Analysis of Potential Tax Savings from the NY Health Act Calculated for Various Upstate New York Towns, School Districts and Counties

Analysis of Potential Tax Savings from the NY Health Act Calculated for Various Upstate New York Towns, School Districts and Counties  Draft 4

Sergia Coffey, PhD  SUNY Empire State College

George Jolly, MD  Saratoga Health Committee

Abstract:   Shahinfar (2015) states “It is my conclusion that single payer health care is inevitable” because it “makes economic sense for everyone, in large part because it will invariably cut our property taxes all throughout New York State”.  NY Assemblyman Gottfried proposed the New York Health Act which has passed the Assembly three times and has been introduced into the NY Senate by Senator Rivera, where it is gaining support.  Darius Shahinfar, as the city treasurer of the City of Albany testified that “there is not a single act being considered by State Government that would do more to cut local property taxes than passing the New York Health Care bill into law.”

Shahinfar examines the potential property tax savings for Albany.  This paper  provides similar analysis, we find the potential property tax savings calculated for various upstate New York Towns, Cities, School Districts and Counties.  Our calculations are based on a study by Gerald Friedman (2015) of the progressive plan proposed in the New York Health Act.  Our analysis shows savings up to millions of dollars for counties, school districts and cities and some towns, which could potentially be passed on to constituents in the form of reduced property taxes at the same time that health care would be expanded to cover all citizens.

Introduction:

The United States health care spending per capita is twice as much as the average for OECD nations, while life expectancy is below the OECD average. (Friedman, 2015)  Historically, the creation of a universal health care system has been embattled since the idea was first proposed in 1916.  Facing vested interests from the AMA, unions, and the insurance industry as well as ideological challenges, it wasn’t until 1965 after a massive grassroots effort that Medicare and Medicaid were passed in Congress and signed into law by President Johnson. (Palmer, 1999).   A similar grassroots movement will be needed to get universal health care passed at the State or Federal levels.[1]

The New York Health Act sponsored by Assemblyman Richard Gottfried in the Assembly (A4738) and Senator Rivera in the NY Senate (S440) passed the New York State Assembly on May 27, 2017 and has been gaining support in the New York Senate.[2]  The Act states “The legislature finds and declares that all residents of the state have the right to health care.” (Gottfried et. al.)  “The New York Health Act would provide comprehensive, universal health coverage for every New Yorker and would replace private insurance company coverage. You and your health care providers work to keep you healthy. New York Health pays the bill.” (New York Health)

Both bills cite concerns that even after the improvements from the Affordable Care Act many New Yorkers still do not have coverage or have inadequate coverage.  The bills state “individuals, employers, and taxpayers” and businesses “have experienced a rise in the cost of health care and coverage in recent years, including rising premiums, deductibles and co-pays, restricted provider networks and high out-of-network charges.”   Many employers have shifted these costs to their employees.  Inadequate health coverage in New York state also affects Health care providers due to care they provide which is not compensated.[3]

Insurance companies health plans “are guided by the plan’s economic needs rather than their health care needs”[4] which deprives individuals of affordable care and choice.

The goal of the legislation is to “address the fiscal crisis facing the health care system and the state and to assure New Yorkers can exercise their right to health care, affordable and comprehensive health coverage must be provided.”[5]

The NY Health Acts  establish “a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state of New York.”  The intent is to “provide a universal health plan for every New Yorker, funded by broad-based revenue based on ability to pay”

NY State plans to “obtain waivers and other approvals relating to Medicaid, Child Health Plus, Medicare, the Affordable Care Act, and any other appropriate federal programs”[6]  will be paid by the Federal government to New York Health trust fund.   The expectation that Federal funds will be allowed to be redirected to NY State to fund the NY Health plan is focused on by a number of critics of the plan, who claim this assumption is unlikely and without the redirected funding the NY Health act will not be able to succeed.  (See Hammond ( 2016 ) and Roy (2017))

The NY Health Act would reduce costs through reduction of administrative costs and monopoly profits which are received by insurance industry.   It will operate as a true single-payer program.  It would reduce inflated drug and device prices and reduce and eliminate fraud.  Friedman (2015) estimates the plan would have gross savings of over $70 billion dollars.  It would expand health coverage to everyone in NY State, without premiums, co-pays, deductibles or networks, expanding access to health care and reducing mortality correlated with lack of health care access. (Friedman)   Businesses, individuals and public entities would save money on lower health care costs.  A progressive tax would replace the insurance premiums and ninety-eight percent of the people would pay less than they currently do.

