Pam Gencarella: Another Bubble to Burst in RI?
Thursday, April 17, 2014
Putting forth an edict can make it so in RI. The hard part is paying for it. When Governor Chafee, through an executive order, provided for the Health Insurance Exchange, he saw green. The original request of $65 million in green from the Federal government to create RI’s exchange and (presumably) another $23 million to run it the first year, for a total of more than $80 million.
What did we get for the $65 million we spent in federal funds to create the exchange? Increased competition as was touted by the proponents of Obamacare? Hardly, Blue Cross and Blue Shield covers 98% of RI’s insureds. Reduced insurance premiums? No evidence of that here. More people taken off the uninsured rolls? Absolutely.
The 65,000 of Medicaid new enrollees was beyond what the Governor’s office projected. But at what cost? Two-thirds were added to the rolls as a result of the decision to further expand Medicaid in the state. Although RI will begin paying for a portion of this cost beginning in 2018 (that’s only a few budgets away), we will pick up the full 10% by 2021. Then there is the other one-third of those who signed up for Medicaid who fall into a category (qualified for Medicaid prior to Obamacare) that leaves RI to pick up about 50% of the cost.
According to the Providence Journal (April 4, 2014), RI’s Secretary of HHS, Steven Costantino, said he was pleased the expansion went so well because it will add $500 million into the RI health care economy, but he could not predict the impact on the state Medicaid budget.
And therein lies the problem.
Not knowing the impact on the budget. Former Finance Chairman Mello was quoted as saying “We are just trying to figure out how this is going to work. We don’t know if we’re building a colonial, a mansion or a bungalow. It always seems like we’ll continue with construction (and) we’ll worry about how much it’s going to cost us later ”.
That is precisely why it is the role of the Legislature to provide an open debate and create laws, and it is the role of the Executive Office to carry out those laws. The presumption is that the debate centers around estimating the cost and determining how to pay for it. While it is a noble goal to provide health insurance to all RI citizens, how can our leaders implement this type of sweeping policy change not knowing the impact it will have on the RI budget and therefore on the RI taxpayer? What percent of that $500 million will be coming from the taxpayer?
The RI Center for Freedom and Prosperity published a report on its website about the cost of the Exchange. It shows a timeline of estimates that have left the state not knowing how much the Exchange and the Medicaid expansion will cost the taxpayer. In 2011, original projections estimated 127,000 private plan enrollees through the exchange. In 2013, those projections dropped nearly in half with estimates of 64,000 enrollees and then, ultimately, dropped again by more than half to actual results of only 28,000 enrollees in private plans. Instead of a system created to handle 127,000 private enrollees, it is currently handling less than one-quarter of that. That means the cost per transaction just shot through the roof.
Back in January, business groups in RI provided the Governor and the General Assembly with a position paper that clearly indicated their sentiment about who pays for the $23 million operating cost of the Exchange - not them. The RI Business Group on Health, RIMA (RI Manufacturers Association), the NFIB (National Federation of Independent Businesses) and the Providence Chamber of Commerce all agree that this cost should not be born by businesses that do not use the Exchange, nor should it be born by insurance carriers or health purchasers in general, nor should there be a general assessment fee on all claims paid in the state. However, here’s the rub. If, as reported in the Pro Jo, a total of 92,000 people signed up for health coverage through the Exchange and 70% of the those users are Medicaid recipients, that leaves only 30% of the users to pay for the annual operating cost of the Exchange. Hmmm, if you do the math, at todays level of private enrollees, that’s over $800 a year for those individuals, some of whom already qualify for subsidies. Not a pretty picture. That’s the problem with edicts in a representative government. You can’t just dictate how the bill gets paid.
So, has the Exchange, with an initial set up cost of over $65 million and an annual maintenance cost of $23 million, really turned into a very expensive advertising campaign to increase the number on medical welfare with no plan for funding these handouts and no plan for funding the operating infrastructure that helps hand them out. Where does that leave the RI taxpayer? The cost of both the Medicaid expansion and the operation of the Exchange are just two more bubbles that will need to be addressed at some point in the near future.
Remember the Trojan’s line (paraphrasing), ‘beware of those bearing gifts’.
Next edict on the agenda - turn the Exchange into a one-stop shopping portal for all welfare benefits. In a press release, the Administration announced, “We will continue our work....to create a place where Rhode Islanders not only can compare and buy health insurance,but also check to see if they qualify for Medicaid - and eventually, food stamps and other government programs.”
Who will take control?
The State Senate has asked the Governor to explore the possibility of relinquishing the operation of the Exchange to the Federal government. Even if that comes to fruition, the full cost of maintenance may very well not be covered and it won’t address the issue of expanded Medicaid. At some point, the General Assembly will need to approve a budget that includes the costs of the Exchange, which, as part of the process, should include a robust debate about the allocation of RI’s scare resources and how to deflate the bubble dubbed ‘The RI Dependency Portal’.
Pam Gencarella is a member of OSTPA, a taxpayer advocacy organization in Rhode Island.
13 Doctors Behaving Badly
Rhode Island Doctors Behaving Badly
Doctors, having professed in their professional lives to "do no harm," are typically looked at in their personal lives as upstanding citizens. But 2013 proved that not all doctors are cut from the same cloth.
With charges ranging from unprofessional behavior in the office to giving morphine to babies to breaking into a residence without permission at 3 in the morning and being in possession of marijuana, this breakdown of reprimanded doctors in 2013 is simply a must see.
