By Rebecca C and Chris M
As our members know, NYC-DSA has campaigned and canvassed door-to-door in support of the New York Health Act (NYHA), a bill cosponsored by Assemblymember Richard Gottfried of Manhattan and State Senator Gustavo Rivera of the Bronx that would establish a “single-payer” system of healthcare. Under this plan, all New Yorkers would have comprehensive health care coverage through NY State rather than through their employers.
Now that the incoming State Senate will be under Democratic control and the bill is gaining real momentum, various vested interests are beginning to make their positions known, including the State’s public unions, which have been crucial to Gov. Cuomo’s electoral base. Several news outlets have covered the challenge that union opposition holds to the NYHA’s prospects for advancing, and on a wider scale, the challenge to a national Medicare for All plan such as the one proposed by Bernie Sanders. It seems that finding a path forward for New Yorkers is very likely to pave the way to healthcare as a human right for all Americans.
A Bargaining Chip in Jeopardy
One of the primary union objections to a single-payer plan is that unions have fought hard over the years for their generally above-average healthcare benefits; the idea of losing that advantage while unions are already being challenged on a national level in courts and legislatures is understandably daunting. Union members also want to ensure that the new plan’s coverage is as good as their existing plans.
A memo sent out to labor leaders from Assemblymember Gottfried and State Sen. Rivera addressed many of the union concerns point by point. As a concession to unions’ demands to maintain the zero-premium insurance they have won through bargaining, the memo explains “we are proposing language to be added to the NYHA requiring that whatever percentage of the health benefit premium a public sector employer now pays, the employer must pay at least that percentage (not just 80%) of the payroll tax. A city employee who is not contributing to the premium today would not pay any part of the payroll tax. Unions would not have to re-negotiate these arrangements.” Gottfried added in an email, “Every employer could choose to pay more than 80% of the payroll tax. Since every public employer is a creature of the state, we’re in a position to order them to do that.”
The memo also affirms that coverage through the NYHA will be as good, if not better, than the current coverage through all union plans, and that the bill will be re-introduced in 2019 with additional long-term care coverage. To convince unions that savings incurred under the NYHA will go back into worker wages, the memo states,“We are proposing language to be added to the NYHA that will specify that any savings by a public sector employer (i.e., the amount the payroll tax is lower than the health benefit cost) will be allocated to wages or benefits, with the allocation subject to collective bargaining for organized employees. What the NYHA advocates have not been able to address is what neutralizing the benefit of better and cheaper healthcare than the average worker has will mean for unions hoping to attract and preserve membership. Unfortunately, some union leaders think that everyone’s gain is Labor’s loss, with respect to making the case for the desirability of union jobs, and the hard-fought gains in benefit negotiations lead to fiercely loyal union workers. This reality is truthfully a concern for labor leadership as opposed to the rank and file, and the NYHA campaign seems to be tacitly hopeful that workers will demonstrate support for the proposed bill over the concerns of the higher-ups.
Support from Rank and File
Considering these challenges, how might rank and file union members be persuaded to support the NYHA? The biggest argument for single-payer is that taking health insurance off the bargaining table would free up money for wage increases. Salaries for far too many unionized public employees, blue and white collar alike, are pitiful compared to their counterparts in other cities. For example, a unionized public librarian with a Master’s degree (and all of the debt that comes with it!) had a starting salary of under $40,000 in 2008. Recent wage increases have barely kept up with the rate of inflation, which has been running at historic lows since the 2008 financial crisis. A single-payer system would wind up putting more money in the pockets of low-wage public employees with every paycheck, and help them meet the cost of living in a very expensive city.
The memo sent out by Gottfried and Rivera notes that under the NYHA, “unions will be able to focus collective bargaining resources on wages, vacations, retirement benefits and other issues, instead of being consumed by an endless effort to protect the health plan. Union welfare funds can continue to provide all other benefits not covered by the NY Health Act. Unions can advocate for their members in any medical necessity reviews or appeals. Union-run health centers could continue to operate, being paid by NYH. They could, if they chose, serve non-union members and families as well.”
In the long-term, separating healthcare from employment may be just the strategic shift that our labor movement needs to really build working class power. For both non-union, and to a lesser extent, unionized workers, fighting back against the boss often jeopardizes your individual healthcare benefits and those of your family, whether for the duration of a strike or permanently if you’re fired. Reducing these risks might embolden many more workers to stand up and fight back.
Unions will be won over to single-payer only on the basis of self-interest. While transitioning to a new system would require a number of changes to business as usual, union workers would come out ahead and the unions would gain popular support as a force that fights for the entire working class, not just their own members. How we move our unions to being more supportive will vary from union-to-union, but members could start by asking our leaderships for their reasons for opposing the NYHA (ideally in writing). We should take the time to understand the nuances of those concerns and how the new bill will address them. With that information, we would be better able to demonstrate the benefits of the NYHA, and hopefully build a movement within our unions that can convince the leadership that it is not only worth endorsing, but worth campaigning hard to win.
The NYHA’s cosponsor, Assembly Health Committee Chair Gottfried, has some words of encouragement for NYC-DSA members who have been pounding the pavement in support of universal healthcare in New York. “Grassroots advocacy has been key to the tremendous progress we’ve seen on New York Health,” commented Gottfried when asked about the role DSA can play in supporting the bill. “We’ve passed the bill the last four years in the State Assembly and now have a clear majority of State Senators who cosponsor the bill, campaigned on it, or voted for it as Assembly Members. But the opposition is rich, powerful, and has barely begun to fight. We need to keep those legislators committed in the face of that opposition, and we need to persuade Gov. Cuomo to get on board. It’s critical that advocates do two things: First, continue educating their neighbors, friends, and co-workers that we all do better under a comprehensive, universal health care system; and second, keep up the pressure on us elected officials who are going to be bombarded by well-financed opposition protecting the broken status quo.”
Given the opposition that we face, we won’t win with simple majority support; some supporters in the State legislature will give in to pressures from the health insurance industry or Gov. Cuomo. That’s why our campaign must set our sights high, for overwhelming support, and in NY State politics, that will almost certainly require union support. For those of us who are union members, it’s effort well placed.