New York Health Gottfried - Rodberg

7/29/2019 New York Health Gottfried - Rodberg

1/21

Can We Bring Single Payer to

New York?Gottfrieds New York Health Bill:

The Single Payer Plan for New York StateLeonard Rodberg, PhD

Urban Studies Dept., Queens College/CUNY

andNY Metro Chapter, Physicians for a National

Health Program

November 2012


2/21

Starting in 2014, state-based insurance

exchanges offer private insurance to

individuals and employers Citizens and legal immigrants required to be

insured.

Subsidies up to 400% Federal poverty level Medicaid for all below 133% poverty level

Affordable Care Act:

Now the Health Reform Law of the Land


3/21

Millions Will Remain Uninsured

Millions

Note: The uninsured include about 5 million undocumented immigrants.

Source: Congressional Budget Office

54 55 56 56 56 5657 58 58

26 26

53 53

41

36

30 29 29 29

53

3732

26 25

0

20

40

60

80

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Current law

ACA 2010

ACA Post-Supreme Court


4/21

while Underinsurance becomes the Norm

(Average Employer Plan: 87% coverage)

60% 70% 80%


5/21

Numbers of NYS Uninsured

Reduced by 37% -- Still 1.7 million

Source: The Coverage and Cost Effects of Implementation of

the Affordable Care Act in New York State, Urban Institute, March 2012

Population figures in thousands of people


6/21

More than Half of NYS Funds Will

Come from Government

Federal Government

( Medicare, Medicaid,

ACA subsidies, other)

43%

State and Local Govt

(Medicaid, other) 11%

Individual19%

Employers

19%

Source: Urban Institute

Federal tax

subsidy 9%

ACA subsidy 2%


7/21

$5,791

$2,196

$15,073*

$13,770*

$13,375*

$12,680*

$12,106*

$11,480*

$10,880*

$9,950*

$9,068*

$8,003*

$7,061*

$6,438*

$5,429*

$5,049*

$4,824

$4,704*

$4,479*

$4,242*

$4,024*

$3,695*

$3,383*

$3,083*

$2,689*

$2,471*

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999Single CoverageFamily Coverage

$5,615*

* Estimate is statistically different from estimate for the previous year shown (p


8/21

While Those with Coverage Pay More


9/21

PNHPs National Program for

Health Care Reform:

Conyers

Expanded and ImprovedMedicare for All/Single Payer

HR 676

Universal - Extend Medicare to everyone

Comprehensivebenefits

Choice of doctor and hospital

No co-pays or deductibles

Funded through progressive taxes

Cost-effectiveCosts less than we now spendand contains future costs


10/21

Health Care Reform in

New York State:

Gottfried

s New York Health BillA7860/S5425

Universal coverage

Comprehensivebenefits

Coordination of care

No cost sharingNo private insurance

Funding by progressive taxes


11/21

New York Health

Eligibility

Every resident of NYS eligible to enroll

No barriers due to age, sex, income, wealth,

employment, or health status

No premiums

No co-pays or deductibles

No regressive premiums


12/21

Comprehensive Benefits

Inpatient and Outpatient Hospital Care

Physician Care

Primary & Preventive Care

Prescription Drugs Dental, Vision, & Hearing Care

Choice of Doctor, including primary care

physician (PCP) and specialists, and

New York Health


13/21

New York Health

Care Coordination Innovative measure to achieve higher quality,

less costly care

Choice of care coordinator, could be PCP Assistance in navigating the system, receiving

necessary care and follow-up

No gatekeeping or other barriers to care,

referral not required Care coordinator paid by capitation (per

capita per month)


14/21

New York Health

Funding

Progressive, graduated payroll tax, 80%

employer-paid, 20% employee-paid

Self-employed pay full payroll tax

Surcharge on unearned (non-wage) income

Existing premiums eliminated

Federal funds from Medicare, Medicaid,

Family & Child Health Plus

Federal


15/21

New York HealthProvider Reimbursement All providers paid in fullbyNew York Health,

with no copays or other charges to patients

New reimbursement methods will be developedto replace wasteful fee-for-service payments

Rates negotiatedwith health care provider

organizations by New York Health


16/21

New York Health

Administration

New York Health administered within the

Department of Health by Commissioner ofHealth

Commissioner assisted by broadly-

representative Board of Trustees


17/21

New York Health

Further Work Needed

Incorporate long-term care, including

nursing home care

Develop hospital, physician, nurse

practitioner, physician assistant payment

methods


18/21

Vermont is using its Exchange to

facilitate transition to Single Payer:

New York can, too


19/21

Building a Forward-looking Insurance

Exchange in New York State(statement endorsed by NY Metro Chapter of PNHP,

Community Service Society, and 27 other organizations)

New Yorks Exchange should

(1) encourage the highest quality, most affordable coverage

(2) facilitate movement toward a simplified, more efficient, morebroadly inclusive health care system.

Administrative Streamlining Create a single application process for all types of coverage.

Unify and simplify the administration of health care

benefits. Create a unified, simplified administrative process forall insurers, patients, and providers.

Integrate private insurance and public programs within theexchange. Improve the transition among existing programs,including the subsidized private insurance and Medicaid


20/21


Exchange in New York State (cont.)

High Quality, Affordable Care Promoting comprehensive, standardized benefits with

the widest possible provider networks and lowest possible

deductibles and co-pays. Spread risk as widely as possible, incorporating as many

plans and users as possible. Require, through newlegislation, that all individual and small group insurance besold through the exchange

Offera true state-run public plan. Start with the BasicHealth Plan provided under the ACA for low-incomeresidents, and then incorporate other public plans tocompete with inefficient, profit-oriented, private insurers.


21/21

Meet the Needs of All New Yorkers Make the exchange as immigrant-friendly as possible.

Provide support for immigrants that Federal law, so far,

does not provide. Facilitate consumer engagement through the exchange.

Help consumers deal with the complexity of the multi-payer health insurance market. Invest in a robust networkof community-based Navigators and a strong independent

Consumer Assistance Program. Position New York State to move forward toward the

simplified, efficient, high quality health care system that itsresidents deserve.


Exchange in New York State (cont.)

Documents

New York Health Gottfried - Rodberg