Health Reform Repeal Harmful to Rhode Islanders
Monday, November 15, 2010
Last Friday, Governor Carcieri joined Minnesota Governor Tim Pawlenty to file a legal brief supporting a lawsuit that challenges the constitutionality of the health reform law. Two key issues are highlighted in the lawsuit: the individual mandate that requires most Americans to have health insurance, and the expansion of Medicaid. Repealing either of these provisions, or any part of the law, would not be in the best interest of Rhode Islanders.
Mandated health insurance
Requiring most people to have health insurance allows insurance companies to implement many of the most popular consumer protections in the law, such as requiring insurers to cover individuals with pre-exiting health conditions. Even among those who support repealing the law, 62 percent favor keeping these consumer protections, according to a recent Kaiser Family Foundation poll.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTThese consumer protections become unsustainable without an individual mandate—all sick individuals would opt to buy health insurance that insurers would be newly required to provide, but healthy individuals would continue to opt out. Health care costs need to be spread across the entire population to ensure that Rhode Islanders can afford to be insured.
Medicaid expansion
Rhode Island’s Medicaid program, RIteCare, provides insurance for pregnant women and children with incomes under 250 percent of the federal poverty level (FPL), and for parents with incomes up to 175 percent FPL. In 2010, the federal government picked up 63.9 percent of the cost of this program, with Rhode Island bearing the remaining cost.
Health care reform will expands RIteCare to cover nearly all non-elderly individuals with incomes below 133 percent FPL. The federal government will pay for the entire cost of this expansion in the first three years, but states will have to cover up to 10 percent of the cost by 2020. Rhode Island will be able to enroll nearly 30,000 previously uninsured residents by 2019, while increasing costs to the state by less than one percent.
The Governors’ brief argues that this expansion “will effectively co-opt control over the state's budgetary processes and legislative agendas.” However, if Rhode Island aims to reduce its uninsured population, the state should not turn down this expansion. Turning down federal funds and leaving this newly eligible population uninsured will be more costly to the state over time.
Criticism: Well-founded?
Governors Carcieri and Pawlenty criticize the health reform law for being “intolerably ambiguous and indefinite” and for its “coercion” of states to participate in implementation. Rather, the law’s ambiguity and deference to states could be spun as state flexibility and control over the direction of reform. Rhode Island can use this flexibility to leverage existing programs and new opportunities to dramatically improve access to health insurance while minimizing costs to the state.
While the lawsuit plays out in the judicial branch, newly elected Republican leaders across the country are poised to put repealing the law at the top of their legislative agenda. Supporters of repeal have dominated national media coverage lately, but nearly as many in the general public support implementing the law. With most (67 percent) Democrats supporting the law, our Democratic-leaning state is moving forward with implementation. Even among those who support repeal, the majority (regardless of party affiliation) would like to keep many key provisions, including tax credits for small businesses offering health insurance, closing the Medicare prescription drug “doughnut hole,” and subsidizing coverage for Americans with low to moderate incomes.
If our state remains committed to improving the accessibility and affordability of health care in our state, repealing any part of the federal health reform law would not be in the best interest of Rhode Islanders.
Angela Sherwin is a health policy consultant at Arrowhead Health Analytics in Fall River, MA.
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