2009 Report Predicted Troubles with RI Health Exchange

Tuesday, June 03, 2014


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A 2009 healthcare consultant report by the Robert Wood Johnson Foundation predicted that the development of a full health insurance exchange in Rhode Island would not result in goals of "increased access and affordability."

See Report HERE

Now, five years later, one of the report authors says that she still does not believe a state based exchange in Rhode Island is viable, at a time when state officials are taking a closer look at the costs associated with maintaining HealthSource RI.

"Personally, I do not think a state-based exchange can be sustainable in a state the size of Rhode Island and with so few carriers I am not sure that it offers a lot of value," said report author Amy Lischko, who was a key architect of former Massachusetts Governor Mitt Romney's 2005 health care reform legislation, and is currently an Associate Professor of Public Health at Tufts University. 

Consultants' Critical Look at State Exchange

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The 2009 RWJF report was released after Lt. Governor Elizabeth Roberts' attempt in 2008 at establishing a state exchange -- "HealthHub RI" -- and prior to the passage of the federal Affordable Healthcare Act in 2010.

"The highest priority goal for HealthHub RI, as defined by stakeholders, was cost containment. Yet stakeholders agreed that implementing HealthHub RI would not, by itself, constrain the growth of health care costs in Rhode Island," wrote the report authors.

Roberts' Communications Director Maria Tocco pointed out that as the report was done prior to Obamacare, the federal legislation presented a new set of parameters for consideration.

"When the [ACA] laws hit, then we had the tools needed to build the exchange as identified in that report -- subsidies, mandate, and access to funding, so it completely changed the landscape," said Tocco.

One of the three report authors, Deb Faulkner with Rhode Island-based Faulkner Communications, was the project lead for the Affordable Health Insurance Initiative at the time of research, and currently counts HealthSource RI among her clients, along with Medicaid, and received $1.2 million in consulting vendor payments from the state in 2013. 

Old Report Raising New Questions

Mike Stenhouse with the Rhode Island Center for Freedom and Prosperity, who testified in front of the House Finance Committee on the proposal to move Rhode Island's health exchange to federal government control, questioned the current arguments for keeping the exchange in the state.

"This report shows that cost containment is not a viable goal, which is what [HealthSource RI]  talked primarily about the hearing," said Stenhouse.  "That's what they talked about for maintaining local control.  Based on this study - and empirical evidence from Massachusetts -- that's just a myth."

Josh Archambault with the Foundation for Government Accountability, who testified along with Stenhouse, spoke to his knowledge of the rollout in Massachusetts.

"I think its important that people look to [Massachusetts] as guidance as to what to expect under federal law," said Archambault.  "What I've learned -- and I spent years and years looking at the law -- is a couple of things.  The direct relevance to Rhode Island today is that the promises being made by the Rhode Island leadership at Healthsource aren't backed up by the example.  You can't expect dramatic impact with a statewide exchange of 28,000 people."

Archambault continued, "It's been very expensive to run an exchange here -- and it's still very expensive.  Massachusetts remains the most expensive state to purchase insurance in country."

Forecast for Rhode Island

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"Rhode Island has been exploring options for containing health care costs for a number of years and reports such as the one you reference have informed the conversation," said Dara Chadwick, Chief of Strategic Communications at HealthSource RI.  "This conversation has changed over time based on state leadership, passage and implementation of the Affordable Care Act, and policy choices made by numerous healthcare stakeholders. HealthSource RI is an implementation of the policy decisions outlined in the strategic plan and Executive Order establishing the Exchange.

Stenhouse questioned why the findings of the RWJF report hadn't come to light until now -- but that he saw it as a start. 

"We are continuing to raise questions here," said Stenhouse.  "We're just now getting the debate and evaluation [the health exchange]  should have had in Rhode Island years ago."


Related Slideshow: New England’s Healthiest States 2013

The United Health Foundation recently released its 2013 annual reoprt: America's Health Rankings, which provides a comparative state by state analysis of several health measures to provide a comprehensive perspective of our nation's health issues. See how the New England states rank in the slides below.



All Outcomes Rank: Outcomes represent what has already occurred, either through death, disease or missed days due to illness. In America's Health Rankings, outcomes include prevalence of diabetes, number of poor mental or physical health days in last 30 days, health disparity, infant mortality rate, cardiovascular death rate, cancer death rate and premature death. Outcomes account for 25% of the final ranking.

Determinants Rank: Determinants represent those actions that can affect the future health of the population. For clarity, determinants are divided into four groups: Behaviors, Community and Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of the population in a state, and improving these inputs will improve outcomes over time. Most measures are actually a combination of activities in all four groups. 

Diabetes Rank: Based on percent of adults who responded yes to the question "Have you ever been told by a doctor that you have diabetes?" Does not include pre-diabetes or diabetes during pregnancy.

Smoking Rank: Based on percentage of adults who are current smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).

Obesity Rank: Based on percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher.

Source: http://www.americashealthrankings.org/

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6. Rhode Island

Overall Rank: 19

Outcomes Rank: 30

Determinants Rank: 13

Diabetes Rank: 26

Smoking Rank: 14

Obesity Rank: 13



1. Low prevalence of obesity

2. High immunization coverage among adolescents

3. Ready availability of primary care physicians  


1.High rate of drug deaths

2. High rate of preventable hospitalizations

3. Large disparity in heath status by educational attainment

Source: http://www.americashealthrankings.org/RI

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5. Maine

Overall Rank: 16

Outcomes Rank: 25

Determinants Rank: 12

Diabetes Rank: 23

Smoking Rank: 29

Obesity Rank: 28



1. Low violent crime rate

2. Low percentage of uninsured population

3. Low prevalence of low birthweight  


1. High prevalence of binge drinking

2.High rate of cancer deaths

3. Limited availability of dentists

Source: http://www.americashealthrankings.org/ME

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4. Connecticut

Overall Rank: 7

Outcomes Rank: 15

Determinants Rank: 4

Diabetes Rank: 16

Smoking Rank: 4

Obesity Rank: 12



1. Low prevalence of smoking

2. Low incidence of infectious diseases

3. High immunization coverage among children & adolescents  


1. Moderate prevalence of binge drinking

2. Low high school graduation rate

3. Large disparity in health status by educational attainment

Source: http://www.americashealthrankings.org/CT

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3. New Hampshire

Overall Rank: 5

Outcomes Rank: 7

Determinants Rank: 5

Diabetes Rank: 16

Smoking Rank: 11

Obesity Rank: 22



1. Low percentage of children in poverty

2. High immunization coverage among children

3. Low infant mortality rate  


1. High prevalence of binge drinking

2.High incidence of pertussis infections

3. Low per capita public health funding

Source: http://www.americashealthrankings.org/NH

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2. Massachusetts

Overall Rank: 4

Outcomes Rank: 14

Determinants Rank: 3

Diabetes Rank: 10

Smoking Rank: 7

Obesity Rank: 2



1. Low prevalence of obesity

2. Low percentage of uninsured population

3. Ready availability of primary care physicians & dentists  


1. High prevalence of binge drinking

2. High rate of preventable hospitalizations

3. Large disparity in health status by educational attainment

Source: http://www.americashealthrankings.org/MA

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1. Vermont

Overall Rank: 2

Outcomes Rank: 12

Determinants Rank: 1

Diabetes Rank: 4

Smoking Rank: 9

Obesity Rank: 5



1. High rate of high school graduation

2. Low violent crime rate

3. Low percentage of uninsured population  


1. High prevalence of binge drinking

2. Low immunization coverage among children

3. High incidence of pertussis infections

Source: http://www.americashealthrankings.org/VT


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