Incorruptible Mass

Medicare for All in New York

• Anna Callahan • Season 6 • Episode 3

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We invite Morgan Moore, executive director of the New York Metro Chapter of Physicians for a National Health Program, to the show for the third part of our series on health care. We take a look at New York as a case study for advancing single-payer health care legislation, challenging reluctant Democratic legislative leadership, and building long-term movements to achieve policy goals.

You’re listening to Incorruptible Mass. Our goal is to help people transform state politics: we investigate why it’s so broken, imagine what we could have here in MA if we fixed it, and report on how you can get involved.

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Hello and welcome to Incorruptible Mass. Our mission is to help us all transform state politics because we know that we could have a commonwealth that truly supported the needs of all of the residents of our beautiful state. Today we are continuing with our conversations about universal healthcare and we are going to talk to someone from New York where that state has been, I think, the closest of any state to actually getting this thing passed.

And so we're going to hear all about it before we do. Well, actually before we even introduce ourselves, let me say that we are going to be talking about the history of the bill in New York City, in New York, New York State. We're going to be talking a little bit about, you know, the Democratic majority and what has been happening in terms of the ability for that bill to move forward.

We will give you details about exactly what is in the bill and we'll talk a little bit about it and the federal level and how it interplays with the Trump presidency. And then we'll have a, you know, talk about union support for it. We'll also get into a little bit the question of whether to rock the boat or not rock the boat in terms of the actual electoral strategies involved.

But before we do, we are going to I will have my wonderful co host Jonathan Cohn introduce himself. 

Hello, I'm Jonathan Cohn. He and his I'm an activist in Boston in the South End. I've been active on progressive issue and electoral campaigns for a little over a decade now. Always happy to be here. 

I am Anna Callahan. She her coming at you from Medford where I'm a city councilor and have done, you know, bunch of stuff in state politics but mostly local level helping folks get elected to local stuff across the country. And and now for our very exciting guest, Morgan Moore from New York. If you can go ahead and tell us a little bit about yourself and about your organization.

Sure, yeah. Thanks for having me. As you said, my name is Morgan Moore.

I use she her pronouns. I am the executive director, pardon me, of the New York Metro Chapter of Physicians for a National Health Program and come from a community organizing background and have been the director for I guess a couple of years now, two or three years. So.

And prior to becoming director was a volunteer with the Campaign for New York Health and was on the board of Physicians for National Health Program on the New York Metro chapter board. So have sort of a long history of being involved in various ways in the movement to pass single payer at the state level. And our organization is focused on getting single payer passed at both the state level and the national level.

And we do a lot of organizing around opposition to privatization of our existing public programs, Medicare and Medicaid. So we sort of have our fingers in a few different pots trying to essentially ensure that people have the health care that they need without interference by private entities. Great.

So we would love to hear from you a little bit of the history of the bill in New York. If you know, when it was introduced originally and then sort of what has it's been been its trajectory in terms of getting passed by the New York State assembly and Senate and made into law. Not yet.

Absolutely. So the bill was first introduced a little over 30 years ago. The lead sponsor and writer of the bill, the author of the bill is retired assembly member Dick Gottfried.

He was approached by the New York State Nurses association, members of the New York State Nurses Association a little over 30 years ago and he asked to look into this type of legislation and draft a single payer bill that could be put forward for a vote. And so, fun fact is that it actually passed the assembly in that very first year when it was introduced right out of the gate and then unfortunately did not pass again in either chamber until around, I want to say around 2017, 2018. And then it passed four times.

Thank you Bernie!

Yeah, exactly. There was, I think, new life breathed into the campaign for the New York state level bill surrounding Bernie's run and his attention to Medicare for all at the national level. And that's what brought me into advocacy work around single payer health care.

So myself and several other folks really started getting involved around 2016. And you know, looking more closely at what's happening within our state legislature and within the movement for national, national Medicare for all, the vast majority of us that are working on state level bills. I would, I can't speak for everyone, I guess, but, but I would, I would guess that nearly 100% of us working on the state level bills are really, our ultimate goal is to have it pass at, at the national level.

