Special Projects Fund

Grantee Name

RAND Corporation

Funding Area

Special Projects Fund

Publication Date

May 2019

Grant Amount


Grant Date:

January 2018–April 2019

In a time of uncertainty over the Affordable Care Act and ongoing efforts to repeal and/or replace it, states have ramped up alternative reform proposals, including single-payer systems.

Single-payer bills have been considered in California, Nevada, Vermont, and New York State. In New York State, the New York Health Act had gained some traction in Albany; it passed the State Assembly for several years in row and had significant support in the State Senate. The intent of the New York Health Act is to provide no-cost coverage to every New Yorker with no out-of-pocket costs and no network restrictions. In 2018, NYHealth awarded the RAND Corporation a grant to conduct an objective, nonpartisan analysis to inform and influence the proposed single-payer health care plan in New York State.

Outcomes and Lessons Learned

  • Conducted the first independent, rigorous, and credible analysis on how a single-payer system in New York State could affect the utilization of health care services; whether administrative and drug and device costs would change; how much taxes would need to increase; any net savings or costs for employers and New Yorkers of different income levels; and the net costs to federal, State, and local governments.
  • Published a final report, “An Assessment of the New York Health Act: A Single-Payer Option for New York State,” summarizing the results and methodology.
  • Widely disseminated the study and its findings through media outreach, webinars, and convenings with policymakers.
  • Informed policy conversations and news coverage about single-payer issues at the State and national levels.

 Among the key findings:

  • All New York State residents would have insurance coverage under the New York Health Act, regardless of immigration status, effectively cutting the uninsured rate down to zero.
  • Under the New York Health Act, total health care spending would be similar in 2022 as with the status quo and become 3% lower by 2031.
  • New taxes for health care would need to be about $139 billion in 2022 and $210 billion in 2031 to fully finance the plan. Under the status quo, the State is expected to collect about $89 billion in taxes from all sources in 2022; thus, the new taxes would be a 156% increase in total State tax revenue.
  • As payments for health care shift from premiums and out-of-pocket payments to progressive taxes, most households in New York could pay less and the highest-income households could pay substantially more. The shift in who pays more or less would ultimately depend on the design of the tax schedule. For example:
    • The average health care payment (taxes or premiums) as a percent of income would be lower for New York households earning below 90th percentile income;
    • For New York residents in the 90th to 95th percentile of the household compensation, average health care payments would increase by $1,700 per person in 2022; and
    • The top 5% of New Yorkers by household compensation—a heterogeneous group with average household compensation of about $1,255,700 in 2022—would pay an average of $50,200 more per person.
  • Employers that currently offer health coverage would contribute $200 to $800 less per worker on average for employee health benefits under the single-payer plan in 2022. Meanwhile, employers who do not offer coverage under the status quo would pay an estimated $1,200 to $1,800 more per worker on average in 2022 because of new payroll taxes.
  • The introduction of new taxes could result in some residents and businesses leaving the State, which would result in the need for revised tax schedules and could require increasing the financial burden on middle- and lower-income residents.

The report became an instant landmark and the definitive assessment of the New York Health Act. It led to five editorials in the Times Union, New York Daily News, Newsday, AM New York, and Times Herald-Record, blog posts, and commentaries from advocates, policymakers, and health care leaders, who expressed a wide range of opinions on the implications of the study. The report also gained—and continues to garner—substantial media coverage statewide and nationally with more than 40 articles citing the report, including in The New York Times, Bloomberg, MSN News, Vice, Modern Healthcare, Politico, The Capital Pressroom, City and State, and NY1. To further disseminate the findings, NYHealth and RAND Corporation co-hosted a webinar briefing on the potential effects of a single-payer health care option for New York State, for which more than 300 health care providers, payers, policymakers, academics, and advocates registered.

In September 2018, the report was cited during a lively gubernatorial primary debate between candidates Governor Andrew Cuomo and Cynthia Nixon. In January 2019, NYHealth President and CEO David Sandman moderated a panel at an Empire Center conference on the New York Health Act in Albany, which include panelists Senator Gustavo Rivera, Chair, New York State Senate Health Committee, and Assembly Member Richard Gottfried, Chair, New York State Assembly Health Committee. Director of Policy and Research Mark Zezza also presented findings to prominent State health care leaders at a briefing in Albany.

The report has come to the forefront of national attention. RAND presented on its analysis at AcademyHealth’s National Health Policy Conference in February 2019. The conference brought together health care decision-makers, policy experts, advocates, consumers, patients, researchers, and leaders from the public and private sectors to share the latest evidence and discuss health care issues and policy priorities in the United States. In April 2019, RAND extrapolated upon its findings to estimate the impact of a national single-payer system. This national analysis was the subject of a New York Times’ The Upshot article, and Senator Bernie Sanders’ cited the report in an op-ed for CNN.

The State Senate and Assembly plan to hold joint hearings on the New York Health Act in 2019. The report continues to serve as the de facto fiscal analysis of the legislation, and statistics from its findings have been used by both proponents and opponents of a single-payer system.

Co-Funding and Additional Funds Leveraged: N/A