I’ve just returned from several days in Albany where I spent time with a broad array of key stakeholders including state officials, policymakers, advocates, providers, payers, and more. Given the sea changes coming out of the nation’s capital, being in the State’s capital felt right and necessary.
The center of gravity in health policy has shifted back to the states. In the run-up to the Affordable Care Act (ACA), the action was in Washington. Lawmakers, advocates of all persuasions, and industry groups all focused on shaping and writing the law, and then either working to enact or block it. It squeaked through by the thinnest of margins.
Then the pendulum swung to the states. That’s where most decisions were made, and where the rubber met the road for implementation. Especially for a state like New York that fully embraced the ACA, success was determined locally.
We are repeating that cycle. But this time, states are left to manage deep cuts rather than expanded resources.
Between the massive health care cuts in HR1—the federal budget reconciliation bill—and anti-science leadership at the Department of Health and Human Services, states must now step up and protect public health. I consider HR1 one of the worst pieces of social policy legislation ever enacted. Along with philanthropic partners, we’ve said this law will “deeply harm the health and well-being of the people we serve for a generation. New Yorkers will be poorer, sicker, and hungrier.” I’ve also written on the dangers of vaccine skepticism—particularly when it comes from the federal government.
Now it’s up to the states to respond to and mitigate the harm to the best of their abilities. So far, I’m encouraged by the choices and actions that New York and like-minded states are making.
For starters, New York is taking decisive action to safeguard public health in the face of federal backsliding on vaccines. Governor Kathy Hochul issued an executive order authorizing pharmacists to provide COVID-19 vaccinations to anyone who wants them. This underscores the State’s commitment to keeping science at the center of health care. Building on that leadership, New York has also joined six neighboring states in creating the Northeast Public Health Collaborative, a coalition dedicated to issuing evidence-based vaccine recommendations independent of Washington’s dangerous and misguided policies. These states are protecting communities, preserving trust in vaccines, and upholding the principle that every life saved through vaccination is a victory against misinformation and preventable illness.
New York is also confronting the painful consequences of federal health care cuts with clarity and resolve. The State stands to lose $7.5 billion in funding for the Essential Plan—which provides affordable, comprehensive coverage for about 1.7 million New Yorkers. Faced with no good choices, Governor Hochul’s administration has opted to wind down the waiver that extended coverage to New Yorkers earning between 200–250% of the poverty level. This is the least bad option they could have chosen though it’s hardly painless; roughly 450,000 New Yorkers will be affected. Some will transition to Qualified Health Plans, some may obtain employer-based insurance, and some will lose coverage altogether. New York is doing what strong leadership requires: making hard choices to shield as many people as possible and limit the damage of reckless federal policy.
The road ahead will not be easy. The cuts are deep, and the tradeoffs will only get more painful. But New York has shown it will not shrink from responsibility. By acting swiftly on vaccines and making tough decisions on health coverage, the State is doing what it can in a moment defined by hostile federal policy. The months ahead will test the strength of our institutions and the resilience of our communities. Leadership now means facing hard truths, weighing imperfect options, and keeping people’s health at the center of every decision. That is the challenge New York faces—and the work it must continue to do.
