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Mike Smith is a no-nonsense guy, a thickly built construction worker with a square jaw and steady eyes. So he gives a no-nonsense answer when asked about how he handles health care for himself, his wife, and two teenage kids. "When we go to a doctor, we've got to pay for it," he says. Lacking health insurance, he pays out-of-pocket and takes his medical problems not to a family physician but to an emergency room, where the medicine is expensive and, says Smith, "the wait is all day."
Smith is one face of America's health care crisis, which a decade ago proved to be too much for even the formidable Bill Clinton to handle. Now, however, the New York City Council is ready to operatepoised to pass a bill that would require employers in five industries to pay for their workers' health care.
Unlike a similar proposal that California voters rejected last fall, the Health Care Security Act has backing from several business groups and individual firms. Unions and major health policy groups like the American Lung Association are on board. A veto-proof 40 councilmembers have signed onto the bill, and Council Speaker and mayoral candidate Gifford Miller supports it.
It looks like a slam dunk. But it's not that simple. There are practical obstacles, and objections from unexpected quarters. Some worry the plan would threaten affordable housing or cost jobs. Others say the bill might not be legal.
Such are the perils that New York City faces when it tries to grapple with the national health care crisis.
The Health Care Security Act would require employers in five industries (building services, construction, groceries, hotels, and commercial laundries) to provide a basic level of health care coverage for their employees. The bill's backers say it would get 60,000 workers insured.
The narrow focus of the bill is deliberate: By targeting service industrieswhich are tied to their customer base in the five boroughsthe bill won't chase businesses out of the city, say proponents. These are industries in which companies traditionally did offer health insurance. But now, those that offer benefits are getting squeezed by less generous competitors.
The proposal is supposed to lift that competitive pressure. "It levels the playing field for those employers who, through collective bargaining, are required, mandated, to provide health care to their workers," says Richard Wishnie, executive secretary of the Association of Electrical Contractors of New York. "If they're competing against people who do not have to provide health care, they're already behind the eight ball."
That's why supermarkets, painters, construction firms, and laundries are counted among the bill's supporters. By eliminating that competitive incentive to drop health insurance, backers say, the Health Care Security Act will protect existing benefits for over 150,000 workers.
Besides the economic rationale, there is a fiscal one: New York taxpayers pick up a $612 million tab for uninsured people who use city hospitals or accept public benefits. Some of New York City's 1.8 million uninsured are employed, so in a way, the taxpayers are subsidizing bosses who don't pay for health care.
Then there's the medical argument: People without insurance don't get preventive care, so they end up sicker, less productive, and more expensive to treat. And the cost is not just in dollars, but also in deaths. "The lack of health insurance is the number one barrier to people getting screened for detection of cancers like breast cancer and colon cancer," says American Cancer Society vice president for advocacy Peter Slocum. "Those lead to early detection of those cancers and can save thousands and thousands of lives."
Saving lives is plainly and simply a good thing. Ordering a company to provide health insurance, however, gets a little more complicated.
The Mayor's Office of Health Insurance Access, for one, has raised concerns that the act might be illegal. Federal law limits what states and cities can do to mandate workers' benefits. Supporters of the measure say they've developed a work-around, but the legal aspects of the bill were still under discussion by City Council lawyers last week.
Part of the debate is over whether the bill should give employers the option of paying the city a fee instead of paying for health insurance. If the fee operates like a tax, that raises another legal issue, because only the state legislature can impose taxes.
Meanwhile, affordable-housing activistsnormally on the same side as the progressives fighting for the billare against the measure, saying it will impose new costs on construction and building-services firms and therefore make it more expensive to build housing for low-income families. What's more, housing advocates argue, federal and state affordable-housing subsidies tend to go to the lower-bidding project, so New York City could lose out on aid.
While the bill has private-sector support, not all businesses are sure that it's a win-win. Laundry lobbyists warn that city laundries could become drop centers, shipping all the real work outside city lines to escape the law. Retail lobbyists contend the law would put city supermarkets at a disadvantage to those just over the line in Westchester or Nassau counties. If either happens, they say, that would cost jobs.