FAQ

Here is a list of FAQs about the New York Health Act. If your question isn't answered here, email us at info@nyhcampaign.org

What is the New York Health Act?

Answer

New York Health is legislation in New York State that would provide comprehensive, universal health coverage for every New Yorker and would replace private insurance company coverage. You and your health care providers work to keep you healthy. New York Health pays the bill. This plan is similar to Medicare or the Canadian system — but better.

Instead of having to worry about getting health insurance through your job, spouse, or buying it on your own, all New Yorkers would automatically have their healthcare covered by a public statewide fund, regardless of age, employment, or financial means. Everyone would have access to healthcare the way everyone has access to the fire department, libraries, and schools – public services provided without your ever having to worry about a bill. 

Why do we need New York Health?

Answer

Every day, five New Yorkers die needlessly due to lack of health coverage. It’s so common that it no longer makes the headlines. In the last ten years, an estimated 20,000 New Yorkers died unnecessarily due to lack of health insurance. Over 1 million New Yorkers lack health insurance, and millions more have plans that would bankrupt them when faced with a medical emergency.

If you’re lucky enough to have a decent health plan, chances are you have been forced to cover more of the cost every year, while having to fight denials and limitations. The fees charged by private insurers have risen by over 50% in the last five years throughout the state. New Yorkers deserve better. We should not have to plan our jobs and lives around how to pay for essential healthcare.

While New York leads the country in how much we spend on healthcare, and the U.S. nationally spends more than $3 trillion on healthcare every year, our healthcare outcomes are far behind other high-income countries in nearly every category. For example, maternal mortality is actually increasing in the U.S. despite every other comparable country making significant gains in reducing deaths related to pregnancy.

Financial barriers and lack of access to care are significant drivers in these shameful health outcomes. Each year, 1/3 of patients with insurance go without prescribed medicines or fail to get the medical attention needed because of high deductibles and co-pays.

The current system relies largely on private commercial health insurance, which spends exorbitant amounts of money on CEO salaries, advertising to healthy “customers” with expensive ads, and creating huge amounts of paperwork and administration. Health insurance companies in the U.S. spend up to 20% of each dollar on administration; Medicare, by comparison, spends 2 cents of each dollar. We throw away billions on commercial health insurance unrelated to direct patient care. 

Inequality is rapidly increasing, and your zip code can actually determine your life expectancy. The richest 1 percent of American men lives 15 years longer than the poorest 1 percent; 10 years longer for women.

The current system is designed to make profits—which it does very well—not provide health care.

How Would the New York Health Act Work?

Answer

It would provide comprehensive, universal health coverage for every New Yorker and would replace private insurance coverage. You and your health care providers work to keep you healthy. New York Health pays the bill. 

1. Freedom to choose your health care providers. There would be no network restrictions. Only patients and their doctors – not insurance companies – would make health care decisions.

2. Comprehensive coverage. All New Yorkers, regardless of immigration status, would be covered for all medically necessary services, including: primary, preventive, specialists, hospital, mental health, reproductive health care, dental, vision, prescription drug, and medical supply costs – more comprehensive than commercial health plans.

3. Paid for fairly. Today, insurance companies set the same high premiums, deductibles, and co-pays, whether it’s for a CEO or a receptionist, and a big successful company actually pays less than a small new business.

Can universal health care really happen in NYS?

Answer

Yes, and we are closer than ever. Last year, the bill easily passed the NYS Assembly for the fourth year in a row. We have nearly a majority of the Senate signed on as cosponsors of the bill. All of the current cosponsors are Democrats, but Republican support for the universal, public healthcare is growing. The Campaign for New York Health is trying to build a powerful grassroots movement to change what is politically possible in New York State. Join us!

Send a message to your Senator today!

Doesn’t the ACA fix health care?

Answer

The Affordable Care Act expanded healthcare to millions of people. But it left the private health insurance companies in charge. Many more health plans have narrow restricted provider networks, rising premiums, high deductibles and co-payments that shift a large part of the cost to the individual. They control which doctors or hospitals we can go to and what care they can provide. We pay for their high administrative costs and profits. Employers continue to shift more of the cost of coverage to their workers, or drop coverage entirely. 

