Opinion: Real health coverage for New York

Almost every problem we face in health and health care – as consumers, patients, employees, employers, health care providers or taxpayers – is made worse and harder to solve by the way we currently pay for health care in America.

People with private health coverage must deal with premiums, deductibles and co-pays that have no relation to their ability to pay, as well as denials of coverage for treatment that their doctor recommends, all while navigating restricted provider networks and drug formularies. Health care providers spend countless hours fighting with health plan bureaucracy instead of caring for patients. Even though most older adults will at some point need long-term home care or nursing home care, Medicare and health insurance don’t cover it, and it can wipe out a lifetime of savings.

It's likely to get worse. We don't yet know what President Donald Trump and the Republican-controlled Congress will do to Medicare, Medicaid, the Affordable Care Act and other federal health programs, but they will almost certainly reduce access to care and increase costs for patients, while cutting funding for health care providers.

Health care for all of us – rich or poor – will be endangered. If a hospital’s Medicare or Medicaid funding is cut, or if ACA changes mean that more patients can’t afford to pay their bills, the hospital will be forced to cut back on personnel.  Even the wealthiest patient arriving with a heart attack will get care that is stretched thinner – leaving them more likely to die.

New York will either just let people suffer, or it will try to fill those gaps. 

There’s already an answer to all this on the table in Albany: the New York Health Act, which would provide comprehensive coverage to every New Yorker, with no out-of-pocket charges and no restricted provider networks. It would fill the gaps in our current inequitable health care system and any new gaps created by the Trump administration.

If New York enacts the NYHA, costs will decrease by about $60 billion every year in New York due to no longer paying for insurance corporation bureaucracy, marketing and profit; slashing provider administrative costs; and using the bargaining clout of 20 million “covered lives” to bring down drug prices. There will be about $40 billion in increased payments – covering the uninsured; filling gaps in coverage; raising payment levels above Medicare and Medicaid levels; ending deductibles, copays and out-of-network charges; and covering long-term care. That’s about $20 billion in net savings annually in New York.

The new health care system will be funded by a graduated tax on income, based on ability to pay. This will be on top of whatever federal health care funding comes into New York. Over 90% of New Yorkers will spend less in New York Health taxes than they do now for health care and coverage.

The NYHA will be a major step for affordability and security for working people and their families. 

Health care is almost 20% of our economy, and the cost of health insurance and health care puts an unfair burden on working families. Private insurance companies charge the same premiums and impose the same out-of-pocket charges whether it’s coming out of the paycheck of a multimillionaire executive or a receptionist.

Under the current system, if you change jobs or lose your job, you can lose your health coverage, or be covered by a plan that doesn’t include your health care providers in its network. For many working people, their health benefits are largely paid for by their employer.  But an economist would tell us that those payments come from money that would otherwise be available for wages or salaries.

Labor unions have fought hard to win strong health benefits for their members, and some in organized labor have been wary of the change that the NYHA would bring. But under the current system, labor unions routinely have to sacrifice wages and other benefits just to protect their members’ existing health benefits. That will no longer be the case under the NYHA. Health care will be a human right, not something you have to bargain for.

Some have asked whether the NYHA would need federal cooperation in order to work, since so much of our health coverage is funded by Medicare and Medicaid. Fortunately, the answer is no. Federal cooperation (“waivers”) could make it simpler to implement.  But if necessary, New York’s plan can act as a wrap-around for federal programs like Medicare, Medicaid and the ACA, so that it works for patients and providers as if it were a single program.

This is a long-established concept. New York’s Medicaid program has always covered categories of people and services that are not covered by federal matching money. New York created our elder pharmaceutical program long before Medicare did, and it still fills gaps in Medicare Part D. NYHA will fill gaps in federal programs – including supplementing inadequate payment levels – without needing Washington’s permission.

I don’t know anyone who thinks our current system is fair, affordable, sensible or secure, even without any new federal cuts.  The New York Health Act – with fully comprehensive coverage, billions in savings, and fair funding – is the only sensible and realistic plan.