Rhode Island’s effort to create a health-insurance “exchange” – a key part of the sweeping federal health care law – has stalled because some state leaders oppose a restriction on abortion coverage in a health-exchange bill already passed by the Senate.
Both Gov. Lincoln D. Chafee and Lt. Gov. Elizabeth H. Roberts say they’re against the language that prohibits health plans from covering abortions if the plans were purchased with public subsidies through the exchange.
The wording has threatened to hold up legislation that would establish an exchange, an insurance marketplace for small businesses and individuals intended to lower health-benefit costs.
The new federal health care law enacted last year requires states to design and establish their own exchanges by 2014 or be placed in a generic federal exchange program. But those involved with the process say enabling state legislation must be approved before the end of this session or Rhode Island will lose its chance to qualify for about $15 million in federal grants.
And while the deadline to get an exchange operational is still more than two years away, advocates say the state will be hard-pressed to complete the work on time, unless the legislation is passed now.
Members of several workgroups – led by Roberts – already have started discussing the design and scope of the exchange, but they are far from reaching an agreement, according to Dan Meuse, the lieutenant governor’s deputy chief of staff.
The R.I. Healthcare Reform Commission, assembled by Chafee and chaired by Roberts, has said it planned to complete a business plan by September, with an operational design finished by March 2012. Then officials expect to spend a year buying, building and integrating the new, complex computer system. Plans call for testing of the system to be completed by June 2013.
Planners envision a quasi-public authority overseeing the exchange, with two small-business representatives, two consumer representatives and four experts, as well as three administration directors serving as ex officio members.
Failing to pass enabling legislation would be “inexcusable and irresponsible,” said Ted Almon, president of The Claflin Co. and a member of the reform commission.
Almon said he understands the General Assembly already has a full slate, with a budget deficit, a sales tax proposal and billions of dollars in unfunded pension liabilities.
“This is on the scale of the pension problem, if not greater,” Almon said.
At Claflin, a Warwick-based, medical-equipment company with 180 workers, health insurance premiums add up to more than a $1 million expense – 18 percent of the company’s payroll. “And many companies are worse of than that,” Almon said.
The abortion language was added to the Senate measure before the bill’s passage in April. Critics of the provision argue that it goes beyond the federal restriction that prohibits the use of federal subsidies in insurance coverage for abortions.
Instead of allowing people to buy insurance plans that cover abortion and mandating that the federal subsidy is segregated, some say the wording in the Senate bill could be interpreted to require people to buy an insurance rider if they wanted to cover abortion.
Meuse said such a rider requirement would dissuade many from getting the coverage.
“This is not language the lieutenant governor would accept,” Meuse said.
Chafee already has asked House leadership to amend the Senate bill to remove the abortion language. After Senate passage in April, the bill was forwarded to the House Health Education and Welfare Committee, which already has held for further study a House version of the health-exchange bill that did not contain the abortion language.
Last week, Chafee “remained concerned” about the wording, according to his spokesman. “As the House considers the health-exchange legislation, the governor hopes that it can reaffirm language that mirrors the current law of the land and does not restrict access to women’s reproductive health service,” said Chafee spokesman Michael Trainor.
Larry Berman, spokesman for House Speaker Gordon D. Fox, acknowledged that legislators and the Chafee administration have been in talks on the exchange legislation.
“There’s still a month left in the session, and it’s still alive,” Berman said.
A spokesman for Senate President M. Teresa Paiva Weed could not be reached for comment.
Other state officials say they’re still engaged in negotiations.
“Our ability to hit our milestones and get federal funding depends on passage this session. I am confident we will find a resolution,” said Christopher F. Koller, the state health insurance commissioner.
The commission estimates the exchange will be available to 219,000 Medicaid-eligible individuals, 95,000 subsidy-eligible individuals, 32,000 people who pay for their own coverage, 77,000 employees at small businesses, and possibly another 443,000 people who work for larger companies.
“We envision that any individual or small business seeking information about their health insurance options could come to the exchange, find an array of choices of plans and products and, if they want, enroll,” Koller said in an e-mail to Providence Business News. “It will change the way we think about health insurance, to a more personalized purchase. Building this is a massive effort – any information entered by the person (such as family status, citizenship, employer, personal income) – has to be verified.”
Steven M. Costantino, director of the R.I. Office of Health & Human Services, said Rhode Island’s early moves to establish an exchange have garnered attention.
Last month, the U.S. Department of Health & Human Services awarded the state a $5.2 million grant to hire staff and develop specifications for the information technology.
That award came just weeks after the Robert Wood Johnston Foundation selected Rhode Island as one of 10 states to receive $1 million to implement the federal health care law. The Ford Foundation also has donated $250,000.
And the state is moving ahead with plans to upgrade the IT system for Medicaid, an improvement that will be vital when a health exchange is established.
Costantino said $15 million more in federal grants is at stake. States have been told they need to approve exchange legislation to qualify for the money.
Also at stake: local control of developing an exchange blueprint. The Chafee administration is worried that Rhode Island’s size will make it difficult to work within a one-size-fits-all federal exchange.
“We don’t want a federal system imposed on us,” Costantino said. “You lose control of designing a system that fits Rhode Island’s needs.” •
Allowing any obstacle to prevent the timely structuring of an efficient exchange, ensuring that every citizen who wants to buy health insurance can do so, would be wrong. Legislators who consider following their personal religious leader’s opinion on this matter more important than the needs and rights of tens of thousands of Rhode Islanders belong in a seminary or nunnery, not the legistature. But ensuring basic access for all, as soon as possible, even if religious motivations are wrongly allowed to intefere with the terms, must be the highest priority.
AMEN, SISTER! It’s high time we start making the catholic church in this state extremely uncomfortable.