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The authors estimate that total health care spending under the New York Health Act (NYHA) could be slightly lower than spending under the status quo.

• Spending would be similar in 2022 and 3 percent lower by 2031, with the ten-year cumulative net savings being about 2 percent, if administrative costs and growth in provider payment rates are reduced.
• The initial similarity reflects the net effect of increased utilization of health care services offset by reduced administrative costs, while the decrease over time reflects the assumption that provider payment rates would grow more slowly over time under the NYHA.

The NYHA would require large shifts in the types of payments people make for health care.

• Tax payments would replace premiums and out-of-pocket payments for covered services.
• After redirection of federal and state health care outlays to New York Health (NYH), the additional state tax revenue needed to finance the program in 2022 would be $139 billion, a 156-percent increase over projected total state tax revenue in the status quo.
• With NYH taxes that scale with income, payments for health care could decline substantially among lower-income residents and rise substantially among the highest-income residents under the NYHA.
• Employer health care payments would vary by whether the employer offers health benefits in the status quo. Those offering health benefits under the status quo would have lower average contributions to the NYH payroll tax than to health insurance under the status quo. Those not offering health benefits under the status quo would have increased contributions under the NYHA.