Can New York Pass Single-Payer in 2021?

In 2018, as State Senate Democrats across New York City and the surrounding suburbs stormed to victory, progressives were filled with great optimism. Long-stalled priorities in Albany, like stronger tenant protections and laws safeguarding reproductive health, were likely to become law, with Republicans chased from power.

Another holy grail loomed: single-payer healthcare for New York State. The Democrat-controlled Assembly had passed the New York Health Act several times, but the bill had no chance in a chamber controlled by Republicans. Many of the winning Democrats, including moderates on Long Island, had pledged support for the legislation during their campaigns. 

But the 2019 legislative session, while full of progressive victories for the new Democratic majority, did not include passage of the New York Health Act, let alone a floor vote. Some of the moderates who backed the legislation during their campaigns refused to co-sponsor it once in office. Governor Andrew Cuomo, by far the state’s most powerful figure, continued to dismiss the idea of a statewide single-payer system, claiming support for a federal program would be less likely under a Donald Trump presidency.

The bill stalled in the Senate, one co-sponsor short of a majority needed for passage.

A year later, the Covid-19 pandemic struck. Cuomo gained new emergency powers over the budget and major legislative priorities were shelved. For months at a time, Assembly and Senate Democrats, seemingly unmoored, couldn’t even come together to vote on bills.

As a hellish 2020 winds down, advocates for single-payer healthcare and progressive lawmakers are planning to make 2021 more fruitful, plotting a renewed push for the New York Health Act when the legislative session resumes in January.

After a pandemic and the resulting economic upheaval threw many workers off their employer-based health insurance plans—738,000 New Yorkers lost jobs that provided health insurance, and those plans covered an additional 634,000 dependents, according to Paul Fronstin of the Employee Benefit Research Institute—there is the hope that new popular support will pressure undecided legislators and even Cuomo.

In addition, a new class of assembly members and state senators will take office next year, most of them far more openly progressive than their predecessors. If two more Democrats flip Republican-held State Senate districts in November, Democrats will have a veto-proof supermajority in the chamber, theoretically allowing them to override Cuomo’s opposition.

“In the Assembly, we are going to have our largest freshman class in 45 years,” said Assemblyman Richard Gottfried, the health committee chairman and the longtime co-sponsor of the New York Health Act. “Almost all of those freshman democrats are people who campaigned strongly supporting the New York Health Act. You don’t have to be a democratic socialist to support the New York Health Act—but we will have quite a few of them in the Assembly in January.”

In the June legislative primaries, all four insurgent Democrats endorsed by the Democratic Socialists of America won their campaigns. A slew of other leftist Democrats won Assembly races as well. Though some of the defeated incumbents had been New York Health Act co-sponsors, the new class will be far more vocally in support of single-payer healthcare.

Jabari Brisport, a DSA-backed candidate who won an open Democratic primary in June for a State Senate seat in Brooklyn, campaigned forcefully on bringing single-payer healthcare to New York. “We’re making the case for single-payer healthcare during a pandemic,” Brisport said. “I think this upcoming session is the best window of opportunity for it."

“It’s not just Rivera and Gottfried pushing it anymore,” said Nolan DeBrowner, a member of DSA’s healthcare working group. “It’s a whole slate of new progressives. The New York Health Act had a lot of cosponsors, but essentially nobody was doing the full-throated advocacy and organizing that these incoming legislators are coming in with.”

Mass Pressure From Below

Over the last few years, one of the primary organizing vehicles around the New York Health Act has been the Campaign for New York Health, an advocacy organization that has held rallies and teach-ins around the legislation, which would abolish private insurance and allow every resident to have a comprehensive public health plan—everything would be covered, including dental and vision—without co-pays, premiums, and deductibles.

Katie Robbins, the director of the Campaign for New York Health, is monitoring competitive State Senate campaigns across the suburbs and upstate, where some of the Democrats running have pledged to vote for the single-payer legislation. As many as 10 Democrats running have expressed support for the bill or featured it on their websites.

“We’re laser-focused on making sure we have a majority, the strongest majority possible,” Robbins said.

Organizers with DSA have been targeting Democratic Senate holdouts, including a conservative who used to caucus with the Republicans, Simcha Felder of Brooklyn, and Diane Savino, a Staten Island lawmaker who once belonged to the now defunct Independent Democratic Conference.

DSA volunteers have focused on advocating for Medicare for All on the national level and a single-payer program for New York, hoping to pressure Democrats through rallies, phone-banking, and canvassing. To build public support for NYHA, they are holding weekly tabling events and are planning virtual town-halls in each of the DSA-backed candidates’ districts.

