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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 work reflects our goal of making complicated subjects more understandable to general readers, while providing detailed insights for people who work in the health policy field.
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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
3 days ago


How Many New Yorkers Will Become Uninsured Due to the One Big Beautiful Bill Act?
PDF available: Introduction The One Big Beautiful Bill Act (OBBBA) represents one of the most consequential shifts in federal health policy in recent years. The Congressional Budget Office (CBO) estimated that over 10 years, the OBBBA would result in $990 billion in reduced Medicaid spending and cause 10 million Americans to lose health insurance coverage, with more than half of them losing coverage by 2027. [i] The Appendix of this Issue Brief shows the CBO’s anticipated co

Paul Francis and Adrienne Anderson
Nov 12


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


Creating a Healthcare-Focused Artificial Intelligence Public-Private Platform for New York State
Enhancing Access to AI Tools for Healthcare Providers Across New York PDF version: Key Takeaways 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. New York State has two important precedents for a new public-private platform involving health information technology and AI: the

Sally Dreslin
Oct 15


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


Announcement of an Interactive Reference Tool for Mental Health Services in New York
The product is an interactive, downloadable worksheet that organizes publicly available information about these various programs. I plan to refresh the worksheet regularly to include suggestions submitted on our website and new information published by government agencies and in news media.

Adrienne Anderson
Aug 19


The Importance of Immigrants in New York’s Healthcare Workforce
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.

Sally Dreslin
Aug 4


What Happened? And What’s Next?
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.

Paul Francis
Jul 24


The Law and Practice of Assisted Outpatient Treatment, Involuntary Removal, and Involuntary Admission in New York State
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.

Adrienne Anderson
Jul 7


Linking School-Based Health Services and Community Schools to Address the Needs of Students and Families
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.

Sally Dreslin & Adrienne Anderson
Apr 24


Democratization of Analysis: An Exercise in Accessing and Visualizing New York Health Data
This paper and the related recent data exercise illustrate the resources that could be developed from existing health delivery system data.

Step Two Policy Project
Mar 10


Reforming Care Management for Adults with Behavioral Health Needs in New York Medicaid
The purpose of this Brief is to describe the existing care management infrastructure in New York and trace its evolution.

Adrienne Anderson
Jan 22


Letter from London
There is an old saw that the United States and Great Britain are “two great countries divided by a common language.”

Paul Francis
Jan 7


The Future of School-Based Health Centers in New York
School-Based Health Centers (SBHCs) represent a relatively small but important component of the healthcare safety net in New York.

Sally Dreslin
Dec 19, 2024


It Is Always Darkest Before the Dawn
At the outset of the Chinese Cultural Revolution, Chairman Mao reportedly said, “It is always darkest before it becomes totally black.”

Paul Francis
Nov 12, 2024


Year Two for the Step Two Policy Project
We have begun Year Two of the Step Two Policy Project. ...

Paul Francis
Nov 4, 2024


Rural Healthcare in New York
To be successful, New York’s health policies need to support the unique needs of rural communities.

Paul Francis
Oct 4, 2024


(Part 2 of 2) Healthcare in Rural New York: Current Challenges and Solutions for Improving Outcomes
Accompanied by the Disparities in Rural and Urban Mortality: New York State Chartbook by Adrienne Anderson Policy Brief: Chartbook:...

Sally Dreslin
Oct 1, 2024
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