These fiscal incentives are overwhelming

Finally, there are a pair of federalism issues that the state would have to deal with to institute a single payer system. ERISA (Employee Retirement Income Security Act), a federal law that originally set certain standards for private pensions, also keeps states from regulating self-insurance plans, or insurance plans in which employers agree to bear the cost of insurance payments. In theory, that would get in the way of the legislation's ban on selling insurance.

Gottfried told us that while self-insured plans could still exist, the NYHA benefits would be better due to the lack of deductibles, co-pays and out-of-network charges. Companies also wouldn't be allowed to pay doctors and hospital systems extra under the bill. Therefore, "there would be no sense in an employer continuing to have a self-insured plan."