Health-reform plan would affect all R.I. stakeholders

Lt. Gov. Elizabeth H. Roberts is proposing a comprehensive health care reform package that would expand insurance coverage while containing growth in related costs. Though far less ambitious than reforms undertaken in Massachusetts, Vermont and other states, her plan would affect every stakeholder in the system: from employers, to consumers, to providers, to insurers, to the government.
Dubbed the “Healthy Rhode Island Reform Act of 2008,” the eight-piece package was unveiled last week after months of public meetings and discussions. Anyone who employs more than 10 full-time workers would be required to pay a “health security assessment” equal to 8 percent of the taxable wage base for the state employment security system, estimated at $1,000 per year per employee.
Those payments would be offset in part or in full by actual health insurance premiums paid, so most employers who insure their workers would not be affected. The money collected from the others would be used to support efforts to cover the uninsured.
Roberts is also proposing to require anyone earning 400 percent or more of the federal poverty level – currently $40,840 for an individual, $82,600 for a family of four – to purchase insurance, starting July 2009, when a new Health Insurance Access Hub would open for business.
The Hub, for its part, would provide a Web-based clearinghouse for individuals and small businesses to buy coverage – Health Insurance Commissioner Christopher F. Koller said it would be like “Travelocity for health insurance” – allowing them to easily compare rates and coverage levels available from different insurers.
To expand options for consumers, Roberts’ plan would allow any insurer licensed in neighboring states to offer coverage in Rhode Island without obtaining a separate license.
To cover more young people, who make up a substantial chunk of the uninsured, Roberts would make anyone younger than 25 eligible for coverage under their family’s plan, regardless of whether they are students. (Students up to 24 are already eligible for such coverage.)
And to address the main drivers of health care spending growth, Roberts’ plan would require all health plans, starting with those financed by the state – Medicaid, as well as public employee coverage – to emphasize primary care; require care management for chronic conditions; and realign provider reimbursements to reflect these priorities.
None of this, Roberts said, will require additional state spending, though she did say it’s crucial that RIte Care, which she isn’t seeking to expand at this time, be kept as it is now, instead of being cut as Gov. Donald L. Carcieri wants.
Yet before the state invests in expanding public coverage, she suggested, it needs to address cost drivers and build a broader agreement among Rhode Islanders of what our health care priorities should be, and of each group’s role in the solution.
Still, that’s a long shot from not doing anything at all right now, she said.
“This is not one of those problems that will go away if we ignore it,” she said. “It will actually get worse. People have told me that we cannot afford to begin reforming health care in Rhode Island this year. I am here to tell you that we cannot afford not to.”
Roberts unveiled her plan flanked by key legislators who are sponsoring the bills that make up her reform package, including Senate Majority Leader M. Teresa Paiva-Weed, D-Newport. (House Majority Leader Gordon Fox, D-Providence, couldn’t make it but is also a key backer of the plan, Roberts said.) Also on hand were Koller, several representatives of the health care provider community, and business leaders including Donald Nokes, president of NetCenergy.
Nokes, who participated in the public meetings that helped shape Roberts’ plan and is also a board member of the Rhode Island Business Group on Health, spoke out in support of the effort, admitting that he’d been “a little skeptical” until he saw the finished product – especially the parts that involve controlling the drivers of health care costs.
“I like the lieutenant governor’s approach,” he said. “It involves consumers, businesses, health care providers and government. Certainly this proposal will not please everyone, but it is a great start, created through a variety of stakeholders.”
“I look forward to engaging in the process,” he added, “and I urge all my small business colleagues to get involved.”
Koller, for his part, said he’s “very pleased” with the package, which he noted “builds a lot on the work that’s been done before” in the state; he did point out some details that he feels need improvement, such as defining what will be done with the money collected from employers, but his general response was positive. Jeff Neal, spokesman for the governor, said Carcieri had not yet reviewed Roberts’ proposal and thus couldn’t comment on it.
However, he added, the governor “has initiated a number of health care reforms,” most notably the creation of the so-called HealthPact plans, which provide lower-cost insurance for small groups. And Carcieri has promoted system improvements, he noted, such as the use of electronic medical records, to reduce medical errors and reduce costs.
“He has always been focused on ways to take costs out of the health care system, and will continue to do so,” Neal said.
Warwick Mayor Scott Avedisian, who attended Roberts’ event to lend his support, remarked afterward that Roberts had come up with “the first substantive health care reform package we have seen in six years.”
Steven DeToy, the lobbyist for the Rhode Island Medical Society, said Roberts “has created a forum for a discussion that we need to have,” and he added that doctors share the sense that substantial health care reforms are needed, even if they don’t all agree on the details.
Given the glum mood at the Statehouse, Roberts’ plan also felt like a refreshing change.
“I’m excited about this,” DeToy said, “because it shows that we can continue to do important things even in the face of this budget deficit and some of the onerous suggestions out there. … It’s the first positive sign I’ve seen in a while, because the budget deficit is all-consuming.” •