Single Payer overview

Transcription

1 Single Payer overview

2 Single Payer Gottfried introduced since 1992 Passed Assembly numerous times Post ACA: tempered initially 2015-present: increased momentum National & statewide VT/CA/CO/Sanders Democratic primary litmus test Cuomo excited Senate R: one seat majority Bottom line: aggressive opposition is critical 2

3 Summary of legislation: key points All New York Residents No waiting period Blind to Immigration Status Sale of Insurance for any benefit offered under NYHA prohibited No premium, deductible, co-pay, coinsurance or other costs DOH charged with implementation using temporary commission NYHA covers all New Yorkers currently receiving: Medicaid Medicare Child Health Plus NYSHIP NYSOH Commercial Insurance HMOs Self-funded (not directly addressed ) Retirees (voluntary) 3

4 Summary of legislation: Coverage & Utilization Provides comprehensive inpatient and outpatient health coverage (pharmaceuticals, dental, vision, rehabilitative, etc.) Includes all services required under State insurance law or covered for State employees and enrollees in Medicaid, Medicare, and Child Health Plus Long-term care services included after two years Existing retiree coverage and Workers Compensation could be included No network restrictions No prior approval for services No utilization review Patients must choose Care Coordinator Care Coordinators are not gatekeepers NYHP Assistors help enrollees, providers and Care Coordinators 4

5 Summary of legislation: NYHP Operation Board of Trustees advises DOH on establishment and operation of NYHP Board develops plans for long term care, retirees and Workers Compensation Creates Regional Advisory Councils. Must hold frequent public hearings & adopt community health improvement plans to improve access and quality Board and Councils have specific membership composed of consumers, providers, local government, employers and labor Provides grants to not-forprofits to promote public, environmental and occupational health Funds Health Systems Agencies Provides funds to Department of Labor for re-training of displaced workers 5

6 Summary of legislation: Financing & Payment Imposes unlimited, progressively graduated payroll tax on employers, employees and self-employed; also taxes other income Tax rate set annually in State Budget to cover cost of the NYHP Assumes approval of federal waivers include and use funds from public health insurance programs and other federal health spending Providers paid in full by NYHP Benefits & payments administered by DOH directly or by contract NYHP pays fee-for-service until other methods developed NYHP negotiates rates Providers can collectively negotiate with NYHP Can include capital component only for not-for-profit facilities Funds direct and indirect graduate medical education 6

7 Spending Annual Cost Single Payer Friedman Analysis Hinman Analysis Projected 2019 $ Billion $ Billion Current Spending Estimated ($ Billion) $4.992 Billion Savings/Cost New State Spending $ Billion $ Billion Total Cost of Single Payer $ Billion $ Billion 7

8 TAXES Friedman Estimate Hinman Estimate Total Cost $ Billion $ Billion Current Health Care Receipts ($ Billion) ($ Billion) New Taxes Required $ Billion $ Billion Tax Collections Current Taxes NYHP Taxes (80/20 split) Total Tax burden under S.P. % Increase Total $ 71,215,174,735 $ 197,941,000,000 $ 269,156,174, % Personal Income $ 47,565,944,451 $ 39,588,200,000 $ 87,154,144,451 83% Corp. & Business $ 6,027,811,511 $ 158,352,800,000 $ 164,380,611, % Sales, Excise, & User $ 15,239,780,631 $0 $ 15,239,780,631 0% Property Transfer $ 2,217,320,539 $0 $ 2,217,320,539 0% Other taxes and fees $ 164,317,303 $0 $ 164,317,303 0% 8

9 150,000 lost jobs ECONOMIC IMPACT 240,000 jobs lost during the Great Recession Upstate as a region still struggling Friedman assumes 70% reemployed within 6 months 99% reemployed by end of second year How?? Uses Federal Bureau of Labor Statistics statistics 5% of financial service industry workers (includes health insurance employees) change jobs every month Doesn t consider size of the health insurance industry as a sector of the overall Upstate economy and difficulty displaced workers may have finding new jobs Doesn t consider reciprocal local economic impact from migration, lower tax base, etc. Friedman assumes job growth of 200,000 new jobs, for net increase of 50,000 jobs How? New demand for health care providers Eliminating job-lock 9

10 Statewide & local impact Sunshine on issues: Single Payer Strategy/Campaign Single payer vs universal coverage Tax burden Jobs impact Administrative complexity Coalition development 10

11 State & Local Impact What is single payer? What does it mean? Tax burden/cost Local: jobs, economic impact Upstate vs. Downstate 11

12 California/Colorado Experience CA focus groups: 32% support single payer 67% support universal coverage 28% mix of both Your Health Care : 83% satisfied Health care system: 57% satisfied If you like your health plan you can keep it : 69% Fix ACA: 60% CO: Coalition Independent Fiscal Analysis 12

13 Build a broad Coalition Fine tune the message Next Steps Develop local strategy varying by region Independent fiscal analysis Communication/PR plan Education of public & legislators 13