Regardless of Who Becomes President, ‘Medicare for All’ May Happen in New York, Bill’s Sponsors Say


State Senator Robert Jackson looks on as State Assemblymember Richard Gottfried speaks.

By Zachary Folk

New York state politicians have been discussing a Medicare for All-type health insurance system for nearly 30 years. But never before has the New York Health Act seemed so achievable as it does today, politicians said at a forum on Monday.

State Senator Robert Jackson, who represents parts of the Upper West Side, along with Washington Heights, Inwood, and Marble Hill, hosted a town hall at the West End Collegiate Church on 77th Street on Monday to discuss the proposed bill with the community. Jackson was joined by Assemblymembers Richard Gottfried and Linda Rosenthal, State Senator Gustavo Rivera, and Carlyn Cowen, chief policy and public affairs officer for the Chinese-American Planning Council. Assemblyman Gottfried and Senator Rivera both chair the health committees in their respective chambers of the legislature. They were joined by several community members and healthcare professionals who testified on the urgent need for universal healthcare.

NYHA would provide all 20 million New Yorkers with the same services currently provided by Medicare, but without copays and deductibles. “It would cover all 20 million of us regardless of age, or income, or immigration status, or anything else,” Gottfried said. In addition to covering primary care, it would also cover things like prescription fees, dental, and long-term care – going far beyond what most plans on the healthcare marketplace offer. NYHA would also eliminate restricted provider networks, allowing patients to choose which doctor they want to see without having to worry about out-of-network charges.


State Senator Gustavo Rivera.

NYHA has been held up in the state legislature for almost 30 years. It first passed in the State Assembly in 1992, where it was championed by Assemblyman Gottfried. It has passed the Assembly three more times since – in 2015, 2016, and 2017 – only to be held up in committee hearings by the Republican-controlled Senate. Since the 2018 election delivered the Senate to the Democrats, the single-payer healthcare bill now has a clearer path to pass both chambers of the legislature.

At the heart of the argument for single-payer healthcare is the financial burden the current system places on individuals. “Let me bottom-line it for you – the system that we have now is unfair at its core,” Senator Rivera explained. “Insurance companies are the ones that make decisions about your healthcare, and I’m sure everyone in this room has had a situation with their families, with their neighbors, or with themselves in which they had to make a decision about their healthcare that has nothing to do with their healthcare and has everything to do with whether or not they can afford that particular thing,” he continued. “You pay premiums. You pay copays. You have to hit a deductible. You actually have to keep in your network. How about we create a system that starts with the basic assumption that healthcare is a human right. Regardless of where you are in the state, who you are in the state, or where you come from – because you’re a human, you’re going to get sick and require care. The system that we have right now is unfair, and it costs a lot.”


Carlyn Cowen, chief policy and public affairs officer for the Chinese-American Planning Council.

According to Assemblyman Gottfried, one of the most important reasons to pass NYHA is the amount it will save both the government and the citizens of New York. According to his estimates, New York loses $55 billion annually by relying on private insurance. “In case you want to know what $55 billion is, the entire capital plan that the MTA has in mind for the next five years is a total of $51 billion. The entire endowment of Bill and Melinda Gates’ foundation is $50 billion. That’s what we burn every year in New York because we base almost all of our healthcare system on insurance companies.” According to Gottfried, New Yorkers would save by cutting expenses that come as a result of our privatized system. “We burn over $20 billion in insurance company bureaucracy, and marketing, and profit,” Gottfried said. “We burn more than $20 billion a year in administrative costs that doctors and hospitals have to incur to fight those insurance companies. We burn almost $20 billion in money we give to drug companies because nobody in our system today has the negotiating power to force down their prices.”

As expected, the issue of payment was talked about extensively. To pay for the bill, NYHA would levy a payroll tax on employers within the state. “We would impose a progressive graduated tax, meaning income under $25,000 a year would be exempt from the tax,” Gottfried explained. “Your employer would pay at least 80 percent of the tax levied on your income.” However, Gottfried was also certain that the proposed tax would not create an undue burden on businesses in the state. “What you would be spending on the New York Health Act taxes would be dramatically less then you are now spending on premiums for your workers because of the enormous savings that we would be pulling down,” he said.

