“We should be able to go to the doc­tor when we need to, with­out wor­ry­ing whether we can afford it,” said its spon­sor, Assem­bly Mem­ber Richard Got­tfried. ​“We should choose our doc­tors and hos­pi­tals with­out wor­ry­ing about net­work restrictions.”

The New York Health Act would elim­i­nate pri­vate health insur­ance and cov­er all New York­ers in a pub­licly financed, uni­ver­sal plan with no patient pre­mi­ums, deductibles, or co-payments.

The bill isn’t expect­ed to pass the Sen­ate or be signed into law any­time soon. But get­ting it through, with unprece­dent­ed sup­port from big unions, shows that state-lev­el cam­paigns are still a fer­tile ground for health care jus­tice orga­niz­ing, despite the recent set­back in Vermont.

New York’s State Assem­bly in May over­whelm­ing­ly passed a bill to estab­lish a sin­gle-pay­er-style health care system.

Got­tfried has led a decades-long effort in the Assem­bly for uni­ver­sal care. But the dif­fer­ence this time was the num­ber of major unions active­ly sup­port­ing it. They gave the bill a big boost.

More unions onboard

Tra­di­tion­al sin­gle-pay­er advo­cates like the New York State Nurs­es (NYS­NA) and the New York City stage­hands’ union, IATSE Local 1, have backed Gottfried’s bills before.

This year marked the first time they were joined by such influ­en­tial statewide unions as Ser­vice Employ­ees (SEIU) 1199 and New York State Unit­ed Teach­ers (NYSUT/AFT).

Those unions’ lob­by­ing efforts helped con­vince leg­is­la­tors the bill was polit­i­cal­ly viable. And their finan­cial sup­port was cru­cial to hir­ing com­mu­ni­ty orga­niz­ers in key regions.

The unions also par­tic­i­pat­ed in statewide hear­ings in Jan­u­ary and mobi­lized mem­bers for Albany lob­by days in May.

“The employ­er-based sys­tem of pro­vid­ing health care is erod­ing, cov­er­ing a small­er per­cent­age of New York­ers each year,” said 1199 SEIU mem­ber Mal­colm Olak­er, a Pough­keep­sie nurs­ing home work­er, at a lob­by day.

“In a just soci­ety, all peo­ple are enti­tled to basic health care. That’s why we are all here today from dif­fer­ent walks of life: patients, health care providers, care­givers and com­mu­ni­ty mem­bers, sup­port­ing sin­gle pay­er health care.”

Advo­ca­cy groups Health­care NOW, Sin­gle Pay­er NY, and Physi­cians for a Nation­al Health Pro­gram were able to cap­i­tal­ize on the momen­tum to play much larg­er roles than in pre­vi­ous years.

Oba­macare did­n’t fix it

Labor sup­port for the ini­tia­tive grew so strong because of how the Afford­able Act has panned out. The much-her­ald­ed fed­er­al law has done lit­tle to ease bar­gain­ing-table pres­sures for health care concessions.

“Our mem­bers work­ing in schools and col­lege cam­pus­es want our state’s poor­est stu­dents and their fam­i­lies to have access to qual­i­ty health care ser­vices, so they arrive at school each day healthy and equipped to learn,” said Antho­ny Pal­lota, NYSUT exec­u­tive vice pres­i­dent, at the Jan­u­ary hearing.

“Our retirees, who tend to be our most med­ical­ly vul­ner­a­ble and frag­ile mem­bers, want afford­able pre­scrip­tion med­ica­tion and access to imme­di­ate health care.”

Despite the fed­er­al man­dates, employ­ers are still try­ing to offer less cov­er­age and shift costs onto the backs of work­ers and retirees.

Pub­lic sec­tor health ben­e­fits are a par­tic­u­lar­ly tempt­ing tar­get, as states and munic­i­pal­i­ties wres­tle with bud­get short­falls. Politi­cians exploit a ​“pol­i­tics of resent­ment” among pri­vate sec­tor work­ers who’ve already seen their own ben­e­fits cut.

Anoth­er fac­tor spurring unions to action is the loom­ing 2018 imple­men­ta­tion of the ACA’s ​“Cadil­lac tax.” This 40 per­cent excise tax will apply to all health insur­ance plan charges over $10,200 per year for indi­vid­ual cov­er­age and $27,500 for fam­i­ly coverage.

These caps are set to rise at a much slow­er rate than the costs of health insur­ance, which means near­ly all union-nego­ti­at­ed plans will even­tu­al­ly face the choice between rad­i­cal cuts to cov­er­age or pay­ing the hefty tax.

Already, the tax has been a major issue in recent union nego­ti­a­tions with Boe­ing, oil refin­ers, and port operators.

State by state

While most health care jus­tice activists would pre­fer a nation­al, Medicare-for-All reform along the lines of Rep. John Cony­ers’ H.R. 676, in recent years the momen­tum has been grow­ing for sin­gle-pay­er-style reforms at the state level.

At a time when any path to sweep­ing fed­er­al action appears closed, groups like the Labor Cam­paign for Sin­gle Pay­er and Health­care NOW have sup­port­ed state cam­paigns as a way forward.

