The New York State Assembly is set to vote on a bill today that, if signed into law and implemented, would enact a single-payer health program in the state.
The New York Health Plan, as the proposal is called, is expected to pass the Assembly with wide margins, as it did in 2015 and 2016. Each of those years, however, the bill wasn’t picked up in the state senate. This year, however, it’s obtained widespread backing and is closer to passing than it’s ever been before — the current count has it just one vote away.
“A single-payer system would create the peace of mind that residents could have access to quality medical care including outpatient and inpatient medical care, primary and preventive care, prescription drugs and laboratory tests,” State Sen. Jeffrey Klein, the head of an independent caucus whose support is critical to bringing the bill withing striking distance of passing, told the Huffington Post.
This latest state-level push comes at a time when single-payer health care is increasingly popular. According to a Morning Consult/Politico poll, a plurality of Americans — 44 percent — now support a single-payer system where all Americans get their health insurance from the government.
After a survey of Trump voters earlier this year, Vox reported that half of the group supported a single-payer system (which would actually fulfill Trump’s campaign promise of “health care for all” better than the plan he backed). Trump himself, when meeting the Australian Prime Minister in early May, praised Australia’s nationalized health care system as “better” than what the U.S. provides.
This new popularity has also erupted at protests and town halls across the country. At a town hall in New Jersey, for example, Trumpcare co-architect Rep. Tom MacArthur’s constituents drowned him out with chants of “single payer” as he tried to defend his additions to the GOP plan, which preliminary analyses estimate would leave tens of millions more uninsured compared to the current health care system.
With Republicans in solid control of all federal branches of the government, single payer advocates have turned to state-level pushes, in states from New York to Colorado to Hawaii. At the moment, New York and California are leading the pack; California is also taking up debate on a single-payer bill this session and has been highlighted by progressive leaders like Sen. Bernie Sanders as a possible testing ground for a national push.
A previous attempt to implement a single-payer system in Sanders’ own state, however, illustrates some of the pitfalls with implementing such a plan on a state-by-state basis.
Deep-blue Vermont passed a single-payer health care plan in 2011. The bill was signed into law by newly-elected Democratic governor Peter Shumlin, who campaigned on a promise to advocate for single payer. The state was widely lauded as a trailblazer by single-payer advocates, though implementation was delayed until the costs could be estimated.
Then, three years later, Shumlin axed the plan’s implementation. In between signing the bill into law and axing it, Shumlin endured a humiliatingly close reelection driven largely by concerns and backlash to the single-payer proposal. And the estimated cost of the bill, when it finally came out, was brutal: paying for the plan would cost around $4.3 billion a year, nearly as much as the state’s entire budget of $4.9 billion. To cover the shortfall, the state would have had to dramatically hike taxes on both residents and businesses — which many worried would drive businesses out of the state.
Advocates of single payer argue that Vermont’s failure should not dissuade other states from taking up their own plans. Some argued that the plan was actually viable, and that Shumlin abandoned it for reasons more political than economic. Many advocates pointed out that the tax hikes to residents would be offset by the reduction to what they had to pay in medical costs. And others argue that the plan’s specific formulation was flawed: It excluded big multi-state corporations from the tax (likely as an attempt to keep large employers like IBM in the state), which drove costs up for smaller, local businesses and contributed to the funding shortfall.
Proponents of California and New York’s plans also point out that those two states are much larger and economically robust than Vermont, and therefore are likely to be better able to withstand the stresses of the expensive implementation period. California, for example, has a population of nearly 40 million and a GDP on par with many countries, and thus may be a better testing ground than a small, economically struggling state like Vermont.
That doesn’t mean, however, that Vermont’s failure should be dismissed as a fluke, or that the path forward for single payer is clear on a state level.
Federal single-payer proposals are based in part on the high level of control and power the federal government has, giving it leverage over employers, pharmaceutical companies, medical patents, and health providers throughout the country. States don’t have the same level of power.
State plans also are necessarily confined to a smaller population pool, which again lessens the leverage they have over corporations and interest groups, and can drive up costs. And while California and New York are both vastly larger than Vermont (whose total population is around one fourteenth the population of New York City alone), they both still lack the leverage over national regulations that is one of the main ways single payer plans can keep down health care costs.
Still, advocates are hopeful that a state-level push can put illustrate the success of single-payer plans, or at least build political pressure and support for an eventual national push for universal health care.