And we see this as a way of leading to that eventuality. And there's precedent, I'm sure you both know that in Canada that's how their universal health care program began. It began one province at a time and then kind of spread to others.

And we've seen precedent for that with other legislation like gay marriage, marijuana legalization. Like it's, there's, I think a good trend in that direction of sort of proving that it can work at the state level and then having other states either sort of emulate that legislation or come up with their own, and then ultimately we'll be able to. To kind of unify everyone.

So it's posed as a sort of either or option. Like either you're working at the state level or the national level. And I feel very strongly that it's a.

Both a yes and like, we're. We're doing this to. To build the movement that we need to ultimately pass it nationally.

Absolutely. And so in terms of the history of the New York bill, so it got introduced, it passed the assembly immediately and then did not pass until, like, for another years almost. And then in 2017 started to pass.

You said the assembly, is that right? Yeah, that's right. So it passed the Assembly. 

So just prior to it passing the assembly, we had majority support in the assembly for several years, and so it was able to pass four times. I think it largely due to the grassroots activism that was happening around the bill. But at that time, we had a technical Democratic majority in the state Senate, but we also had what is called the idc, the Independent Democratic Conference, which was a group of Democrats that were caucusing with Republicans and really blocking legislation and like. 

And I think both rumored and true, to have the blessing of Andrew, former Governor Andrew Cuomo in doing that, right? Yeah, Yeah. I think there was a lot of sort of backroom dealing happening, and several of those legislators, you know, I think enjoyed having that power.

Whether or not bills moved forward. It was a very powerful position. One of our senators in Brooklyn was part of that conference.

And so we were, you know, targeting his office heavily, heavily sending folks, advocates in, speaking with him a lot and his staff a lot, trying to get him to move. But it really seemed like it was. It was less about him whether or not he supported the legislation and more about, like, him holding this sort of having this kingly seat in determining whether or not things.

Things moved. So sort of recognizing that landscape and that reality, a lot of us began, you know, trying to do work to inform our fellow constituents about that. That conference and about, you know, kind of what was happening legislatively and the bills that were being held up, like the New York Health act, and we began pretty seriously sort of campaigning specifically around that as an issue that this bill, our efforts are being blocked.

And we were able to ultimately flip enough of the seats of the IDC members that we gained a majority support in the state Senate. There was an actual majority support of Democrats and not folks that were caucusing actively. You had people from your Medicare for all in New York like actively knocking on doors for candidates to unseat these conservative, you know, Democrats in name only.

Yeah, yeah, People were very active around it. We, we are a 501 c3, so Physicians for National Health Program didn't, you know, have a, have a direct hand in that. But we certainly have, you know, lots of folks within our coalition that were, that had identified that as being the real barrier at that time and were, you know, really aggressively, you know, going out and, and sort of trying to just make people aware of what was happening.

Because I think a lot of people do get complacent. They think, oh, I've elected this person. They say that they're a Democrat and so they must be for the same types of policies that I support.

But I think not very many people were aware that many of our Democrats at that time, and certainly the, the state senator that was in New York at that time in, in Brooklyn that we were trying to move, he had been running as a, on all three lines essentially. So he was running as a Democrat, an Independent and a Republican and he won as a Democrat. So he did call himself a Democrat.

But because, because of the way our elections work, you can run on multiple lines and that's the one that Alessandra Biaggi ended up beating. Am I mixing up races or is. It's a different.

Yeah, it's a different. Okay. But I mean, I've heard of this multi party like thing that you can do in New York and that like you can be both on the Working Families Party and on the Democratic Party.

Yeah, yeah. I did not know that people were running as a Republican and a Democrat. It's pretty wild that, that, that's, that you can do that, you know, so, so yeah, so we, there was definitely a lot of kind of civic engagement happening around.

Like I'm running as both night and day. Yes, yeah, exactly. And the, so the, the state senator that we were concerned with at that time actually is still in office.

We were not able to flip his seat ultimately. He has a really, you know, close connection with the community there. But we were able to flip enough other seats that we were essentially the, the IDC disbanded.

