New York will have a solid Democratic trifecta in 2019. The New York State Senate will have a 39-24 Democratic majority. This means any Democratic only bill can lose 7 votes or 18% of the Democratic Senate caucus and still maintain a minimal viable winning coalition. The New York House will have a 106-44 majority. Any Democrat only bill can lose 29% of the Democratic Assembly Caucus and still maintain a minimal viable coalition. As a reminder Senate Majority Leader had an effective 0% margin and Speaker Pelosi had a 14% margin within her caucus to pass the ACA.
Politico reports that one of the major bills that is being debated and prepped for a 2019 introduction is New York state single payer. It is a bill that is splitting the caucus as major internal interest groups are at loggerheads.
While public-sector unions in New York City have voiced concerns over the bill’s potential to curtail their generous health benefits, which POLITICO first reported last week, two leading health care unions are among those continuing to back the legislation….
The Municipal Labor Committee, an umbrella group of New York City unions, recently met with the bill’s sponsors — Assemblyman Dick Gottfried (D-Manhattan) and state Sen. Gustavo Rivera (D-Bronx) — in the Lower Manhattan offices of District Council 37 to express their concerns.
They worry they will lose the option to select virtually full coverage because of a provision in the legislation that passes a fraction of a proposed payroll tax onto employees. They are also concerned about losing union-controlled “welfare funds” to which the city contributes about $1,500 per member. Those accounts pay for a variety of expenses, including prescription drugs, eyeglasses and hearing aids.
The biggest challenge for national single payer is that it is massively disruptive. People who have good to very good benefits right now and who make significantly more than median income (ie high propensity voters) are going to be incredibly disrupted in the short term even if they are promised that they will be better off in the long term. The union fight in New York state is a good exemplar of how the political coalitions can be fractured.
The biggest challenge at the state level is two parts of the same problem:
- How does this get paid for
- How does this work in a 2008-2010 scenario?
- How do the waivers that are not yet legal get approved by the Feds
The bill would cost an estimated $139 billion in new tax revenue each year, making its fate especially uncertain in the hands of a governor who has been reticent to raise taxes. Sponsors have argued that the price tag is misleading because the taxes displace money already being paid in co-pays and premiums…
A state-level plan would need an unprecedented federal waiver to allow for federal Medicaid, Medicare and Obamacare funds to be redirected into the new system, among other complications….
Single payer is a good slogan. Figuring out the nuts and bolts of how to implement this slogan into policy is an extraordinarily difficult political and policy act.
Is the challenge and pain worthwhile?
If the goal is to eliminate insurance companies it may be; if the goal is to make sure there is universal coverage that is good and affordable then other methods may be superior.