What happens if Washington cuts Medicare and Medicaid and people lose their ACA coverage?

Answer

The only way New Yorkers can protect ourselves—the only way we can afford to fill the huge gaps that will be created by Washington—is by adopting our own highly-efficient form of health care financing with the New York Health Act.

Won’t New York Health be just like every other health plan, only bigger?

Answer

Not at all. By law, it will not limit who you can go to for care and will not dictate health care decisions. Financial barriers won’t limit your ability to get care when you need it. Because wealthy and well-connected New Yorkers will be in the same plan with the rest of us, you can be sure it will be a better plan—better for patients and for health care providers. 

Won’t this be a huge new tax increase?

Answer

No. We’ll save $45 billion, because we won’t be paying for insurance company administration or health care provider costs for dealing with them, and save through State bargaining for reduced pharmaceutical and equipment prices. We won’t be paying regressive premiums, or any deductibles, co-pays, or out-of-network charges. Property taxes will go down because local governments won’t pay for Medicaid, and health care for their employees will be cheaper. New Yorkers will have more money in our pockets and better health care for our families, and the tax that pays for the plan will be based on ability to pay. 

Can I buy private insurance?

Answer

Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents. That’s important to prevent a 2-tier system, so wealthy New Yorkers have a stake in maintaining the quality of New York Health. But private coverage could be sold for benefits that would be outside the NY Health program, like purely cosmetic surgery. 

Is long-term care covered?

Answer

Long-term care (e.g., home health care, nursing homes) will be covered, but the bill sets a two year period to develop the specific plans once it is passed. Many advocates are urging Long-term care to be included immediately upon passage. The New York Health Foundation recently commissioned a study to examine long-term care and the New York Health Act, so more information on this important proposal will be available soon.

What about retiree health benefits?

Answer

Most retirees will simply be covered by New York Health, plus Medicare. A plan will be developed to cover retirees who move out of state. 

What is single-payer healthcare?

Answer

“Single payer” is a simple and proven solution to the two intertwined crises in our current healthcare system: the skyrocketing costs and the fact that millions lack access to care. A single-payer system like New York Health provides everyone with guaranteed, comprehensive healthcare at a much lower cost by eliminating the middleman that currently stands between you and your doctor: the insurance companies.

Under New York Health, doctors and hospitals would be paid for their work by a single tax-supported fund, similar to Medicare, rather than wasting time and money dealing with hundreds of insurance bureaucracies as they do now in our “multi-payer” system. Instead of the multitude of plans currently available, each with different networks of providers and different services covered, every resident is automatically enrolled in the same comprehensive plan.

In addition, New York Health removes all financial barriers to care. The system is funded through progressive taxation, which means you only pay a percentage of your income based on what you can afford, unlike the skyrocketing fees charged by private insurers. NYH would also eliminate all co-pays and deductibles. Finally, New Yorkers would no longer have to worry about finding “in-network” doctors or being stuck with a bill for healthcare due to an insurance denial.

What services are covered under New York Health?

Answer

New York Health will fully cover all medically necessary services comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, mental health, reproductive health, rehabilitation, dental, vision, hearing, and medical supply costs. All New Yorkers would gain access to all benefits required by current state insurance law or provided by the state public employee package, Family Health Plus, Child Health Plus, Medicare, or Medicaid, as well as others added by the plan. 

Who would be covered under New York Health?

New York Health covers all residents of New York state from birth until death, regardless of health, financial or employment status. Coverage follows you if you travel, retire, or lose your job.

We provide fire and police protection for everyone – why shouldn’t we do that for healthcare? With New York Health, no one would be denied care because of pre-existing conditions and no insurance company clerks would tell your doctor how to practice medicine.

Won’t it cost more to cover everyone?

Answer

No. Though it seems hard to believe, it’s much cheaper to cover everyone. In fact, our government already spends MORE per person on healthcare just for the elderly and poor under Medicare and Medicaid than the Canadian government spends to provide healthcare for every citizen throughout their entire life. Why? There are many reasons. Right now our government shoulders the burden of paying for those whose care is most costly — the elderly and the needy — while private health insurers reap billions in profits by insuring those who need care the least — those healthy enough to work. This makes no sense.