Under the current multi-payer system, operated through insurance companies, the share of the Gross State Product spent on health care and administration of the health care system has risen from by 12% of GPS in 1991 to 16% of GPS in 2014, and is projected to continue to increase to 18% by 2024.   Health care spending has increased in New York, without improving healthcare outcomes.[7] (Friedman).

At the same time as costs have risen, deductibles, co-pays and premiums have also risen, reducing access to health care and increasing mortality.   The use of networks by insurance companies has further reduced access, especially in rural areas, by increasing the transportation costs of acquiring health care.

The majority of the increasing costs are due to the high administrative costs of the current multi-payer system operated through private and public insurers rather than from increased utilization.   The increased costs of health care for their employees has effected the payrolls of Towns, School Districts, Counties and New York State, which are struggling with the rising costs of health care.  These costs are passed on to taxpayers.

The NY Health Act would replace the less efficient multi-payer system operated through public and private insurers with single payer system operated through NY State, in a similar manner that Medicare part A is operated.  In the current system over half of the health care spending is from public sources, including federal programs such as Medicare, Medicaid, the Children’s Health Insurance (CHIP) and the Veterans Administration.  Medicaid, CHIP and a portion of Medicare, are paid for with public funds, but are administered by insurance companies, “including managed care plans”.[8]   The use of insurance companies has increased their administrative cost in comparison Medicare part A.  Friedman points out the NYHA would have savings from more efficient administration of payment plans, eliminating waste caused by the insurance industry.  Savings would come from the elimination of insurance company administrative costs and profits now borne by health care providers, saving twenty-five percent of current expenditures, while expanding coverage to the uninsured providing universal health care to a hundred percent of New Yorkers.  The insurance would cover all medical expenses, including dental and vision.

In New York State, part of the non-federal cost of Medicaid is paid for in part by local governments, putting a burden on local property taxpayers.   The New York health Act would eliminate the Medicaid mandate.  In addition, savings would come from reduced spending on public employee health insurance, which can be significant.   Our paper focuses on the savings from the NYHA would have for Towns, Counties and School Districts which could be passed on to taxpayers in the form of reduced property taxes.

Potential Tax Savings

The NY Health Act indicates that revenue to pay for the health care would come from a “progressively graduated premium on all payroll and self-employed income paid by employers, employees and self-employed, similar to the Medicare tax” and “interest, dividends, and capital gains not subject to the payroll premium” (Gottfried et, al. p. 19) Under the NY Health Act the Governor would “submit a specific revenue proposal to the Legislature”  (Friedman 2015 p. 29)  Friedman  proposed  progressive rates, based on the Act, would raise the revenue needed to fund the NY Health Act.

School districts, Town governments and counties struggle under the cost of rising health insurance for their employees.   These costs are passed  on as taxes.   In New York local governments pay for Medicaid costs, under the NY Health Act the State would assume these costs.   Under the NY Health Act there would be significant saving to all these entities.

Methodology:

Freidman (2015) calculated the cost of the Health Care Spending, predicted for 2019, after savings from the New York Health Act as $254,941,000,000.  Revenue from other sources (including Medicare, Medicaid, Chip, VA, ACA subsidies)[9]  equal to $163,623, 000.  Friedman assumes that the Federal Government would make this money available to NY State. The Revenue that would be needed would be $91,318,000,000.   This amount would be divided between revenue from progressive payroll assessment $59,013,000,000  and from revenue from progressive assessment on dividends, interest, and capital gains $32,559,000,000.

We based our calculations based on the marginal assessment rates by income bracket proposed by Freidman, see table 1.  (2015 p. 30  his Table 5).

Table 1. “Suggested marginal assessment rates by income bracket.”

