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As New York Nears Vote on Single-Payer, Divisions Show

Analysis  |  By Jack O'Brien  
   June 14, 2018

The plan to implement a government-run single-payer healthcare system in the Empire State has drawn praise from supporters and the ire of detractors. 

Several states are considering proposals to institute a single-payer healthcare system, including New York, where it has become a polarizing political topic in an election year.

The New York State Assembly passed the New York Health Act Thursday, which would create a statewide single-payer healthcare system permitting all New Yorkers to enroll while eliminating network restrictions, deductibles, and co-pays. The legislation has been passed four previous times by the Assembly but never received approval from the Republican-controlled state Senate.

Due to recent special elections, Democrats have a numerical majority in the upper chamber, which has renewed the effort to pass single-payer in New York. However, Republicans still maintain control due to a power-sharing arrangement with a Democratic senator who caucuses with the party.

Elements of the proposed bill

  • Creation of a statewide single-payer healthcare system available to all New Yorkers regardless of "age, income, wealth or employment."

  • All health benefits required by state insurance law are included in the plan, which would be funded through public medical programs or provided through the public employee package.

  • Establishes the New York Health Trust Fund to oversee state funds, as well as Medicare, Medicaid, and Child Health Plus federal funding, to finance the plan.

  • Shared local Medicaid funding would be eliminated.

  • According to a 2015 analysis from University of Massachusetts-Amherst Professor Gerald Friedman, PhD, the single-payer health plan would result in a $92 billion tax hike while saving $45 billion in statewide healthcare costs.

What proponents are saying

  • The New York Health Act was sponsored in the Assembly by Health Committee Chairman Richard Gottfried.

  • The bill is sponsored in the upper chamber by Sen. Gustavo Rivera.

"The health care system is rigged against working people, and Congress and the Trump administration are working to restrict health care access even more. New York can do better with an 'improved Medicare for all' single-payer system that covers all of us and is funded fairly," Gottfried said in a statement. "Support is growing with the public and in the State Senate. Assembly passage is an important step as we continue to build support for universal health care to benefit everyone."

Gottfried's press release also included statements of support from the 1199SEIU, the New York State Nurses Association, and the Campaign for New York Health, an advocacy organization aimed at passing the New York Health Act.  

What critics are saying

While the legislation received significant support in the Assembly, it faces an uphill challenge from Republicans in the state Senate, industry experts examining the proposal, and public opinion.

The New York State Business Council cited a poll from late May which found 54% of New Yorkers oppose a government-run single-payer healthcare system, while only 33% support such a plan.    

Bill Hammond, health policy director at the Empire Center for Public Policy, has been a vocal critic of the plan for years, questioning the legislation's fiscal projections and ramifications for New Yorkers maintaining their current health plans.

In 2016, Hammond authored a report entitled "The Case Against Albanycare," which argues that the favorable fiscal projections from single-payer advocates depend on "highly questionable math" and warns that the plan could present more opportunities for corruption.  

"By making the change on its own, New York would risk becoming a magnet for people from other states and countries in need of costly care," Hammond wrote. "To make up for lost insurance premiums, the move would also entail more than doubling the tax burden of what’s already the nation’s most heavily taxed state."

How does it stack up with other single-payers?

New York's single-payer proposal has also drawn comparisons to recent efforts to enact single-payer across the country.

  • Last year, the California state Senate approved the Healthy California Act, which had similar elements to the New York Health Act.

  • The California legislation would have created a statewide-single payer system that was available to all Californians and eliminated co-pays and deductibles, while costing the state an estimated $400 billion.

  • The plan was sent to the Assembly but was shelved by Assembly Speaker Anthony Rendon, who called the bill "woefully incomplete."    

  • The legislation's fate has become a political lightning rod in the state's gubernatorial election this year.  

  • Vermont passed its own single-payer system in 2011, creating Green Mountain Care, which would cover all Vermonters and replace the previous fee-for-service model.

  • Green Mountain Care instituted a five-member governor-appointed board that determined provider payment rates, benefits, and other system components.

  • However, in 2014, Gov. Peter Shumlin, D-VT, dropped his support for implementing the program, saying it was "just not affordable."

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.


The proposal would create a statewide single-payer healthcare system available to all New Yorkers regardless of "age, income, wealth or employment."

The bill, estimated to result in a $92 billion tax hike, is supported by numerous health groups, including the head of the New York State Nurses Association.

A recent poll found 54% of New Yorkers oppose a government-run single-payer healthcare system, while only 33% support such a plan. 

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