Rather, as proven in every country with universal healthcare, when everyone is in the same public insurance pool, our money gets used more efficiently. More of our money goes to providing actual healthcare instead of being wasted on insurance companies’ marketing, claims denial departments, shareholder profits, or bloated CEO salaries.

New York Health would also bring costs down by reducing doctors’ expenses. Doctors spend less when they don’t have to pay for extra staff to manage all the intricate billing that comes with private insurers. For example, Duke University’s 900 bed hospital employs 900 medical billers to deal with all the insurance company paperwork. The cost of employing huge departments to handle all this red tape gets passed on to you, making everything more expensive. By contrast, Toronto General hospital has only 3 medical billers on staff. Why? Because a single payer system is more efficient and therefore cheaper.

Finally, New York Health would save money by giving people more access to care in a timely way before conditions worsen and become more costly to treat in the emergency room. Even prescription drugs would cost less, since the state would negotiate bulk prices. 

How does New York Health reduce costs?

Answer

New York Health reduces costs by cutting waste, not by denying care to patients. As proven in other countries, providing universal coverage is actually much cheaper since you aren’t paying for insurance companies’ marketing, claims denial departments, shareholder profits, or bloated CEO salaries. Also, when people have more access to care, they get treatments earlier before conditions worsen and become more costly. Even prescription medicine costs less, since the government could negotiate bulk prices.

In addition, doctors charge less when they don’t have to pay for extra staff to manage all the intricate billing that comes with private insurers. The cost of employing huge departments to handle all this red tape gets passed on to you, making everything more expensive. 

In fact, our government already spends MORE per person on healthcare just for the elderly and poor under Medicare and Medicaid than the Canadian government spends to provide healthcare for every citizen. 

NYH controls costs through:

  • Simplifying Paperwork: getting rid of the vast private insurance bureaucracy devoted to billing, coding, denying care, and reimbursing the same procedure at different rates
  • Reducing Wasteful Spending: your money won’t be diverted towards marketing, shareholder profits, or bloated CEO salaries.
  • An Ounce of Prevention: increasing access to preventive services and early intervention for everyone to avoid costly emergency room and hospitalization expenses.
  • Bulk Purchasing: buying drugs and medical supplies at lower, negotiated prices
  • A Bigger Pool: putting all New Yorkers in the same plan decreases costs since most people are healthy most of the time, offsetting the cost of providing care
  • Providing Care Where It’s Needed: hospitals and surgical centers can be located where they are needed, ambulances can go to the closest hospital, etc.
  • Simplifying Payments: annual budgets for health care facilities, rather than itemized reimbursements.

What about people who work for insurance companies?

Answer

Reducing our current bloated insurance bureaucracy will inevitably lead to some job loss. However, the adoption of a single-payer system is expected to lead to the creation of many new jobs in other industries throughout the state. Once employers are freed from the burden of buying private insurance for their workers, they will have much more money to invest in their business and hire more workers.

By the same logic, single payer will also make it much easier for freelancers and entrepreneurs to start and expand their businesses. Finally, with a single-payer plan, unemployed New Yorkers will no longer have to worry about how to pay for healthcare as they will be automatically covered by the statewide plan regardless of work status (even those who worked for health insurers).

For those who currently work for private insurance companies, or in the billing department for providers, there is funding in the bill to support their transition to new employment. Some will transition to work in the new system, and others may take on roles for care coordination or healthcare delivery. The economic impact study performed in 2015 estimated that over 70% of the displaced workers will have new jobs within six months. By the end of the second year, over 99% of the displaced workers will have found new employment. While this may present individual challenges, advocates prioritize a just transition to meaningful and well-compensated work in the new system.

For more information on a just transition for workers, see our fact sheet here.

Will this lead to huge waiting lines for care?

Answer

American health insurance companies have a long history of trying to scare Americans away from universal healthcare by claiming that we’ll be stuck with huge waiting lines. As evidence, they usually reference Canada, which has a very popular single-payer system that covers everyone, while spending only about half as much as the U.S.

