My union represents thousands of New Yorkers working in retail and other sectors, and we negotiate strong health benefits. For decades, union plans have set the standard for what high-quality coverage should look like. But now maintaining these benefits has become increasingly difficult.
Medical inflation continues to outpace overall inflation, and New York’s Health Care Reform Act taxes employers and unions who do the right thing and provide health benefits — adding roughly 4% a year to their cost. Those taxes account for $6.5 billion in the governor’s budget, making them the third or fourth largest state revenue source depending on the day. That means unions and employers are already more than 10% in the hole due to these taxes and rising costs before we even begin discussing improvements to benefits.
New York Medicaid — among the most expansive in the nation — remains a lifeline for millions. The governor’s proposed FY 2026–27 budget projects the state’s share of Medicaid expenses will reach a record $38 billion. New York continues to overlook a basic question with enormous fiscal consequences: Which profitable corporations don’t pay their fair share and rely on Medicaid and the Essential Plan (and tax payers) to cover their workforce?
New York should follow other states that require annual reporting identifying employers — and large contracting platforms — whose employees or independent contractors are enrolled in Medicaid or the Essential Plan.
For years, unions have warned that some large employers effectively “free ride” on the state’s health care infrastructure. Companies that fail to offer affordable, comprehensive coverage — or that depend heavily on part-time, low-wage, or misclassified workers — often contribute little or nothing to the state’s health care financing system. Yet their workers frequently turn to Medicaid or the Essential Plan, both funded partly by taxes paid by employers who do provide robust coverage.
Responsible employers help finance the system, while others shift their labor costs onto the public. Today, the scale of this imbalance remains invisible.
Washington State requires its Health Care Authority to publish an annual list of employers with the highest number of workers enrolled in Medicaid. Washington’s 2023 report revealed that companies such as Walmart and McDonald’s have thousands of employees on Medicaid. This helps lawmakers shape policy debates on wages, benefits, and health care financing. Given New York’s far larger Medicaid program and more complex labor market, the potential benefits of similar transparency are even greater.
The rise of app-based platforms and spread of worker misclassification as independent contractors intensified the problem. These companies avoid payroll taxes and are not required to offer health benefits, contributing to higher rates of uninsurance, Medicaid enrollment, and Essential Plan use.
Washington’s reporting already captures this trend, identifying companies like DoorDash and Uber among the top entities with workers on Medicaid. In New York, misclassification — especially in construction — creates a substantial disadvantage for union employers bidding against non-union competitors.
New York faces a potential Medicaid funding cliff; policymakers need accurate data to craft sustainable revenue strategies. Transparent reporting would identify which corporations rely most heavily on Medicaid (and taxpayers) and could support targeted reforms, such as a broad-based employer assessment or a public-goods surcharge on firms with large numbers of publicly insured workers.
Requiring annual reporting is a common sense step. It does not impose new benefits, taxes, or wage mandates. It simply clarifies how the state’s largest public program is being used — and by whom. Washington State has shown that employer Medicaid reporting is feasible, informative, and durable. New York should follow suit.
Taxpayers, responsible employers, and policymakers deserve the transparency needed to build a fairer, more stable health care system.
Appelbaum is president of the Retail, Wholesale and Department Store Union.