Even though there seems to be political willpower to pass Medicare for All if a Democrat were to win in 2020, the legislators at the town hall were determined to pass single-payer in New York regardless of who the candidate is in the presidential election. “We cannot wait until it happens on the national level,” Senator Rivera said. “Certainly, if it happens on the national level – God Bless America. I’ll be the first one that’ll take the bill and dance around with it and throw it out. But until that happens, we not only have the obligation to do it in the state of New York but we have the ability to do it in the state of New York.”

A livestream of the town hall can be found at Senator Jackson’s Twitter feed (@SenatorRJackson). If you have any questions about NYHA, the senator will be hosting another town hall on November 12, at the Y.M. & Y.W.H.A. at 54 Nagle Ave.

NEWS | 44 comments | permalink
    1. m says:

      I have a company and provide benefits to the people who work for me. I love NYC and have lived here for 40 years. The article says it will save money. But it also says that they will raise taxes once again. I live between NYC and Beijing. My employees can live anywhere as it is IT consulting. Time. (sadly) to leave as tax burden is beyond stupid.

      • Robert Goodman says:

        Do your employees pay any or all of their health insurance premiums? If they do, is the premium the same for the plan they select regardless of employee compensation? If so, wouldn’t it be more equitable for more highly compensated employees to pay higher premiums than less highly paid employees? Might even reduce the costs to lower compensated employees and hence the “tax” burden since health insurance premiums are indistinguishable from taxes when it comes to calculating a household’s disposable income.

      • Kevin says:

        You would pay taxes that fund Medicare For All, but then won’t pay health insurance premiums to your health insurer.

      • Bruce E. Bernstein says:

        you do understand, if you are currently paying employer-based healthcare premiums, you would no long pay these? and neither would your employees pay any share. So compare your current employer/employee premiums to the suggested payroll tax, which is easy to find. I am pretty sure your costs will go DOWN. And then you can use the extra money, which is employee compensation anyhow, to give a raise to your workers! I am sure they will appreciate that. win/win!

      • CitizenM says:

        You provide benefits to your employees. I think the point of it is that the tax raise will be smaller than what you pay for health insurance already. Just hypothetical, if you pay $700 a month per employee, you will eliminate that cost for a raise in taxes of maybe $400 per employee, so you are making an extra $300 per employee. Why are you not celebrating that?

    2. michael says:

      It’s Carlyn Cowen not Carlyn Cowan.

    3. WestsideGal says:

      Let NYC be the Guinea pig. NYC’s want it, they should show the rest of the county what a socialist experiment gone wrong really is before we ruin the rest of the country.

      • Bruce E. Bernstein says:

        are you aware that NYC already has a form of government run socialized medicine, which goes beyond “single payer”? NYC Health + Hospitals runs 11 hospitals, several nursing homes, a home care agency, and over 70 primary care clinics (outside of those within the hospitals). Over 1,000,000 New Yorkers rely on H+H for their healthcare needs. We (I am an employee) take care of the sickest, the poorest, children, immigrants… and we turn no one away. And we do it quite well, thank you. all owned and run by NYC.

        further, NYC actually OWNS an insurance company: MetroPlus.

      • Bruce E. Bernstein says:

        while NYC H+H is the largest publicly owners healthcare agency in the US outside of the VA, states and cities all over the country own and run hospitals and primary care clinics, and thus are providing “government run healthcare.” I believe close to 20% of hospital beds in the US are in publicly owned facilities, including in the South.

    4. Glen says:

      I have no confidence in the ability of New York State to successfully run anything close to a mandatory Medicare for all program. The level of corruption in Albany is known to This is going to turn into another scheme for our politicos to line their pocket (“ThriveNYC,” anyone?), and another reason for business to leave the state.

      • Robert Goodman says:

        The NYS pension system works quite well as does the DMV. Government agencies are distinct from the legislature. Your comment is boiler plate anti-government nonsense. Rather deal with Medicare than any private insurer by the way.

