It’s Time for the NY Health Act

Those paying attention to New York State politics over the last handful of years have likely seen reference to the New York Health Act at some point or another. First introduced to the State Assembly in 1992, the bill eliminates private insurance and replaces it with universal, publicly-funded healthcare for every New Yorker. Each year from 2015–2019, the bill passed in the state assembly only to stall in the senate. Now, with a senate Democratic supermajority, the NY Health Act’s chances of becoming reality may be more realistic than ever. And not a moment too soon — in this crucial time for our state, with the Covid-19 pandemic compounding the harsh realities of our for-profit healthcare system that continue to disproportionately underserve marginalized communities, the time for action is now.

Universal healthcare is one of those frustrating political issues that has broad public support — as high as 69% nationally in one recent poll — but seems to get stuck in the political mud somewhere between public polling and the passage of actual legislation. It can feel like an intimidatingly complicated topic, and the flurry of complex middle ground solutions proposed in recent years has significantly contributed to that confusion. Yet, above that noise, an overarching principle remains steadfastly true. The simplest, best, and — if we’re being honest — the only reason to pass the NY Health Act is the moral one. The World Health Organization states in its constitution: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” And yet, 50% of New York respondents to a recent survey admitted to skipping care due to cost. Medical debt is the leading cause of personal bankruptcy nationwide. A 2009 study determined that 45,000 Americans die every year directly due to being uninsured. If we believe that healthcare is a human right — as 94% of New Yorkers do— then it is time to admit that the current system only offers that right to the wealthy.

As the seed of the fundamental moral case for universal healthcare starts to germinate, additional arguments for the concept quickly blossom in every direction. It takes capitalistic profit out of healthcare (try to say the sentence “my insurance company executives make more money when they deny my claim” without getting nauseous). It unties the artificial & prejudiced knot between healthcare and employment in a year where unemployment, thanks to the pandemic, reached 20% in New York City. It eliminates premiums, co-pays, co-insurance, and deductibles, replaces them with a progressive tax system, and, according to a 2015 study, ends up cheaper overall for 98% of New Yorkers (the 2% who take on a heavier burden are doing just fine). It’s simpler for healthcare providers — instead of being paid by Medicare, Medicaid, private insurers, patients out-of-pocket, and beyond, all their bills go to one place (this consolidation, as Dr. Abdul El-Sayed & Micah Johnson point out in their recent book on the topic, also leads to increased negotiating leverage against drug companies). It’s simpler for patients as well — no more “networks” to tiptoe in and out of, no more back-and-forth between you, your doctor, and your insurance company about who is going to pay for the test you needed. As mentioned before, it’s politically popular.

Crucially, it’s also a highly intersectional issue. The NYHA provides health insurance “without regard to the individual’s immigration status,” which means its passage would effectively give 400,000+ undocumented immigrants, many of whom are frontline workers, healthcare overnight. Black and brown New Yorkers have died from Covid-19 at twice the rate of their white counterparts, and they’re twice as likely to be uninsured. Women in New York are more likely than men to face problems getting the care they need, and that number goes through the roof for transgender folks. Black women in New York City are 12 times as likely to die during childbirth as white women. It’s appallingly clear that the current healthcare system disproportionately harms women, BIPOC, and LGBTQIA+ communities, and a universal healthcare system would be a monumental step towards solving that inequity.

Of course, we don’t have to look too hard to find examples of single payer systems in other areas of the world. Indeed, in a glorious feat of American exceptionalism, the United States is the only industrialized nation not to offer a universal healthcare program for its citizens. And that isn’t changing any time soon. Despite the recent presidential upgrade, a single payer healthcare system is not anywhere close to passing nationally. In fact, President Biden just last year made the incredulous claim that even if Medicare for All passed in congress, he’d veto it. So, New York faces a critical opportunity in 2021 — a chance not only to provide the care its citizens desperately need, but to be a leader for the rest of the country and demonstrate that a single-payer health care system can really work.

It won’t be an easy road to passage, but the NYHA’s growing list of endorsements & supporters provides reason for optimism. Its most vocal advocates in the state legislature include Senators Gustavo Rivera (the lead co-sponsor in the senate), Julia Salazar, Jabari Brisport, Jessica Ramos, Alessandri Biaggi, Robert Jackson, and Jeremy Cooney; Assemblymembers Richard Gottfried (the original author of the bill), Jessica Gonzales-Rojas, Zohran Kwame Mamdani, Linda Rosenthal, and Anna Kelles; and prominent organizations like the NY State Nurses Association, Working Families Party, New York City DSA,NY State Poor People’s Campaign, and VOCAL-NY. Outgoing Mayor Bill De Blasio supports the bill, but interestingly, among a large field of 2021 mayoral candidates in a city that has largely shifted leftwards over the last decade, only two significant candidates have come out in support: Dianne Morales & Carlos Menchaca. Scott Stringer, who has secured the endorsements of many of the state legislators who support the NYHA, recently waffled on an answer about his position on the bill. Maya Wiley did the same. Governor Andrew Cuomo does not support the legislation, but thanks to the supermajority, his support may not be necessary.

Critics of the bill come from the familiar places. Stringer & Wiley both referenced a concern about “passing premium costs onto workers.” One might point them towards a 2018 study by the RAND Corporation, a nonprofit policy institution who found that “New Yorkers with household compensation below the 75th percentile would pay an average of $3,000 less per person for health care.” A UMass study from 2015 goes further, asserting that “98% of New York households would spend less under the Act than they do now.” Other critics claim the plan would be too expensive overall. RAND says otherwise — “Total health care spending under the NYHA would be slightly lower than spending under the status quo in 2022, and the difference would grow over time.” Still others propose that such a major switch would be disruptive, and would upend folks who are satisfied with their existing plans. To that, one can ask themselves that tried-and-true American question — “does anyone I know actually like their health insurance?” Lastly, many who are against the plan claim to support single payer insurance, but assert that it is the responsibility of the federal government, not the state. And while in an ideal world this may be true – how many more New Yorkers are we willing to sacrifice while we wait?

In a recent online panel about the act, Gonzalez-Rojas put it bluntly: “We have a supermajority in the Senate. We have 107 Democrats in the State Assembly. We have a Democratic Governor. There’s absolutely no reason this can’t get done.” She’s right. With the 2021 state legislature now in session, the pandemic approaching its first anniversary, and New Yorkers’ healthcare costs growing at an alarming rate, it’s time. Let’s get it done, New York. It will save lives.