

“The insurance industry rightly understands that the bill would have them look for another line of work,” Gottfried said.


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