Assemblymember Sarahana Shrestha, whose 103rd Assembly District includes Hurley, Olive, Saugerties, and Woodstock, is trying to build support for a decades-old proposal to create a state-run, single-payer health system in New York.

Shrestha is a co-sponsor of the New York Health Act, which would provide universal coverage without premiums, deductibles, copays, or restricted provider networks. The legislation was referred to the Assembly Health Committee in January and has not advanced.

Over the past two weeks, Shrestha has held healthcare town halls in seven Ulster and Dutchess County communities including Saugerties and Woodstock. Her office is also conducting a survey about constituents’ healthcare costs and experiences.

The Overlook spoke with Shrestha about how the plan would be funded, whether it would improve access to care in the Hudson Valley, and what political obstacles stand in its way.

This interview has been condensed for clarity and length. 

You’ve described the New York Health Act as a way to lower costs for more than 90% of New Yorkers. The legislation promises comprehensive coverage without premiums, deductibles, copays, or restricted provider networks. How exactly would the program be funded, and what would prevent costs from exceeding the revenue?

So the reason the New York Health Act reduces costs for 90% of New Yorkers is for two reasons: One is we see significant savings by removing these administrative costs because New York Health Act is a single-payer healthcare system, which means for this plan that provides comprehensive care, you don’t have a private replacement option, but you can supplement it with another plan for things that are not covered. However, it covers every you know medical thing that you could possibly imagine that does not veer into the cosmetic category. So we see an estimated saving of $26.5 billion from removing admin costs on the insurance company side, then $18.3 billion from the hospital and provider side, then $13.4 billion from the prescription drug prices and device prices and so on.

But on top of that, we spend new money to expand coverage, to pay providers better, to add long-term care, so altogether you get 16.8 billion dollars of savings on the healthcare system. That’s the source of saving, right? So that’s part one.

Part two of why it reduces costs for 90% of New Yorkers is in its funding mechanism. It’s being funded by three things: one is the federal funds we already get for the federal share of Medicare, Medicaid, and so on. Right there’s money that each state is owed for these federal programs, so that’s one source of funding. The second source of funding is what the state already pays for its share of Medicaid, and then the third share is coming from a progressive health tax that is based on people’s ability to pay, and because this is tied to how much money you have, it means that you know the people who have less money are paying less to access the same level of care. So when you combine these savings and these cost shifting into a progressive system, you end up with 90% of New Yorkers paying less for their healthcare than they do now.

Under the proposal, employers would generally pay 80% of the new payroll tax, and employees would pay 20%. What would that mean in dollars for a typical worker and small business in Saugerties, for example?

Yes, employers have to pay at least 80% of a payroll tax based on what the employee is making. So, for example, if an employee is making you know $50,000 worth of the income that is taxable under this plan, then the employer’s share would be 80% of around $133. So the full cost of covering that employee would be $133. But if the employer pays 80% of that, which they would be required to, then the employee is only paying $27.

And then we also have very small businesses where the owners themselves are currently using Medicaid or have a self-purchase plan that is very expensive. So if you’re a small business owner that you yourself qualify for Medicaid, it means you’re making very little money. So under this plan, you would probably be paying, if you’re making $25,000 or less, actually, you would be exempt. You don’t have to pay any healthcare tax.

If you’re making $50,000, but you also qualify for Medicare, which could be true for some people, you are also exempt. But if you’re a small business owner who’s making around $35,000 of income in the end, that would be considered taxable under this system. Then you’re probably paying like, you know $50 or something like that to get this very comprehensive plan that does not have copays, does not have deductibles, has long-term care, has no network restrictions.

Health coverage doesn’t necessarily guarantee access to care. Parts of the Hudson Valley already face shortages of primary care physicians, mental health professionals, dentists, and home-care workers. How would this legislation increase the number of providers available here and support rural providers currently operating?

To your point, the reason there is a primary care physician shortage under this current system are many-fold but one of them is that primary care physicians are underpaid, especially when you compare them to specialists, who some could say are overpaid. So under the New York Health Act, a few things happen. First of all, the payment structure is explicitly designed for primary care providers to be appropriately paid, and the payment methodology that the commissioner has to establish has to prioritize access to care, but also the way the rates are set for services is the providers actually collectively negotiate with the New York Health Plan fixed rates for certain services.

So that you know the mechanism is very different. But the second thing is right now, less people get primary care when they don’t have insurance, right? But if you’re a primary care physician running a small family practice under New York Health Act, more people would be able to use your service, and you would also know that when people walk into your office, they are insured, which means you will be paid for the service because we have universal care under this system, right? So the doctors are also just seeing more assurance and less risk that when people come to their office to get care, they will get paid for the service without having to fight with the insurance companies.

So this also makes just generally providers, whether that’s physicians or hospitals, more financially stable. But I will also say that outside of this bill, there are other systemic issues. We have student debt and education hurdles where it is also challenging to become a physician. So that is also something that we have to simultaneously tackle. But the New York Health Act just makes it much easier to be a practicing primary care physician and get paid for it without having to navigate this very convoluted system that you probably don’t have the resources for.

