Last month, the GOP raced to convince members of Congress to vote in favor of the American Health Care Act, but Congress ultimately rejected the Republican plan to repeal and replace the Affordable Care Act, getting a bill that would limit essential coverage for a number of social groups off the table. But as many celebrate the continued existence of Obamacare, it might be wise to question whether the it is the best possible option, because while it did remarkable things for a number of Americans, the ACA still left many uninsured or underinsured. Many New York healthcare advocates say there is the hope of a better alternative in the New York Health Act (NYHA).
The NYHA is a single-payer plan that would create a state healthcare system that is, as Assembly Health Committee Chair Richard Gottfried told the Village Voice, “funded entirely by broad-based taxes based on ability to pay.” This means that the NYHA would be funded by taxation on taxable income from employment, capital gains, interest, and dividends.
According to Physicians for a National Health Program, individuals and families would be the ones to choose “the delivery of care,” which means that there will be no network restrictions (like those of private insurers) that keep certain doctors out of reach. This is because when everyone is covered by the same single-payer plan, instead of a number of private insurance programs, everyone has access to the same comprehensive care. So instead of having individuals worry about whether a doctor is in their personal private insurance network and whether they can afford the co-pay, every doctor in New York state would be within reach.
"There is no question that we are in a unique political moment," says Ursula Rozum, the Campaign for New York Health upstate campaign coordinator. "Now is the time for us to speak up and organize for a healthcare system that guarantees health care for all of us."
The NYHA would provide any medical service currently required by New York state insurance law, including primary, preventive, specialist, hospital, mental health, reproductive health, vision, dental, and hearing care.
Passing the New York Health Act could also influence federal legislature in the future, considering how past state policies have changed federal ones. The Massachusetts healthcare model has striking similarities to the ACA and demonstrates how impactful state legislation can be. Katie Robbins, the executive director of Physicians for a National Health Program’s NY Metro Chapter (PNHP NY) tells Bustle that the ACA was actually first established in Massachusetts in 2006. “At the time it was known as RomneyCare, and had long been touted by the Heritage Foundation, a conservative think tank," Robbins says. "Ironically, as soon as President Obama supported it, the Heritage Foundation started to oppose the policy.”
A 2012 article published by the Huffington Post outlined the similarities between the ACA and the Massachusetts model, which proves that a state healthcare model can be a significant influence for federal models. The importance of the New York Health Act — a system funded entirely by broad-based taxes — increases with the knowledge that it could be a model for federal legislation, like the Massachusetts model was.
The New York State Assembly passed a version of the New York Health Act in 2015, and then again in 2016, but it never got a committee hearing in the Republican-run state Senate. In previous years, the healthcare issues that were discussed centered on problems with the ACA. While Obamacare did remarkable things (like banning lifetime limits of healthcare cost) for a large population of Americans, the act still gave control to insurance companies. Many insurance companies demanded high — and quickly rising — insurance premiums and high deductibles that shift costs to the individual.
Robbins says the ACA expanded access to insurance for millions of Americans, but many New Yorkers remained underinsured, which means that many insured people can't afford to use the insurance they gained access to because of the high deductibles and co-pays.
The New York Health Act guarantees that every resident of New York State will have access to publicly funded health insurance.
Economists Milton I. Roemer and John E. Roemer questioned the effectiveness of a healthcare system controlled by private insurance companies in their 1982 article "The Consequences of Free Trade in Health Care: A Public Health Response in Orthodox Economics." The authors asserted that “only replacement of free trade by systematic social planning could hope to achieve a health care system that allocates resources and distributes services both efficiently and equitably.”
One way to look at how this theory relates to today is to consider that while the ACA covered many more Americans, there are competing private insurance companies with specific provider networks and out-of-network fees. Under the New York Health Act, every healthcare provider can participate in the program and there will be no specified networks. And while healthcare providers are not required to participate, there will be no other insurance coverage to pay a provider who decides not to participate, which incentivizes participation.
Another way to look at it is to consider that private insurance uses money from premiums to fund the needs of people in need of medical services, so insurance companies can set premiums that are quite high. According to the PNHP, the New York Health Act would eliminate these high premiums, deductibles, and co-pays set by insurance companies because, unlike the ACA, the NYHA would not be controlled by private insurance companies.
The NYHA would replace private insurance company coverage for all New York state residents. This is to ensure income equality under the plan by preventing a two-tier system of care, which is when there is a basic system of care and then a secondary option for wealthier people who can afford more, creating a segregated health system like Medicaid. In a two-tier system, people who can pay more often have access to better resources and those who can’t pay more don’t.
The NYHA wants to make sure that all people (wealthy and low-income alike) are equally invested in the healthcare system and have equal access to the same healthcare. To make this possible, there would be no private coverage offered by employers. Instead, every New York resident would have access to New York Health, and employers would pay at least 80 percent of the tax on payroll.
Robbins, the executive director of PHNP's New York metro chapter, emphasizes that the NYHA would have an equalizing impact. “The New York Health Act guarantees that every resident of New York State will have access to publicly funded health insurance that covers all medically necessary care—no matter what their income, job, health, marital, or immigration status,” Robbins says. She notes that, in this time of immigration uncertainty, that the NYHA would be offered to anyone who could provide proof of residency, not citizenship, in New York State. This allows undocumented New York residents the same right to health care.
So while the ACA did extraordinary things — like making sure preexisting conditions don’t impact health coverage and expanding Medicaid — it’s not perfect, and it might be good to talk about a single-payer plan where the government funds all residents’ health care because this is a path to universal health care where all residents have health coverage. And, New York could soon be an example of universal healthcare for the United States.