Writings

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

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.

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...

 The intersection of recent federal healthcare and immigration policy changes will have a significant impact not only on the recipients of government-funded healthcare services and on non-U.S. citizens residing in New York, but also on the immigrants who comprise New York’s healthcare workforce.

From the standpoint of healthcare in New York State, which is the principal preoccupation of the Step Two Policy Project, the passage into law of the One Big Beautiful Bill Act (OBBBA) on July 4, 2025, was highly consequential. What comes next for healthcare in New York is still a puzzle that policymakers and stakeholders are now beginning to confront.

Together, court-mandated outpatient treatment and involuntary removal and hospitalization represent a safety net for individuals who fall through the cracks in the system of voluntary care, often cycling through hospitals, jails, and shelters.

Community Schools represent an integrated educational approach designed to transform traditional schools into community hubs by offering comprehensive services and supports to students and their families. Linking school-based health services and Community Schools is a low-barrier, high-impact approach to improving educational and health outcomes for students, and to better engaging families and the surrounding community in supporting student success.

This paper and the related recent data exercise illustrate the resources that could be developed from existing health delivery system data.

The purpose of this Brief is to describe the existing care management infrastructure in New York and trace its evolution.