Lawmakers and labor unions are working to amend a longtime bill that would establish a single-payer health care system in New York as budget talks get under way. 

About 1 million New York adults, or about 1 in 6, lack health insurance, according to the New York City Health Department.

Lawmakers have debated the best way to ensure every New Yorker has access to health coverage for decades, including replacing existing coverage through private insurance companies and implementing socialized health care in the state.

Legislation nicknamed the New York Health Act would create a universal health care system and cover all primary, preventive and specialized medical care for all New Yorkers, regardless of immigration status.

The system would be funded through an income-based graduated tax based on a person's ability to pay.

"If we allow insurance companies to remain at the center of the health care endeavor, then we're never going to be able to get out of it," said sponsor Sen. Gustavo Rivera, who chairs the Senate Health Committee.

The proposed universal health plan for the state would differ from the federal Affordable Care Act in eliminating insurance companies as the core of the system.

"...Ultimately, what Obamacare did was to provide some standards for a marketplace of insurance plans," said Rivera, a Bronx Democrat. "We want to move away from that completely. The notion of premiums, the notion of out-of-pocket costs, the notion of networks, these are all the things that insurance companies rely on and want to continue to push on us." 

Lawmakers will not provide details on potential changes to the legislation as they work to amend the measure, which has continued to gain support from Democrats in the state Senate and Assembly signing on as co-sponsors over the last few years.

Assembly Health Committee Chair Amy Paulin is new to sponsor the bill, taking the reins from original sponsor Assemblyman Richard Gottfried who retired last year.

Many of the state's public employment unions have long opposed a universal health system in New York, wanting to ensure their workers will retain the same level and quality of coverage they secured in contract negotiations. 

"They have not been enamored with the bill," said Paulin, a Democrat from Scarsdale. "I know that Dick had proposed some language to address their concerns. I'm waiting to see what those reactions to that language are before I go forward."

Republicans blast the idea of New York creating and implementing a universal health system in the state.

Sen. Patrick Gallivan, a Republican from Elma, stresses the No. 1 obstacle is the exorbitant, unknown cost of the change — estimated to be billions of dollars — and impact on higher tax rates for New Yorkers and businesses. 

"The bill leaves a lot to speculation and simply says, 'we're going to go and do this and then we'll figure it out after we pass the law,'" Gallivan said Thursday. "That's not acceptable."

Gallivan also expressed the concern a single-payer health system would impact the quality of health care available to New Yorkers.

Bill Hammond, senior fellow for Health Policy with right-leaning think tank the Empire Center, says the Health Act would completely dismantle the state's current health system when most of the 1 million uninsured people could get coverage through expanding existing programs or better advertising.

Opponents are also skeptical the state could handle overhauling its health system, citing examples of problematic government programs or corrupt entities.

"This is not a state that's known for efficient management of programs," Hammond said. "And this would be the mother of all programs to manage."

Meanwhile, conversations between lawmakers and labor unions remain ongoing. 

The new version of the Health Act is expected to be reintroduced in the coming weeks as the Senate and Assembly prepare to release their one-house budget proposals next month. But the specific timeline and priority for this legislative session remains unclear.

"Whether it's this year, I don't know, but I am planning on trying to push forward," Paulin said.

Several labor unions that have been publicly opposed to a single-payer health care system didn't respond to requests for comment or declined to be interviewed Friday.

Those in support of the Health Act argue a single-payer system would cost less by cutting out private insurance companies, out-of-pocket costs and county Medicaid expenses.

"Single-payer is a way to actually have a system that we pay less money for and that produces better results," Rivera said, adding, "...The idea that health care is a human right is something that everyone can agree on. Not everyone can agree the same that there's one way to get there."

Rivera has had discussions with Hochul's staffers about a single-payer health system in the state and said some people in her administration are on board with universal medical coverage for New Yorkers.

Representatives with Hochul's office did not respond to questions Friday about the governor's stance on the need for socialized health care in New York. It was not something she included in her executive budget proposal released last week or her State of the State address on Jan. 10.