Municipal Government

Is Single-Payer Health Care Labor’s Next Step?

May 7, 2014
By Steven Wishnia

How can the labor movement get a single-payer health-care system enacted? Or should it concentrate on preserving current union health benefits and trying to fix the provisions in the Affordable Care Act that are undermining them?

About 50 people from New York City labor unions and related businesses turned out to discuss those issues at LaborPress’ second health-care summit of 2014, held April 23 at the Retail, Wholesale and Department Store Union Local 338’s Manhattan headquarters. The four featured speakers were RWDSU executive vice president Gemma De Leon; Ben Johnson, president of the Vermont American Federation of Teachers; Jim McGee, head of the health and welfare plan for Amalgamated Transit Union Local 689 in Washington, DC; and Assembly Health Committee chair Richard Gottfried, lead sponsor of a bill to set up a state single-payer system called New York Health.

Moderator Gene Carroll, codirector of the state AFL-CIO’s Cornell Union Leadership Institute, called single-payer “like collective bargaining for the entire population.” McGee said it took him a long time to come around to support it, but that he now believes it is the best way to provide continuity of medical coverage, affordability, and group solidarity, “like a multiemployer plan writ large.” The current system means people have to pay more for health coverage if they lose their job, and that makes no sense, he said.

That was the problem the Affordable Care Act was supposed to solve, but it’s had deleterious unintended consequences, especially for part-time and low-wage workers. It’s given employers an incentive to cut workers’ hours so they don’t have to pay for insurance, said De Leon, and the plans available on the exchanges have high deductibles and narrow networks, and are expensive even with subsidies. “Part-time workers have lost coverage completely,” said Bridie Bugeja, member assistance director for Local 338. “We’re drowning,” said Sarah Cutler of Musicians Local 802.

A single-payer system would solve this, said Gottfried, because it would make health care a public service like police protection or snow removal, funded by taxes instead of by individuals. Employers and health providers “wouldn’t have to hire people to fight with insurance companies,” and profits and administrative costs wouldn’t eat up 10 to 30 percent of the money spent on health care.

Getting that enacted is another story. On a federal level, said Mark Dudzic of the Labor Campaign for Single-Payer, “I see no path forward.” In New York, said Mark Hannay of the Metro New York Campaign for All, the state Senate and Gov. Andrew Cuomo are opposed, so it’s unlikely it could pass before 2019. But even a “one-house bill” that passes only the Assembly would help advance the cause, argued Laurie Wen of Physicians for a National Health Program.

In Vermont, which enacted a single-payer plan called Green Mountain Care in 2011, “consciousness-raising” was key, said Johnson. When opponents called it “the biggest tax increase in state history,” he said, supporters countered by framing it as “repealing your insurance premium.”

The Vermont program, scheduled to go into effect in 2017 or 2018, hasn’t been designed yet. This leaves many unresolved questions. What would happen to unions’ current plans, especially Taft-Hartley multiemployer plans? If New York had a state single-payer plan, how would people who work here and live in New Jersey be covered? What would happen to retirees who move out of state?

De Leon said afterwards that she would prefer to concentrate on fixing the ACA. Self-administered plans have won exemption from the $63-per-member “belly-button tax,” she noted. “We shouldn’t give up on Taft-Hartley plans,” she added. They’re less expensive, better run, and not-for-profit, so “let us compete with the insurance companies.”

The advantage of single-payer, Carroll said afterwards, is that no longer will people lose their health care if they lose their job. But unions are not going to support it “if there’s a perception that their members are going to get less than they have,” and providing health care is also an important link with rank-and-file members. “We’ve got to get all those concerns out on the table.”

May 7, 2014

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