The current bill states that New York Health would “wrap around” Medicare, Medicaid, and other federally funded programs, depending on the degree of federal cooperation. What does that mean? What would happen if a presidential administration refused to cooperate or redirected those funds?

So, if we need a federal waiver to make the federal money go directly into this plan, basically we only need a friendly federal administration if we want to get a waiver that flows the federal money for Medicare, Medicaid, and so on directly into this plan so that we can use that money that is owed to us for this purpose. So for that, we need a cooperative federal administration.

What we don’t need a cooperative federal administration for is the wrap-around option. So that’s Plan B. So under that instance, what would happen is, if we pass this bill, the federal money would continue to flow into the respective programs like Medicare, Medicaid, Child Health Plus or whatever it is, and those programs would just roll into the New York Health Act. What that would mean for the patient getting care is that all of your benefits are coming from a single plan, but behind the scenes they are being covered by different plans. So some might be covered by Medicare, some might be covered by Medicaid and so on, but as a user, you are interfacing with just one plan. So for you, it doesn’t matter where it’s coming from. So that’s what the wrap-around looks like.

What do you consider the strongest legitimate criticism of the New York Health Act, and does any part of the current bill need to change in response? Does Gov. Kathy Hochul support the bill in its current state?

I would say there isn’t so much a criticism of what the bill is trying to do, as maybe fear of the fact that this would be such a big change, and I think that is a legitimate concern to have. You know, have we considered everything because it would be a significant change, right? But the thing is, when you pass this bill, it’s not like we change into a different system overnight. There is a period for the regulations, the nuts and bolts, etc. to be set. There is a period for the finalized funding tax brackets to come out.

There is also good faith concern from some unions, and these tend to be public sector unions. So, for example, teachers, DC 37 down in the city, they have concerns as to all these healthcare benefits that they have fought for as labor unions. Is that going to be compromised? We don’t believe they will be compromised, but they have concerns because this is something that they feel very protective about.

And as for the governor, I would say the governor recently did not want to do congestion pricing. Then we made her do it, and now she celebrates it as something that is successful.

So I think that if we have built enough support, if we have done our homework in creating a very resounding support for this bill, and having answered all of the pending questions that people have, then I think that she would have very little reason to stand in the way if we have made this an undeniable solution to the current problem that we are facing.

You’re a co-sponsor of the bill. It was referred to the Assembly Health Committee in January and hasn’t received a floor vote. If the New York Health Act can’t pass, what provisions would you pursue separately in the next legislative session?

The first movement we would see if people are serious about passing this bill is that it would actually pass out of the Health Committee. And as you can see, we are not there, and I think we won’t be there unless we have had conversations with some of the unions who have concerns.

We are a Democratic majority, so in the end, that means that the industry opposition doesn’t mean a whole lot. I mean, it has a role; it is definitely an obstacle, but it’s not the final obstacle. We just really have to have the political will to say that this is the solution we want to try out, and we don’t have the political will right now. And the only way to enforce that political will is for the people to demand it. And we see that happening both with Medicare For All at the federal level, and we also see that happening with the New York Health Act at the state level. This bill has a little bit of a fatigue factor because it is so old. You know, it’s been here since the 90s, and we haven’t passed it out of both houses in decades. So there is this fatigue and apathy over it. But we’re trying to say that the crisis is so severe right now in healthcare that we can’t have passive supporters. We need active supporters who are trying to figure out the ways to carve out the path for winning this bill.

There are countless bills that we are simultaneously pushing. I have a bill, for example, to create a pilot program that caps the prescription drug prices of the top 20 most expensive ones by using the Medicare drug prices. And this would be a three-year pilot where we want to test out the mechanism for whether the state can do this or not. So we are also simultaneously exploring a lot of intermediate options. There’s also a bill I support, which is to remove the middleman managed care from home care, and that would save the state $5 billion. That is also supported by the healthcare workers as well as people who need home care. There are thousands of bills floating around at any given time that we are supporting, but a lot of those are just trying to tackle one or two things at a time. But this would be the more comprehensive fix.

Your office is collecting responses through a healthcare survey. Will you release the complete results, including the number and geographic distribution of respondents, the questions asked, and responses from people who oppose the legislation?

We have not broken it down geographically because for us the only thing that matters is that they are in our assembly district. It would be a little bit of more work to break it by town. But what we are already sharing at our town halls are actually live updates of what people are saying.

So after the town halls are done, we’re actually going to release a recording of our presentation and also where the survey is at. But we want to keep the survey rolling for a little bit because we would like many more people to take it right now. I think around a little over 700 something people have attempted to take it, but not everybody is answering every question. I will say that no matter how many people take it, the trends have been holding pretty much the same, and the overall support for this bill, which matches the national support as well as the statewide support, is a little over 75%.

Isabella Schoonover is a staff reporter for The Overlook covering Woodstock, Saugerties, Hurley, and surrounding Ulster County communities. Send correspondence to isabella@theoverlooknews.com.