      • CitizenM says:

        So in your mind, paying an extra $20 billion to healthcare insurance companies is better than the state run alternative? Sounds like you are cutting of your nose to spite your face.

    5. Sherman says:

      “It would cover all 20 million of us regardless of…….immigration status”

      Herein lies the reason the Democrats are in such trouble and why Trump will likely win reelection.

      • Bruce E. Bernstein says:

        i have news for you, Sherman. We ALREADY provide undocumented workers with health care in NYC, although we do it in an extremely inefficient way.they go into emergency rooms, mostly at city-owned and run H+H hospitals such as Bellevue, Kings County, Elmhurst, Lincoln, etc.

        for inpatients and emergencies, if they are low enough income, they will get NY State “Emergency Medicaid” that is just as good as regular medicaid except it sunsets quickly.

        the inefficiencies lie in not having regular insurance and not getting a primary card doctor, thus not enough preventive care. the Mayor’s NYC Care program, being rolled out over the next few years, addresses this.

        of course undocumented immigrants get treated! do you think they get turned away? they probably don’t get turned away in most states. for one thing, that would be terrible public health policy.

        what you said is simply a Republican talking point, aimed at jingoistic people. if health care is a human right,everyone should get treated and seen. Unless you consider undocumented immigrants less than human.

        they get public schooling, up to and including CUNY and SUNY. Would you do away with that?

        • Sherman says:

          Hi Bruce

          Yes, I see the “undocumented” immigrants receiving free healthcare in the emergency room.

          A few years ago my son got a serious injury and we rushed him to the hospital. We had to wait in line because of hordes of people who couldn’t speak a word of English and appeared to have minor ailments.

          Yes, healthcare for illegal immigrants is VERY expensive.

          One more reason for enforcing our borders and making sure only citizens and legal residents get their healthcare taken care of.

          Sherm

          • Jennifer says:

            I’m an ER RN in NYC. They’re not all illegal immigrants in the ER. It’s a lot of poor people who don’t have health insurance so they don’t go to primary care doctors for general care- they wait until they’re very sick and go to the ER. This costs everyone money. I can tell you that 95% of hospital employees would love to see socialized healthcare.

            • Sherman says:

              “95% of hospital employees would love to see socialized healthcare”

              You should talk to my boss. He’s from a Scandinavian country which, of course, has socialized healthcare.

              He has a lot of friends from back home who are doctors but emigrated to the US because the pay for doctors is lousy in his country.

              I guess socialized healthcare has its drawbacks.

              Besides, I find your comments about poor US citizens not having access to healthcare almost impossible to believe. Poor people have Medicaid.

        • Scott says:

          “jingoistic people’

          And there’s your left-wing moonbat talking point for the day.

          Did you know European welfare states are very tough with illegal immigrant access to their prized health systems? In Denmark, officials DO treat illegal immigrants in emergency situations in order to comply with EU human rights law.

          After that, all bets are off. The patient may be removed from the country to get treatment in their country of origin. European welfare states do not just stupidly give away the store to anyone who shows up. They regard their health systems as precious assets designed to help taxpayers. I suppose this is jingoism, isn’t it.

          • Bruce E. Bernstein says:

            Scott,

            you should look up facts before you make claims. the following chart (bottom) gives the policies of all EU member states regarding healthcare for illegal migrants. in many cases it is free across the board; in others payments must be given, but these payments are vastly lower than in the US. france treats them for free “across the board”; same for UK; Denmark gives healthcare free for emergencies, treats the with payment in all other cases.

            there are very few situations where EU countries will not treat illegal migrants.

            https://fra.europa.eu/en/publication/2016/healthcare-entitlements-migrants-irregular-situation-eu-28

            • Scott says:

              Your chart is ridiculously outdated.

