Feb 5, 2019 5:05 PM

The Democratic Party’s newfound control of all three branches of New York State government this year has led many to believe that progressive bills previously blocked by the formerly Republican-controlled Senate have a better chance of making it to the governor’s desk.

One of those bills is the New York Health Act, a proposal to implement a single-payer health care system in the state.

This program has been proposed for several years—with the bill passing the Assembly the last three sessions—and those fed up with the current health care system and its ever-rising costs say they are optimistic that the bill may actually get approved this year.

The Progressive East End Reformers, or PEER, a South Fork-based group lobbying for approval of the measure, will hold a public forum at the Stony Brook Southampton campus on Saturday, February 9, at 1 p.m. in the Duke Lecture Hall, to educate the community on the details of the legislation. A panel of experts, representing different segments of the health care system, will discuss all facets of the proposed single-payer program and what it would mean for New Yorkers if it were to be implemented.

Panelists will include State Assemblyman Fred W. Thiele Jr.; Martha Livingston, chairwoman of the Public Health Department at SUNY Old Westbury and vice chairwoman of the New York Metro chapter of the Physicians for a National Health Program; and Dr. Michael Hynes, superintendent of schools at the Patchogue-Medford School District.

“We want people to come and learn about what the New York Health Act is,” PEER co-chairwoman and Sag Harbor resident Kathryn Szoka said. “We want people that are on the fence. We want to get beyond just the people who are already supporting it—although we want them to come, too.”

This single-payer method, called New York Health, would replace the existing multi-tiered system of employer-based insurance, individually purchased insurance and federally sponsored programs such as Medicare, Medicaid, and all those mandated under the Affordable Care Act, and pool all health coverage into one, state-sponsored system. The only exception would be long-term care, which would not be covered under the plan.

Overall, it would save the state and a majority of taxpayers money while providing more comprehensive care to more people. Around 90 percent of residents would see savings, according to a 2018 report by the Rand Corporation, an independent think tank. Funding would come from income-based taxes rather than insurance premiums, and spending would come from a government-run trust fund.

Every resident would be eligible to enroll, regardless of income, employment, age or citizenship status.

In Suffolk County alone, more than 100,000 people were uninsured in 2015, and more than 64,000 people were unemployed in 2016, according to the latest data from the County Health Rankings and Roadmaps. All of them could be covered under the new plan.

“Obviously, health is a basic right. This is something all residents of the U.S. should have access to,” said Cheryl Cashin, a health economist who has 25 years of experience working in international health policy and a PEER member who will be moderating the upcoming forum.

Removing private health insurance companies from the equation means that there would no longer be any out-of-pocket costs like co-payments and deductibles, nor any network restrictions—allowing patients to choose their health care provider rather than being limited to those covered by their insurance.

Financing New York Health would require dramatic shifts in the way people pay for health care, but it would likely save most residents and employers a significant amount of money, according to several independent studies.

Funding would come from two forms of taxes that scale with income—a payroll tax and a non-payroll tax for all other forms of taxable income such as interest, capital gains and dividends. Employers would pay at least 80 percent of the payroll tax, while employees would pay the remaining 20 percent.

Current legislation does not include specific marginal tax rates by income bracket, so state lawmakers would have to negotiate that if the bill were to be passed. Estimated tax rates show lower-income residents paying much less and highest-income residents paying more on average, according to the Rand Corporation report.

With regard to long-term care, the bill states that the New York Health Board of Trustees would develop a proposal for long-term care coverage within the first two years of the program. Mr. Thiele said that the bill’s sponsor, Assemblyman Richard Gottfried from Manhattan, is considering adding a section for long-term care into the bill soon, among other changes.

“The best insured person in New York State will be better off once this passes than we were beforehand,” said Ms. Livingston, a panelist at the forum who is also an active union member. “Our current system is far too expensive and satisfies absolutely nobody but shareholders and executives of the insurance industry and pharmaceutical industry.”

She added that doctors are also frustrated with the existing system, saying that there are “endless hoops they have to go through” to provide the care they want for their patients and “endless stories of them having to fight with insurance companies.”

Having a single-payer system has been proven to be the most effective health care method in other countries, according to Ms. Cashin. She has helped design and implement health financing policies in regions throughout Asia, Europe and Africa.

“I’ve read the act in a lot of detail,” Ms. Cashin said. “And this act has many elements that we know are good practices and can make the system better.”

Dr. Hynes, the forum’s school representative, said that many families and employees in the Patchogue-Medford School District struggle to get their health care needs met. “For me, and I would say for most educators, it’s extremely important that our employees and kids are taken care of. As of right now, that’s not the case,” he said.

Dr. Hynes said that his district offers robust health coverage to its employees, but they still have to contend with rising out-of-pocket payments. His district provides free health and social services, like medical and dental screenings and assistance from the Huntington-based Family Service League, which a significant number of students and employees take advantage of because they otherwise cannot afford them, he said.

“You see the way [health care] is now, there’s such a long way to go. But I’m hoping this bill is a step in the right direction,” Dr. Hynes added.

The superintendent also mentioned the need for more mental health services for the growing number of students experiencing anxiety and depression. A wide range of mental health services are offered under Medicare and Medicaid, which would in turn be offered under New York Health.

Implementing a single-payer system on a state level rather than on a national level may come with a few setbacks, however.

Currently, the federal government provides a number of health programs in New York, including Medicaid, Medicare, Family Health Plus, Child Health Plus and the Affordable Care Act, among others.

In order to create a true single-payer system, the state would have to obtain federal waivers to replace and merge the health coverage under those programs into New York Health. The waivers would allow all federal funds that the state receives for such programs to be deposited into the New York Health trust fund. That way, New York residents could receive all health services from the state system.

Obtaining the federal waivers could prove difficult, as the current administration remains hostile to the Affordable Care Act and Medicare for All.

“For this to move forward, the idea that we might get waivers from the Trump Administration is a heavy lift,” said Mr. Thiele, who supports the bill. “If you take Medicaid and Medicare out of [New York Health], you’re talking about a substantial portion of the population. To make it truly work, those waivers are important.”

Another concern lies in the fact that the wealthiest New York residents would pay the most toward the health plan, likely more than they do right now. That could incentivize them to move to a state where they could pay less.

“Can you do this only on a state basis? The tax structure you have to create—does it create issues where wealthy taxpayers might leave the state?” Mr. Thiele questioned.

Regardless, experts agree that starting at a state level is the right first step.

“In an ideal world, this would work at the federal level,” Ms. Cashin said. “But I don’t think states can sit back and wait. There is a long history of health care innovation on the state level.”

At the PEER forum, guests will be encouraged to take a health care survey for the Campaign for New York Health, the primary statewide coalition advocating for the implementation of the New York Health Act. The Campaign plans to present the data from the surveys to the State Legislature when the bill goes onto the floor, as well as to the general public to inform residents of the current quality of the health care system, according to Ms. Szoka.

Charts and graphs comparing the American health care system to systems in other countries will also be displayed at the event.

“Just reflecting on PEER and the last three years, one of the most satisfying aspects of it is being able to learn about a particular subject in depth like the New York Health Act and then see that the community, when you offer the opportunity to be educated about it, really respond and be eager for that,” Ms. Szoka said.