So at that time we were able to, to gain majority support in the state Senate. We had a majority of people of legislators signed on as co sponsors in both the Senate and the Assembly. Okay, so hang on.

You have a majority of support in the House. Yeah. And the Senate, you're, it's clearly gonna pass.

That's what you would, that is what you would hope. And we certainly were Very hopeful. You know, when we hit that sort of target, we.

We achieved what we had been told, you know, by legislators. We need to get rid of the idc. We need to have majority support.

And we thought, you know, this is setting us up perfectly to be able to move this bill forward. And we actually at that time also had a super majority of Democrats in both chambers. So if the governor had vetoed it, we technically had the power to override that veto.

But what happened instead is that it was not moved forward in the assembly any longer. So really the leadership blocking it, keeping it locked in committee and not moving it forward to the. To the floor for a vote in either chamber.

And that's where we've been, you know, essentially for the last four years. 

I feel like I should have given a trigger warning to people. Sorry, yes, nobody wants to hear the bad ending of the story. Just turn it off right now. 

It reminds me as well of that, like, although there are like, I feel like so many cases in Massachusetts of things that get majority support, they never end up seeing the light of day on a single payer basis. That reminds me of how back when Schwarzenegger was governor of California, I think that like, they voted on single payer a few times and then like suddenly, once there was a governor who could have been pressured into signing it as opposed to being fully hostile, suddenly the legislature was less interested in voting.

Yeah, I think the first thing that happened in California is that it was sent for more study. That's what, that's what the decision, like, oh, we're gonna. Yeah, move it over and we'll produce a report about it and sort of show that it can be done, which we feel is, you know, we're not interested in any further study in it.

We feel like there are enough real world examples that single parents, money and will save lives. And the people in Massachusetts who listen to this podcast understand that the phrase sent to study means killed means that means. Yeah, not even a very subtle way of trying to.

So I have to jump in here because this is something that, that really gets me. And, and one of the reasons why I think a lot of people have really fled the Democratic Party. And the way I phrase it right, is this qu.

This question of, like, what is the one thing that is worse than your enemy? And the only thing worse than your enemy is a traitor. And I really believe that, like, people have gotten this sense from things like this in the state level, from stuff that happens at the national level, that the Democrats are pretending to agree with us. They're pretending that they're going to pass all this stuff.

Oh, they're really going to do it. As soon as you get this, you know, a little more carrot, you know, here, come get this carrot. Come get this carrot.

And as soon as you do all the things they say, then suddenly the leadership is going to find a way to kill it. And that means they were never going to support you in the first place. They just made you do 20 years of work for nothing.

And that. That is worse than just having an enemy who's going to tell you that they're against it. And so, you know, this is, I think it's like a visceral problem with the Democratic Party that the elites think that they're just going to message their way out of.

You know, it's like, well, we're just going to keep telling people stuff. And it's. The problem is not the messaging.

The problem is the action. So that, to me is like, it is so sad every time we hear one of those stories. We have those stories here in Massachusetts as well.

But the fact that you guys got to the point where you have super majorities apart in both houses and now it's being killed by the leadership, I would say, as well. Like, even kind of point kind of related to that is like states like Massachusetts and New York are both overwhelmingly Democratic in their legislature, but are very unequal states. They're affluent states and they're unequal states.

And it kind of, with this issue, I think, points very much so well to the fact that if the Democrats, when in power, need to show that they're willing to deliver, that they're going to need to deliver in ways that actually do help working people across the state, and that it's kind of quite damning that inequality is as high. Part of that is because of the extremes on. Extremes of wealth are particularly high in the large metro centers.

But that means that there's the money to do what we need to do. Yeah, I mean, it has certainly been a real struggle for us in trying to convince our legislators that if you run on this issue, it is a winning issue. And we've seen time and time again that the people that are really championing this kind of legislation win pretty handily across the state.

And I think it's really like being consistent about this issue is key, and really being as forthright and kind of outspoken about the issue as possible is key to people, you know, kind of believing what you're saying. It can't just be when you're looking for A vote. It has to be, you know, once you're in office, in between when you're running, you have to really champion these, these issues that are vital to working New Yorkers and working folks in Massachusetts.