              Britain’s NHS is now charging upfront fees before migrant patients can even see a doctor. For ER visits the fee ranges from $1500 to $2000. We should do the same. I’m sure you’ll call them jingoistic for caring about NHS’s financial solvency.

              https://improvement.nhs.uk/documents/1866/Overseas_Patient_Tariff_201920.xlsx

            • Bruce E. Bernstein says:

              Scott,

              You again made incorrect statements.

              the chart is not “ridiculously outdated.” it is from 2016. it is accurate for the UK, for example, which updated migrant regulations in 2015 and even lists the document.

              you are wrong about “upfront ER fees” and NHS fees before a patient can even see a doctor. GP services, family planning services, and what the NHS calls “A&E department services” (“accident and emergency services”) remain free to all; in fact, they cannot ask immigration status. There are fees for “non-regular” patients for elective services; that is what you sent.

              Asylum seekers as well as other categories are free of all charges.

              Studies have shown that the migrant use of the NHS has been relatively minor, and most of it is through temporary visitors with reciprocal agreements with the UK.

              Sherman is making derogatory, exaggerated, frankly untrue statements about immigrants. I hope you would be able to identify those as jingoistic.

              Frankly, the idea that an Emergency Room would demand up-front payment is a little ridiculous.

              Here is the actual listing of NHS policies on migrants:

              https://www.gov.uk/guidance/nhs-entitlements-migrant-health-guide

      • John says:

        If trump wins this cant happen the state would need him to sign off on this. Also Vermont already did this and failed miserably

    6. Chris says:

      I work at a hospital, this plan will never work. Medicare payments are much less then private insurance. Hospitals will close. and the rich will get batter care and everyone else will be on a waiting list.

    7. Allison says:

      YES.

      I was on Medicaid when I was unemployed for 5 months earlier this year and it was a life saver. Totally not crappy at all.

      FOR ANYONE WHO’S UNEMPLOYED IN NEW YORK STATE:
      If your ONLY income is unemployment insurance, you are ENTITLED to be on Medicaid. If you go down to 75 Varrick (I think that’s the address), and go to the 6th or 7th floor, there will likely be a tall nice man with white hair and he’s a rep from United Healthcare and he can sign you up.

      • Mark P says:

        Agree with Allison! Facts not fear. When my job ended I had the option of $800 a month for COBRA or purchasing a plan through the NYS marketplace. As it turned out, I qualified for Medicaid. My health was excellent and I thought I would try this experiment. And frankly – though I had to change ALL of my doctors, I think all of my doctors are BETTER than the ones under my former United Health Care plan. More thorough. As (bad) luck would have it, I actually ended up needing surgery due to an accident and the care I received was awesome. Very happy with Healthfirst, which manages my benefits. YES to Medicare for All!

    8. Denton says:

      Will this encourage everyone to move to NYC? Free stuff is an incentive, and why it seems this needs to be done on a national, not local, level. Remember that Bernie couldn’t make it work in Vermont.

      https://www.npr.org/2017/09/13/550757713/why-bernie-sanders-single-payer-health-care-plan-failed-in-vermont

    9. Denton says:

      And what happens to people on actual Medicare? Will they still have to pay $500 a month for B, D, and G? And if they do, will the premiums for NY ‘medicare for all’ be less? Where do I sign up?

      • MAD says:

        That’s a good question, Denton. And will those on traditional Medicare still have to pay $185 deductible per year? Also, what happens to freelancers under this so-called Medicare for all plan? Will we have to contribute to our own healthcare because we employ ourselves? Nothing is free.

    10. PQDubya says:

      For me, the issue is less one of cost (which is significant) than management of the program. Do you trust the bureaucracy to run the system cost effectively and efficiently? And who do you turn to when they don’t?. (see NYCHA) If you opt to stay in your employer provided insurance as a hedge against inevitable government ineptitude, you will in effect be paying twice.

      • Chris says:

        In the NYS plan you can not have a secondary policy. My cost will be 36,000 a year for the states Medicare. I only pay 18,000 now for a family plan .
        I am middle class in NYC can hardly afford rent and my insurance cost will double . This makes no sense

    11. John says:

      If you look at the bill those that make 27,000-137000 will pay a 8 % new tax
      above 137000 18% tax
      above 336000 22% Tax
      These are new tax’s (Over state and city)so you have to make less then 27,000 to get it free
      And it says these taxs may have to increase

      So if you make 200 K a year you will pay 36,000 for your Medicare so 3,000K a month for insurance (this is for one person)not a family plan

      • Joe R. says:

        I knew this was a bad bill but I had no idea it imposed such a ridiculous amount of additional taxes on working class people. The self-employed would be hurt big-time by this as they would probably have to pay all the taxes both the employer and employee would have to pay.

