June 5th was Single-Payer Healthcare Day in Albany, New York
This post was authored by Dan Colacino, Vice President of Underwriting and Compliance at Rose and Kiernan, Inc.
June 5th was Single-Payer Healthcare Day in Albany, New York. This is the day that advocates of turning our health insurance over to New York state rallied for passage of the New York Health Act – New York’s version of single payer. The bill would prohibit the sale of private health insurance for the majority of New Yorkers and force them to enroll in a state-run health plan while making everyone who lives and works in New York state – whether they enroll in the state-run plan or not – pay for it through new taxes on payroll and investment income.
Everyone agrees that universal access to healthcare is a goal we should strive for, but universal access to healthcare is not synonymous with single-payer healthcare or even Medicare for All. Why? First, over half of New Yorkers get their health insurance through their employer, but this bill would unnecessarily eliminate employer-sponsored health insurance.
Second, in 2009, prior to the passage of the Affordable Care Act (ACA), New York’s uninsured population stood at 13.5 percent. Since the introduction of the New York State of Health (NYSOH), New York’s health insurance marketplace, the uninsured rate has dropped to less than six percent. Approximately 4.3 million New Yorkers signed up for care through NYSOH – 1 million in the individual market – the vast majority of whom received a subsidy to help with their insurance. The remaining balance received insurance for no cost through Medicaid or the Essential Plan.
Third, a large number of those who are still uninsured do so at their own choice even though affordable health insurance may be available through the marketplace. As a direct result of the ACA, premium rates in New York’s individual market have dropped by over 50 recent.
Fourth, New York State does not have a favorable track record of making good use of additional tax dollars, even when they’re specifically designated. In 1996, the NYS Legislature passed the Health Care Reform Act (HCRA). This legislation was intended to help hospitals pay for uncompensated care by imposing an almost 10 percent tax on inpatient and outpatient hospital care. In 1996, the uninsured population was over 15 percent, and there was a need. Now, as noted, the uninsured rate is below six percent, but the tax keeps increasing every year and goes to fund other initiatives. It is now New York’s third-largest tax, generating almost $6 billion dollars in revenue. Also, it is not used exclusively for healthcare anymore. It often goes to plug gaps in the state budget. The New York Health Act is projected to cost up to $226 billion, in addition to the $168 billion current State budget. Where do you think that will end up?
As far as Medicare for All, if you didn’t notice the President’s new prescription drug blueprint, American Patients First, very quietly shuffles some drug benefits from Part B to Part D, significantly raising copays for a number of Medicare beneficiaries, with no vote or legislation required. State governments in charge of single-payer healthcare will do the same when budget crunches hit and they need to find cuts somewhere.
What more can the New York Health Act provide for New Yorkers other than to raise taxes? Vermont passed a single-payer healthcare bill, but when then-Governor Peter Shumlin and the Vermont legislature finally figured out the cost of the bill, they immediately repealed it since it would raise the tax burden by 12 percent on Vermont residents.
A recent poll shows that the majority of New Yorkers oppose single payer (53 percent against, 31 percent in favor), and that an even greater majority (64 percent) have major concerns about having state politicians in charge of a government run single-payer healthcare system. The number of those opposed increased to 66 percent when told that funding the plan would require as much as $225 billion per year in increased tax revenue, almost doubling New York State’s current annual budget.
Voters are concerned about the quality of care that they’d receive under a state-run single-payer system as well; 61 percent said that they are worried about patient outcomes, and 60 percent said that they were worried about being able to keep their current provider.
Voters are in favor of universal healthcare; 58 percent favor requiring all New Yorkers to have healthcare. Sixty-three percent favor revising health insurance rules to encourage younger, healthier people to buy coverage, and 68 percent favor expanding subsidies for working and middle-class families while expanding eligibility for Medicare or Medicaid Managed Care.
The solution is not in reshuffling the insurance deck, but in finding ways to bring down the cost of healthcare. The New York Health Plan accomplishes only the former and is not a plan that we can afford in New York State.