New York State Senator Gustavo Rivera talks to Jacobin about his proposed state-level single-payer health care bill, why covering undocumented immigrants is crucial, and the state of progressive politics in New York.

State Senator Gustavo Rivera, speaking at the New York State Capitol for a press conference to push back against Governor Kathy Hochul’s proposed plans to increase criminalization to address the overdose crisis, and demand lawmakers implement harm reduction strategies, January 31, 2023. (Erik McGregor / LightRocket via Getty Images)

Numerous polls show widespread support for single-payer health care. But since the end of Bernie Sanders’s second presidential campaign, the issue has waned from political discourse.

State Senator Gustavo Rivera wants to change that. Rivera, who has represented the 33rd Senate District in the Bronx since 2010, aims to pass the New York Health Act, which would guarantee health care to all New Yorkers. Jacobin spoke with Rivera about why he’s pushing the bill, what the barriers are to its passage, and the role of socialists in New York State progressive politics.

Jules Grifferty

What would the New York Health Act accomplish?

Gustavo Rivera

It would guarantee health care to every single New Yorker regardless of your age, wealth, or immigration status. It would actually make the system cost less by wasting less money. Right now, we have the most expensive health care system in the world, but certainly not the best results. The reason for that is that health care is a commodity. That is an obscene proposition. As long as health care is a commodity, we’re not going to have a system that actually serves people.

The idea that health care is insurance has been so locked in their head that people just figure, “At least I know how to deal with this system. What you’re proposing is some crazy notion. I don’t know if we should go down that road.” My response is that we’re not talking about finding a unicorn. I’m talking about something that exists in basically every modern country in the world. We should do the same thing here.

Jules Grifferty

The bill extends health care to every New Yorker. In the bill, a New Yorker is defined as a resident or individual who is employed full-time in New York, regardless of age, income, wealth, employment, or status. Is the word “status” supposed to encompass immigration status?

Gustavo Rivera

Let me be very clear: this bill will include undocumented people. And it will include undocumented people for a very simple set of reasons. Number one, because undocumented people are people. They’re still going to get sick. They need health care. It is not crazy to say that if you were here in the state and you are already giving back to the state, you should get health care.

When people have access to care, when people have health care, and you don’t have to pay for it as a business, you’re actually saving money and increasing worker productivity. Individuals are now able to get access to health care and take care of conditions that might be chronic that would otherwise reduce their productivity because they don’t get to work. The bill deals with that.

On the question of undocumented folks, it’s worth asking: Where do they go when they get sick? They go to the emergency room. Not only is that more costly than providing them primary care — it also provides them the lowest-quality health care, because it’s only for addressing emergencies.

The New York Health Act will absolutely cover undocumented people.

Jules Grifferty

Your goal for the 2023 legislative session was to extend Coverage for All. Now that the state budget is finalized, to what extent did you succeed?

Gustavo Rivera

We didn’t succeed. We moved the ball forward a little bit. The goal here was to reintroduce this bill during the session right after the budget, and then build momentum going into the end of the session, potentially move it out of committee, and get public hearings going. Everything got messed up because the budget was a month late.

We were told in black-and-white by the federal government, “You can use federal money to extend the essential plan to undocumented people without spending a cent of your own money.” My goal was to get a commitment from the administration to amend the waiver to include this aspect of using federal money for extending an essential plan for undocumented people, then reintroduce the New York Health Act, which would specifically address some concerns that we have from our friends and labor, and then build momentum toward the end of the year.

We didn’t get to do that. We had about four and a half weeks at the end of session where everything had to be squeezed in — including battling on Coverage for All. I was able to get it over the finish line to the Senate, but unfortunately, it didn’t make it past the Assembly. But we’re still in the fight for that one. Because — as was stated very clearly by the federal government — yes, we can do this without having the state pick up any of the cost.

Jules Grifferty

Does the Assembly have the chance to vote on Coverage for All in the future?

Gustavo Rivera

Yes. A legislative session is two years. The bill will have to be reintroduced in January 2024.

We will have to pass it again. But the administration can, without passage of the legislation, amend the waiver administratively. The legislation is so that the money can be used for that purpose. I’m hopeful that this is something that we can get done before next year.

Jules Grifferty

A single-payer system would cause an upheaval in the industry that would affect current employees in the for-profit health system. What would a just transition to single-payer look like?

Gustavo Rivera

There’s language in the bill that relates to retraining. There will be enhanced unemployment for some of these workers. Also some of these workers’ skills could be used for the processing of information similar to what they might have done in the insurance industry, but within government work. We’re talking about adding more people to state agencies, for the purposes of processing some of this stuff.

