Health Care Reform: The Five Biggest Questions Facing RI
Tuesday, November 16, 2010
The national health care reform debate may be over—at least for now—but how it will change health care in Rhode Island remains an open question. Yesterday, the Rhode Island Public Expenditure Council issued a report that outlines how the reform could impact Rhode Island and listed a series of key questions that should be answered sooner, rather than later.
As Governor-elect Lincoln Chafee prepares his transition, RIPEC Executive Director John Simmons says now is the time to start seriously planning for the state’s transition to a new health care system. (Click here to read RIPEC’s full report.)
“My understanding is the Legislature will pick this up as an issue beginning in January and what we wanted to do was just to sort of chart a blueprint or give them a course,” Simmons said. “It is coming one way or another.”
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLAST1. How will expanding Medicaid affect the state budget? By 2014, as many as 68,000 new people could be added on to the state’s Medicaid program, when individuals who earn up to 133 percent of the federal poverty level become eligible. The state Medicaid program currently has about 180,000 people in it and constitutes roughly one third of the state budget. “When you’re looking at numbers of that magnitude, that’s a significant expansion of Medicaid rolls,” said Brian Daniels, a research consultant with RIPEC. The federal government will pick up 100 percent of the cost starting in 2014. After that, the state will start to share some of it—5 percent beginning in 2017 and 10 percent in 2020. Simmons said it’s unclear what the impact will be on the state budget—because the expansion of Medicaid could cut down in costs elsewhere, such as Medicaid and Medicare reimbursements to hospitals that provide care to patients who are not insured.
2. Are cities and towns prepared for increased costs? While some costs remain unclear, one is not: health insurance costs will go up an estimated 2 percent because parents can cover children for longer—up to the age of 26. That will have consequences for both state and local budgets. “The state we know is [planning] fairly well. The question is municipal governments—making sure they’re taking a look at it,” Daniels said.
3. Will Rhode Island set up its own health insurance ‘exchange’? By January 2013, Rhode Island has to decide whether it wants to set up its own health care “exchange”—an online forum where individuals between 133 and 400 percent of the federal poverty level can review and purchase health insurance plans as well as check to see whether they are eligible for federal subsidies, according to RIPEC. If the Ocean State partners with other New England states to establish a regional “exchange” that could expand choices for Rhode Islanders. If Rhode Island decided not to do its own exchange, the federal government will set one up by 2014.
4. How will it affect the economy? Once the state has determined how health care reform will be implemented in the state, Simmons says it needs to examine how it will affect the health care industry, which is a major sector of the state economy. “This does change the health care economy in Rhode Island. It does shift, for instance, the coverage of individuals and where do you go for coverage—where do you go for services, so that needs to be analyzed as well,” Simmons said.
5. Who’s in charge? It remains to be seen which state agency will oversee the implementation of health care reform, according to RIPEC. The Department of Health and Human Services, for example, is responsible for the Medicaid program, while planning for the new health care exchanges is being spearheaded by the Office of the Health Insurance Commissioner, which recently received a $1 million federal grant for that purpose. Lt. Governor Elizabeth Roberts has taken the lead on some planning as well—but Simmons says the new Governor and General Assembly need to work together to take implementation to the next level.
“The state has an opportunity to get in front of this and to ensure that implementation goes smoothly and that every stakeholder’s voice is heard,” said Ashley Denault, a policy analyst at RIPEC.
Lawmaker: State already planning ahead
One state rep who is a leader on health care issues said state lawmakers have already begun planning for the change. “The health care reform agenda is on our radar screen,” said Joseph McNamara, D-Cranston, Warwick. McNamara, who is chairman of the House Committee on Health, Education, and Welfare, pointed to a bill that committee member Frank Ferri sponsored in the last legislative session.
The bill would have established a quasi-public state agency, the HealthRIght Authority, through which all health insurance would have been purchased in Rhode Island, as of January, 2012. The bill also calls on the state to ensure that all residents have health insurance by that date. However, the bill was never passed; instead it was held for further study.
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