The Healthcare Crisis Deepens
The consequences of President Donald Trump’s One Big Beautiful Bill Act (OBBBA) have created an unprecedented healthcare emergency across America. Millions of Americans have already lost their health insurance coverage, while millions more face dramatically soaring costs that threaten their financial stability. This crisis has exposed the fundamental fragility of our current healthcare system and the urgent need for comprehensive reform.
State-Based Solutions Emerge
Why Federal Reform Remains Blocked
Despite overwhelming public support for universal coverage, fierce political opposition to national Medicare for All legislation persists in Washington. The gridlock has become insurmountable, making federal action virtually impossible in the current political climate. This reality necessitates a new approach: implementing universal health care programs in states where voters actively support comprehensive reform.
The State Based Universal Health Care Act
To facilitate this state-level transformation, the State Based Universal Health Care Act (SBUHCA) has been introduced in both the United States Senate (S. 2286) and House (HR. 4406). This groundbreaking legislation establishes minimal standards for state-based healthcare delivery programs and, crucially, codifies the transfer of federal funds from Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) to states operating their own universal programs.
Historical Context of American Healthcare
Six Decades of Incremental Progress
Over the past 60 years, repeated attempts to improve healthcare quality and availability have achieved only partial success. Each reform effort has faced significant political obstacles, resulting in a patchwork system that leaves millions behind.
The Medicare and Medicaid Legacy
In 1965, President Lyndon Johnson passed America’s first national healthcare legislation: Medicare for those age 65 and over and younger adults with disabilities, alongside Medicaid for indigent populations. However, this framework deliberately excluded most working- and middle-class Americans, who were expected to obtain health insurance through their workplaces.
The Compromise That Created Inequality
The Social Security Amendment of 1965 reveals the political compromises that shaped our current system. Before the 1965 Civil Rights Act, Democrats held wide majorities but included Southern politicians whose principles echoed their Civil War-era Democratic Party predecessors. To secure their support, Johnson crafted legislation that perpetuated inequality between White and Black Americans. While Medicare for retirees required hospital desegregation—which was successfully achieved—Medicaid for working-age people included means testing and state discretion that allowed continued discrimination.
Modern Incremental Reforms Fall Short
Presidents Clinton and Obama, neither advocating for true universal programs, passed legislation providing incremental improvements. Clinton’s Healthcare Act of 1997 and Obama’s Affordable Care Act of 2010 reduced uninsured Americans but failed to achieve universal coverage, address insurance system segregation, stem rising healthcare costs, or reduce medical debt among the underinsured. These piecemeal reforms created the convoluted and cumbersome healthcare system Americans navigate today.
The drawbacks of state discretion became painfully apparent during COVID-19 when ten red states rejected Medicaid supplements offered through the Affordable Care Act, resulting in significantly higher COVID mortality rates compared to states that participated in Medicaid expansion.
The Canadian Model: A Blueprint for Success
Can State Programs Lead to National Coverage?
State-based programs present a critical question: will they serve as stepping stones toward national coverage, or will achieving single-payer systems in progressive states reduce momentum for true national reform? While the Medicaid experience suggests potential pitfalls, Canadian healthcare history demonstrates how state-based programs can successfully evolve into comprehensive national systems.
Saskatchewan’s Revolutionary Start
The Canadian healthcare system began in 1947 as Saskatchewan’s provincial hospital insurance program. Over subsequent decades, other provinces developed their own health programs until they coalesced in 1984 into the Federal Canada Health Act—proving that state-level innovation can indeed create national transformation.
New York Leads the Way
A History of Progressive Leadership
New York State now stands at the forefront of state-based healthcare legislation through its New York Health Act (NYHA). This leadership role has historical precedent. Following the tragic early 20th century Triangle Shirtwaist Company fire in Greenwich Village, social worker Frances Perkins, serving as executive secretary of the newly formed Statewide Committee on Safety, crafted groundbreaking minimum wage, child labor, and worker safety laws for New York. These state laws later became the template for much of FDR’s New Deal legislation.
How the New York Health Act Works
Comprehensive Coverage for All Residents
The NYHA would provide comprehensive healthcare coverage to every New York resident without exception. The legislation establishes a trust fund to hold patient funds and reimburse providers directly. Healthcare providers would bill the fund for services, with fees subject to negotiation—creating cost controls while maintaining quality care.
True Freedom of Choice
Under NYHA, patients would enjoy unrestricted choice of physicians without network limitations or prior authorization requirements. The legislation explicitly avoids dictating physicians’ practice methods, preserving medical autonomy while ensuring universal access.
Progressive Funding Structure
All New Yorkers would contribute through a progressive graduated annual tax scaled to income levels. Capital gains and stock transfers would also be taxed, creating an equitable funding base. Additional resources would flow from Medicare, Medicaid, and CHIP. While these federal funds could transfer through a wraparound process, SBUHCA would codify this transfer mechanism, providing legal certainty.
Eliminating Financial Barriers
Patients would make no additional healthcare payments—no co-pays, deductibles, point-of-service payments, or coverage denials. Medical debt would be eliminated entirely. Projections indicate that 9 out of 10 New Yorkers would pay less for medical care under NYHA than under the current system.
Economic Feasibility and Cost Savings
International Comparisons Prove Affordability
New Yorkers can absolutely afford the NYHA. Every other industrialized nation provides superior care to their citizens at lower per-capita costs than America. New York possesses the resources to achieve the same results.
Comprehensive Services Within Budget
The cost of providing comprehensive care—including services currently excluded from Medicare such as dental, vision, hearing, and long-term care—represents a substantial investment. However, eliminating middlemen in the insurance, pharmaceutical, and provider industries would generate massive savings.
Independent Analysis Confirms Savings
A recent RAND Corporation analysis assumed physician fees and service provider rates higher than Medicare but lower than current commercial rates. The study concluded that NYHA would reduce overall healthcare costs by 4% while dramatically expanding coverage and eliminating out-of-pocket expenses.
Current Status and Path Forward
Legislative Progress
The process of advancing legislation from drafting to passage remains arduous but achievable. Currently, NYHA has secured majority co-sponsors in both chambers: 32 senators and 78 assembly members. However, greater public support is necessary before legislators will advance the bill for chamber votes.
Overcoming Opposition
Opposition from two major public service unions has hindered efforts to bring the bill to a vote. Building broader coalition support and addressing union concerns will be critical to advancing the legislation.
The Fight Continues
Passage of the NYHA would represent a meaningful forward step toward adequate health insurance for all Americans. As federal gridlock persists and millions suffer under inadequate coverage, the state-based approach offers our most viable path to achieving the universal healthcare that every American deserves. The fight for healthcare justice must continue.
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