Under $25,000                                                                            0%
$25,000 under $50,000                                                                           9%
$50,000 under $75,000                                                                         11%
$75,000 under $100,000                                                                          12%
$100,000 under $200,000                                                                         14%
$100,000 under $200,000                                                                         16%

Note: At each bracket the rate applies only on the margin, that is to income above the previous level.”

We used Friedman’s (2015) proposed  marginal assessment of the NYH Act to calculate savings with 80% paid by the employer and 20% paid by the employees.   We got salaries from a public web site:  http://seethroughny.net/payrolls.   The lists of employees and their salaries were copied from the “seethroughNY”.  The employees were broken into salary brackets and the total number of employees in each income bracket were counted and used for our calculations.

The second part of the calculations were based on the individual entities budgets.  All calculations are based on 2016 budget numbers and gotten from budgets posted for Towns, School Districts, the County and the State or from the Towns directly.   For a number of Towns the information was gathered through contact with the Town Clerk.[10]

Our data is organized into Counties (Table 1 and 2), Towns and Cities (Table 3) and School Districts (Table 4).  The charts are organized ordered from the greatest health care savings to the least.

In table 1 the data of eighteen upstate counties are ordered by the amount of savings under the NY Health Act.  The data is for 2016, the first column is the total budget, the second column is the health care expenses for 2016, the third column shows the percentage of the budget spent on healthcare in 2016.  The fourth column shows the calculation of the health care costs under the New York Health Act, the fifth column shows the percentage of the budget spent on health costs under the NY Health Act, the sixth column show the estimated savings of medical costs under the NYHA.  The seventh column shows the Medicaid mandate for each county. The last column shows the total savings, a combination of savings for employee health care and Medicaid mandate, for each county.

Erie county shows the largest total savings of $297,341,364, followed by Albany county whose savings would be $108,481,355.  Each county shows significant savings, which could be used to reduce property taxes.

Table 2 shows the tax savings for eight counties.  In this table column 1 is the healthcare expense for county employees in 2016, the second column shows healthcare expenses as a percentage of the budget.  The third column shows our calculation of the employer healthcare costs under the NY Health Act, the fourth column shows the estimated annual savings generated by the NY Health Act, the fifth column is the Medicaid mandate, the sixth is the total savings (the saving from the cost of employer health care plus the Medicaid mandate that would be eliminated).  The sixth column shows the property tax levy for 2016.  The last two columns show, column seven shows the ratio of the percentage of healthcare plus Medicaid mandate to property taxes in 2016, column eight shows this what this ratio would be under the NY Health Act.

The savings for the counties is quite significant. For Albany county the ratio of total health care costs to taxes in 2016 drops from 126% to 6.26% under the NY Health Act.  For Saratoga county the ratio of total health costs to taxes would have dropped from 83% in 2016 to 4.23%.  Each county examined shows significant decreases under the NY Health Act.

Table 3 shows the savings under the NY Health Act for twenty upstate cities and towns. These are ordered by the amount of estimated annual savings under the NY Health Act.  The data used is for 2016.  The city of Albany shows the greatest savings of $22 million, decreasing health care costs from 14.5% of their budget to 2%.  The city of Syracuse would have a savings of $14 million, a decrease of healthcare spending form 6.9% to 1.84%.  The city of Schenectady would have had savings of $13 million a drop of healthcare costs from 15% to 1.84%.  Similar savings can be seen for each Town and City in the chart.   These significant savings could be passed onto property owners in reduced taxes.

Table 4 shows the savings for twenty-one School districts, arranged in order of the greatest savings from the NY Health Act.  All the data is for 2016. The first column is the total budget for 2016, the second column is the medical expenses, the third column is healthcare as a percent of the total budget.  The fourth column shows what the healthcare expense would have been under the NY Health Act, the fifth column shows this as a percentage of the total budget.  The sixth column shows the percentage of healthcare under the NY Health Act to the total budget.  The last column shows the total savings.  The Albany school district shows the greatest savings of $21 million, a drop from 11% to 2% of the total budget.  Shenendehowa would have also had a savings of $21 million, a drop from 14.9% to 2% of the total budget.  Each school district we examined showed similar savings. All these savings could be passed on as a reduction in property taxes.