12 Staying Healthy + Fit
10 Ways To Stay Healthy + Fit This Summer—Miriam Experts
Summer brings soaring temperatures, family cookouts and tempting warm-weather treats like ice cream and margaritas, and can easily sabotage your fitness and diet plans. That’s why leading nutrition and exercise experts at The Miriam Hospital shared their timeless top tips for staying fit and eating healthy while still having fun in the sun.
Summer fitness never goes out of style. Click here for tips you can use every year to maintain that beach body!
11 Well-Being Index
How Happy Is Rhode Island—Latest Gallup Well-Being Index
Rhode Island may need an attitude adjustment, according to the latest Well-Being Index numbers from Gallup-Healthways. The state's latest ranking for happiness is #37 in the nation, a drop of 2 spots from last year. And that ranking was a drop from the year before.
10 Retail Insurance
Smart Benefits: Health Insurers Go Retail
Healthcare reform has brought about lots of changes to the procurement of individual and family plans. Now, when you head to the mall, you'll be able to buy health insurance in addition to shopping for clothes. In a move that continues to gain steady momentum, leading health insurers across the country are opening retail stores to cater to individuals who now have to purchase health insurance on their own because of healthcare reform.
9 A Healthier You in 2013
13 Ways To Be Healthier in RI in 2013
As we embarked on 2013, Rhode Island's Director of Health, Michael Fine, MD, encouraged Rhode Islanders to make health and wellness a priority in the new year. Check out the 13 steps he recommended Rhode Islanders take to get and stay well in the new year. Whether you stuck to them or not in 2013, we find ourselves at another time for goal-setting and resolutions. Brush up on your healthy living and put your knowledge to good use in 2014!
8 RI’s Sexual Health
Rhode Island’s Sexual Health Worst In New England—New Ranking
Rhode Island's abysmal showing in the 2013 Sexual Health Rankings landed them at last place in New England.
The first-ever assessment of state-by-state data on 26 comprehensive health and services measures that speak to sexual health put the Ocean State at #19 overall in the US, and #6 among New England states.
7 Deloitte's Big Contract
Deloitte Awarded $105 Million Contract to Create New Healthcare System
Last January, Governor Lincoln Chafee announced that the State had awarded a $105 million contract to Deloitte Consulting to create the technology infrastructure to modernize the way the state administers Medicaid and other human service programs, and, most importantly, to create Rhode Island’s Health Benefits Exchange in compliance with the Affordable Care Act. Do you think Deloitte was the right choice? Read on for a breakdown of why Deloitte was chosen and the outlook on the exchange - who's rollout was not without its hiccups - while it was in just the conception phase.
6 Non-Profit Hospital CEO
Rhode Island Non-Profit Hospital CEOs Criticized For Big Paychecks
The American healthcare system may be quite deathly ill. But the paychecks CEOs of Rhode Island non-profit hospitals are quite healthy.
Because of the trend of for-profit chains buying non-profit hospitals, which has swept the nation over the last decade or so, only eight non-profit hospital groups remain in the Ocean State. Together, they control a total of 11 hospitals.
And you won't believe how handsomely the CEOs of these hospitals are paid.
5 Healthiest Counties
Rankings: Where the Healthiest Rhode Islanders Live
Where do the healthiest residents in Rhode Island live? According to 2013 rankings by the Robert Wood Johnson Foundation, a national foundation focused on improving public health, Bristol County took top honors -- while Providence County was the bottom of the list of the five counties in the state.
4 Health Exchange Rebrand
Rhode Island’s First Health Benefits Exchange Launches
In July, The Rhode Island Health Benefits Exchange announced a number of important updates and initiatives – including a new name and the creation of 70-100 new jobs – in preparation to enroll Rhode Islanders in quality affordable health insurance plans starting on October 1, 2013.
Dubbing the Health Exchange HealthSource RI and announcing the state's new contact center in Providence, the exchange announced it would employ 70-100 Rhode Islanders when fully operational who would be accessible to individuals and small employers to talk in-person or over the phone with engagement specialists who would provide personalized assistance in finding, comparing, and purchasing health insurance options available through HealthSource RI.
3 Heart Health
RI’s Go Red Day 2013: 10 Ways Women Can Keep Their Hearts Healthy
According to the AHA, nearly half of American women do not know that heart disease is their No. 1 killer, and less than half know the best blood pressure and cholesterol levels for cardiovascular health. Making red visible on Mondays could help sound the alarm and keep heart health ever present in the lives of American women.
2 Health Exchange Launch
Healthsource RI Announces Health Benefits Exchange Rates
In late August, HealthSource RI announced the plans and rates that were to be offered through the state's health benefits exchange when open enrollment began on October 1 for individuals and small businesses. Blue Cross & Blue Shield of Rhode Island, United HealthCare, and Neighborhood Health Plan of Rhode Island all signed on to offer 28 plans through the exchange.
The exchange launched on October 1st with no shortage of hiccups, but the launch was relatively smooth by comparison to those in states whose exchanges were facilitated federally. By November, the exchange had processed over 4500 applicants. And by December the New York Times noted that the RI exchange was the second-best performing in the country with enrollment exceeding target rates by a sizeable margin.
1 Patients Rank Hospitals
New England’s Best Hospitals Rated By Patients
Traditionally, hospitals are rated and ranked on a combination of sound technical care, adequate resources, and impressive statistics. But an increasing emphasis is being placed on perhaps one of the more important measures: the patient’s perspective. With that in mind, GoLocal has sifted through and analyzed the results from a government-sponsored survey of more than 50,000 patients in 176 hospitals in New England (full chart here), and emerged with the first-ever patient-based ranking of the region’s top hospitals.
GoLocal consulted with patients, experts, and hospital administrators for their take to contextualize the rankings- click here to read the story.