The most feasible path toward improving insurance coverage and access to care is to implement a targeted package of reforms rather than a state single-payer system, the Citizens Budget Commission said this week during a presentation in Manhattan.

The budget watchdog group recommended that the state pursue an individual mandate to help draw younger, healthier people to buy insurance if they don't already get coverage through their employer. CBC also said the state could offer a low-cost public health plan, otherwise known as a public option. It said expanding eligibility for subsidies to lower-income immigrants who are not eligible for public insurance programs was also worth exploring as a way to lower the uninsured rate.

"The state should not pursue options that are not currently feasible—single-payer, expanded insurance subsidies for those earning more than 400% of the federal poverty level or price regulation," said Andrew Rein, incoming president of the CBC. "Instead, [the state] should pursue insurance and access improvements."

Bea Grause, president of the Healthcare Association of New York State, said she opposes a single-payer system and is skeptical that New York would be able to obtain the federal waivers necessary to combine the Medicare and Medicaid population into its New York health plan.

"Single-payer is a misnomer," she said during a panel discussion hosted by the CBC. "I really dislike the term. It's really more like fewer payer."

Helen Schaub, 1199SEIU's state director of policy and legislation, gave a lukewarm embrace of the concept but said the debate will help legislators clarify how to improve health care.

"We're not opposed to single-payer as a concept," she said. "As much as we're not opposed to that on the horizon, we're also certainly willing to support interim steps. We're realists about the politics."