Cheryl Cashin of Shelter Island is among advocates who believe that the New York Health Act has a better chance of passage than ever before. <\/p>\n
The proposed New York Health Act, which would create a universal single-payer health plan providing comprehensive health coverage for all New Yorkers with no co-pays, deductibles, or out-of-network costs, could see passage in the upcoming legislative session, advocates say.\u00a0<\/p>\n
The act would be funded through a payroll tax and federal money received for Medicare and other federally-funded, low-cost health insurance programs. It would replace private insurance and out-of-pocket costs, which proponents say would result in massive cost savings to all, including municipalities and school districts that are seeing sharp annual cost increases.\u00a0<\/p>\n
The act, which if implemented would make New York the first state to establish a universal, single-payer health care system, is not a new idea: Former Assemblyman Richard Gottfried initially sponsored it in 1991. The current version of the bill is presently in the State Senate\u2019s Health Committee.\u00a0<\/p>\n
Cheryl Cashin of Shelter Island is the managing director of global health systems for Results for Development, a nonprofit with a mission to work with government and private-sector leaders to create self-sustaining systems for health, education, and nutrition. With Judith Esterquest, the League of Women Voters\u2019 health care issues specialist for New York State, she wrote a white paper positing that the act could significantly reduce overall health care spending by eliminating private insurer profits and marketing costs, improving administrative efficiency, and leveraging stronger bargaining power to negotiate prices.\u00a0<\/p>\n
The white paper analyzes the New York Health Act\u2019s fiscal impact on local governments and school districts using Suffolk County, Islip Town, and the Brentwood School District as examples. According to their analysis, by replacing insurance costs with the NYHA payroll tax Suffolk would see a 92-percent reduction in health care costs, or more than $745 million; Islip would see an 87-percent reduction, and the Brentwood School District would see an 84-percent reduction. \u201cThe analysis suggests that by replacing health insurance-related costs with the progressive payroll tax, local governments could save on average between 12 and 14 percent of their total budgets,\u201d the white paper concludes.\u00a0<\/p>\n
\u201cI came to my support of this as a professional working 30 years in global health, seeing every possible option tried and failed,\u201d Dr. Cashin told The Star. \u201cI\u2019m coming at this from a professional-practical viewpoint. Single-payer is the only system that gets us affordable health care.\u201d<\/p>\n
The United States spends significantly more on health care than any other high-income country while frequently achieving worse health outcomes. \u201cWhen you put private, for-profit entities in the middle of anything, that\u2019s their incentive,\u201d Dr. Cashin said. \u201cThey\u2019re responding to shareholders. At least 20 percent off the top is going to marketing, to profit.\u201d And \u201cbecause they don\u2019t need to, they don\u2019t really negotiate prices for drugs, or with hospitals. . . . The way big hospitals are billing is a complete sham: overpriced everything.\u201d<\/p>\n
Insurance premiums, and segments of health care costs, are rising dramatically, often by double digits annually, and around half of all hospitals in New York are operating in the red. In the public sector, Dr. Cashin said, \u201call they can do is raise taxes to cover cost increases. A lot of what is driving the increase in property taxes can be attributed to this double-digit growth.\u201d\u00a0<\/p>\n
\u201cI\u2019m not saying public employees shouldn\u2019t have the excellent coverage they do,\u201d she said. \u201cI\u2019m saying we all should. The way it\u2019s organized now, it\u2019s so inefficient,\u201d rife with waste and dysfunction, she said. She is \u201con the phone every week with a county who has just closed their last maternity clinic or long-term care facility. It is a disaster. If we don\u2019t look at the New York Health Act as revenue-stabilizing, we\u2019re missing a big part of the looming crisis. We\u2019re at such a dire moment in our health care system that thinking from an individualist perspective \u2014 the instinct of so many \u2014 will let our system collapse.\u201d<\/p>\n
\u201cThe bill always got introduced,\u201d said former Assemblyman Fred. W. Thiele Jr., who was a co-sponsor of the bill before retiring in 2024. \u201cThere was always some discussion, but it had become dormant, really. What I\u2019ve detected a bit, from my retirement perch, is that there has been a series of events, both political and policy-wise, that have started to raise the profile of the New York Health Act.\u201d<\/p>\n
