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.
But Paul Sonn, associate counsel at the Brennan Center for Justice and a backer of the bill, tells the Voice that since minimum wage laws haven't cost jobs, the health care mandate is unlikely to either. "We expect that they really need a base level of staffing to handle the operation of their sales," he says. Besides, says Frank Watson, an uninsured construction worker, "I'd rather have less money with health benefits for my family. It's going to cost you more without benefits."
Still, other critics take a different tack: Rather than going too far, perhaps the bill is too narrowly tailored. "It doesn't reach far enough to address some of the core issues of lack of health insurance in the business sector," says Marjorie Cadogan, Mayor Bloomberg's health care coordinator.
With the council considering the health care bill, Democrats running for City Hall could try to make medical coverage one of the bread-and-butter issues they use to attack the mayor. Congressman Anthony Weiner last week used a health care address to skewer Bloomberg for saying, back in January, "Medical care in this city is arguably one of the few services you can point to anyplace in the world where the poor get better services than the wealthy."
"If you follow that to its logical conclusion," Weiner quipped, "then Mayor Bloomberg and his friends would go to a public hospital if given the choice." But rather than forcing employers to get into the game, Weiner's health care plan would expand and improve existing government health plans.
The Bloomberg administration emphasizes government-sponsored programs and public-private partnerships like Family Health Plus and Health Pass. Doing anything more ambitious is tough, Cadogan says, because of the scope of the health care problem. "I think the city can always initiate a good idea," she says. "The ability to come to a viable solution, though, takes the partnership of players at the state and federal level to look at what's viable across the board."
After all, health insurance costs are crunching across the economy, rising more than 11 percent from 2003 to 2004, straining the balance sheets of everything from small businesses to General Motors to Medicare. The breadth of the crisis means, according to city Health and Hospitals Corporation president Alan Aviles, that "the city and the state alone cannot address this problem. It must be addressed at the national level."
But Washington doesn't seem to be in a rush to jump in. And until it does, the Cancer Society's Slocum points out, the Health Care Security Act is "a real incremental step. It represents lives savedpotentially many lives saved."
"I wish national lawmakers would solve it," says Simon Greer, co-director of New York Jobs With Justice, which is pushing the City Council bill. But for now, he adds, "It's clear to us in New York: We'll have to innovate here."
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