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Policy Project
The Step Two Policy Project is a policy think tank that focuses on issues involving health, behavioral health, and human services in New York. Our goal is to make complicated subjects more understandable to general readers, while providing detailed insights for people who work in the health policy field.
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Thoughts on the FY 27 Executive Budget – Part I
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.
Paul Francis
4 days ago


The Days of Wine and Roses Are Back
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.”
Paul Francis
Jan 23


The Affordable Care Act at the Brink – Part II: Evaluating the HSA Construct
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
Paul Francis and Adrienne Anderson
Dec 29, 2025


The Affordable Care Act at the Brink
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.
Paul Francis and Adrienne Anderson
Dec 9, 2025


Tax Revenue is Destiny
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.
Paul Francis
Nov 13, 2025


How Many New Yorkers Will Become Uninsured Due to the One Big Beautiful Bill Act?
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.
Paul Francis and Adrienne Anderson
Nov 12, 2025


The Mamdani Mayoralty
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
Paul Francis
Nov 10, 2025


Creating a Healthcare-Focused Artificial Intelligence Public-Private Platform for New York State
This paper proposes establishing a healthcare-focused, AI public-private platform to enable broader access to AI’s benefits in patient care, outcomes, and operational efficiency, and to help close the technological divide among healthcare entities.
Sally Dreslin
Oct 15, 2025


Back to School
The Back to School season led me to ponder a public policy paradox that has interested me for some time. That paradox is the divergent trajectories of the healthcare sector and the education sector in the United States over the last several decades – especially in the last decade. Healthcare and education arguably are the two most important sectors in American life: both sectors engage nearly every American at some point in their lives, are massive in size, and...
Paul Francis
Sep 8, 2025
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