Editorial: Will COVID-19 open a wider policy window for single-payer health care in New York State?

1 June 2020

NOTE: The following excerpts come from a column published by The Indypendent. To read the full article, click here.

According to the Economic Policy Institute, around 16.2 million of the roughly 35.3 million workers who lost their jobs due to COVID-19 (so far) likely had employer-provided health insurance. For New York State, the number of newly unemployed workers — not including their families — who probably lost employer-provided health benefits is around one million and counting. Where I live, in Western New York, that number could end up topping 100,000.

Nothing exposes the risks of coupling employment and healthcare quite like a pandemic that shuts down broad swaths of the economy and leads to massive job loss. What is more, beneath the obvious consequences of working families losing their health insurance lies an “anemic” social safety net that, in its present form, ostensibly lacks the resources to close widening income and benefits gaps for households being impacted by COVID-19.

As just one example, health experts anticipate that Medicaid enrollments might skyrocket due to current economic conditions. At the same time, absent more federal assistance, “New York’s Medicaid program could see [budget] cuts as high as 30 percent in the middle of [the] pandemic,” as one trade publication put it. In other words, as Medicaid becomes more essential to more New Yorkers, it stands to receive less state funding.

Added to the negative implications that growing demand and underfunded supply might have for new and existing Medicaid enrollees, higher enrollments can also take their toll on local governments. New York passes more Medicaid costs onto counties than any other state. According to the Empire Center, Erie County — home to Buffalo, the state’s second-largest city — is one of three counties where Medicaid already accounts for more than 75 percent of annual property tax receipts. These steep ratios could presumably climb even higher as more newly uninsured households apply to the program.

Between unprecedented unemployment, attendant loss of health coverage and increasingly stressed social support systems, now is precisely the time to reimagine healthcare. Of course, protecting and reinforcing existing safety nets like Medicaid must still take priority in the immediate term.

But, alongside those efforts, we need to engage more substantively and inclusively in a conversation about moving to a system that extends comprehensive coverage to everyone and is delinked from employment. Many of us have been focusing on this discussion at the national level. However, with the two remaining major-party presidential candidates both stating that they do no support such a system at this time, the onus might be on states to lead the way.

New York is positioned to do just that. The New York Health Act (NYHA) establishes a comprehensive, universal, statewide single-payer health system that would provide health coverage to all New Yorkers and eliminate local governments’ hefty Medicaid payments.

The system would be funded primarily by a payroll tax designed to be “progressively graduated based on ability to pay.” Independent analysts have found that such a system, under the right conditions, would result in lower total healthcare payments for households earning below 1,000 percent of the federal poverty level, and for most employers that currently offer health benefits.

In a separate analysis, an economist at the University of Massachusetts at Amherst concluded that NYHA would “save thousands of lives each year” while lowering annual healthcare payments for 98 percent of New York households.

NYHA has been introduced in the legislature every year since 1992, passing the Assembly in each of the last four sessions with endorsements from diverse local governments throughout the state only to die in the Senate every time.

Now is not the time to once again plastic wrap this bill in committee and allow it to suffocate. The current crisis demands that a bold healthcare proposal like NYHA reach the floor and be put to a vote.

There are still important questions about the bill that legislators and advocates will need to grapple with in the meantime, including how the State will generate necessary revenue for all of NYHA’s provisions and how to ensure a just transition for workers in the health insurance industry.

Likewise, there are legitimate concerns that a single-payer system might induce “medical migration” of un- or underinsured residents from other states into New York. Such circumstances could turn a single-payer New York into a “magnet” for persons and households who would contribute little or nothing to the system. Although most research suggests that the impacts from geographical mobility of this sort are typically “slim” or “modest” in states that expand benefits programs, we are not in typical times.

The enormous scale of COVID-related job losses could mean that medical migration becomes a serious option for more households going forward, as newly unemployed workers plan for their futures. Even so, it seems far-fetched that migration would reach unmanageable levels.

It’s true that there are inherent risks in moving to a statewide single-payer system. However, the likely rewards from meeting those risks with courage and creativity — namely, comprehensive medical coverage that will save lives and lower payments for most households — are too big for us to fail to try. More generally, overcoming any crisis requires risk-taking and innovation. The New York Health Act involves both. Now is the time for both.