1. THE NEW YORK HEALTH ACT: Single Payer Health Care for New York State May 2016

2. This presentation will: 1.Give an overview of the current health system and why reform is needed 2.Explain single payer health care 3.Discuss how the New York Health Act would work 4.Review the financing proposal for New York Health 5.Make the case for business – and everyone else --+- to support single payer health care.

3. Starting in 2014, state-based insurance “exchanges” or “marketplaces” offer private insurance and Medicaid to individuals and employers Citizens and legal immigrants are required to be insured. Subsidies for incomes up to 400% Federal poverty level Medicaid for all below 133% poverty level Affordable Care Act: Now the Health Reform Law of the Land

4. Millions Remain Uninsured… Millions Note: The uninsured include about 5 million undocumented immigrants. Source: Congressional Budget Office

5. Source: Census Bureau 2014. NYS Dept. of Health 2015

6. Underinsurance is Now the Norm

7. What’s Covered

8. * Estimate is statistically different from estimate for the previous year shown (p<.05). NOTE: These estimates include workers enrolled in HDHP/SOs and other plan types. Average general annual health plan deductibles for PPOs, POS plans, and HDHP/SOs are for in-network services. SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2015. More and More Workers face Deductibles of $1,000 or More (Single Coverage)

9. Average Annual Worker and Employer Contributions to Premiums and Total Premiums for Family Coverage, 1999-2015 * Estimate is statistically different from estimate for the previous year shown (p<.05). SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2015. $ 5,791 $6,438* $7,061* $8,003* $9,068* $9,950* $10,880* $11,480* $12,106* $12,680* $13,375* $ 13,770 * $ 15,073 * $ 15,745 * $ 16,351 * $16,834* $17,545* Insurance Premiums Continue to Rise

10. Health Insurance Costs vs. Workers’ Earnings SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2015. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2015; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2015 (April to April). …and Those with Coverage Pay More

11. It doesn’t have to be this way. Every other country covers all their citizens, and spends half of what we do. Note: $US PPP = purchasing power parity. Source: Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris: OECD, November 2013). Total expenditures on health as percent of GDP $8,508 $3,182 17.7% 8.9% Average spending on health per capita ($US PPP)

12. What Makes the Difference? Unlike in the US -- in every one of these countries, government has a central role in: Funding the system Overseeing and regulating coverage and pricing Our own experience with Federally-run Medicare shows the beneficial effects of a government-funded and regulated system: Reliable, predictable financing Slower cost growth Transparent decisionmaking

13. The Problem, and the Answer The Affordable Care Act will not solve the central problem of our health care system: continually rising, unaffordable cost. We can do better, through a system where government has a central role.

14. Health Care Reform in New York State: New York Health Act A5062/S3525 A single State fund covers every resident: Universal coverage — Everybody in, nobody out! Comprehensive benefits No financial barriers to care: no deductibles or co-pays Medicare and Medicaid integrated into NY Health Funded by progressive State premiums along with existing Federal and State funds Covers everyone -- Costs less! Passed 92-47 in 2015

15. Eligibility Every resident of NYS coveredEvery resident of NYS covered No barriers due to age, sex, income, wealth, employment, or health statusNo barriers due to age, sex, income, wealth, employment, or health status No regressive insurance premiumsNo regressive insurance premiums No payments at time of serviceNo payments at time of service No deductibles, no co-paysNo deductibles, no co-pays New York Health Act

16. Comprehensive Benefits Primary & Preventive Care Inpatient and Outpatient Hospital Care Prescription Drugs Dental, Vision, & Hearing Care Free choice of doctor, including primary care physician (PCP) and specialists, and hospital New York Health Act

17. Provider Reimbursement All providers paid in full by New York Health, with no charges to patients New reimbursement methods will be developed to replace fee-for-service payments Rates negotiated with provider organizations New York Health Act

18. Financing Progressive graduated payroll premium, 80% employer, 20% employee Graduated premium on non-wage income for high-income earners Federal Medicare and Medicaid funds NY Health pays Medicare Part B premiums & local share of Medicaid Bottom line: Premium on $50,000 wages ~ 6%; current employer-based ins cost ~ 11% of wages New York Health Act

19. Covering Everyone while Saving Money! Additional Costs Covering the uninsured and poorly-insured +1.4% Elimination of cost-sharing +3.9% Enhanced Medicare & Medicaid fees +3.8% Savings Reduced insurance administrative costs -9.9% Reduced physician & hospital admin costs -7.2% Bulk purchasing of drugs & devices -5.7% Reduced fraud -1.9% -24.7% Source: Economic Analysis of the NY Health Act, Gerald Friedman, April 2015 4.0 11.2 10.8 26.0 -28.6 -20.7 -16.3 - 5.4 -71.0 2019 $B Total Costs +9.1% Total Savings Net Savings -15.6% - 45

20. Marginal Payroll Premium & Effective Premium as Percent of Income Source: Economic Analysis of the NY Health Act, Gerald Friedman, April 2015 Premium

21. Why Business Should Support the New York Health Act Eliminates the cost and headaches of running a health benefits program. Eliminates conflicts with employees and unions over benefit cuts, givebacks, etc. Reduce the cost of providing health benefits. Eliminates competition from businesses that don’t provide benefits. Produce a healthier, more productive work force. Make health care costs controllable and predictable, eliminating a major source of business uncertainty and barrier to planning.

22. New York Health is Affordable and Sustainable Eliminates burden of unnecessary, wasteful administrative costs Unified, simplified funding allows control and planning of future costs Unified purchasing lowers drug and equipment prices Coordinated planning of investment allows savings on facilities & equipment

23. New York Health Beyond the ACA! We can do better! Everybody in, nobody out! Single payer health care for New York!