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An Assessment of the New York Health Act

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An Assessment of the New York Health Act Research Report An Assessment of the New York Health Act A Single-Payer Option for New York State Jodi L. Liu, Chapin White, Sarah A. Nowak, Asa Wilks, Jamie Ryan, Christine Eibner C O R P O R A T I O N For more information on this publication, visit www.rand.org/t/RR2424 Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2018 RAND Corporation R® is a registered trademark. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Preface As of July 2018, the New York State legislature is considering a comprehensive single- payer health plan (the New York State Health Act). The plan would provide coverage to all residents of the state, including undocumented immigrants, and would transform the delivery and financing of health care in the state. To understand the near-term and longer-term impact of the single-payer proposal, the New York State Health Foundation (NYSHealth) commissioned RAND to assess how the plan would affect a number of outcomes, including health care utilization and spending. This report presents the results of RAND’s analysis. Support for this work was provided by NYSHealth. The mission of NYSHealth is to expand health insurance coverage, increase access to high-quality health care services, and improve public and community health. The views presented here are those of the authors and not necessarily those of NYSHealth or its directors, officers, and staff. The research was conducted in RAND Health, a division of the RAND Corporation. A profile of RAND Health, abstracts of its publications, and ordering information can be found at www.rand.org/health. iii Contents Preface ............................................................................................................................................ iii Figures............................................................................................................................................ vi Tables ............................................................................................................................................ vii Summary ...................................................................................................................................... viii Acknowledgments ........................................................................................................................ xvi Abbreviations .............................................................................................................................. xvii 1. Introduction ............................................................................................................................... 1 New York Health Act ................................................................................................................. 1 Prior Analyses of Single-Payer Proposals .................................................................................. 2 Objective of This Analysis ......................................................................................................... 3 2. Status Quo in New York ........................................................................................................... 5 Health Insurance Coverage and Financial Assistance ................................................................ 5 Financing .................................................................................................................................... 8 Premium Payments ................................................................................................................. 9 Tax Payments .......................................................................................................................... 9 Out-of-Pocket Payments ....................................................................................................... 10 Provider Payment Rates and Prescription Drug Prices ............................................................. 10 3. New York Health Program ..................................................................................................... 12 Eligibility and Benefits ............................................................................................................. 12 Financing .................................................................................................................................. 12 Provider Payment Rates and Prescription Drug Prices ............................................................. 14 Federal Waivers and Legal Considerations .............................................................................. 15 Medicaid Waivers ................................................................................................................. 15 Medicare Waivers ................................................................................................................. 16 Affordable Care Act Section 1332 Waiver ........................................................................... 17 Federal Regulation of Employer-Sponsored Health Benefits ............................................... 18 4. Overview of Methods ............................................................................................................. 20 Modeling Approach .................................................................................................................. 21 Population and Health Care Spending .................................................................................. 21 Utilization of Health Care Services ...................................................................................... 23 Taxes Supporting Health Care Programs .............................................................................. 23 Employment Effects .............................................................................................................. 25 iv Key Inputs and Modeling Assumptions .................................................................................... 26 Provider Payment Rates ........................................................................................................ 29 Administrative Costs ............................................................................................................. 30 Prices Paid for Prescription Drugs and Medical Devices ..................................................... 33 Fraud and Abuse Detection Costs ......................................................................................... 34 Long-Term Care Costs .......................................................................................................... 35 Limitations ................................................................................................................................ 36 5. Results: Estimated Impact of the New York Health Act ........................................................ 39 Coverage ................................................................................................................................... 39 Health Care Spending ............................................................................................................... 39 Health Care Payments ............................................................................................................... 44 Individual Health Care Payments ............................................................................................. 47 Employer Health Care Payments .............................................................................................. 50 Employment and Wages ........................................................................................................... 52 Long-Term Care ....................................................................................................................... 55 Possible Tax Avoidance and Migration Effects ....................................................................... 56 Tax Avoidance at the Individual Level ................................................................................. 56 Tax Avoidance on the Part of Businesses ............................................................................. 59 Location of Health Care Providers ....................................................................................... 59 Individuals Migrating to Gain Access to Care ...................................................................... 60 6. Impact of Alternative Assumptions .......................................................................................
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