Lawmakers amended and reintroduced legislation Friday to create a statewide universal health care system after months of negotiations with labor union leaders concerned they would absorb a significant portion of the cost.

The measure, known as the New York Health Act, was changed to clarify state and municipal employees and out-of-state retirees would be entitled to New York Health benefits.

Sponsor Sen. Gustavo Rivera says technical changes were also made to ensure employers do not shoulder the entire cost, with public employers paying a minimum of 80% of the payroll tax breakdown and employees footing a maximum of 20%.

"It is made clear that that can always change, and that can also be negotiated," said Rivera, a Bronx Democrat.

Former Assemblyman Richard Gottfried, who retired last year, first introduced the bill more than 30 years ago. It has yet to pass the full Legislature.

Some of the state's largest and most powerful labor unions, including 1199 SEIU, the New York State Nurses Association, Communications Workers of America, the Retail, Wholesale & Department Store union and others have long supported the proposal. New York State United Teachers and DC 37 — New York City's largest public employee union — backed the measure in the past, but have since rescinded it, fearing their members will forego quality of coverage secured in previous contract negotiations. 

"We are working on them," said Rivera, adding the bill should address their concerns. "...We put it out there so that [they] can read it... That it will be stated clearly and in statute that these are things that are going to be protected for you and everybody else."

Lawmakers in favor of the bill say they'll tout the changes to get more union support.

If it becomes law, a New York Health Act board would devise a plan to fuse retiree benefits with the new system within two years. The updated bill permits health care providers and the state health commissioner to declare an impasse in negotiations with the state — prompting the use of a mediator or separate board.

The proposal to establish a single-payer health system would also cover long-term care, which Rivera noted is not covered under any standing union contracts. The senator argues many people have medical debt after paying high health care premiums, co-pays, deductibles and other out-of-network costs, which show the current system is failing.

"And I'm going to ask everybody to take one step back and ask themselves: Does the current system work for you? Does it? Has it?" Rivera said Friday. "Has it worked for your family? Has it worked for your community? Has it worked for you individually? And the answer will be 'No.'"

But many argue the new model would cost the state hundreds of billions of dollars to implement, and limit choices where people access care.

"This would increase the burden on the state of New York by about $250 billion, or about a quarter of a trillion dollars annually, increasing our taxes in the state by at least probably another 100, if not 150% in year one," said Lev Ginsburg, executive director of the state conference of Blue Cross & Blue Shield plans.

In addition to cost concerns, Ginsburg says a state-operated universal health system would outlaw private insurance in the state and put thousands of New Yorkers out of work.

Lawmakers in support of the legislation argue a single-payer system would reduce current administrative and emergency care costs, and insurance companies are against the change because they benefit from the current system.

But Ginsburg formerly represented state business leaders who fear the system would negatively impact jobs and increase taxes. 

About a million New York adults, or about 1 in 6, lack health insurance, according to state health officials. Ginsburg said lawmakers could expand coverage to those New Yorkers through other, more fiscally responsible policy changes.

"There are many things that I think the government is capable of doing," he continued. "Getting involved in my health care is not one of the things that I think most New Yorkers really, really want."

The change stands to reduce property taxes across the state, Rivera said, because counties and localities shoulder significant Medicaid and health care insurance costs for county employees.

"This is less cost for those counties as well as a better system for every single New Yorker, regardless of where they live or who they are," the senator added.

Democrats pushing for the bill said they'll work the rest of the year to gain support of counties and local governments ahead of fighting for its passage next year.

Supporters also argue the U.S. is the only industrialized country in the world that does not have universal health coverage for all citizens, and insurance companies making decisions in the current system do not care about people's health or well-being.

Even the Legislature passes the Health Act, it's doubtful Gov. Kathy Hochul would support transitioning to a single-payer system after she publicly denounced an effort to expand health care coverage for hundreds of thousands of undocumented immigrants in the state, citing fiscal concerns. A recent state comptroller report shows the state took in $6 billion less in tax revenue than expected.

"We will engage with the governor when it comes to it on how this bill should be implemented," Rivera said. "None of this stuff is easy. It would be transformational and revolutionary, but I believe it is necessary because again, health care is a human right."