New York Health Plus is a new plan to offer health coverage, like Medicare and Child Health Plus, but open to everyone. It is sponsored by Assembly Health Committee chair Richard N. Gottfried (A. 7854) and Senate Health Committee chair Thomas K. Duane (S. 4884).
We should build on what works: Offer New York’s popular publicly-funded health insurance programs, Family Health Plus and Child Health Plus, to everyone – and save $20-30 billion of the over $100 billion that New York employers and individuals spend every year on premiums, deductibles, and co-payments. No New Yorker – individual or employer – would have to pay a health insurance premium or deductible. And people who want to keep their current coverage could do that.
This issue is not only about people who are uninsured. It is about all of us:
People who have no coverage, too little coverage, or lose coverage face serious health and financial damage.
People with health coverage selected by their employer find their health plan refusing to pay for care or paying as little as possible.
People who try to buy coverage on their own find the cost way beyond their means and the fine print makes intelligent consumer choice almost impossible.
Employers – especially small businesses, low-margin businesses, or start-up companies – find the cost of coverage a burden. More employers are dropping coverage or shifting the cost – especially with high deductibles and limits on coverage – to employees who cannot afford it.
Health care providers face endless hassles in dealing with health plans, and are not rewarded for providing preventive care.
A universal coverage plan for New York needs to work for all of us. It should promote better health care, reasonably control costs, and fairly distribute costs.
Here are the highlights of New York Health Plus:
Build on what works: The plan is built on New York’s popular Family Health Plus and Child Health Plus – comprehensive health coverage, delivered through a variety of participating health plans. They consistently show higher patient satisfaction rates than private insurance plans.
Open it to everyone: Remove income eligibility limits for this coverage. Every New Yorker would be eligible to enroll.
Guarantee choice: Individuals who choose to enroll would pick their own participating health plan. There would also be a public plan option, like traditional Medicare. Individuals or employers could choose to opt out and continue to pay for private coverage.
Relief from high health care costs: No longer would any employer or individual have to pay premiums, deductibles and co-pays. By taking over the financing (but not the actual care), New York would be able to control costs, improve care, and pass on the savings to taxpayers.
Financed with fairness: Premiums and deductibles are a regressive “tax” we wouldn’t have to pay anymore. New York State would pay for the coverage (plus Federal matching funds where eligible), using revenue based on ability to pay.
We can make New York dramatically more employerfriendly and job-friendly by eliminating the need for any employer to provide health coverage for its workers. This is especially important for small businesses, start-ups and lowmargin businesses.
New York employers and individuals now spend over $100 billion a year for premiums, deductibles and copayments, plus more for care for the uninsured. New York Health Plus would save us $20-30 billion.
New York Health Plus would more effectively control costs while also assuring better quality care and more preventive care.
Health plans today are accountable mainly to costconscious employers, so they are under extraordinary pressure to refuse to pay for care and to pay as little as possible. The pressure from employers is almost entirely "downward."
Under New York Health Plus, there would certainly be pressure from taxpayers and elected officials to control costs. And the state as purchaser would be able to do that. But there would also be "upward" pressure on our elected government from millions of vocal voting customers to make sure that the state uses its power – as sponsor and purchaser of the coverage –to make sure that participating health plans deliver quality care and deal fairly with patients and providers.
All patients who choose to join the plan – rich and poor – and health care providers would be in the same boat. That is the best guarantee that the Governor and the Legislature (not insurance companies) would make sure that the balancing of downward and upward pressure makes it the best possible coverage. This is what has made traditional Medicare such a successful and popular program.
Look at the record. Family Health Plus and Child Health Plus now provide comprehensive coverage at lower cost than anything employers or individuals can buy. New York sets the premium it pays. And unlike privately-sponsored coverage, New York has kept its premiums virtually flat for the last several years.
New York Health Plus would have standards and incentives to improve the quality of care. But under privately sponsored coverage, health plans have little incentive to promote quality or preventive care, because an individual patient is likely to have moved on to another employer or another health plan by the time any savings are seen. New York Health Plus does not require complex new programs or bureaucracies, because it is based on Family Health Plus and Child Health Plus.
Today, we pay premiums and deductibles set by insurance companies. It’s a regressive "tax" – without regard to whether the person being covered is a receptionist, assistant manager, or company president, or whether an employer is a huge prosperous company or a small business struggling to get by.
New York Health Plus would replace that regressive tax and also save $20-30 billion a year. The state would pay for the coverage, using revenue based on ability to pay (plus Federal matching funds where eligible), without deductibles or co-pays. The revenue would come from an assessment modeled on the Medicare payroll assessment, plus a surcharge on upper-bracket non-wage-and-salary taxable income.
Individuals or employers who choose to opt out and buy private coverage would receive a credit against most of the assessment.
Compare health care with education. Educating children is a parent’s responsibility. But we don’t ask parents to pay a premium or deductible to send their children to school. We insist that New York provide free quality education for every child.
Universal health coverage is a major issue not just because a minority of the population lacks coverage. It’s also because the overwhelming majority is fed up with our current system and wants it changed.
Any serious plan for universal coverage will be attacked by powerful special interests. To overcome those attacks and win public support, a plan should offer real change that people want: universal access, ability to control costs, ability to promote preventive care and quality care, fairness and equity. That’s what New York Health Plus will do.
New York State Assembly Committee on Health
Richard N. Gottfried, Chair
822 Legislative Office Building
Albany, NY 12248
GottfrR@assembly.state.ny.us
Who is covered? Every New York resident would be eligible, regardless of age, income, where you work or whether you work. But individuals and employers could choose to keep buying the coverage they now have.
What is covered? Full comprehensive health and mental health benefits.
Can I choose my own plan? Yes. People would choose from any health plan that offers Family Health Plus. (Child Health Plus would be merged into Family Health Plus.) There would also be a public plan option, like traditional Medicare.
What do I pay? Individuals and employers would not pay any premiums or deductibles, and copayments under Family Health Plus are very limited.
Who pays for the Plan? New York Health Plus would save $20-30 billion of the over $100 billion we now spend on premiums, deductibles and co-payments. New York State would pay for the coverage (plus Federal matching funds where eligible), using revenue based on ability to pay, from an assessment modeled on the Medicare payroll assessment, plus a surcharge on upper-bracket non-wage-and-salary taxable income.