As Democrats prepare to take full control of New York's state government, Governor Andrew Cuomo is tempering expectations on a key issue: Single-payer health care.
"I have a lot of great ideas of Christmas gifts I want to give, but then I have to deal with the reality and the cost in the budget," said Cuomo.
The price tag for single-payer is a relatively high one at $150 billion — New York's budget alone is about $170 billion.
Cuomo has said he supports a federal level single-payer system for health care, but is skeptical it can work on the state level.
"There will be a rhetorical desire to do things and then governmentally there will have to be a reality test to fit in the budget," said Cuomo.
For lawmakers, next year will bring more challenges after many campaigned on making health care more affordable.
"The sad part is as health care continues to grow, it's a large part of our economy, we're seeing family's pay checks decrease even when there's an increase in compensation," said McDonald.
One proposal may be to codify aspects of the Affordable Care Act, or Obamacare, into state law. But lawmakers like Assemblyman John McDonald are wary of what President Donald Trump's administration may do.
"The biggest challenge we have is what's next with Washington? What are they going to be doing?," said McDonald.
McDonald, who runs a pharmacy in addition to being a state lawmaker, is also concerned with the ongoing opioid and heroin epidemic, which he said needs to be treated as a public health issue.
"If we don't take that more longer view and wraparound approach as a health care issue we're going to be spending an awful lot more money without results," said McDonald.
The 2019 legislative session will begin in January.