For Saratoga County, we calculated the savings for 2016.  The total budget was $296,536,296 and the healthcare employee expense was 7.16% of the budget or $21,230,000.  The annual payroll was $55,489,459 and the health care cost was 38.46% of payroll.  Under the New York Health Act, the employer assessment would drop to 4.14% of payroll or $2,295,447.  In addition the Medicaid mandate paid by Saratoga County in 2016 was $24,100,952, this would be eliminated under the NYHA.  The approximate savings for the county would be $43,035,505.

For the Saratoga Springs School district, the employee health care costs  in 2016 were $20,663,414, under the NYHA employee health care costs would have been $2,424,251, a savings of  $18,000,000.

For the city of Saratoga Springs, the employee health care costs for 2016 were 16.80%of the budget, at a cost of $7,366,971.  Our calculations show that the cost of employee health care under the NYHA would have been $1,321,767, a savings of $6,000,000.

A resident of the City of Saratoga Springs would have had potential tax savings, from the reduction of  health care costs for Saratoga County (employee plus Medicaid mandate) of $43,035,505, for Saratoga Springs School district of $19,000,000 and for the City of Saratoga Springs of $6,000,000.   This is an overall savings of  $67,035,505, which could translate into significant property tax cuts.

In addition, the potential savings for the State of New York employee health care expense is $2.6 billion.   New York State would go from a high tax State to a lower tax State by the adoption of the New York Health Act.

Bill Hammond (2016) raises the concern that the NY Health Act will cost too much and would cause taxes to rise on the State level.  Assemblyman Gottfried argues that the progressive taxes will be less than the current costs of premiums.[11]   Our work lends support to Gottfried’s argument by showing the savings which taxpayer could benefit from through reduced taxes from counties, towns and school districts.

The New York Health Act single payer system has numerous benefits, including universal health care and reduced mortality.  Those who are not persuaded by the arguments of health care as a human right, should be persuaded by the lower property taxes that would result from reduced cost of public employee health care and the Medicaid mandate on property taxes.   These tax savings would have dynamic results, increasing the disposable income of taxpayers which would stimulate the economy.   The reduced cost of employee health care and property taxes would also have positive effects on business, increasing the potential of small business and allowing entrepreneurial endeavors with significantly reduced healthcare costs.

As Shahinfar (2015) indicates single payer is inevitable because of the huge property tax savings that will result, “there is not a single act being considered by State Government that would do more to cut local property taxes than passing the New York Health Care bill into law.”   Our work provides data on the significant savings that would result to counties, towns and school districts that could be translated into reduced property taxes.

Table 1:  County Savings for the NY Health Act from reduced cost of Health Care expense for employees plus elimination of the Medicaid Mandate.

All data for the calculations of the reduced health care costs is from 2016.

County Total Budget For 2016 Healthcare Expense for 2016 % Budget Employer NYHA assessment NHYA  % of  Budget Estimated Annual Saving Medicaid Mandate Total Savings under NYHA
                                                                                Erie $1,439,573,871 $103,650,000 7.20% $10,008,192                               0.70%      $93,641,808                                                    $203,699,556                               $297,341,364
Albany $649,788,366 $47,666,890 7.34% $5,613,139    0.86% $43,000,000 $65,481,355 $108,481,355
Chautauqua $268,495,053 $20,032,443 7.46% $1,875,936 0.70% $18,156,507 $30,637,946 $48,700,000
Saratoga  $296,536,296 $21,230,000 7.16% $2,295,447 0.77% $19,000,000 $24,100,952 $ 43,100,952
Sullivan $235,069,583 $21,834,117 9.29% $1,907,043 0.81% $19,890,000 $19,900,000 $39,800,000
  Ontario $213,157,934 $15,454,953 7.25% $2,289,905 1.07% $13,000,000 $16,033,295 $ 29,033,295
Washington $100,584,401 $12,023,438 11.95% $798,556 0.79% $11,000,000 $22,327,054 $ 33,327,054
Warren $152,886,728 $11,312,329 7.40% $1,306,154 0.85% $10,000,000 12,059,718 $ 22,059,718
Tompkins $170,885,638 $11,532,449 6.75% $1,899,790 1.11% $9,000,000 11,580,199 $ 20,580,199
Rensselaer $283,470,034 $24,904,918 8.79% 3,166,393                  1.12% $21,700,00  
Tioga $77,632,571 $8,589,982 11.06% $522,350 0.67% $8,000,000 7,956,641 $ 15,956,641
Franklin $100,999,452 $6,282,949 6.22% $572,343 0.57% $5,710,606 $9,858,994 $15,600,000
Orleans $64,435,941 $4,809,022 7.46% $501,222 0.78% $4,307,800 $8,074,102 $12,200,000
     Chemung                                                            $224,700,699 $13,568,382 6.04% $1,779,532 0.79% $11,800,000 $11,800,000
Essex $96,953,620 $5,137,433 5.30% $620,763   0.64%  $4,516,670                 $6,671,534        $11,100,000
Fulton $88,752,128 $8,042,000 9.06% $606,639 0.68% $8,000,000  
Yates $41,893,513 $2,581,409 6.16% $432,395 1.03% $2,000,000 4,199,604 $  6,199,604
Hamilton $18,924,428 $1,879,074 9.93% $166,234 0.87% $1,700,000 $613,719 $  2,313,719

