Ren Art 50 §§5000 - 5003 to be Art 80 §§8000 - 8003, add Art 51 §§5100 - 5111, Art 49 Title 3 §§4920 - 4928,
amd §270, Pub Health L; add §89-l, St Fin L
Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1466
SPONSOR: Paulin (MS) TITLE OF BILL:
An act to amend the public health law and the state finance law, in
relation to enacting the "New York health act" and establishing New York
Health
PURPOSE OR GENERAL IDEA OF BILL:
This bill would create a universal single payer health plan - New York
Health - to provide comprehensive health coverage for all New Yorkers.
SUMMARY OF SPECIFIC PROVISIONS:
Every New York resident, and individuals employed full time in New York
but living out-of-state, will be eligible to enroll, regardless of age,
income, wealth, employment, or other status. There would be no network
restrictions, deductibles, or co-pays. Coverage would be publicly fund-
ed. The benefits will include comprehensive outpatient and inpatient
medical care, long-term care (including home care and nursing home
care), primary and preventive care, prescription drugs, laboratory
tests, rehabilitative, dental, vision, hearing, and hospice, as well as
all benefits required by current state insurance law or provided by any
state or local public employers, the Essential Plan, Child Health Plus,
Medicare, or Medicaid, and others added by the plan. All these benefits
would apply to all NYH enrollees.
Everyone would choose a primary care practitioner or other provider to
provide care coordination - helping to get the care and follow-up the
patient needs, referrals, and navigating the system. As with most health
coverage, New York Health covers health care services when a member is
out of state, either because health care is needed while the member is
traveling or because there is a clinical reason for going to a partic-
ular out-of-state provider, or for individuals that are employed in New
York but live outside the state.
A broadly representative Board of Trustees will advise the Commissioner
of Health. The Board shall develop proposals relating to out-of-state
retiree health benefits, and coverage of health care services covered
under the workers' compensation law, vehicle insurance and veterans'
benefits.
In addition to the Board, there will be six regional advisory councils
to represent the diverse needs and concerns of the region. The councils
shall include but not be limited to representatives of health care
consumers, providers, municipal and county government, and organized
labor. The councils shall advise the Board, Commissioner, Governor, and
Legislature on matters relating to the NY Health program and shall adopt
community health improvement plans to promote health care access and
quality in their regions.
Health care providers, including those providing care coordination,
would be paid in full by New York Health, with no co-pays or other
charges or "balance billing" to patients. The plan would develop payment
methods and rates. (Fee-for-service would continue unless new methods
are phased in.) Payment is required to be reasonably related to the cost
of providing the service and sufficient to assure an adequate supply of
the service.
The bill would authorize health care providers to form organizations to
collectively negotiate with New York Health.
Health care would no longer be paid for by insurance companies charging
regressive "tax" insurance premiums, deductibles, and co-pays imposed
regardless of ability to pay. Instead, New York Health would be paid for
based on ability to pay, through a progressively-graduated payroll-based
tax (paid at least 80% by employers and not more than 20% by employees,
and 100% by self-employed) and a progressively-graduated tax based on
other taxable Income, such as capital gains, interest, and dividends. An
individual's first $25,000 of income ($50,000 for Medicare recipients)
would be exempt from the tax. Public employers that are already contrib-
uting more than 80% of the cost towards health benefits would be
required to maintain the level of financial support that was in effect
prior to enactment. A specific revenue plan, following guidelines in the
bill, would be submitted to the Legislature by the Governor.
Federal funds now received for Medicare, Medicaid, the Essential Plan,
Child Health Plus and the Affordable Care Act would continue to come
into New York. Depending on the degree of federal cooperation (or not),
NYH would wrap around those programs or fold them into NYH. In any
event, people eligible for Medicare or the other programs would be enti-
tled to every right and benefit they are entitled to under New York
Health. The "local share" of Medicaid funding - a major burden on local
property taxes - would be ended.
Private insurance that duplicates benefits offered under New York Health
could not be offered to New York residents.
JUSTIFICATION:
The New York State constitution states: "The protection and promotion of
the health of the inhabitants of the state are matters of public concern
and provision therefor shall be made by the state and by such of its
subdivisions and in such manner, and by such means as the legislature
shall from time to time determine."(Article XVII, § 3.) All residents
of the state have the right to health care.
To address the fiscal crisis facing the healthcare system and the state
and to assure New Yorkers can exercise their right to health care, this
legislation would establish a comprehensive universal single-payer
health care coverage program, funded by broad-based revenue based on
ability to pay, for the benefit of all residents and employees of the
state of New York.
New Yorkers - as individuals, employers, and taxpayers - have experi-
enced a rapid rise in the cost of healthcare and coverage in recent
years. A million New Yorkers are without health coverage. Every year,
millions of New Yorkers who have health coverage go without needed care
because they can't afford it or suffer financial hardship to get it.
Businesses have also experienced extraordinary increases in the costs of
health benefits for their employees.
Health care providers are also affected by inadequate health coverage in
New York State. A large portion of voluntary and public hospitals,
health centers and other providers experience substantial losses due to
the provision of care that is uncompensated. Individuals are often
deprived of affordable care and choice of provider because of decisions
by health plans guided by the plan's economic needs rather than their
health care needs.
This act does not create any employment benefit, nor does it require,
prohibit, or limit the providing of any employment benefit. In order to
promote improved quality of, and access to, health care services and
promote improved clinical outcomes, it is the policy of the state to
encourage cooperative, collaborative and integrative arrangements among
health care providers who might otherwise be competitors, under the
active supervision of the commissioner. It is the intent of the state to
supplant competition with such arrangements and regulation only to the
extent necessary to accomplish the purposes of this act, and to provide
state action immunity under the state and federal antitrust laws to
health care providers, particularly with respect to their relations with
the single-payer New York Health plan created by this act.
PRIOR LEGISLATIVE HISTORY:
1992: A.8912-A - passed Assembly
1993: A.5900 - reported to Ways and Means
1994: A.5900 - referred to Health
1995-96: A.6801 - reported to Ways and Means
1997-98: A.6172 - reported to Ways and Means
1999-00: A.3571 - reported to Ways and Means
2001-02: A.6779 - reported to Ways and Means
2003-04: A.6952 - reported to Ways and Means
2005: A.6576 - reported to Ways and Means
2006: A.6576 - referred to Health
2007-08: A.7354 - reported to Ways and Means
2009-10: A.2356 - referred to Health Committee
2011-12: A.7860-A - reported to Ways and Means
2013: A5389 - referred to Health
2014: A5389 - reported to Ways and Means
2015: A5062 - Passed Assembly / Senate Health
2016: A5062 - passed Assembly / Senate Health
2017: A4738 - passed Assembly / Senate Health
2018: A4738 - passed Assembly / Senate Health
2019: A5248 - reported to Codes / Senate Health
2020: A5248 - referred to Health / Senate Health
2021: A6058 - reported to Codes / Senate Health
2022: A6058 - reported to Ways and Means / Senate Health
2023-2024: A7897, referred to health / Same as S7590, referred to health
FISCAL IMPLICATIONS:
Full funding for New York Health would come from the revenue measures to
be proposed by the Governor under guidelines in the bill, plus available
federal funds. The revenue package would also replace: local share of
Medicaid, the state share of Medicaid, state and local payments for
public employee health coverage, and various other health care spending.
Numerous analyses document that a single-payer system would be most
effective for reducing and controlling costs, for taxpayers, employers,
and individuals.
EFFECTIVE DATE:
Immediately. The program will begin functioning when the Commissioner of
Health declares the beginning of the implementation period.