DSA hopes to recreate the success they had around pressuring Congressman Hakeem Jeffries, a more centrist Brooklyn lawmaker, to co-sponsor Medicare for All.

“Our goal for the next session is to get a floor vote on the New York Health Act,” said Emma Claire Foley, a member of DSA’s healthcare working group. “If the governor doesn’t support it, we want to give him a chance to have to navigate that in public.”

“We have a lot of work to do to get people unafraid of Cuomo,” said Christie Offenbacher, chair of the healthcare working group. “And the only way that’s possible if there’s mass pressure from below.”

“We need to get a mass base out in the streets,”  Offenbacher added. “Our vision here is a thousand people out in the streets in January, around Cuomo’s State of the State address, and then a thousand people in February, and then ten thousand in March!”

Senate Holdouts

The full Democratic conference co-sponsored NYHA in the 2017-2018 session, when Republicans controlled the Senate. Since the Democrats took control of the chamber in 2019, several senators who had previously co-sponsored the bill have refrained from supporting it. Faced with the possibility of NYHA passing, these senators began to form concerns about the bill, which generally fall into the category of either cost or public union opposition.

Long Island Senator John Brooks, who sponsored the bill in 2018, has since registered concerns that a single-payer system could be overwhelmed by people moving to New York if the Trump Administration successfully repealed the ACA. He has also indicated to advocates that he does not believe there has been enough fiscal analysis of the bill.

If, like in 2018, a surge in Democratic turnout fuels another wave of Senate victories and a veto-proof majority is achieved, major hurdles would still remain. For New York to afford a single-payer healthcare program, major tax increases would be required.

A RAND Corporation study found that the New York Health Act would save New Yorkers $15 billion by 2031 by dramatically lowering administrative costs. But it would also require $139 billion in new tax revenue, 156 percent more than the state currently collects, the study found.

Moderate Democratic senators on Long Island and Andrea Stewart-Cousins, who represents parts of Westchester, have been wary of voting for any kind of tax increase. And Cuomo has long resisted raising taxes on the wealthy, let alone the middle and upper middle classes, and has so far rejected the idea to close a budget shortfall during the pandemic—let alone fund a major healthcare expansion.

“To be really blunt: the biggest roadblock in my opinion is still the governor,” said State Senator Julia Salazar, a Brooklyn Democrat and DSA member.

Union Opposition

Two major healthcare worker unions, 1199 SEIU and the New York State Nurses Association, are supporters of the New York Health Act, but other large unions are wary of the legislation. At least one senator, Diane Savino, has told advocates that she cannot support the legislation as long as major unions oppose it.

One fear is that the state-run health plan would be inferior to the union plans negotiated for members. Municipal unions also fret that a statewide single-payer plan could make the idea of joining a union less attractive.

In past cycles, unions have brought up another logistical concern: how to manage the single-payer program with out-of-state workers, particularly those in labor unions. Many unions pool their money to purchase more comprehensive benefits; such pools could be diminished if every in-state union member has a state-run health plan, potentially draining benefits for New Jersey or Connecticut residents who work in New York but can’t access the single-payer plan.

Mischa Sogut, Gottfried’s legislative director, said this challenge has been resolved through amended legislation. Originally, the bill had a tax credit against the New York Health Act for the cost of employers buying out-of-state health coverage for out-of-state residents who work full-time in New York.

Sogut said that since the employer would be subject to a New York Health tax whether the worker is in New York or out-of-state, the bill was amended in 2019 to just deem the out-of-state worker a “resident” under the bill’s definition of a resident. They would get the same health coverage package that a New York resident working in New York would get.

New York would also need a federal waiver to redirect Obamacare funds for Medicare, Medicaid, and tax credits to a new single-payer system, an unlikely event as long as Trump is president.

Even if Biden is elected president, said Michael Sparer, the chairman of the department of health policy and management at Columbia University’s School of Public Health, securing a waiver for Medicare would be especially challenging.

“If Biden wins and Democrats take the Senate, all effort and action around healthcare will be on the federal level,” Sparer said. “I don’t think it’s feasible at the state level.”

The waiver has been cited as a reason for some Democrats to not support the New York Health Act as long as Trump is president.

No state has successfully implemented a single-payer model. New York, with its large population and high tax base, could be a better fit than Vermont, which attempted to implement single-payer and failed.

Gottfried, the New York Health Act architect, is still optimistic New York can eventually stand apart.

“The state’s current financial situation does not get in the way of the New York Health Act,” Gottfried said. “If many New Yorkers’ personal finances stay the way they are, they are certainly going to need the coverage of the New York Health Act.”