New York Governor Eliot Spitzers plan to revamp health care in the state by expanding some programs, streamlining others, and implementing various cost-cutting measures has received mixed reactions, as noted in the last issue of Insurance Advocate. But Spitzer, of course, is not the only person in Albany with plans for reform. Various bills have been drafted recently. Among them:

A bill put forward by Assemblyman Richard Gottfried, who chairs that bodys Health Committee, would enable low-income workers whose employers offer health coverage but who cannot afford the workers share of the premium to participate in employment-based health coverage. In essence, employers would be able to buy their qualified employees into the Family Health Plus program, which typically runs about 15 percent less than the cost of private insurance. The state would pay only the low-income workers share of the premium, which would stretch public dollars without imposing an additional burden on the employer. The bill passed the assembly in 2006 and is due to be reintroduced in February 2007.

A number of bills were put forward as of August 2006, calling for mandated employer health insurance coverage in one form or another. The businesses affected range from those with more than 10,000 employees to all businesses, regardless of size. several bills call for employer payments of a dollar figure multiplied by the number of hours the employee works annually; one in essence gives the money to the employee to be used for benefits or added to the paycheck; and one, the so-called Massachusetts bill, mandates that individuals purchase their own separate health insurance policies.

Though some, including the Empire State Medical Association, support employer mandates, for the most part there is strong opposition. The Business Council of New York State, for one, launched a campaign in April 2006, to show lawmakers the strong statewide opposition to numerous health insurance mandate proposals circulating in Albany. The council believes that the mandate bills would force employers " of all sizes " to pay significant fees for worker health insurance coverage.

The issue of mandates in general is troublesome to many. It has been noted that ERISA could block any state program that requires employers to alter their health insurance plans. Moreover, the percentage of employers offering health insurance is declining, and there is evidence that the number of self-employed individuals is growing. Notwithstanding various portability measures introduced on the federal level, several reports suggest that workers are effectively trapped in their current employment by the need for health insurance, particularly if a pre-existing condition makes a new insurance policy problematic. Under all these circumstances, it is reasonable to question whether any proposal that focuses on employment-based coverage.

As for employee mandates, analysts of both the Massachusetts and California plans have argued that these are workable only when states also require affordable, quality policies, which in essence means more controls on the industry. And the industry itself is fiercely opposed, both to the employer buy-in plan, which exacerbates competition, and to restrictions on and requirements for their business. Carriers have been concentrating their efforts in Albany on legislation that would curb the states ability to enact further mandates, such as the mental parity bill.

In December 2006, the assembly committees on health, insurance, and labor held hearings, one in a series, on various proposals to improve access and reduce costs. The testimony ranged from general positions to specific recommendations, and inevitably reflected the speakers respective interests and agendas. In written testimony on behalf of the New York State Association of Health Underwriters, Thomas W. Faist asserted that health insurance is not the problem, cost is. Health problems, he wrote, are a function of our lifestyles, not shortcomings of the health care system, which is the best in the world.

In stark contrast, the Empire State Medical Association made it clear that the insurance industry is the problem and that vast sums are lost to private insurers for executive pay, bonus, and stock options and for lobbying and advertising. Were already paying for universal coverage, wrote Daniel Laroche, MD. Were just not getting it.

That leaves single-payer plans, which many who testified support, as do others, including, for instance, the League of Women Voters of New York State. But that is a goal whose time has almost certainly not yet come. In its briefing materials for the 2007 legislative agenda, the league notes, Although many leagues have an interest in single payer legislation, a single payer system remains a long-term goal.

Every year, Assemblyman Gottfried sponsors a bill to create a single-payer health care system; typically, the bill is moved out of the assembly health committee and goes no farther. It remains to be seen whether he will, once again, attempt to move it forward. The single-payer concept appears to be gathering support and momentum, and not just in New York State. But for the moment, everyone is focused on the Spitzer plan and, perhaps, waiting to see what will emerge from Washington and from the presidential campaigns. [IA]