The ACA may help facil­i­tate these efforts — because, begin­ning in 2017, the fed­er­al gov­ern­ment is autho­rized to grant states ​“inno­va­tion waivers.”

Such a waiv­er frees the state from the require­ment to estab­lish a pri­vate insur­ance exchange. Instead, it can real­lo­cate fed­er­al sub­si­dies for pri­vate insur­ance and Med­ic­aid into fund­ing its own plan.

To be approved, the state’s plan must meet the law’s min­i­mum require­ments for cov­er­age and cost-shar­ing, and cov­er at least as many res­i­dents at a cost no high­er than what the fed­er­al gov­ern­ment would have assumed.

“We believe that a vic­to­ry for a pub­licly financed, uni­ver­sal plan in one or more states can pro­vide a pow­er­ful impe­tus to the move­ment for nation­al health care,” said Ben Day, exec­u­tive direc­tor of Health­care NOW.

State efforts suf­fered a set­back when Vermont’s gov­er­nor announced in Decem­ber that he was sus­pend­ing plans to imple­ment Green Moun­tain Care, the sin­gle-pay­er-style pro­gram to real­ize the 2011 law that made health care a right.

Shum­lin was sched­uled to sub­mit a financ­ing pro­pos­al to the leg­is­la­ture in advance of the plan going into effect in 2017. Instead, he announced the health care for all was ​“just not afford­able”—despite the fact that even his own eco­nom­ic esti­mates showed Ver­mon­ters would spend less for health care than they cur­rent­ly do.

Ger­ald Fried­man, a Uni­ver­si­ty of Mass­a­chu­setts econ­o­mist, called Shumlin’s deci­sion ​“polit­i­cal, not eco­nom­ic.” Nonethe­less, sin­gle-pay­er oppo­nents seized on the Ver­mont deba­cle as proof that uni­ver­sal health care at the state lev­el is unworkable.

But the book isn’t closed. The law is still in effect, and hun­dreds have tak­en to the streets to demand its implementation.

The Ver­mont Work­ers’ Cen­ter — which main­tains that the state still has an oblig­a­tion to imple­ment the law — issued its own financ­ing plan, which it sub­mit­ted to the leg­is­la­ture for consideration.

Strat­e­gy conference

All health care jus­tice cam­paigns, if they get far enough, will be forced to wres­tle with the same conun­drum Ver­mon­ters are fac­ing. The clos­er they come to vic­to­ry, the greater the resis­tance from the med­ical-indus­tri­al com­plex and free-mar­ket fun­da­men­tal­ists who vis­cer­al­ly oppose any form of social insurance.

In Cal­i­for­nia, the leg­is­la­ture twice passed sin­gle-pay­er bills in the 2000s, only to have them vetoed by Repub­li­can Gov­er­nor Arnold Schwarzeneg­ger. Once Demo­c­rat Jer­ry Brown was elect­ed gov­er­nor, the move­ment couldn’t even find a bill sponsor.

Cal­i­for­nia activists are gear­ing up for a mul­ti-year project to muster the sub­stan­tial funds and orga­niz­ers it will take to win (and then defend) a sin­gle-pay­er-style sys­tem through the state’s ini­tia­tive process.

Orga­niz­ers in the strong, labor-backed cam­paigns in Ore­gon and Wash­ing­ton are also look­ing to use the ini­tia­tive process if pend­ing leg­is­la­tion founders. Ore­gon passed a bill to fund a study of alter­na­tive plans to ensure uni­ver­sal coverage.

New York will sure­ly expe­ri­ence the same polit­i­cal chal­lenges as Ver­mont and Cal­i­for­nia. Nonethe­less, the bill’s pas­sage with such a big major­i­ty and the out­pour­ing of labor and com­mu­ni­ty sup­port have giv­en the nation­al move­ment a wel­come shot in the arm.

“This is a great vic­to­ry, but now the hard work begins,” warned Joel Shufro, a long­time occu­pa­tion­al health and safe­ty advo­cate who worked to recruit unions to sup­port the bill.

“Get­ting the bill through the Sen­ate and get­ting the gov­er­nor to sign it will be a long and dif­fi­cult strug­gle. We must keep on build­ing the grass­roots move­ment if we ever hope to win the right to health care for every­one in New York.”

Activists will dis­cuss and debate how to build this move­ment when they meet in Chica­go, Octo­ber 30-Novem­ber 1, for the largest-ever sin­gle-pay­er nation­al strat­e­gy con­fer­ence.

“Our move­ment con­tin­ues to grow, as peo­ple real­ize that the Afford­able Care Act does not do enough to solve the health care cri­sis afflict­ing almost every­one in Amer­i­ca,” said NYS­NA Vice Pres­i­dent Mar­va Wade. ​“We need to come togeth­er to fin­ish the job and make health care a right for everyone.”

Mark Dudz­ic is the nation­al coor­di­na­tor of the Labor Cam­paign for Sin­gle Pay­er. He can be reached at mdudzic@​igc.​org.

This arti­cle first appeared on Labor Notes