2025 has been a rough year. Core safety net programs like Medicaid and SNAP were gutted. Millions of hungry Americans were used as political pawns. The nation’s top health officials turned their backs on science and are undermining our public health infrastructure.
But we also saw resilience in the face of adversity, and we saw some big wins. Here at home, New York State became the 9th state to fully fund universal free school meals for every student. This means that 2.7 million students across the State have the food they need to be healthy and ready to learn. Universal school meals are a proven strategy to reduce food insecurity, improve mental and physical health, boost academic performance, and increase educational and economic equity. That’s a wish come true and worth celebrating.
It’s become a December tradition for me to share a wish list for how New York can be a healthier place in the upcoming year. As this year winds down, here’s what I’m wishing for:
1. Keeping health insurance more affordable. The federal government shutdown accomplished nothing except that it caused pain. The issue at the heart of the matter — enhanced ACA health insurance subsidies — went unresolved. ACA enhanced premium tax credits were introduced in 2021 and then extended through 2025. They will expire at the end of this month without action.
It will be a disaster if they lapse. Nationally, expiration of the credits is estimated to more than double what subsidized enrollees currently pay annually for premiums — a 114% increase. New Yorkers will feel this acutely. The State estimates average premiums statewide will rise by nearly 40%, an average monthly increase of $114 for individuals and $228 for couples.
With a renewed focus on affordability, this one ought to be a no-brainer. Congress needs to extend the subsidies.
2. Healthy and affordable food for all. The hunger rate in New York has climbed higher than it was in the early days of the pandemic. More than one in ten New Yorkers now faces food insufficiency. Families with children are hit especially hard. Black and Hispanic New Yorkers are more than twice as likely to struggle to put food on the table as white New Yorkers. More than half of older adults in New York State report difficulty accessing affordable, high-quality food.
The Supplemental Nutrition Assistance Program (SNAP) is our single best and most enduring weapon against hunger. Yet the federal administration has taken aim at the program by slashing its budget, shifting costs to states, and enacting all kinds of barriers to the program.
It is not realistic for New York to fully backfill the federal cuts, but it can mitigate the damage. For example, New York State can and should include SNAP outreach as a requirement for all schools participating in the State’s Universal Free Meals Program. Federal regulations already require schools to publish information regarding the availability and eligibility criteria for free and reduced-price meals. As trusted messengers within communities, schools can leverage their existing communication channels to connect families to SNAP. New York can also increase support to food hubs at schools and emergency food programs that offer culturally responsive food options.
3. A shot in the arm for primary care. This one stays on the list for another year. Primary care has the best return on investment of any type of health care service — a rare “win-win” associated with both better health outcomes and lower costs. Yet, we chronically underinvest in primary care, spending only 5–7 cents of every health care dollar in this area. We can and should do better by devoting a greater share of total health spending to primary and preventive care. Doing so wouldn’t require spending more; it would mean spending in smarter and better ways.
I’m optimistic we will get there. The full New York State Senate has already passed the Primary Care Investment Act, which will gradually raise the share of health spending devoted to primary care. In a constrained budget climate with lots of painful choices on the table, doubling down on primary care is about the only move policymakers can make that will both save money and benefit patients.
Of course, just wishing doesn’t make things come true. Success will take hard work, persistence, coordination, and some luck. Let’s work together to make these wishes a reality. And please share your own wishes for the new year in the comments.
My final wish: a healthy and happy holiday season for you and your loved ones.
By David Sandman, President and CEO, New York Health Foundation
Published on Medium on December 8, 2025
