single payer

Can New York Pass Single-Payer in 2021? As New York recovers from a pandemic and an economic crisis that threw millions off their employer-based health insurance, proponents of the New York Health Act see a unique opportunity to make single-payer a reality.

Single-payer healthcare for New York State has been waiting in the wings.

What is the New York Health Act?

New York Health is legislation in New York State that would provide comprehensive, universal health coverage for every New York resident and worker, replacing existing 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. 

Here is what Happened.

In 2018, progressive Democrats in New York City and moderates in the suburbs and upstate campaigned on realizing the dream of single-payer healthcare in New York.  And as State Senate Democrats across New York City and the surrounding suburbs were filled with great optimism after long-stalled priorities in Albany, like stronger tenant protections and laws safeguarding reproductive health, became law.

The Democrat-controlled Assembly had passed the New York Health Act several times, but the bill had no chance in a chamber controlled by Republicans. Many of the winning Democrats, including moderates on Long Island, had pledged support for the legislation during their campaigns. 

When Senate Democrats took control of the chamber in 2019, there were high hopes that the New York Health Act, at last, would come to the floor for a vote. It never did. 

The 2019 legislative session, while full of progressive victories for the new Democratic majority, did not include passage of the New York Health Act, let alone a floor vote. Some of the moderates who backed the legislation during their campaigns refused to co-sponsor it once in office. Governor Andrew Cuomo, by far the state’s most powerful figure, continued to dismiss the idea of a statewide single-payer system, claiming support for a federal program would be less likely under a Donald Trump presidency.

The Single-Payer Healthcare bill stalled in the Senate, one co-sponsor short of a majority needed for passage.

A year later, in 2020, the Covid-19 pandemic struck. Cuomo gained new emergency powers over the budget and major legislative priorities were shelved. For months at a time, Assembly and Senate Democrats, seemingly unmoored, couldn’t even come together to vote on bills.

After a pandemic and the resulting economic upheaval threw many workers off their employer-based health insurance plans—738,000 New Yorkers lost jobs that provided health insurance, and those plans covered an additional 634,000 dependents.  

What's Next?

As 2020 winds down, advocates for single-payer healthcare and progressive lawmakers are planning to make 2021 more fruitful, plotting a renewed push for the New York Health Act when the legislative session resumes in January.

In addition, a new class of assembly members and state senators will take office next year, most of them far more openly progressive than their predecessors. If two more Democrats flip Republican-held State Senate districts in November, Democrats will have a veto-proof supermajority in the chamber, theoretically allowing them to override Cuomo’s opposition.

“In the Assembly, we are going to have our largest freshman class in 45 years,” said Assemblyman Richard Gottfried, the health committee chairman and the longtime co-sponsor of the New York Health Act. “Almost all of those freshman democrats are people who campaigned strongly supporting the New York Health Act. You don’t have to be a democratic socialist to support the New York Health Act—but we will have quite a few of them in the Assembly in January.”

In the June legislative primaries, all four insurgent Democrats endorsed by the Democratic Socialists of America won their campaigns. A slew of other leftist Democrats won Assembly races as well. Though some of the defeated incumbents had been New York Health Act co-sponsors, the new class will be far more vocally in support of single-payer healthcare.

On #RepresentNYC: Assembly Member Gottfried discusses #healthcare, the effect of tying #healthinsurance to #employment, and a #singlepayer health system.

RAND Corporation study found that the New York Health Act would save New Yorkers $15 billion by 2031 by dramatically lowering administrative costs.

But it would also require $139 billion in new tax revenue, 156 percent more than the state currently collects, the study found.

Moderate Democratic senators on Long Island and Andrea Stewart-Cousins, who represents parts of Westchester, have been wary of voting for any kind of tax increase. And Cuomo has long resisted raising taxes on the wealthy, let alone the middle and upper middle classes, and has so far rejected the idea to close a budget shortfall during the pandemic—let alone fund a major healthcare expansion.


Two major healthcare worker unions, 1199 SEIU and the New York State Nurses Association, are supporters of the New York Health Act, but other large unions are wary of the legislation. At least one senator, Diane Savino, has told advocates that she cannot support the legislation as long as major unions oppose it.

One fear is that the state-run health plan would be inferior to the union plans negotiated for members. Municipal unions also fret that a statewide single-payer plan could make the idea of joining a union less attractive.

In past cycles, unions have brought up another logistical concern: how to manage the single-payer program with out-of-state workers, particularly those in labor unions. Many unions pool their money to purchase more comprehensive benefits; such pools could be diminished if every in-state union member has a state-run health plan, potentially draining benefits for New Jersey or Connecticut residents who work in New York but can’t access the single-payer plan.

New York would also need a federal waiver to redirect Obamacare funds for Medicare, Medicaid, and tax credits to a new single-payer system, an unlikely event as long as Trump is president.

The waiver has been cited as a reason for some Democrats to not support the New York Health Act as long as Trump is president.

No state has successfully implemented a single-payer model. New York, with its large population and high tax base, could be a better fit than Vermont, which attempted to implement single-payer and failed.

Gottfried, the New York Health Act architect, is still optimistic New York can eventually stand apart.

“The state’s current financial situation does not get in the way of the New York Health Act,” Gottfried said. “If many New Yorkers’ personal finances stay the way they are, they are certainly going to need the coverage of the New York Health Act.”


Parts of this blog were written by Ross Barkan   

This edited article has been reposted with permission from New York Focus