As Senator Gustavo Rivera and Assemblyman Richard Gottfried continue their campaign to create one state-run healthcare plan for everyone, they are finding that they still have a ways to go to build a consensus on single-payer among labor unions.

At a joint Senate and Assembly hearing on the New York Health Act in Albany Tuesday, legislators on both sides of the issue were particularly concerned with what the unions had to say. It turns out they are still split—and that may not change until some of the blanks that remain about what the single-payer system would look like get filled in.

“We have been successful at negotiating good quality health care for many of our members and many don’t pay for health care right now,” said Fran Turner, director of legislative and political action at the Civil Service Employees Association (CSEA), which represents 300,000 members and retirees throughout the state. “This plan would impose a cost they are not used to paying.”

Some CSEA members do currently pay fees for health care such as copays and deductibles, Turner said. Under the New York Health Act, they would not have to worry about those costs but would instead be responsible for covering 20 percent of the payroll tax levied to pay for the program, with their employers covering the other 80 percent.

But, as Turner put it in her written testimony, “Twenty percent of what?”

According to the oft-cited RAND report, the single-payer system would require the state to raise an additional $139 billion in annual tax revenue—but that’s just one estimate. RAND has also modeled a progressive tax structure to pay for the system, although it would likely look different in reality. Gottfried has emphasized that the bulk of the tax burden will be placed on the wealthy and taxes will be offset by the fact that people aren’t paying monthly health insurance premiums or other fees. But the real annual cost projections and tax structure will remain unknown until after the bill passes and legislators get down to brass tacks.

Peter Maringola, chair of the New York State Public Employees Conference, said these are the kinds of details that would determine whether unions with public employees could support the legislation. After all, unions are accustomed to spending countless hours at the negotiating table hashing out their members' benefits and in many cases have sacrificed salary increases over the years in order to improve them.

"What is the cost?” Maringola asked the legislators seated before him. “I cannot sell an estimate to my members. No way.”

By contrast, representatives of the powerful health care unions 1199SEIU and the New York State Nurses Association, said at the hearing they are willing to pass the bill now and hash out the details later.

“The members of our union really see the consequences of our broken health care system everyday,” said Helen Schaub, the state policy and legislative director at 1199SEIU. “People are walking into the emergency room much sicker than they have to be because they put off care.”

Proponents of a single-payer system emphasized at the hearing that it’s not just about providing insurance to the estimated 1 million New Yorkers who lack it, but also about addressing the fact that many who currently have coverage forego care or medicine because it’s still unaffordable.

“We believe it’s the precariousness of our current system—people afraid of losing coverage—that leads to a lot of the fear that change could leave people worse off and not better off,” Schaub added.

Members of NYSNA and 1199 would be among those most affected by the New York Health Act, given the impact it would have on budgets and staffing at the hospitals and nursing homes that employ them. The rates the state-run plan would pay hospitals and other health care providers for their services are still undetermined, making it unclear exactly what that impact would be.

Assemblyman Andrew Garbarino pointed out that he has heard from nurses who currently feel underpaid and overworked. “I just feel like if this bill passes and reimbursement rates go down for hospitals, it’s going to put more of a strain on nurses,” he said.

Carl Ginsburg, a spokesman for NYSNA, responded that the safety net hospitals that primarily serve low-income people are underfunded and stand to make gains under the bill. “The nurses, who I think very much want a place at the table as this transition is undertaken, are willing to make changes,” Ginsburg said.

The New York Health Act could also affect the types of health care jobs available. But Schaub said that 1199’s Training and Employment Funds would be able to retrain members for new jobs if necessary.

“It may mean less work in hospitals and more work for diabetes counselors and nutritionists,” said Schaub. “We’ve done this before.”

The union reps who were skeptical about single payer also expressed concerns about the mechanics of how retirees who leave the state would receive benefits, among other specifics.

“Just about every point each of you has raised, I think if we sit around a table talking about them one by one, there’s nothing we could not resolve,” said Assemblyman Gottfried. “I would hope that you would be amenable to having that kind of nuts-and-bolts discussion.”

Despite its newly-won Democratic majority, the state Senate will not vote on the New York Health Act before the legislative session ends next month. Some legislators who previously expressed support for a state single-payer system are more cautious now that it is closer to becoming reality. It seems Gottfried and Rivera will need to have more of those detailed discussions in order to get the support they need for the New York Health Act to pass.