        If this plan supposedly saves $60 billion a year, why do we need to increase taxes on anyone? The savings in theory should more than pay for it.

        I can see a mass exodus from NYS if this awful idea ever passes. Vermont tried something similar and it failed big-time. The only way something like this can work is on a national scale, where the federal government has the power to negotiate lower reimbursment rates and drug prices in order to contain costs. NYS doesn’t have the clout to do that.

        Hopefully in the unlikely event it passes Cuomo won’t sign it, and the legislature won’t have the votes to override his veto. Taxes in NYS are ridiculous as it is. We don’t need them going higher.

      • Z says:

        John, can you provide a link to where you found those numbers?

        These are the ones posted to the website of the Campaign for New York Health:

        $50K 6.9% effective tax
        $100K 12.3% effective tax
        $175K 16.3% effective tax
        $225K 17.8% effective tax
        $400K 20.8% effective tax

        Source:
        https://www.nyhcampaign.org/how_will_we_pay_for_the_new_york_health_act

        • Joe R. says:

          If the self-employed have to pay both the employer and employee parts of the tax this is going to hit them really hard. If you make $100K you’ll be paying over $12K in new taxes. When you count federal, state, city, and FICA taxes you’ll be facing incremental tax rates of perhaps 65% for any income over $100K. It seriously doesn’t even pay to work when you’ll be paying this much in taxes.

          If this passes, the self-employed should only have to pay the employee part of the tax. That said, I hope this awful proposal never sees the light of day. This is a 100% solution to maybe a 15% problem (i.e. the number of uninsured in NYS). It also covers far too many things. If we want to have some type of coverage for all, let’s just have catastrophic coverage. We can probably do that with no new taxes on the middle class.

          • Bruce E. Bernstein says:

            Joe R,

            Assuming the marginal rates quoted above are correct (0 for <27,000; 8% for 27K-137K), self employed will be paying much less than $12K on the first 100K of earnings. Assuming it is taxable earnings, after deductions, it is 5,840 (0* 27,000 + .08*73,000). If employed, the employer pays 80%, so the employee pays 20% (1,680 extra in taxes per year).

            for self-employed, you pay the whole amount. so it comes to $5,840 extra in taxes, or approx $485 per month. That will cover all your medical care, all your dental, all your vision. I believe it will cover prescription drugs as well. No premiums, no deductions, no copays. And you will be ensured for long term care.

            if you are single, making $100,000 in self-employed taxable income, and currently have Obamacare health insurance, i have to assume this will lower your costs substantially.

            if you are making $250K taxable income as self-employed, it might be a different story. But at $100K, the bill benefits you quite a bit financially.

            • Joe R. says:

              You’re looked at the chart wrong. Assuming a self-employed person makes $100K and is required to pay both the employer and employee portions, they would be paying an effective rate of 12.3%, or over $12,000.

              I’m not making anything now, but the last year I made $100K I paid $0 under Obamacare. I filed form 8965 and checked the “health insurance not affordable” box because it would have been over 8% of my adjusted gross income. Note that AGI is your income AFTER you subtract things like SEP, solo 401K, and IRA contributions, as well as the deduction for half the FICA taxes. The cheapest plan for someone my age was around $500 a month, and this was over 8% of my AGI, so health insurance was considered unaffordable under ObamaCare. Is NYS going to at least use the AGI to figure the tax, or are the going to use total earnings? If they use AGI, then the extra taxes the last year I made $100K would only have been about $3,000. I wouldn’t mind paying $250 a month for coverage (i.e. that’s less than Obamacare), but over $1,000 a month is ridiculous.

