NEW: Stenhouse Refutes Roberts’ Claims on 2009 Health Policy Study

Wednesday, June 04, 2014

 

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Mike Stenhouse

Mike Stenhouse with the Rhode Island Center for Freedom and Prosperity issued the following response to Lt. Governor Elizabeth Roberts' statement on the 2009 Robert Wood Johnson Foundation report "Considering a Healthcare Exchange."

"There are a number of counter-points that need to be made," said Stenhouse, who is the Executive Director of the free enterprise public policy think tank.

Stenhouse's Response

Stenhouse offered the following statement on the current debate. 

"After reviewing Lt. Governor Robert’s official statement in response to revelations that her own 2009 group advised against the viability of Rhode Island maintaining a state-based exchange, there are a number of counter-points that need to be made.

First, this issue of transferring the state’s health care exchange to the federal government is critically important to discuss for two reasons. It is not too late to begin an orderly transfer to the federal government and to purge related expense items from the FY2015 state budget, then use that money to pay for other reforms such as tax cuts, eliminating bridge tolls, etc.

Further, as a new Governor will inherit this huge budget problem in 2015, along with his or her own executive order powers, it is vital that this year’s gubernatorial campaign rigorously debate the stated positions of each candidate.

Back to the Lt. Governor’s recent statements, along with those made by HealthSourceRI Director, Christine Ferguson, and other state officials. It appears that a pattern of evasion and mis-information is emerging, indicating that these officials believe they cannot otherwise justify the value of the exchange’s continued existence in our state. Especially when RI taxpayers can have essentially the same system for ZERO dollars if the exchange is turned over to Washington, DC for management."

Stenhouse's Counterpoints

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In addition to his statement, Stenhouse added the following "counterpoints."

"Lt. Gov. Roberts complete ignores the ongoing cost issue, namely, whether there is enough value in burdening Ocean State taxpayers or policyholders with the very high ongoing expenses of running HealthSourceRI – to the tune of $23 million per year, when we can transfer the exchange to the federal government for less than $5 million per year. In deliberately changing the topic, by stressing that the federal government funded subsidies and the start-up costs of planning and building the exchange, Roberts knowingly ignores that the high, ongoing annual operational burden will remain; a burden that lawmakers are grappling with today. The 2009 report stressed the lack of scale in Rhode Island to support the cost of ongoing annual operations. Start-up funding and subsidies were not the primary consideration.

Roberts continues to insist cost containment and affordability is achievable.  Robert’s own study group’s 2009 issue brief stressed the reality that it is not a viable goal for an exchange to seek to bend the cost-curve down; a mythical benefit that we also have empirically not seen in Massachusetts after six-plus years of operation of its exchange. In mentioning that she expects “less expensive” policies to be available next year, she offers few details and fails to explain that premiums are just one component of health insurance policies, and that overall healthcare expenses include other important components. How high will the deductibles be? What will be the total out-of-pocket cap, if any?  What provider network will be available? These latter three components are just as important to policyholders, and cannot be ignored.

Officials continue to tout that federal funds will cover the cost of the exchange over the entire FY2015 budget cycle. This is false, as there are $15 million in line items for the related UHIP project in the proposed budget.

Director Ferguson repeatedly and incorrectly promoted a $17.3 million federal fee as a scare tactic, when the real figure is under $5 million, also ignoring the $38 million total cost of keeping the exchange state-funded.

With the vast majority of HealthSourceRI sign-ups enrolling in Medicaid, which will require an additional $50 million per year from RI taxpayers, why do we need a $23 million per year system for such, when we previously had a Medicaid enrollment system in place?

Director Ferguson and Chief-of-Staff Licht purposely floated, or allowed to float, the perception that RI may have to repay some of the federal funds. There is no such provision in the ACA law. They should know this.

The federal funds, so cavalierly boasted about to finance the exchange for the next year, may be illegal; federal funds are expressly prohibited from being used to operate the exchange after 2014 BOTH by the federal ACA law and by Governor Chafee’s executive order.

Supporters of the exchange repeatedly are attempting to deceive the public and point towards a dubious cost-containment potential as the primary benefit. Do they have no other leg to stand on?

If HealthSourceRI is permitted to continue to be operated locally, at the expense of Ocean State taxpayers and/or policyholders, accountability for this professed affordability benefit will likely end-up working against the exchange’s viability in future years. Our Center, and others, will keep close watch."

 

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.

 

Definitions

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

 

Strengths:

1. Low prevalence of obesity

2. High immunization coverage among adolescents

3. Ready availability of primary care physicians  

Challenges:

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

 

Strengths:

1. Low violent crime rate

2. Low percentage of uninsured population

3. Low prevalence of low birthweight  

Challenges:

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

 

Strengths:

1. Low prevalence of smoking

2. Low incidence of infectious diseases

3. High immunization coverage among children & adolescents  

Challenges:

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

 

Strengths:

1. Low percentage of children in poverty

2. High immunization coverage among children

3. Low infant mortality rate  

Challenges:

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

 

Strengths:

1. Low prevalence of obesity

2. Low percentage of uninsured population

3. Ready availability of primary care physicians & dentists  

Challenges:

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

 

Strengths:

1. High rate of high school graduation

2. Low violent crime rate

3. Low percentage of uninsured population  

Challenges:

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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