These, he said, include soaring costs, including for Affordable Care Act insurance coverage following the Dec. 31, 2025, elimination of enhanced subsidies. Around four million Americans have dropped out of Affordable Care Act coverage this year, according to the federal Centers for Medicare and Medicaid Services. \u201cWith the loss of those subsidies on the federal level, there is a host of people now losing their health insurance coverage,\u201d Mr. Thiele said. \u201cThat has piqued interest again.\u201d<\/p>\n
He also pointed to a changing composition of elected officials and candidates in the state, from the election of New York City Mayor Zohran Mamdani, who identifies as a Democratic Socialist, to \u201ca number of progressive, in some cases Democratic Socialist, candidates supportive of single-payer. . . . We\u2019ll see who gets elected to what in a couple of months, but there is the perception that the Legislature will have a membership that moves it somewhat more to the left.\u201d<\/p>\n
These, he said, \u201chave created a climate and environment where the New York Health Act will probably get a second look starting in 2027.\u201d The Legislature is scheduled to reconvene for its next regular session in January.\u00a0<\/p>\n
Dr. Cashin agrees. \u201cThe political winds now are favorable,\u201d she said, \u201cbecause of massive federal cuts, because candidates who won primaries are more focused on this,\u201d and \u201cthe mood of the country with affordability have created this moment. And, I would add, the over-the-top villainy of the private insurance industry.\u201d<\/p>\n
There is, of course, opposition to the act, starting with that private insurance industry. A second group of opponents, Dr. Cashin said, \u201cthink they\u2019re doing well and are afraid to lose something.\u201d This group includes members of unions who \u201chave negotiated away salaries all these years to get good health care. I\u2019m more worried about getting them on our side, helping them understand there is so much waste and abuse in the system.\u201d<\/p>\n
A third group, she said, opposes the act on ideological grounds. \u201cThey don\u2019t believe government should be doing this.\u201d Those who \u201cdon\u2019t want to see an immigrant getting coverage, I get really annoyed at this one. Their coverage is revenue for the hospital you want to visit! Their emergency care visit that doesn\u2019t get covered will show up in your higher premiums.\u201d<\/p>\n
A spokesman for Assemblyman Tommy John Schiavoni, Mr. Thiele\u2019s successor, said that the assemblyman is a co-sponsor of the New York Health Act. \u201cHe believes in fair and equitable access to health care for all New Yorkers,\u201d the spokesman said.<\/p>\n
In a statement, Senator Anthony Palumbo said that \u201cSince 2019, Democrats have had full control of the State Legislature and all statewide offices, including the governor. Not once in this time frame has the N.Y. Health Act been brought to the floor for a vote. The real reason why this legislation never passed in both chambers is cost. The price tag for Medicaid for all is astronomical and would require the state to take in $140 billion in new revenue \u2014 nearly tripling state taxes. Simply put, the proposal is unaffordable in a state that leads the nation in unaffordability.\u201d<\/p>\n
Leslie Moran, senior vice president of the New York Health Plan Association, a trade association and lobbying group representing managed care health plans, said in an email that, while the group \u201csupports the goal of providing every New Yorker with health coverage,\u201d it is opposed to the New York Health Act. \u201cThis proposal would result in massive new taxes, provide fewer choices over doctors, treatment, and coverage, and threaten the quality of care. In short, it is the wrong approach for New York.\u201d<\/p>\n
Dr. Cashin responded that \u201cit is incorrect that people will have fewer choice of doctors\u201d under the act. \u201cIt is clearly written in the bill that there will be no pre-defined networks like private insurers have today \u2014 all doctors and hospitals are eligible providers under the N.Y. Health Act and included in the system.\u201d<\/p>\n
The act can be successfully implemented, she insists. \u201cWhat I have found is, our state has tremendous capacity to run things,\u201d she said, pointing to the New York State Health Insurance Program, which provides comprehensive health coverage for state and local public employees. NYSHIP is \u201ca beloved public health institution,\u201d she said. \u201cWe can make this work in New York.\u201d<\/p>\n
Momentum is building, she said, \u201cand for first time ever, the governor\u2019s office met with Campaign for New York Health,\u201d a coalition of universal-health-care advocates. \u201cI don\u2019t know what that means, but our job is to show [Gov. Kathy Hochul] this is an affordability bill as much as a health care bill, a trust-in-government bill, a local government bill.\u201d\u00a0<\/p>\n
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