I'm sure, where it really means, you know, the, it's the difference between, you know, whether you're sort of stable and not living paycheck to paycheck and you have sort of an anchor in your community. It's just there's so much legislation like this that I think, you know, folks really believe so strongly in and it's incredibly frustrating to hear paid sort of lip service instead of our legislators, you know, really, really seriously engaging around it and, you know, having the, the political will to meet the moment instead of just kind of chipping away at the edges and cautioning folks to, to kind of wait and, and see how it goes and, you know, oh, we'll, you know, kind of adjust this one small thing. We just need more people to be covered.

But if we're all covered inadequately, having coverage doesn't really help you. You know, it's. If you're just covered for catastrophic care, that's not really having healthcare.

That's how we have, I have. We pay like $20,000 a year and get basically nothing at all. Like, unless we get hit by a bus.

Like we get. Yeah. So before we go on, I want to invite everyone listening to go ahead and donate to the show.

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And now I would love it, Morgan, if you could tell us a little bit about what's actually in the bill. That would be great. Sure.

Yeah. So the New York Health act is a single payer bill similar to Medicare for all at the national level. It would cover all necessary medical care.

So inpatient, outpatient, emergency, emergency care, primary care, preventive care, mental Health, dental, vision, hearing. It remarkably covers long term care, which essentially no other plan, private or public covers right now, at least in New York State. And I'm trying to think of what else.

What else. It covers pretty much any necessary care that you can think of. It does cover.

And the long term care piece includes in home care as well as in facility care in nursing facilities. So people would really have the option, you know, to get to stay at home and receive care at home. It's also a huge job creator in that it would raise, so it would raise the reimbursement rates for providers above what's currently reimbursed for Medicare and Medicaid, those rates, it would be closer to the private insurance rates that are paid out currently.

And it would really expand the, the job market because of the extra folks that would be covered finally. And it would be a huge win for folks that are working as home care attendants, for example. Those folks would now get paid through the New York Health Fund and would be a huge job creator in that market specifically.

And those jobs are largely held by women and women of color. So it would be a huge sort of boost to communities that are most underfunded and under resourced. So, yeah, I'm trying to think of anything else that's in the bill that I've.

That I've left out comprehensive, so that's amazing. Yeah, yeah, it's really the most comprehensive that it can be. The way that we were able to ultimately incorporate long term care was really through advocacy from various groups within the state that are disability rights advocacy groups and also some senior advocacy groups.

The statewide Senior Action Council was really key in, you know, helping to refine the language that, that addresses that particular issue. And they were really key in working with the Campaign for New York Health to, to get the legislators to kind of focus on that as a necessity to include in the bill. And that's, I think, one really important thing that I'd like to point out about the New York Health.

We really want it to be the most robust and the most just bill that it can be. And so we want as much feedback from folks within the state and as much buy in from folks within the state who are working and sort of suffering the great injustices of the inequity in our health care system. So we want doulas, we want midwives, we want nurses, we want everybody who, we want patients, you know, who are, who are experiencing the system to really be a part of creating this legislation.

And so if there's ever something that has been left out or something that could be improved. The bill sponsors are more than willing to sit down with people and make amendments to kind of address those issues. We did clarify language.

There was an amendment made in 2023 clarifying some of the language around unions and sort of how their benefits would be, would be paid for. A lot of unions in New York have the employer covering 100% of their health benefit. And so in the language, in the language in the bill prior to this amendment, it said that the, the way that the bill is paid for, there's an 8020 split.

So an employer pays 80% and then the employee pays 20% of the, of the graduated tax. So it's a graduated tax of income according to ability to pay. So the first $25,000 is excluded for people.

So the lower, if you're lower income, you're paying less into the system. And then above $25,000 a year, there would be a graduated tax. So you would pay, you know, sort of according to your ability.

So if you're a secretary at a company, a receptionist at a company, you would not pay as much as the CEO. And that's the way our current health care system is funded is very much a flat tax where like we're all paying the same premium if you're covered under the same company policy. So given that 8020 split, some of the unions were covered.

