Writings

Issue Brief by Sally Dreslin PDF Available: Introduction The use of artificial intelligence (AI) has rapidly expanded across industries in recent years, transforming operations, decision-making processes, and user experiences. From automation and predictive analytics to generative models produced by OpenAI, Google, and Anthropic, among others, enterprises across sectors are increasingly utilizing AI to gain efficiency and pursue innovation. In healthcare, some examples of are

Commentary #32 by Paul Francis

This Issue Brief examines the issues related to the inclusion of outpatient behavioral health services under managed care.

Commentary #31

Commentary #30

Oral health is a core component of overall health, with population-level gains driven largely by preventive public health interventions. As this is the Step Two Policy Project’s first publication focused exclusively on oral health, this Issue Brief begins with an overview of dental care delivery in Part I, then turns to the challenges facing individuals with intellectual and developmental disabilities (IDD) in Part II.

Commentary #29

Commentary #28

Commentary #27

This Issue Brief provides background information on maternity services in rural areas of New York and examines rural-tailored strategies, including care delivery and payment models that have evolved in the state. This paper also examines a new delivery model set to be piloted in California that may serve as a roadmap for preserving maternity services and improving access to perinatal care in rural New York.

This commentary on New York City’s budget deficit introduces an article published in Vital City on February 3, 2026, under the title "Evaluating Mamdani's Diagnosis of New York City's Budget Deficit." The article/commentary points out that, notwithstanding Mayor Mamdani’s expressed surprise that the City was facing a large budget deficit going into Fiscal Year 2027, numerous budget observers in 2025 had identified this looming deficit.

Even a relatively noncontroversial State Executive Budget, which the FY 27 Executive Budget surely is, includes a wealth of important issues to be addressed in the areas of focus of the Step Two Policy Project. Rather than trying to comprehensively review all of these issues, I want to comment today on three such issues in the FY 27 Executive Budget, all of which we have written about in the past.

When New York’s newly elected governor, Hugh Carey, delivered his first State of the State address in January 1975, he famously said, “Now the times of plenty, the days of wine and roses are over.” Gov. Hochul could have begun her FY 27 Executive Budget address by saying, “the days of wine and roses are back.”

Time will tell whether the Democratic strategy of holding out for a clean extension of the enhanced PTCs will be successful. Engaging with the Senate on the HSA construct as reflected in the Crapo/Kennedy Senate Bill could give Democrats a better opportunity to reshape aspects of the bill in order to mitigate the areas of greatest concern, while improving the chances that the country does not take a giant step backwards in terms of the total level of federal subsidies for hea

The purpose of this Issue Brief is to clarify the terms of debate about the enhanced PTCs and the future of the ACA. We will supplement this paper as the enhanced PTC debate evolves in Congress.

This article appeared in Vital City on November 13, 2025.The piece is an excerpt from a longer Commentary called “The Mamdani Mayoralty,” which was posted to the Step Two Policy Project Substack and website on November 10, 2025.

We expect that loss of coverage under Medicaid due to new work requirements and redetermination rules, and loss of coverage of non-citizens under the Essential Plan, may well be less than predicted.

In this Commentary, I want to address two matters: first, how the campaign proposals on affordability of Zohran Mamdani and Andrew Cuomo illustrated the divide between the Progressive wing of the party and the “Moderate/Often Technocratic/Traditional Liberal/Establishment” wing, which I describe collectively as “Traditional Democrats.” Second, I want to discuss the threshold challenge Mr. Mamdani will face in implementing his affordability agenda, which is the fiscal conditi