Single-payer push ramps up again; industry groups point out flaws

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Assemblyman Richard Gottfried and state Sen. Gustavo Rivera touted the new version of the New York Health Act on Monday in Albany. It goes further in protecting New Yorkers from health costs by including coverage of long-term care.

But groups representing hospitals, doctors, insurers and employers said the new version of the bill, which would create a state single-payer system, is flawed and inferior to alternative ways to get coverage for the about 1 million state residents who remain uninsured.

“Millions of New Yorkers, almost all of the people who have health coverage, go without needed health care or face financial obstacles and hardships to get it,” Gottfried said at the press conference, which was broadcast on Facebook. He said his plan would address that need.

The bill would create a state trust fund to finance medical coverage, including long-term care, for all state residents with no required premiums or deductibles. An analysis by Rand Corp. conducted last year, estimated it would cost $139 billion to fund the program in 2022, with an additional $18 billion to $22 billion needed to cover long-term care. The analysis showed that households earning up to $290,000 would pay less in new taxes than their current health spending as a percentage of their income. But for small businesses that don’t offer coverage, costs would go up significantly. The new bill still lacks a specific tax structure to finance the program.

One new aspect of the bill is a dispute resolution process for negotiating fees with providers. The process would involve, if necessary, the appointment of a three-member fact finding panel to advise the health commissioner. Such a process could hinder the state’s ability to control costs, which is critical to making the plan feasible, said Bill Hammond, director of health policy at the Empire Center in Albany.

“The state’s contract with hospitals, nursing homes or doctors could be decided by a three-person panel,” said Hammond, who opposes the bill. “You would want that panel, at the very least, to remember the state has limited resources, and the taxpayers are on the hook for whatever they decide and there’s no mention of that.”

Lev Ginsburg, director of government affairs at the Business Council, said the employer group is opposed to the bill and concerned that the long-term-care benefit increases the cost.

“What’s to stop hundreds of thousands of people from turning to New York to take advantage of the benefit after not contributing to it?” he said of the possibility of people retiring in New York. “We simply don’t buy the idea that it would be much cheaper for your average employer.”

Gottfried and Rivera look to begin debate on the bill after the state budget is passed, by April 1. “Something as complicated as this should not be dealt with in the budget,” Rivera said.

Gottfried said he would aim to bring the bill to a vote in the Assembly some time after the budget passes, while Rivera said he plans to hold hearings to discuss it in the Senate.

Despite public comments from CMS Administrator Seema Verma that she would deny waivers to states seeking to create a single-payer system, Gottfried said the program could be created with or without federal approval. Without continued federal support from Medicare and Medicaid, New York’s bill would climb higher.

A spokesman for the Greater New York Hospital Association said the bill isn’t the right way to help the 5% who are uninsured statewide get access to health care and endorsed Gov. Andrew Cuomo’s budget proposal to create a commission to find solutions.

The state Health Plan Association made a similar argument that more people could get insurance without disrupting the current system.

Driving down the uninsured rate further won’t make the same dent in affordability as the New York Health Act, though. As employers shift more medical costs to workers, a growing share of U.S. adults are underinsured, according to the Commonwealth Fund. Of adults ages 19 to 64, 37% said they had trouble paying a medical bill.

Dr. Thomas Madejski, president of the Medical Society of the State of New York, said the new version offered some improvements. It clarified that for services covered by Medicare, prior authorization for care will be no more restrictive than with traditional Medicare. Its membership is divided on the issue, but the medical society has a “longstanding policy in support of a multi-payer insurance system to achieve universal coverage and in opposition to a single-payer system,” Madejski said.

© 2019 Crain’s New York Business