On Feb. 12, Lt. Gov. Elizabeth Roberts announced her proposal for a new comprehensive healthcare reform package called the Healthy Rhode Island Reform Act. The Act consists of a series of eight bills aimed at expanding health insurance for the 13 percent of Rhode Islanders without coverage, but it does not mandate coverage for the state's poorest individuals.
Robert's announced her proposed legislation amid growing concern over the rising costs for a new healthcare reform law in Massachusetts, with which Robert's plan shares some features. A Feb. 3 Boston Globe article reported that the Massachusetts plan could cost as much as $1.35 billion annually by 2011, even as the state's budget tightens.
Rhode Island is facing a similar budget crunch, with a $151 million deficit this year. To remedy the budget shortfall, Gov. Donald Carcieri '65 proposed to reduce state spending by $130.9 million this year in order to balance the largest deficit in the last two decades, according to a Feb. 1 Providence Journal article.
Despite the budget woes, Roberts told The Herald, "What's important to note is that these eight bills have no significant budget impact."
While Massachusetts issued a mandate that requires all adult residents of the state to have health insurance coverage or face legal penalties, Roberts' proposed plan does not. Roberts said the fundamental difference between her plan and the Massachusetts law is that while her office confronted issues of cost control from the beginning, "Massachusetts is just starting to look at those issues."
Roberts' plan would institute an individual mandate that requires state residents with annual incomes exceeding 400 percent above the federal poverty line - $40,840 for an individual, and $82,600 for a family of four - to purchase health insurance. The Office of the Health Insurance Commissioner estimates that more than 10 percent of the Rhode Island uninsured, about 15,000 Rhode Islanders, would be covered by this mandate.
The plan also requires businesses with more than 10 employees who do not provide insurance for their employees to pay $1,000 annually per full time employee to the state. The funds would then be used to support coverage for the uninsured.
Roberts said that her plan is important because "our hospitals can't afford to provide growing levels of free care."
Memorial Hospital of Rhode Island, in Pawtucket, lost $15,048,332 in uncompensated care - free care and allowances for debters - for fiscal year 2007, Louise Paiva, the hospital's director of public relations and marketing, wrote in an e-mail to The Herald.
The uninsured in Rhode Island have little choice but to go to the emergency room because they can't afford preventative care and chronic disease management, according to the Healthy Rhode Island Reform Act. "We also know that the cost of care finally provided in an emergency room is being passed along to everyone else through higher taxes and increased insurance premiums," a summary of the act reads.
The major problems with financing healthcare reform in Massachusetts is that "the price (of insurance) for individuals and the price that firms have to pay who are not offering health insurance is probably not high enough," said Vincent Mor, professor of medical science and chair of the Department of Community Health. "There are enough people who have not paid, both employers and employees."
Massachusetts requires employers who do not provide health insurance to pay $295 per full time employee.
He added that Massachusetts was unable to manage cost control. "How do you control costs is a very complicated issues and pretty hard for a state to do that all by itself," he said. Mor said that he was not in a position to comment on the Robert's reform act, though he will be meeting with her today.
Rhode Island's reform legislation will likely have the biggest impact on small businesses. Roberts said that she meets with small business owners in an effort to maintain a dialogue with people who agree and disagree with the proposal. "There is concern in the business community," she said.
The number of businesses in Rhode Island that will be affected by the legislation "was not a statistic we were able to obtain," said Linda Lulli, who serves on the board of directors at the Rhode Island Business Group on Health was involved in discussions on the plan. The Business Group on Health's 75 member companies all offer insurance to employees. Lulli said that despite differing views between the member companies, "overall the Business Group on Health supports the tenets behind the legislation - affordability and quality and value of healthcare."
The legislation also introduces an agency called the Rhode Island Health Insurance Access Hub, known informally as HealthHub RI. Modeled on the Massachusetts' Commonwealth Connector, it will allow individuals and small business owners to buy insurance online, by phone or in person. Roberts compared HealthHub RI to the online travel agency Travelocity, which provides consumers with options at a range of prices. HealthHub will allow Rhode Island residents to compare different insurance plans, she said.
Though HealthHub's goal is affordable coverage, what qualifies as "affordable" has yet to be determined, Roberts said. HealthHub will have a board that includes representatives for consumers, insurance companies and government officials who will establish what the minimum amount of coverage should be, Roberts said.
For the very poor and uninsured, who are not mandated under Robert's plan to purchase health insurance, future discussions will determine when to subsidize insurance, Roberts said. After the reform act is put in place, the state needs to look at who in Rhode Island is left without insurance and then decide "how much is an employer's responsibility and a taxpayer's responsibility," she added.
