Health insurers will gain $1 trillion in new revenue over the next eight years under the 2010 health-care law, assuming it’s upheld by the Supreme Court, according to a Bloomberg Government study. The money comes from U.S. subsidies to people purchasing insurance beginning in 2014 and an expansion of Medicaid.

Last week, Senator Thomas Duane and Assembly member Richard Gottfried introduced their bill that would create a universal, single-payer healthcare system in New York. The bill is an updated version of one introduced by Gottfried in the early 90s. If it passes, New York would become the second state, following Vermont, to pass such legislation. Several other states are moving toward single payer, and California’s legislature came within two votes of passing such a bill earlier this year. Onward!

A growing number of Americans are finding their credit destroyed due to medical debt. In many cases the size of the debt is small and the debtor is simply unaware of it existence until contacted by a collection agency. Due to the many issues that can arise during the billing process –incorrect billing; improper processing of the bill by the insurance company; delayed payment from insurance company resulting in the hospital billing the patient; multiple bills resulting from one office visit–a patient can easily become liable for a payment he or she thought was already covered.

Doctors, Nurses, Patients Advocates (of course including members from HCN!-NYC) joined Assembly member Richard Gottfried, Senator Thomas Duane and 70 lawmakers in unveiling an updated and revised single-payer legislative proposal for New York State. A state study says that single payer would reduce overall health care expenditures in New York by $20 billion annually by 2019. And people would not need to choose between getting less income to qualify for Medicaid and going without insurance since it is unaffordable.

Americans with private health insurance are increasingly postponing needed care or foregoing it altogether because of rising out-of-pocket costs. At the same time, public programs are failing to keep up with the needs of the uninsured and those living in poverty. Even if it withstands its Supreme Court challenge, the Affordable Care Act will not be sufficient to address these gaps in care.

Debt collection agencies have become more aggressive in their pursuit of medical debt.  A recent investigation into the practices of Accretive Health, one of largest medical debt collection agencies, reveals that agency workers were given front-line staffing positions, such as registering patients, and did not distinguish themselves from hospital employees. They then attempted to collect delinquent payments from patients or dissuaded them seeking care if they could not pay. The debt collectors stalled patients in emergency rooms and placed patients on “stop lists” if they were delinquent on payments.

Chairman Richard Gottfried of the New York State Assembly Committee on Health responds to insurers cheating on out-of-network payments.  No matter what rules are imposed, health insurance companies quickly find a way around them.  That is why he has introduced an Assembly bill – A. 7860 to create a universal single-payer system in New York State.

A settlement intended to increase insurers’ coverage of out-of-network care has instead led to lower reimbursement rates and higher out-of-pocket expenses for families.

Under the Affordable Care Act, those whose job-based coverage is deemed unaffordable by the government will be eligible for subsidized private insurance. However, “affordability” is based only on the cost of individual insurance, meaning that many workers will be unable to cover their families, while remaining ineligible for subsidies.

Meanwhile, 1.5 million New Yorkers could face gaps in health coverage because of fluctuating incomes and eligibility requirements for subsidies and other programs.

At present, there is little transparency in healthcare costs and the resulting discrepancy in pricing for the same service contributes to the rising cost of care.  A single-payer system would remove this discrepancy and save money for consumers.