 

Table 2:  County Tax Savings due to the New York Health Act

County Healthcare

Expense for 2016

% Budget Employer NYHA assessment Estimated Annual Saving Medicaid Mandate Total Savings under NYHA

Potential tax savings

Tax Levy for 2016 property % of healthcare + Medicaid mandate/ property taxes  2016 % of healthcare costs

under NYHA/Property tax 2016

Albany              $47,666,890                  7.34%                       $5,613,139       $43,000,000 $65,481,355 $108,481,355 $89,615,090 126.26 % 6.26%
Saratoga $21,230,000 7.16% $2,295,447 $19,000,000 $24,100,952 $ 43,100,952 $54,170,081 83.68% 4.23%
Ontario $15,454,953 7.25% $2,289,905 $13,000,000 $16,033,295 $ 29,033,295 $54,297,654 81.93% 7.89%
Washington $12,023,438 11.95% $798,556 $11,000,000 $22,327,054 $ 33,327,054 $31,464,000 109.17% 2.54%
Warren $11,312,329 7.40% $1,306,154 $10,000,000 12,059,718 $ 22,059,718 $32,639,960 71.6% 4%
Tompkins $11,532,449 6.75% $1,899,790 $9,000,000 11,580,199 $ 20,580,199 $46,663,731 49.53% 4.07%
Tioga $8,589,982 11.06% $522,350 $8,000,000 7,956,641 $ 15,956,641 $24,545,804 67.4% 2.01%
Yates $2,581,409 6.16% $432,395 $2,000,000 4,199,604 $  6,199,604 $16,023,444 42.3% 2.69%
Hamilton  

$1,879,074

 

9.93%

 

$166,234

 

$1,700,000

 

$613,719

 

$  2,313,719

 

Sources for Property Taxes for table 3:[12]
Table  3 :  City and Town Savings under the NY Health Act  Data for 2016

Town or City Total Budget Healthcare Expense % Budget Employer NYHA assessment  

 

NYHA %

of Budget

Estimated Annual Saving
City of Albany $180,067,786 $26,107,651 14.50% $3,621,168 2.01% $22,000,000
City of Syracuse $283,763,059 $19,700,000 6.94% $5,574,114                          1.96% $14,000,000
City of Schenectady $101,818,195 $15,298,466 15.03% $1,874,408  1.84% $13,000,000
City of Saratoga Springs $43,841,077 $7,366,971 16.80%    $1,321,767                     2.4% $6,000,000
Town of Queensbury $30,559,860 $4,059,950 13.29% $211,511                     0.69%   $3,750,000
City of Glens Falls $17,357,129 $3,403,976 19.61% $361,950  2.1%    $3,000,000
Town of Bethlehem $40,004,124 $3,327,201 8.32% $688,162 1.72% $2,640,000
City of Geneva $24,545,469                           $2,351,621 9.58% $448,448 1.83% $1,900,000
City of Cananadaigua $21,246,298 $1,621,302 7.63% $299,637                     1.41%     $1,300,000
Town of Clifton Park $16,944,216 $1,313,600 7.75% $251,808                1.49% $1,000,000
Town of Milton $6,795,283 $580,618 8.54% $24,090 0.35% $556,528
Town of Newcomb $4,500,774 $582,000 12.93% $56,193 1.24% $500,000
Village of Saranac Lake $10,244,351 $590,500 5.76% $81,011  0.79%       $500,000
Town of Minerva $2,349,172 $430,295 18.32% $9,658          1.04% $400,000
Town of Indian Lake $5,063,065 $406,727 8.03%       $30,351          0.60% $370,000
Town of Lake Luzerne $3,796,000 $380,000 10.01% $28,641           0.75% $350,000
Town of Tupper Lake $2,260,840 $370,365 16.38% $15,472  0.68%       $350,000
Town of Greenfield $4,669,297 $344,565 7.38% $33,210  0.86% $300,000
Town of Johnsburg $3,640,046 $294,100 8.08% $19,103  0.52%       $270,000
Town of Greenwich $1,683,913 $138,840 8.25% $8,508   0.51% $130,000
State of New York (state employees) $152 billion $3.45 billion 2.27% $854,000,000 $2.6 billion

