Assemblyman Kenneth Zebrowski, D-Rockland, speaks at the opening of a new headquarters of Jawonio Inc., which provides services to those with intellectual/developmental disabilities, behavioral health challenges, and chronic medical needs. Submitted photo

Assembly Democrats are proposing a new way to provide health coverage in New York state.

Assemblyman Kenneth Zebrowski, D-Rockland, has introduced A.10664 to establish a public health care insurance option and a related fund for program revenue. Zebrowski’s approach is a stark difference from the New York Health Act, which has been pushed by many Democrats for more than three decades.

Many state legislative Democrats have pushed the New York Health Act, which would create a single-payer health care system in New York state. First introduced by Assemblyman Richard Gottfried, D-New York City, in 1991, the New York Health Act has been much-discussed and debated — even garnering state Assembly approval five times from 1993 through 2018 — but never becoming law. Gottfried is set to retire from the Assembly at the end of 2022.

Sticking points for the New York Health Act have largely been costs. The legislation would nearly eliminate private insurers in the state unless they offer coverage not provided by the state plan. The system, deemed feasible if certain conditions regarding federal funding were met, would increase state spending on health care from $34.1 billion to $172.5 billion, according to a Rand Corporation analysis.

Zebrowski’s approach is different from Gottfried’s. A public option for health care is still run by the state or federal government but can be administered by a private entity or private insurance company and then be made available as an option alongside existing private health insurance companies.

There is much yet to be fleshed out in Zebrowski’s proposal, such as rate structures, because it would be up to the state health commissioner to present an implementation plan to the state Legislature after the legislature establishes the program. The Rockland Democrat is proposing a Board of Trustees to manage the program with appointments by the governor and legislative Democrats and Republicans.

“Although New York has expanded Medicaid availability and embraced the marketplace under the Affordable Care Act, health care remains prohibitively expensive for too many New Yorkers,” Zebrowski wrote in his legislative justification. “There is major gap that middle class New Yorkers fall into if they do not qualify for either employer-based health care or federal tax credits for health plans on the exchange. It is time that New York fills this gap with an affordable public option plan that all New Yorkers have the ability to purchase.”

OTHER STATES’ EXPERIENCES

New York now joins Connecticut, Oregon, New Jersey and New Mexico among states with a public option plan now pending in their respective state legislatures.

Washington state began offering a public option in 2020, but through February only 25 of the state’s 39 counties had public option plans available for their residents. In 2021, only 1% of people buying health care plans on the exchange chose the public option plan. A February Kaiser Health Network report quoted state Rep. Eileen Cody, who sponsored the public option legislation, as saying it was difficult to put networks together because the original legislation didn’t require hospitals to participate, though the Washington State Hospital Association said the majority of hospitals have chosen to participate.

The Kaiser Health Network notes public option proposals are often opposed by health care providers because the public option concept is based on a foundation of lower reimbursement rates for medical providers, hospitals and other providers that will decrease their revenue. Private insurance companies tend to oppose public options since they offer lower premiums than private health care companies offer.

Nevada approved a public option health care plan in 2021 that will be avialable to consumers in the fall of 2025. To enter the market, the public option plan will have to undergo an actuarial study and then the state would need to apply for a waiver from the federal government. Afterward, Nevada could become the second state to offer a state-managed health care plan, following Washington in 2019.

Nevada officials would select certain plans for approval and mandate that they charge 5% less in monthly premiums than the average plan on the state insurance marketplace created by the Affordable Care Act and 15% less four years after it is first offered, according to the Associated Press. The bills detractors decry the price controls and worry that forcing doctors and hospitals to accept patients at lower costs could lead them to leave the state and exacerbate a practitioner shortage.

According to the Kaiser Health Network, the Washington experience shows the difficulty of lowering health care costs while working within the current system.

“That’s kind of the big trade-off,” said Aditi Sen, a health economist with the Johns Hopkins Bloomberg School of Public Health, to the Kaiser Health Network. “You are trying to lower premiums enough that people will enroll, but not so much that providers won’t participate.”