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7/29/2019 New York Health Gottfried - Rodberg
1/21
Can We Bring Single Payer to
New York?Gottfrieds New York Health Bill:
The Single Payer Plan for New York StateLeonard Rodberg, PhD
Urban Studies Dept., Queens College/CUNY
andNY Metro Chapter, Physicians for a National
Health Program
November 2012
7/29/2019 New York Health Gottfried - Rodberg
2/21
Starting in 2014, state-based insurance
exchanges offer private insurance to
individuals and employers Citizens and legal immigrants required to be
insured.
Subsidies up to 400% Federal poverty level Medicaid for all below 133% poverty level
Affordable Care Act:
Now the Health Reform Law of the Land
7/29/2019 New York Health Gottfried - Rodberg
3/21
Millions Will Remain Uninsured
Millions
Note: The uninsured include about 5 million undocumented immigrants.
Source: Congressional Budget Office
54 55 56 56 56 5657 58 58
26 26
53 53
41
36
30 29 29 29
53
3732
26 25
0
20
40
60
80
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Current law
ACA 2010
ACA Post-Supreme Court
7/29/2019 New York Health Gottfried - Rodberg
4/21
while Underinsurance becomes the Norm
(Average Employer Plan: 87% coverage)
60% 70% 80%
7/29/2019 New York Health Gottfried - Rodberg
5/21
Numbers of NYS Uninsured
Reduced by 37% -- Still 1.7 million
Source: The Coverage and Cost Effects of Implementation of
the Affordable Care Act in New York State, Urban Institute, March 2012
Population figures in thousands of people
7/29/2019 New York Health Gottfried - Rodberg
6/21
More than Half of NYS Funds Will
Come from Government
Federal Government
( Medicare, Medicaid,
ACA subsidies, other)
43%
State and Local Govt
(Medicaid, other) 11%
Individual19%
Employers
19%
Source: Urban Institute
Federal tax
subsidy 9%
ACA subsidy 2%
7/29/2019 New York Health Gottfried - Rodberg
7/21
$5,791
$2,196
$15,073*
$13,770*
$13,375*
$12,680*
$12,106*
$11,480*
$10,880*
$9,950*
$9,068*
$8,003*
$7,061*
$6,438*
$5,429*
$5,049*
$4,824
$4,704*
$4,479*
$4,242*
$4,024*
$3,695*
$3,383*
$3,083*
$2,689*
$2,471*
$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999Single CoverageFamily Coverage
$5,615*
* Estimate is statistically different from estimate for the previous year shown (p
7/29/2019 New York Health Gottfried - Rodberg
8/21
While Those with Coverage Pay More
7/29/2019 New York Health Gottfried - Rodberg
9/21
PNHPs National Program for
Health Care Reform:
Conyers
Expanded and ImprovedMedicare for All/Single Payer
HR 676
Universal - Extend Medicare to everyone
Comprehensivebenefits
Choice of doctor and hospital
No co-pays or deductibles
Funded through progressive taxes
Cost-effectiveCosts less than we now spendand contains future costs
7/29/2019 New York Health Gottfried - Rodberg
10/21
Health Care Reform in
New York State:
Gottfried
s New York Health BillA7860/S5425
Universal coverage
Comprehensivebenefits
Coordination of care
No cost sharingNo private insurance
Funding by progressive taxes
7/29/2019 New York Health Gottfried - Rodberg
11/21
New York Health
Eligibility
Every resident of NYS eligible to enroll
No barriers due to age, sex, income, wealth,
employment, or health status
No premiums
No co-pays or deductibles
No regressive premiums
7/29/2019 New York Health Gottfried - Rodberg
12/21
Comprehensive Benefits
Inpatient and Outpatient Hospital Care
Physician Care
Primary & Preventive Care
Prescription Drugs Dental, Vision, & Hearing Care
Choice of Doctor, including primary care
physician (PCP) and specialists, and
New York Health
7/29/2019 New York Health Gottfried - Rodberg
13/21
New York Health
Care Coordination Innovative measure to achieve higher quality,
less costly care
Choice of care coordinator, could be PCP Assistance in navigating the system, receiving
necessary care and follow-up
No gatekeeping or other barriers to care,
referral not required Care coordinator paid by capitation (per
capita per month)
7/29/2019 New York Health Gottfried - Rodberg
14/21
New York Health
Funding
Progressive, graduated payroll tax, 80%
employer-paid, 20% employee-paid
Self-employed pay full payroll tax
Surcharge on unearned (non-wage) income
Existing premiums eliminated
Federal funds from Medicare, Medicaid,
Family & Child Health Plus
Federal
7/29/2019 New York Health Gottfried - Rodberg
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New York HealthProvider Reimbursement All providers paid in fullbyNew York Health,
with no copays or other charges to patients
New reimbursement methods will be developedto replace wasteful fee-for-service payments
Rates negotiatedwith health care provider
organizations by New York Health
7/29/2019 New York Health Gottfried - Rodberg
16/21
New York Health
Administration
New York Health administered within the
Department of Health by Commissioner ofHealth
Commissioner assisted by broadly-
representative Board of Trustees
7/29/2019 New York Health Gottfried - Rodberg
17/21
New York Health
Further Work Needed
Incorporate long-term care, including
nursing home care
Develop hospital, physician, nurse
practitioner, physician assistant payment
methods
7/29/2019 New York Health Gottfried - Rodberg
18/21
Vermont is using its Exchange to
facilitate transition to Single Payer:
New York can, too
7/29/2019 New York Health Gottfried - Rodberg
19/21
Building a Forward-looking Insurance
Exchange in New York State(statement endorsed by NY Metro Chapter of PNHP,
Community Service Society, and 27 other organizations)
New Yorks Exchange should
(1) encourage the highest quality, most affordable coverage
(2) facilitate movement toward a simplified, more efficient, morebroadly inclusive health care system.
Administrative Streamlining Create a single application process for all types of coverage.
Unify and simplify the administration of health care
benefits. Create a unified, simplified administrative process forall insurers, patients, and providers.
Integrate private insurance and public programs within theexchange. Improve the transition among existing programs,including the subsidized private insurance and Medicaid
7/29/2019 New York Health Gottfried - Rodberg
20/21
Building a Forward-looking Insurance
Exchange in New York State (cont.)
High Quality, Affordable Care Promoting comprehensive, standardized benefits with
the widest possible provider networks and lowest possible
deductibles and co-pays. Spread risk as widely as possible, incorporating as many
plans and users as possible. Require, through newlegislation, that all individual and small group insurance besold through the exchange
Offera true state-run public plan. Start with the BasicHealth Plan provided under the ACA for low-incomeresidents, and then incorporate other public plans tocompete with inefficient, profit-oriented, private insurers.
7/29/2019 New York Health Gottfried - Rodberg
21/21
Meet the Needs of All New Yorkers Make the exchange as immigrant-friendly as possible.
Provide support for immigrants that Federal law, so far,
does not provide. Facilitate consumer engagement through the exchange.
Help consumers deal with the complexity of the multi-payer health insurance market. Invest in a robust networkof community-based Navigators and a strong independent
Consumer Assistance Program. Position New York State to move forward toward the
simplified, efficient, high quality health care system that itsresidents deserve.
Building a Forward-looking Insurance
Exchange in New York State (cont.)