              I don’t go to doctors and don’t use any drugs, so my medical costs are essentially zero. Even if I got insurance under ObamaCare, that would have been about $6K annually, versus over $12K in new taxes with this ill-conceived plan. I don’t see how that saves my money. I would be paying $12K more than before for essentially nothing. I’m not going to go to doctors even if there’s no fee at the point of service. I hate doctors and they didn’t do anything positive for either of my parents.

              The only people the bill benefits are those making too little to pay the tax. And if it passes, I can assure you I’ll be among them. I won’t bother earning over $27,000 a year. Once I hit that number, I’ll just turn away work until the following. That’s one of the advantages of being self-employed.

              I also did a little math. The combined NYC/NYS income tax rates for someone making over $250K are about 10%. The federal rate is 32%. FICA tax is ~14% after the FICA tax deduction. The incremental tax rate under this plan for incomes over $250K is 25%. That’s a total incremental tax rate of 81% on every dollar you earn over $250K. As things stand now higher earners are already fleeing the state on account of the tax burden. This will make them flee in droves, leaving those earning less with the entire burden of paying for this plan. Obviously that’s not possible, so the plan won’t work. They never figured out two things. One, how many people will leave the state once faced with an enormous additional tax. Two, how many people, especially illegals, will flock here for free medical care. That’s why this plan can’t work. Single payer needs to be done either nationally or not at all. I actually support the idea, just not on the state level.

              Like I said, just figure out how much it would be to give everyone catastrophic insurance only. I remember there used to be plans for than for a few hundred a month tops. That’s all NYS should do-insure people so they don’t go bankrupt if they have a major illness. There’s no need to cover routine things like dental or doctor’s visits. People can afford the small stuff out of pocket. Just cover anything requiring hospitalization. Such things are rare but costly when they happen.

            • Joe R. says:

              One more thing. Before we implement single payer, whether it’s nationally as we should, or at the state level, the first thing to do is cost-containment. This should be done before anything else. Getting insurance middlemen out of the picture helps but it’s not enough. We need to reexamine the return we get for medical spending in an end of life situation. There’s little giving expensive treatments to a person to give them a few more weeks or months of life, especially when the quality of life in most cases is nonexistent. We also need to take more preventative measures. Keeping people from getting obese makes more sense than treating diseases caused by obesity. We probably shouldn’t treat conditions caused by smoking or other substance abuse. Just make the person comfortable in their last days with sedatives or pain killers. Finally, there’s no reason why NY should give medical care to illegals. This burdens the system needlessly.

              If we do all of the above, probably costs will drop by half or more. If you look at the pie chart in the link you gave, that would mean medical costs can be entirely covered by existing state, federal, and other funds, with no need for new taxes at all. The bottom line is the number to reach for here is a ~50% reduction in costs prior to implementing any form of single payer.

        • Z says:

          Actually, I looked at that chart in haste. It appears those taxes are only on INVESTMENT INCOME: https://assets.nationbuilder.com/pnhpnymetro/pages/7770/attachments/original/1550775746/Screen_Shot_2019-02-21_at_2.01.53_PM.png?1550775746

          The chart shows that an individual pays 20% a year and that an employee would pay as follows:

          $50K income/year – $690 employee pays/year
          $100K income/year – $2,455 employee pays/year
          $175K income/year – $5,695 employee pays/year
          $225 income/year – $8005 employee pays/year
          $400 income/year – $16,615 employee pays/year

    12. B.B. says:

      Oh I bet local 1199 is licking their chops at the prospect of this happening.

    13. Richenda Kramer says:

      As our health system increasingly costs more and provides less, and becomes more and more complicated with insurance policies, this bill offers hope to those of us caught in the present system.

      • Mike says:

        I don’t know. Not like the Veteran’s Administration is doing a great job providing health care… Not sure this will work well in America.

    14. Mike says:

      Honestly, if my taxes go up anymore, I’m moving to Connecticut. This is ridiculous. I was going to move to Westchester anyhow in a couple years before my kids have to start school (bc of the mess that is NYC public schools these days). Connecticut isn’t much further. I don’t think it’s fair for the government to take the majority of what I earn.