The State Legislatures
in California and New York are debating legislation designed to create
single-payer systems in their respective states. Under a single-payer system,
all residents of that state would be covered for all medically necessary
services, including doctor, hospital, preventive care, dental, vision,
prescription drug, long-term care, mental health, reproductive health care and medical supply
S.B. 562, titled the Healthy
California Act, would create the Healthy California program to provide
comprehensive universal single-payer health care coverage and a health care
cost control system for the benefit of all residents of California. The bill,
among other things, would provide that the program cover a wide range of
medical benefits and other services and would incorporate the health care
benefits and standards of other existing federal and state provisions,
including but not limited to the state’s Children’s Health Insurance Program
(CHIP), Medi-Cal and the Medicare program. This bill would also create the
Healthy California Board, made up of nine members with demonstrated expertise
in health care, to govern the program.
The legislative bill analysis
estimates the total annual costs of the Healthy California program to be about $400
billion per year, including all covered health care services and administrative
costs, at full enrollment.
Existing federal, state and local funding of about $200 billion could be
available to offset a portion of the total program cost. Finally, approximately
$200 billion in additional tax revenues would be needed to pay for the remainder
of the total program cost.
Specifically, the proposed
law would make the following changes to the health care system in California
(this list is not exhaustive):
every resident of California eligible for the Healthy California program.
any cost sharing for enrollees such as premiums, copayments or deductibles.
coverage for “all medical care determined to be medically appropriate by the
member’s health care provider.”
coverage for all health care services covered by Medi-Cal, Medicare, health
plans regulated under the Knox-Keene Act and the essential health benefits
mandated in the Affordable Care Act.
- Authorize any licensed
health care provider to provide services to a member.
- Authorize members to
receive health care services from any willing provider, without needing a
referral from a primary care provider or a care coordinator.
- Require payments to
providers to be made on a fee-for-service basis unless other payment
methodologies are developed by the Healthy California Board (Board).
- Require all payments to be
reasonable and reasonably related to the cost of providing health care services
and ensure an adequate supply of services.
- Require the Board to apply
to the federal government for permission to include the participants and
funding streams for Medicare, Medi-Cal and Covered California in the program.
SB 562 passed the full Senate on June 1 and has been
sent to the Assembly for further consideration.
A. 4738 and companion bill S. 04840 establish the New York
Health program, a comprehensive system of access to health insurance for New
York state residents.
The proposed law would make
the following specific changes to the health care system in New York (this list
is not exhaustive):
- Make every resident of New
York eligible for the New York Health program.
- Prohibit any cost sharing
for enrollees, such as premiums, copayments or deductibles.
- A college, university or
other institution of higher education in the state may purchase coverage under
the program for any student, or students’ dependent, who is not a resident of
- Require coverage for all
health care services covered by Child Health Plus, Medicaid and Medicare.
- Establish a broadly
representative Board of Trustees of the New York Health (Board) program to advise
the Commissioner of Health.
- Require that the Board develop
a plan for long-term care coverage within two years of the law’s passage.
six regional advisory councils to represent the diverse needs and concerns of
the region. The councils must include but not be limited to representatives of
health care consumers, providers, municipal and county government and organized
labor. The councils will advise the Board, Commissioner, Governor and
Legislature on matters relating to the New York Health program and must adopt
community health improvement plans to promote health care access and quality in
According to the press
release issued by Assembly Speaker Carl Heastie (D-NY), “[b]enefits would
include comprehensive inpatient and outpatient care, primary and preventative
care, prescription drugs, behavioral health services, laboratory testing and
rehabilitative care, as well as dental, vision and hearing care.”
Funding for the program would be based on a shared 80/20 employer/employee contribution system.
Additionally, state funding would be combined with federal funds that are
currently received for Medicare, Medicaid and Child Health Plus to create the
New York Health Trust Fund. The state would also seek federal waivers that will
allow New York to completely fold those programs into New York Health. The
local share of Medicaid funding would end, offering property tax relief for New
Note: The fiscal estimates made in the legislative analysis are
subject to enormous uncertainty. Completely rebuilding the California health
care system from a multi-payer system into a single-payer, fee-for-service
system would be an unprecedented change in a large health care market. There
are numerous uncertainties about how enrollees, providers, employers, and the
state would adapt to such a system.
New York Health would be paid for based on ability to
pay, through a progressively graduated
payroll-based premium (paid at least
80% by employers and not more than 20% by employees, and 100% by self-employed) and a progressively graduated premium based on other taxable income, such as capital
gains, interest and dividends.