Last month, U.S. Sen. Bernie Sanders of Vermont, the once and perhaps future presidential candidate, unveiled legislation to create a single-payer health care system. U.S. Sen. Kirsten Gillibrand, another potential presidential candidate in 2020, was one of 16 senators to sign on as a co-sponsor of the Medicare for All Act. And Gov. Andrew Cuomo, who’s also on short lists of likely Democratic presidential contenders, offered his support for the proposal as well.

In an interview on WNYC’s “The Brian Lehrer Show,” Cuomo called the federal plan, which would make health care universal and publicly funded by the taxpayer, “a good idea.”

But Congress isn’t the only route to obtaining single-payer health care in New York. Assemblyman Richard Gottfried has repeatedly introduced the New York Health Act, which would establish a single-payer system on the state level. The bill passed in the Assembly, but failed in the Republican-controlled state Senate.

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However, Gottfried is optimistic that the state Legislature could pass such a measure, especially with the support of Cuomo. Gottfried said that he was “delighted” by the governor’s remarks, as they indicated he was moving forward on this issue.

“I believe as he looks at that set of issues, he will be favorably inclined,” the assemblyman said. “I’m certainly not speaking for him, but it’s enormously encouraging that he said the concept makes sense.”

One of the key arguments against the proposal, however, is the high price tag as patients shift from paying insurers and providers to covering costs through taxes. The state would need to raise significant funds – about $92 billion in tax hikes, according to one academic analysis – to pay for the act.

“I think if you look at it realistically, you’re going to dramatically increase costs,” Bill Hammond, the Empire Center for Public Policy’s director of health policy, said on a recent City & State podcast. “And that $92 billion tax increase – which by the way would more than double our total taxes in the state – that tax increase could be substantially more than that. I’ve seen estimates that may be triple that.”

The math could make it politically unpalatable for Cuomo, who said that state-level single-payer health care was “an exciting possibility,” but was more likely going to be achieved through “a federal play.”

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But Gottfried believes his proposal has almost enough support to be passed in the state Senate, a task which would be even easier if Cuomo named single-payer health care a priority in his budget address. Assuming that former state Sen. Daniel Squadron is replaced by another Democrat who supports the bill, Gottfried said that his bill would have 31 supporters in the state Senate – one shy of a majority.

“Being so close to the majority gives us enormous momentum,” he said.

Gottfried’s bill eliminates the need for private insurers and Medicaid, and would provide “all benefits required by current state insurance law” without any copays. The assemblyman argued that single-payer would be cheaper for the average New Yorker, as they will be paying less in taxes than in payments to insurance companies, but the state would nonetheless have to absorb some costs.

And if the federal government reduces the funding for Medicaid in New York, Gottfried thinks that his proposal would be the most feasible path to providing health care for all.

“The savings that we can achieve with a single-payer system are about the only way we can survive the assaults we expect from Washington,” he said.