Five New Yorkers die every day due to lack of health coverage, according to the Campaign for New York Health. More than a million New Yorkers lack health insurance, and millions more have plans that would bankrupt them in a medical emergency.

Enter single-payer health care, which would provide comprehensive health coverage for every one of New York’s 19.8 million residents.

Health-care advocates are hopeful a potential Democratic majority in the New York State Senate might finally pass universal health coverage next year, although corporate opposition to the health-care proposal has amped up in recent months. The New York Health Act (NYHA) passed in the Democratic-dominated Assembly four years in a row but died every time in the state senate, including this year.

The state-run, tax-funded health plan is one vote shy of a majority in the senate, which has seen the Independent Democratic Conference (IDC) join forces with GOP lawmakers to block progressive measures. Many members of the IDC were defeated by progressive challengers in this month’s primaries, months after the IDC disbanded amid intense pressure from progressive groups.  

If the state’s record 1.5 million primary turnout is mirrored or surpassed in the midterm elections, many hope it will help flip the senate for a Democratic majority that would put single-payer health care on the governor’s desk.

“I think we have an excellent chance of electing a real working Democratic majority in the state Assembly made up of people who support the New York Health Act,” said Manhattan Assembly Member Richard Gottfried (D) who plans to re-introduce the bill (A.4738) in the Assembly in January. “I think we have a very good shot next year of having a bill that passes both houses.”

But the single-payer health care legislation is seeing record pushback from insurance groups and some labor unions. These include the Hilliard Corporation, the Business Council of New York State, the New York State Conference of Blue Cross and Blue Shield Plans, and the Uniformed Firefighters Association of Greater New York, according to the website Realities of Single Payer. It claims the legislation would lead to “staggering tax increases” and “unprecedented job losses.”

Advocates told Rewire.News these claims are exaggerated, even unfounded, and are no different from the misconceptions and falsehoods spread by anti-choice activists when it comes to New York’s Reproductive Health Act, another progressive measure that was defeated this year in the state senate.

“It’s going to be very, very intense. We have to fend off the opposition, we have to win a majority of senate seats to the Democrats, and those folks have to be committed to pushing it forward in the senate in order for this to get done,” said Katie Robbins, director of the Campaign for New York Health that is advocating for the NYHA.

State Sen. Gustavo Rivera (D-Bronx), who sponsored S.4840, said these arguments ignore that the system is broken for those who are uninsured or underinsured. “When medical decisions are made by insurance companies and not by doctors or their patients, that’s a system that doesn’t work,” he said.

What single-payer opposition doesn’t say is that New York is already spending millions on health care that leaves too many people out in the cold. Winn Periyasamy, policy analyst at FPWA (formerly Federation of Protestant Welfare Agencies), an anti-poverty policy and advocacy nonprofit in New York, said the Democratic-backed NYHA would “absolutely strengthen New York, increase employment, increase wages and increase services that our communities need.”

“We see single-payer as an opportunity to advance health equity, to make sure that low-income New Yorkers are able to devote more resources to housing, food, education and all the other things they need to live their lives,” she said. “Research shows that nearly a quarter of all working age adults with employer-based coverage have such high out-of-pocket costs and deductibles that they are effectively underinsured. Every day, across the state, their health care costs are growing at a faster rate than their incomes are.”

Studies have found that the NYHA would ensure “a system that covers everybody, offers better care, is less expensive as time goes on, but also one that has a more equitable distribution of funding,” Rivera said.

He poses the moral question: If there is a child who has cancer but her parents can’t afford the kind of treatment she needs to stay alive, do you believe that child should die? “If the answer is yes, then we have nothing to talk about. But if you believe the answer is no, then we have to figure out a system that works better than the one that we have now,” he said.

A recent report from the RAND Corporation indicates that the NYHA could “transform” the state’s health landscape by reducing health-care spending and adding an estimated $139 billion in new taxes in 2022. It would do so by shifting funds from insurance administrators and bill collectors to actual health services. Patients would have no deductibles, co-payments, or other out-of-pocket payments at the point of service for covered benefits.

That system works in countries like the United Kingdom and Canada where one can walk into any clinic or hospital for health care without worrying about the cost, said Martha Livingston, who has lived in both places. Professor and chair of the public health department at SUNY-Old Westbury, and board vice chair of the New York Metro chapter of Physicians for a National Health Program, Livingston said she has been fighting for a single-payer system for years.

“It’s really a shame that in the richest country in the world we can’t take care of our people when they are in need of health care,” she said. “We spend over $3.2 trillion a year on health care and for anybody residing in this country not getting it because of fear of bankruptcy or financial ruin is immoral.”

A March Kaiser Family Foundation health tracking poll found 59 percent favor a national single-payer government plan, including a majority of both Democrats and independents and about one-third of Republicans. More localized polling, like a recent one in Maryland, shows similar support for universal health care. 

Physicians for a National Health Program research indicates that 31 percent of U.S. health spending goes towards “unnecessary” administrative costs; medical bills contribute to half of all personal bankruptcies; taxes already pay for more than 60 percent of the nation’s health spending, with business paying for less than 20 percent, and the United States could save more than $350 billion annually on administrative costs by implementing a single-payer system to cover the uninsured.

Cynthia Nixon, whose primary challenge to New York Gov. Andrew Cuomo fell short this month, strongly supported a single-payer system in the state. Cuomo recently said it would be “a good idea,” according to the Albany Times Union.

“I am encouraged that Gov. Cuomo has said he supports the single-payer idea. We need to persuade him that it is practical at the state level,” said Gottfried, who has introduced the NYHA in the Assembly every year since 1992. He has supported the idea of states leading the charge on universal health care and has floated the idea of building a state health-care system supplementing Medicaid programs, or for the state to create a private Medicare plan.

He said he’s not surprised to see the efforts launched against the NYHA “because we will be getting rid of billions of dollars of administrative waste and profit by insurance companies and administrative costs for health care providers to fight insurance companies.”

People want to pay less for health care, he said. The issue is not where people send their checks but the fact that it will be a smaller bill.

Robbins from Campaign for New York Health said there is momentum behind the idea of single-payer health care—one that has inspired a broad movement across New York and the United States. “People want to see their ability to access health care not be tied to employment, or income level, or health status, or even immigration status or marital status,” she said.

The prospects for single-payer health care hinge on November’s midterm elections, especially outside New York City, health-care advocates said.

The NYHA does not cover long-term home or nursing home care but Gottfried said they will expand it in the new version they plan to file in January.

“No New Yorker should have to go without health care or suffer financial hardship to get it. No one has ever shown me a way to get there other than the New York Health Act. We need to spend less than we are today, and we need the money we spend to go for health care, not administrative waste,” he said.

There is political momentum going into the primaries with many engaged, but the work is not done, said Robin Chappelle Golston, president and CEO of Planned Parenthood Empire State Acts. “What really matters is people voting in the general election because right now, even with the success in the primaries, it doesn’t help us have a majority in the state senate to get our priorities done,” she said. “At the end of the day, the more people have access to health care and the services that they need the better, but the devil’s in the detail in terms of making this a robust plan that works for the state, especially in this hostile environment.”