They have their employer paying 100% of their benefit or 90% of their benefit, and they wanted to ensure that they don't have to go back to the drawing board to renegotiate for that additional 20% coverage. So the way the bill is phrased now, I think previously it said that employers could cover above the 80% and now it says if they currently pay above the 80%, that they, that will be kind of grandfathered in and they would continue to pay that same percentage of the, the New York health tax. 

So, so I want to just say how amazing it is to hear you talk about this, because I think a lot of people, their theory of how you get things passed is you, you, you ask for the minimum, right? You ask for just a tiny thing, right? And then you're going to get that passed.

And then once you get that, like, let's not include dental, it's not include vision, let's not include long term, let's not include hearing, let's not include, you know, long laundry list of things, you leave them all out because we have to get, you know, the moderate, whatever is the, the idc, the independent Democratic credit cards or whatever. We have to, we have to rely on them. We have to do whatever they want.

Right. But like hearing you talk about it, it's the opposite. Right.

You're saying no. If we make this the absolute best healthcare that it could possibly be for the people, then we will be able to get the support of these electeds because anybody who says no is like, you've got to be like that's not going to look good. So I love how, I love the way that you're framing it that, that you're really going for the absolute best care rather than trying to like water it down to supposedly meet some sort of middling, you know, elected dino.

The one thing I would say that it also feels like a key takeaway when you're talking about some of the, like the way that it handles those specific union plans is knowing that when comments people are making are like one good faith issues that one can incorporate and address and when they're being made in bad faith by somebody who wants a re just looking for an excuse to not support something and like being able to tell the difference, being able to like constructively work with those who have actual, let's say like a genuine issue and then you can get them, you can find a way of getting them on board in a way that ends of actually improving the legislation and then about the same time being able to call, call BS when people give you reasons for why oh that they can't support it because of reason X, Y and Z when it's clear that if you fixed reason X, Y and Z there would just be another, it'd be x1x like whatever, etc, another list of things down the road. And I think that's such a core part of legislative advocacy. Yeah, yeah, we, it is.

It can be very frustrating because we do spend a lot of time answering questions that we've already answered. You know, like these answers exist. There's a lot of misrepresentation, I think, of what, what the bill will and won't cover, will and won't do.

We hear a lot from a lot of misunderstandings. I'll be generous, I guess, in, in saying that around, you know, the New York Health act blowing a hole in the state budget. We hear that from legislators sometimes when the New York Health act is actually funded completely separately from the state budget and it would be like billions of dollars less than what we currently pay for health probably.

I mean if it's like in Massachusetts, it would in fact help the state budget immensely. Right? Absolutely. Yeah, yeah.

The opposite. You know, people could get the primary care and preventive care that they need so that we're not overtaxing our emergency rooms and, you know, having people seek urgent care because they don't have a primary health care doctor that they can go to or nurse. So I got to jump in because we're nearing the end, and I just want to make sure we get to.

We get to my favorite part of this discussion, which already we've had a lot of this talk about, like, how do you. How do you move this politically, Right? How do you gain enough power to actually get this thing passed? You know, and so I, to me, like, you guys not watering it down. That's part of that discussion as well as, you know, the whole discussion of getting the super majority support and then the leadership suddenly lets you down.

Like that is part of the discussion. I want to ask you, because you mentioned before we started record, that there's a debate as to whether to bring this to the floor for a vote. And I would love to hear you talk a little bit about that in terms of, like, you know, the ability to get things passed, the power dynamics.

How do you see that? And to me, it's like, do you rock the boat or do you not rock the boat? Right. Because people don't like to be forced to vote on things and to have their votes known. So I would love to hear your take on how this works in New York with this particular bill.

Yeah, we. So, yeah, I think there is some disagreement within the movement about whether or not we should, you know, push for this to be brought to the floor for a vote without knowing whether or not we can pass it. We.