 

 

 

 

Table 4: School District Table shows savings under NY Health Act based on 2016 budgets The Savings are based on 80% of Assessment which is the Employer Contribution

School District

 

2016 Total Budget 2016 Medical Expense Percent of 2016 Budget 2016 Medical Expense under NYHA NYHA % of 2016 Budget Annual Savings
Shenendehowa $166,308,680 $24,894,271 14.97% $3,646,388 2.19% $21,000,000
Syracuse City $392,683,824 $28,300,000 7.21% $10,266,812 2.61% $18,000,000
Saratoga Springs City $118,398,718 $20,663,414 17.4% $8,051,112 6.8% 12,612,302
Bethlehem

 

$96,654,000

 

$11,859,312

 

12.27%

 

$2,110,773

 

2.18%

 

$9,750,000

 

Queensbury Union $59,196,134

 

$9,889,766

 

16.71%

 

$1,068,421

 

1.80%

 

$9,000,000

 

Geneva City $50,249,590 $7,301,011 14.53%

 

$753,598 1.50%

 

$6,500,000

 

Schuylerville Central $34,131,860 $7,047,959 20.65%

 

 $582,404

 

 1.71%

 

$6,000,000

 

Saranac Lake Central $29,750,000 $5,587,224 18.78%

 

$471,641

 

1.5% $5,100,000

 

 Glen Falls      $41,422,882

 

  $5,975,000

 

14.42%  $782,488   1.89% $5,000,00
 Saranac Central     $32,163,541     $5,617,888 17.47%

 

$558,308 1.74% $5,000,000
Greater Johnstown       $33,359,454        $5,652,200       16.94%           $496,994         1.49%       $5,000,000
Lake George Central    $22,632,957

 

$4,441,250

 

19.62%

 

$415,853

 

1.84%

 

$4,000,000

 

Lewiston-Porter Central $43,091,723

 

$4,779,112

 

11.09%

 

$867,763

 

2.01%

 

$3,900,000

 

Ticonderoga $20,114,290

 

$3,381,315

 

16.81%

 

$342,502

 

1.70%

 

$3,000,000
Johnsburg Central $10,547,175

 

$2,508,130

 

23.78%

 

$154,595

 

1.47%

 

$2,300,000

 

Schroon Lake

 

$7,873,597

 

$1,092,980

 

13.88%

 

$155,983

 

1.98%

 

$900,000

 

Minerva Central $5,039,753

 

$1,052,143

 

20.88%

 

$81,294

 

1.61%

 

$900,000

 

Schroon Lake $7,873,597

 

$7,873,597

 

13.88%

 

$155,983

 

1.98%

 

$900,000

 

Long Lake Central $4,179,743

 

$928,914

 

22.22%

 

$55,431

 

1.33%

 

$870,000

 

Newcomb Central $6,397,802

 

$1,004,268

 

15.70%

 

$118,903

 

1.86%

 

$800,000

 

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“seethroughNY ;  http://seethroughny.net/payrolls