First, it’s important to clarify that, as in Canada, there are NO waiting lists for emergency procedures. It’s also important to bear in mind that waiting times are a part of every healthcare system. Although patients in some parts of Canada have reported longer wait times for certain non-emergency procedures, it seems to vary widely by province. In many parts of Canada, the waiting times are similar to those in the United States… assuming you have insurance. Overall, the waiting time issue in Canada is much smaller than portrayed by American health insurance companies.

The New York Health Act will remove many of the sources of long wait times in the US. There will be no limited provider networks, and providers will no longer discriminate against Medicaid and Medicare patients, since reimbursement rates will be standardized. There will be no barriers to provider choice, creating a greater range of options, especially in urban areas with greater concentrations of providers.

With reduced paperwork and administrative burden, providers will have more time to devote to patient care and the management of patient flow. This will be especially important in the face of the expected increase in utilization of health care services. Hospitals, too, will be relieved of an administrative burden and be able to devote more resources to patient services.

In the longer run, NY Health planners will be able to work with the Governor and the Commissioner of Health to increase the supply of providers in rural areas and to provide the necessary capital for expanding patient care facilities and diagnostic technology where it is needed.

For more information on wait times, read this briefing paper

Why does NYH include “care coordination”?

Answer

Patients stay healthier when someone checks whether they are taking their medications, watching their weight, and coming in for check-ups or follow-up appointments. That is why the bill says that each patient must choose a “care manager” to help coordinate these essential services. In most cases, your “care manager” would be your primary care provider.

This should not be confused with “managed care” which refers to the many ways that insurance companies and HMO’s currently limit your care by shifting costs on to you and by forcing you to get referrals or prior authorization before seeing specialists. By contrast, under NYH your care manager is there to help give you more access to care and to check in with you between visits. 

Why not have a national system? Why should New York be doing this?

Answer

It would be great to have truly universal coverage in every state. But Washington is heading in the opposite direction. A progressive state like New York can and should take the lead. The states have long been the “laboratories of democracy,” and the Affordable Care Act gives states new authority to set up their own health care systems that meet Federal goals. Our advocacy could help set the model for healthcare, inspiring other states and then Washington to follow. Canada's system was set up in a province first before being adopted shortly after by the rest of the country.

What doctors and hospitals will I be able to use?

Answer

There will be no restricted network of providers. Every health care provider in the state will be able to participate, and patients can go to whichever provider they choose. 

Will doctors and hospitals be required to participate?

Answer

No. However, there would be no other insurance coverage to pay a non-participating provider.

Will doctors and hospitals be able to charge more than New York Health will pay?

Answer

If a provider is paid by New York Health, the patient may not be charged more (no “balance billing”). 

What share will my employer pay?

Answer

Employers will pay at least 80% of the tax on payroll, and employees up to 20%. Employers can agree to pay all or part of the employee’s share (e.g., through collective bargaining). 

My employer now pays the whole premium for my coverage. Will I now have to pay 20% of the payment?

Answer

If workers have bargained to get the employers to pay more than 80% of the premium now, it will be easier to get the same under New York Health, since the total cost will be less than it is now. 

What if I’m self-employed?

Answer

You will pay the entire contribution, just as you now pay your whole insurance premium. 

I have a good health plan. Why would I want to trade it for New York Health?

New York Health will upgrade everyone with better and more comprehensive coverage with full choice of providers, and will save families thousands of dollars by eliminating premiums, deductibles, co-pays and out-of-network charges.

Why should businesses support the New York Health Act?

Answer

The New York Health Act would be hugely beneficial to businesses. Instead of paying a per employee premium, the business would pay a proportionally smaller tax to the government to offset the cost coverage. Business owners can focus on running their businesses, instead of fighting health insurance companies. The savings can be passed on to their customers, and allow them to pay more in wages. For more on the business case for universal, single-payer healthcare, visit: www.fixithealthcare.com

Will NY need federal waivers to implement the NY Health Act? What about ERISA?

Answer

In order to efficiently integrate existing federal funds (Medicare, the federal share of Medicaid and CHIP, ACA subsidies) into the new system, the New York Health program will seek waivers from the federal government that will enable bulk transfer of these funds to the state based on global, prospective budgeting. 

For a more thorough overview of the issue, read the FAQs on federal waivers and ERISA.