There are some folks that think we should only bring it to the floor if we are certain that we have the votes to pass it. But then, you know, I think an alternate strategy that I personally support is sort of being able to find out who is supportive in reality versus just a supporter on paper. And we've had, you know, I think this bill has been around for 30 years.

We've had a lot of increased activism around it in the last six years or so, seven years, and we've. They've really sort of had the opportunity to. To pass it when we did have majority support in both houses.

So I think at this point, my feeling is that it would be helpful to have it brought to the floor so that we know concretely who will support ultimately when they have to actually sign their name on a yes or no vote. So it's something that we're really working on, I think within coalition and we're working on building the mass movement that we need to not only pass it but to be able to make sure that it is the most just bill that it can be once it, once it is brought forward. There is a two year implementation period after passage during which time there is a board that will be convened to kind of oversee the, the structure of the, the fund and the, and sort of how it's implemented.

And we need all New Yorkers who have a stake in this, which is all New Yorkers essentially to be watching this issue and, and engaged on it. I think as you were saying, it being this kind of unifying issue, we don't want anyone to have to fight for their health care on their own. We have lots of associations that are for folks with diabetes or folks with disabilities or folks seniors that are looking for long term care and none of those people should have to fight for healthcare on their own.

We're so much stronger when we're fighting for it together and we, so that's one of the reasons why we want the New York Health act to be as robust as it can be, is to really serve every population. And if any population feels like it's not serving them, you know, we want them to, to come in and, and work on it and make it better and really hold our legislators feet to the fire to, to make sure that it's not watered down and that there's nothing, you know, as far as I'm concerned, there's no expendable population. You know, we're not willing to lose anyone.

We want trans folks to be covered, we want immigrants to be covered. And that's actually an important note to go out on is that they, the bill covers undocumented folks within, within the state, regardless of your employment. You don't have to have a job, you don't have to have documentation.

It's irrelevant to your need for health care and to our duty and the state legislature's duty to, to provide healthcare for everyone. Particularly in light of the attacks from, from at the national level on a lot of those really vulnerable communities. Yeah.

And Jonathan, I know you had some thoughts here as well in terms of bringing things up. Yeah. The one thing you're just going to chime in I thought was always a really interesting question with that issue about like putting something up to a vote and whether, whether there's value in doing that when there isn't yet full.

If you don't think that you'll win, view it as is that you can win votes in ways that build power, you can win votes in ways that somehow lose you power, you can lose votes in ways that lose power and lose votes in ways that win power. And it depends on what you're. Where it fits in a sequence of different strategies and tactics with the game of building support for something, and that intentionality is one of the most.

Is, like, more important in many ways than the outcome itself. Yeah. And that question of, like, if you're.

If you're going to push for a vote, then you want to make sure that whatever the outcome, like, you have to set it up in such a way that whether it loses, you have built power around this issue and you can move forward. Yeah. Yeah.

I feel like in a lot of ways, the. The sort of feeling of limbo that we've been in in the last few years has been the most discouraging to people, and I feel like that's why I support bringing it to the floor for a vote and kind of having some kind of tangible happen so that we have something that we can kind of look at directly, because it is this sort of middle ground of, like, we don't. We don't exactly know if there are folks undermining it in the state legislature who are on.

On paper, supporting it, but who behind scenes, are kind of trying to slow it down and asking leadership not to bring it to the floor for a vote. I presume that that is happening. I'm not sure who amongst us is doing that, though, so.

So, yeah, and that's such a key point when it comes to, let's say, the perspective of constituents in advocacy, that getting people to put their name to something is step one. Because them saying, yes, I support this doesn't mean they're actually doing anything to help advance it. And it doesn't even mean that they aren't doing things to prevent it from advancing.

And so that, like, continuing to, like, ask them to do additional things is so critical. This has been so enlightening. Really incredible to hear.

I had no idea how close you guys are, and. And I'm thrilled, and I can't wait to hear more, and I look forward to you succeeding. And again, thank you so much for all the work you do and also for coming on the show.

Yeah. Thanks so much for the invitation. It's really been wonderful to talk with both of you.

Wonderful. We look forward to chatting with everybody next week. Bye.