Palmer, Karen S.; “A Brief History: Universal Health Care Efforts in the US”,  ((Transcribed from a talk given by Karen S. Palmer MPH, MS in San Francisco at the Spring, 1999 PNHP meeting) http://www.pnhp.org/facts/a-brief-history-universal-health-care-efforts-in-the-us (retrieved 2/12/18)  (1999)
Roy, Avik S.; “The Price of Single Payer, A Fiscal and Economic Analysis of the New York Health Act”, The Foundation for Research on Equal Opportunity, 2017

Shaninfar, Darius; Testimony of Albany City Treasurer Darius Shahinfar to New York State Legislature on the New York Health Act,  1/13/2015

Various Town, County and School District 2016 Budgets

Endnotes:

[1] On the Federal level, single payer legislation, the Medicare for All Act (S.1804)  has been filed by Senator Bernie Sanders on September 13, 2017.  In Congress the Medicare for All bill is  HR 676.  http://www.pnhp.org/

[2]   See http://legislation.nysenate.gov/pdf/bills/2017/A4738  and https://www.nysenate.gov/legislation/bills/2017/s4840/amendment/original

[3] “A large portion of voluntary and public hospitals, health centers and other providers now experience substantial losses due to the provision of care that is uncompensated.” See http://legislation.nysenate.gov/pdf/bills/2017/A4738  and https://www.nysenate.gov/legislation/bills/2017/s4840/amendment/original

[4] See http://legislation.nysenate.gov/pdf/bills/2017/A4738  and https://www.nysenate.gov/legislation/bills/2017/s4840/amendment/original

[5] Ibid.

[6]  See http://legislation.nysenate.gov/pdf/bills/2017/A4738  and https://www.nysenate.gov/legislation/bills/2017/s4840/amendment/original

[7]  Friedman (2015) points out that in the U.S. health care spending per capita is twice as much as the average for OECD nations, while life expectancy is below the OECD average. (p. 8)

[8] Friedman (2015) p. 14

[9] For a full list see Friedman,  (2015 p. 28)  One criticism which a number of authors have identified is the assumption that the Federal Government will allow NY State access to these funds. (City and State, 2017)

[10] For  the Town of Greenfield, the numbers were gotten from the town office for the total 2016 budget and the Total 2016 health care expenditures.  For the Town of Lake Luzerne, the book keeper, Linda Mason, was able to provide the Lake Luzerne numbers on the phone.

[12] Sources for Table 3: Saratoga County Tax Levy 2016 Tentative Budget of Saratoga County Nov. 2, 2015,  Ballston Spa.  www.saratogacountyny.gov/wp/wp-content/uploads/…/2016-Tentative-Budget-bw.pd

Albany County Tax Levy for 2016: 2016 Albany County, Executive Budget Introduction and Highlights, Fiscal Strategies, by Daniel P. McCoy, County Executive and David J. Friedfel Commissioner of Management & Budget.  app.albanycounty.com/dmb/budget/2016/executive/pdf/fiscalstrategies.pdf

Ontario County: Real Property Tax Services Agency, 2016 Annual Report by Robin L. Johnson, Director.  https://www.co.ontario.ny.us/96/Real-Property-Tax

Warren County Property Tax Levy: 2017 Warren County Adopted Budget, Kevin B. Geraghty, Chairman,  Frank E. Thomas

Budget Officer; 11/18/2016 p. 1 http://www.warrencountyny.gov/budget/2017/

Washington Country Property Tax Levy for 2016: 2 0 1 6 Adopted Washington County; http://www.co.washington.ny.us/967/Budget-Resources

Tompkins County Property Tax Levy for 2016:  2016 Adopted Budget Tompkins County, New York Adopted, Section 2 page 1

http://www.tompkinscountyny.gov/ctyadmin/2016budget

Tioga County Property Tax Levy for 2016:  2016 County Budget Adopted December 15, 2015. Revenues Schedule 2, page 69, From line titled Real Property Tax Items, Sec. Totals, from column Adopted 2016.  https://www.tiogacountyny.com/media/2591/2016adoptedbudget.pdf

Yates County Tax Levy 2016:  2016 – Adopted Budget County of Yates,  Winona Flynn, Budget Officer.  2016 Adopted Budget Summary – All Funds.  https://www.yatescounty.org/Archive.aspx?AMID=36