Differences emerging in health care policies and priorities between Gov.-elect Lincoln D. Chafee and outgoing Gov. Donald L. Carcieri provide some early indication of how Rhode Island’s health care landscape may be shifting, although it could be months before anything definitive will be seen.
Carcieri is seeking to have the federal health care reform law overturned in court, filing an amicus brief with Minn. Gov. Tim Pawlenty that joins a lawsuit filed by Fla. Attorney General Bill McCollum in U.S. District Court in Pensacola, challenging the new law’s constitutionality.
Legal work on the friend-of-the-court brief, filed Nov. 19, was done by The Competitive Enterprise Institute, a conservative think tank in Washington, D.C., which in the past challenged the constitutionality of the 1998 tobacco settlement.
“If the law is unconstitutional, it’s a nonstarter,” said Amy Kempe, spokeswoman for Carcieri, “And that’s the question that will be before the U.S. Supreme Court. It’s more prudent to have those questions answered before implementing something that may need to be undone.”
Chafee called Carcieri’s support of the lawsuit “unfortunate.” Instead, Chafee says he wants to make sure that Rhode Island sets the national standard for preparedness in implementation of the new law. “Let’s give this national health care a try, before we start repealing it,” he said.
As one of his first steps in that direction, Chafee last week named Lt. Gov. Elizabeth H. Roberts to chair the “Joint Health Care Task Force,” “to ensure that Rhode Island is well-prepared for the coming national health care reforms,” according to a statement released by Chafee.
At the Nov. 15 Rhode Island Kids Count “Celebration of Children’s Health,” his first public event since his election, Chafee pledged to support efforts to make sure every child in Rhode Island has access to health insurance through RIte Care.
Rhode Island, once a national leader in providing health insurance for its children, saw its national standing slide during the last eight years. Today, there are about 20,000 children under the age of 18 who are uninsured; more than 14,500 of those are income-eligible for health insurance under RIte Care but remained uninsured, according to Elizabeth Burke Bryant, executive director of Kids Count.
Chafee’s pledge may have raised expectations about his budget priorities, but his promise has not yet been translated into a budget commitment, according to one health care executive. “The budget is the ultimate policy document, where you put the money,” said Jane A. Hayward, president and CEO of Rhode Island Health Center Association. She said it was premature to speculate on Chafee’s intentions, but added, “I’m encouraged so far.”
One of the immediate budget challenges confronting Chafee and the General Assembly will be the loss of $240 million in federal Medicaid funding as of July 1, 2011, according to Paiva Weed.
With the passage of the American Recovery and Reinvestment Act of 2009, the shared cost for Medicaid in Rhode Island shifted from its 52 percent federal, 48 percent state ratio to about two-thirds federal, one-third state. As of July 1, 2011, the additional federal resources will end.
“At the same time that we’re going to have federal health care reform, urging us to expand the accessibility of affordable health care for all our citizens, we’re going to be losing the very funding that, in many ways, helps us accomplish that,” Paiva Weed said.
But rather than focus on trimming spending to meet the budget challenge, many in the business community and health care industry are choosing to focus their energies on successful implementation of the law, and with it, the opportunity to maximize the capture of all available federal funds by Rhode Island.
Meanwhile, the Greater Providence Chamber of Commerce has begun to assemble the “Business Coalition for Affordable Health Exchange Choices,” which currently includes the Rhode Island Business Group on Health and the Hospital Association of Rhode Island. The coalition’s goal is to influence how health exchanges mandated under the new law will be set up in Rhode Island beginning in 2014, with an eye toward reducing costs for businesses.
The coalition has focused on the belief that marketplace solutions are essential to achieving cost containment. “We believe that the health-benefits exchange should serve as an accompaniment to the market, not the end-all, be-all. The essential principles are to reserve flexibility and choice for employers and employees,” said Laurie White, president of the Chamber.
White said that the Chamber was putting its efforts on implementation and the new coalition. “[The goal is to have] the insurance community in, the hospital community, the payers and the providers,” she said, describing the sought-after coalition membership.
Edward J. Quinlan, president of the Hospital Association of Rhode Island, said that with the law’s enactment, “we have moved from the debate to implementation,” adding the caveat that with the political change in the U.S. House, that debate may continue. “But for the state, we have an obligation and opportunity to implement federal health reform. The focal point turns to our new governor.”
Moving forward, Quinlan stressed that “consensus is a requirement” for health care reform implementation in Rhode Island. “There may be disagreements, but we have an obligation to come together on behalf of the patients we serve. These disagreements should not prevent us from improving quality, access and cost-effectiveness,” he said.
A major challenge for Rhode Island hospitals is the projected loss of about $450 million in revenue over the next decade as a result of changes prompted by health care reform. “Not every state starts from the same place,” Quinlan began. “The national margin for profitability [for hospitals] is 2.5 percent. Here in Rhode Island, that margin is .10 to .05 percent. We start from a weaker point,” Quinlan said.
One important new player in development of the state’s health care policy and implementation of health care reform may be soon-to-be first lady Stephanie Chafee, who was a front-row participant at a policymakers breakfast hosted by the Neighborhood Health Plan of Rhode Island and the Rhode Island Health Center Association.
A co-founder of the Rhode Island Free Clinic in 1999 and president emerita of its board, she is a long-time advocate for the medically underserved. She listened attentively as two plans were introduced as a cost-effective solution to address the uninsured adult population through an expansion of RIte Care under health care reform.
For the record, Christian Varieka, a transition associate with the office of Gov.-elect Chafee, issued a statement saying that “the governor-elect is currently in the process of working with his transition team to craft a specific set of health care policies, and will decline to comment further until they are firmly and clearly established.” Chafee’s objective, Varieka continued, is to “make Rhode Island ready to prepare and integrate the coming health care reforms.” •
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