I want to destroy the health insurance companies’ business model. I’m very clear on that.

The transition itself is transformative, but there’s no question that it would be disruptive, That’s on purpose. The disruption here needs to happen, because we need to aggressively move away from a system in which health care is a commodity. As long as we keep that going, we cannot be better. We cannot continue down a road where we keep health care as a commodity. As long as we do that, this will not serve the majority of the people.

That’s why I want to destroy health insurance companies’ business model. I’m very clear on that. Sometimes when they come and meet with me, I tell them, “Listen, it’s cool that we’re working on this now. But please understand, I want to destroy your business model, because you are not in the business of providing care. You’re in the business of denying it.”

Jules Grifferty

How important is it to get labor’s support for this bill? And what’s required to make that happen?

Gustavo Rivera

There’s plenty of labor support already for this bill. Whether we’re talking about the New York State Nurses Association; the Communication Workers of America; the Retail, Wholesale and Department Store Union; or the Service Employees International Union. The support is there, but public sector unions have been resistant so far. I will legitimate the concerns that I call the bird-in-the-hand problem. Over generations, they have fought for what is — in comparison to what health care is available to other people in the United States — a better product, but it’s still an insurance product.

Number one, it has limited networks. Number two, it does not include long-term care. Overall, as has been demonstrated by some economic studies on the proposed New York Health Act, 95 percent of people would pay less, because you don’t have premiums, co-pays, networks, or deductibles.

In the last fifty years, nearly every labor contract that has been negotiated in the country has health care at the core of the conversation. So you have members that are saying, well, “I fought for this, I gave up things for this.” My response is,“I can guarantee that you’ll never have to negotiate for these things again because we’re creating a higher floor for everybody, including your membership.”

One of the changes that we put to the 2023 version of the bill is specifically related to maintaining union workers’ hard-won benefits.

I’ve been a union member for most of the time that I’ve been in the United States. I’m originally from Puerto Rico; I came to New York ’98, started teaching college in ’99, and came to the Bronx in 2000. I was a member of the Professional Staff Congress. I have a deep love, affection, and appreciation for the working class and for labor unions. I want them on board.

If you’re a union leader and you don’t think that the bill as written addresses your concern, let’s have that conversation. I want the unions on board. They’re the best example of what happens when we actually all get together and fight: we can get better conditions for everybody.

Jules Grifferty

Which unions do you plan on meeting with to get on board, and what were their concerns?

Gustavo Rivera

Folks who have been resistant in the past are District Council 37 downstate, the largest district council in the country, and particularly the Civil Service Employees Association upstate. Both of them are public sector unions. I have a relationship with both of them, so my doors are and will remain open.

Some folks were concerned about the employer’s contribution. We’re funding it with a graduated assessment, basically a payroll tax based on ability to pay. In the bill, it says 80 percent minimum would be the employer and 20 percent of it maximum would be the employee. That’s always been the case.

Some folks were concerned, asking, “What if the employer wants to pay less?” So we put it in black-and-white on the bill.

Jules Grifferty

New York State politics have undergone a sea change in recent years. There’s a lot more energy in progressive policymaking, most spectacularly by the rise of socialist legislators. How do you feel about these progressive shifts in New York State politics?

Gustavo Rivera

I’ve been in the Senate since 2010. I’m one of the most senior members of the legislature. For a lot of these battles, there were a few of us who fought by ourselves for a very long time. I love all my colleagues. I have a particular level of respect and appreciation for Julia Salazar. She just gets better all the time. Her heart and her brain have always been in the right place. Being in public service — being a legislator — is not something that she had sought. There’s many people in this business — this is all they live for. They just want to be an elected. That’s not what she wanted. But all things kind of came together to get her there. She’s a thoughtful legislator — smart, caring. She’s a great person. I love having her as a colleague. Kristen Gonzalez is great as well; Jabari Brisport is a ball of fire. And Zohran Mamdani, I mean, why are you so pretty? Emily Gallagher is phenomenal.

It’s great having all of these folks. We’re in agreement 98 percent of the time. They are relentless in their advocacy. Having all these folks who came to the legislature with a specific set of goals in mind, who want to push the envelope on things that I’ve been fighting for forever. I’m just glad to have a lot more allies and to be able to say that it’s not just me doing it.

Universal health care is my number one legislative priority.

My story is not one of struggle. My story is one of privilege. I am an exceedingly lucky human. Therefore, I’m deeply obligated to open the door for folks who aren’t. That’s how I look at my life.

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