Five Decades of State Health Policy Leadership: A Q&A with New York State Assembly Member Richard Gottfried

New York State Assembly
Member Richard Gottfried

Richard N. Gottfried, now New York’s longest-serving state lawmaker, will retire next month after 52 years of service in the New York State Assembly. The Manhattan-based policymaker, who has served as chair of the Assembly’s health committee since 1987, has been the driving force behind many laws designed to improve access to high-quality health care for New York residents. 

For many years, Assembly Member Gottfried participated in the steering committee of Milbank Memorial Fund’s network of state health policymakers, the Reforming State Group (RSG), where he met Milbank program officer and former fellow RSG-er Kate McEvoy. (In 2021, the RSG sunset and became the Milbank State Leaders Network.) Gottfried recently chatted with McEvoy about his career, including his mentorship of new legislators, his work with officials from different branches and political parties, and the most urgent health policy challenges facing incoming legislators. 

McEvoy: How would you describe your origin story? In other words, where did you come from and what influenced and inspired you in public service? 

Gottfried: I grew up in a household of two politically active, social democratic parents in Flushing, Queens. When I was 13, in 1960, John Kennedy was running for president. And like many other people, I got infatuated with him and decided that I wanted to make elective office my career. About a year later when I got into high school, I joined the debating team and ran into a group of classmates who similarly wanted to go into politics. One of them is now my congressman Jerry Nadler.  

[After college] we set about essentially taking over Democratic politics on the west side of Manhattan. You know, it never occurred to us 22-, 23-year-olds that that was a preposterous notion. In 1970, my local assembly seat opened up, so I ran in a hotly contested Democratic primary and won. And I have been doing this ever since. They say if you find a job that you love, you’ll never have to work a day in your life. And that has certainly been the story of my career.  

In 1987, I experienced the next major change in my life when the then-chairman of the Assembly Health Committee James Tallon became the Assembly Majority Leader. I had been involved in the early years of HIV policy because my district covered the Chelsea neighborhood, which was a real hotbed of the HIV epidemic, but I would not have considered myself a health policy person. But the head of my Albany staff called me up and said, “You know, this Health Committee would really be a good job, and you’d be good at it. You ought to tell the Speaker you’re interested.” And I said to her, “You’re right, get off the phone, so I can go call the Speaker’s office and let them know before they give the job to somebody else.” So, since May 1, 1987, I’ve been the Assembly Health Committee chair. And it was about the best move of my political career. It’s been absolutely fascinating and absolutely rewarding. 

McEvoy: I’m so inspired and impressed by your answer. And to think of a person being so fully formed in his kind of personal trajectory at age 13 is just amazing. My formative experience around health policy was at age 15, reading The Village Voice, which my father brought home from working in New York City, and learning about HIV. So, I share that period with you of a time of incredible awakening to the different needs of different folks.  

Dick, I want to thank you so much for always having been so professionally generous to me. As a much less tenured person coming into the RSG a number of years ago, you reached out and gave me opportunities to have dialogue with a person with extensive expertise in health policy. What advice do you have for established leaders what they can do to bring along rising leaders?  

Gottfried: I’ve made it a point over the years to, I don’t know if mentor is the word, but to work with freshman members to explain to them how the bizarre legislator process in Albany works…how to move your bills through the process, and also what it means to be part of a legislative body with a relatively strong leadership structure.  

I do this in part because I really believe in the [Assembly] and like the idea that other talented people would get committed to the place and find it rewarding — and therefore stick around. I’ve always tried to identify people with real potential. I’m happy to say that several of them every year are among the handful of people who get the most bills passed every session.  

People have learned over the years that I can’t resist editing a bill draft, so they come to me with their bill drafts and ask nicely if I could help them out. And then I spend the rest of the day rewriting their bill for them. I always say some people like to do crossword puzzles. I love to draft bills. 

McEvoy: How have you benefited from your involvement in multi-state groups like those supported by the Milbank Memorial Fund? 

Gottfried: The Milbank experience for me was just extraordinarily valuable. The RSG was about as nonpartisan as you can get. Very often it was not at all clear who the D’s and the R’s were. 

There were any number of ideas that I either refined or got out of the blue at an RSG meeting. What the RSG was all about is that one’s home state does not have a monopoly on innovative and terrific ideas. It’s vital to find ways, whether it’s through something like the RSG or the National Academy for State Health Policy or reading journals, to plagiarize good ideas from other states. 

McEvoy: I absolutely love the way you put that, and I totally resonate. Can you think of an example where you really had to do a lot of coalition building, maybe across the aisle, to get a proposal across the finish line?  

Gottfried: For most of my time in the legislature, except for really the last four years, we have had a Republican majority in the state Senate, while we’ve had a solid Democratic majority in the Assembly since 1975. Every year as health chair, I would work with the Republican health chair from the Senate to negotiate bills and get them passed. Whether it was the creation of what we call Child Health Plus, New York’s Children’s Health Insurance Plan program, my bill dramatically lowering penalties for possession of marijuana, or our legislation on health care decisions for people who lose capacity, and innumerable other bills and budget items. 

That [advance directive] process involved both legislation creating what we call a health care proxy, which is designating someone to make decisions for you, and legislation to enable family members, even without a health care proxy, to make decisions for someone who has lost decision-making capacity. Both of those bills took extraordinary work both on the Democratic side and with the Senate Republicans, and even some Assembly Republicans. It was an issue that raised a lot of religious objections from the Catholic church and from the Orthodox Jewish community. The bill enabling family member decision-making took 17 years to pass and was one of the most grueling experiences of my legislative career. Even thinking about it sometimes brings me close to tears. But we finally got that done.  

McEvoy: I was part of a big coalition that modernized those laws in Connecticut. And I cannot think of a more complex, thorny personal set of issues. It affects everyone so viscerally depending on your religion, your spiritual persuasion, your personal morality. That is an amazing example. 

Dick, let’s say you were not retiring. What issues do you feel like people should be focusing on in the 2023 session and going forward?  

Gottfried: I think the most important set of issues deal with vertical and horizontal integration. Horizontal integration [is when] all the hospitals in a region forming one big network. Now you have vertical integration where doctors work for a hospital. Some work for a pharmacy, which in turn is merged with the insurance company. If we’re not careful, there will come a point where the practitioner who is in solo practice or part of a group of physicians is going to be outcompeted by doctors who work for CVS or Walgreens or Walmart. If you think it’s hard to get your doctor to fight with an insurance company today, imagine [how it is] when your doctor works for the insurance company.  

McEvoy: What do you feel is a principal lever for policymakers to address vertical and horizontal integration in health care?  

Gottfried: It’s a variety of things, but I personally think that really the only answer to this issue is a single payer system. While that does consolidate all power in one payer, it’s one payer that is accountable to the public, not to stockholders. I don’t know how else we overcome the oligopoly on the insurance side, which forces an oligopoly on the provider side. There was a time when America enforced antitrust laws. But that era is about 40 years past. Alas. 

McEvoy: That’s an incredible call to action, and I know you’ll continue to carry the torch for that broad scale solution. Dick, for everything that you’ve done in your own leadership, and on behalf of my Millbank colleagues, cheers and congratulations. This is an epic moment and I just wish you every joy in whatever’s coming next.