BILL NUMBER: S3425
SPONSOR: RIVERA
 
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:
This bill would create a universal single payer health plan, New York
Health (NYH),to provide comprehensive health coverage for all New York-
ers.
 
SUMMARY OF SPECIFIC PROVISIONS:
This legislation establishes that every New York resident, and individ-
uals employed full time in New York but living out-of-state, would 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 funded. This legislation would also
outline the benefits of this plan to 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 of these benefits would apply to all NYH enrollees.
This legislation would allow each enrollee to choose a primary care
practitioner or other provider to provide care coordination, referrals,
and assistance with navigating the healthcare 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
particular out-of-state provider, or for individuals that are employed
in New York but live outside the state.
This legislation would also establish a broadly representative Board of
Trustees Ito advise the Commissioner of Health (COH). The Board would
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.Furthermore, this legis-
lation would establish six regional advisory councils to represent the
diverse needs and concerns of the region. The councils would include but
are not to be limited to representatives of health care consumers,
providers, municipal and county government, and organized labor. The
councils would 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.
Additionally, this legislation would ensure that 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.
This bill would authorize health care providers to form organizations to
collectively negotiate with New York Health.
Under this legislation, health care would no longer be paid for by
insurance companies charging regressive "tax" insurance premiums, deduc-
tibles, 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 that is paid at least 80
percent by employers and no more than 20 percent by employees, 100
percent by those that are 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 contributing more than 80 percent 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, follow-
ing guidelines in the bill, would be submitted to the Legislature by the
Governor.
Federal funds currently being 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 coop-
eration or lack thereof, NYH would wrap around those programs or fold
them into NYH. In any event, people eligible for Medicare or the other
programs would be entitled 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 experienced a
rapid rise in the cost of healthcare and coverage in recent years. More
than one 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:
2015-16: S3525-A (Perkins)/A5062-A Gottfried - Referred to Health
2017-18: S4840-A (Rivera)/A4738-A Gottfried - Referred to Health
2019-20: S3577-A (Rivera)/A5248-A Gottfried - Referred to Health
2021-22: S5474 (Rivera)/A6058 Gottfried - Referred to Health
2023-24: S7590 (Rivera)/A7897 Paulin - 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, 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 control-
ling costs, for taxpayers, employers, and individuals.
 
EFFECTIVE DATE:
Effective immediately upon the declaration made by the Commissioner of
Health to begin the implementation period, after the revenue plan and
needed regulatory and administrative actions are in place.

Statutes affected:
S3425: 270 public health law, 270(11) public health law