Boost seen for R.I. reform

The U.S. Supreme Court’s historic, 5-4 decision last week upholding the national health care reform law will bolster reform efforts already under way in the state, according to Rhode Island officials.
“I have fully committed to ensuring Rhode Island is a national leader in implementing health reform … and this [ruling] just reinforces that commitment,” said Gov. Lincoln D. Chafee, in a statement released shortly after the June 28 decision. “This ruling,” he continued, “also will help to bend the health coverage cost curve for Rhode Island small businesses and their employees. It will ensure the continuation of provisions already in effect – including the small-business tax credit on employee premiums paid that can save small businesses up to 35 percent per year. We are energized by this decision and will work with Rhode Island’s business community to continue to implement health reform in our state.”
In Rhode Island, the creation of the R.I. Health Benefits Exchange, one of the signature efforts undertaken as part of health care reform, remains on track to begin operation in late 2013 as an online marketplace for health insurance for individuals and small businesses, as well as a clearinghouse of information on health-insurance products, according to R.I. Health Insurance Commissioner Christopher F. Koller.
The exchange was created by executive order by Chafee in September 2011. Its new director, Christine C. Ferguson, who was appointed by Chafee on June 21, hailed the court’s ruling: “This decision reaffirms our efforts in moving forward with a health-benefits exchange,” she said in a statement. “We will continue our work, with already-approved federal funding, 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. Rhode Island families and small businesses soon will have a place where they can easily buy and compare health insurance options. Some residents will even qualify for free or low-cost insurance depending on their income,” Ferguson said.
Ferguson, who helped to write the health care bill introduced by then-Sen. John Chafee in 1993, said that one of the key provisions was “to create an environment for small businesses and individuals who didn’t have power in the marketplace [offering] more of an ability to influence the price and quality and value of health insurance. That’s where we all want to be able to be,” she said. “It will be a challenging road.” In his majority opinion, Supreme Court Chief Justice John G. Roberts ruled that the “individual mandate must be construed as imposing a tax on those who do not have health insurance,” finding that it was and thus, constitutional. The court also ruled that the expansion of Medicaid coverage was constitutional, but the condition that participation by the states was an all-or-nothing proposition, so that if they chose not to participate, they may lose Medicaid funds, was not constitutional. As a result, states may be able to opt out of Medicaid expansion.
For some businesses involved in health care reform in Rhode Island, the greater issue was not the mandate, but predictably of health-insurance premiums. Don Nokes, president and co-founder of NetCenergy in Warwick and president of the Rhode Island Business Group on Health, told Providence Business News he was a little surprised by the ruling. “I thought it might go another way,” he said.
His business group, he continued, would continue to work to drive down costs, to make insurance premiums more predictable and affordable. “Businesses like things to be predictable, so you can go along and make your plans,” he said. Despite the Supreme Court ruling and the intense debate over the individual mandate, Nokes continued, “it doesn’t put the issue to rest, so that you can move on. There is the presidential election, and the U.S. House will attempt to defund some of the law’s provisions. Either way, this court decision doesn’t give us much certainty.”
In Rhode Island, Nokes continued, his group will be watching the decision by Koller on the proposed 2013 rate increases requested by commercial health insurers. “I think we really need to start demanding more transparency in reimbursement rates,” he said.
Health care reform was poised to move ahead in Rhode Island, regardless of what the Supreme Court decided, according to Dr. Timothy J. Babineau, the newly named president and CEO of Lifespan and president and CEO of Rhode Island Hospital and The Miriam Hospital. “Personally, I think the train has left the station [on health care reform],” Babineau told PBN in advance of the ruling. Although the Supreme Court decision will have an impact on the individual mandate, he continued, “I think that the wheels have been set in motion that are going to [move forward with] health care reform in this country.” One way or another, he continued, “employers are going to demand it, and patients are going to demand it, for the right reasons.” From the perspective of Lifespan, the state’s largest private employer, with more than 14,000 employees, Babineau said, “We’ve already started down a path that we’re committed to, irrespective of what the Supreme Court has to say about it.”
In terms of the individual mandate, Babineau said, “if folks are required to have health insurance, that could potentially have an impact on how much charity care we give. Other than that, we know we need to improve quality, we know we need to be more patient-centered, we know we need to lower costs, and we’re going to do that irrespective of the decision.”
Edward Quinlan, president of the Hospital Association of Rhode Island, predicted that as a result of the new health care reform law, about 19,000 Rhode Islanders would enroll in a basic health plan, out of an estimated 30,000 income-eligible residents.
“You have the societal and public-policy gains, which [are] to increase the level of insured across the country. That is not debatable; it’s the first opportunity in history to accomplish that goal,” he told PBN.
In a statement released after the ruling, Quinlan said: “More than 120,000 Rhode Islanders currently lack health insurance. Each day, nearly 150 patients seek care in our hospitals without the ability to pay. The cost of uncompensated care exceeded $160 million last year and has become a monumental fiscal burden for our struggling hospitals. The Affordable Care Act will help to alleviate these challenges and ensure that every Rhode Islander has access to quality health care.”
Quinlan also praised the work done by the state in its comprehensive approach to develop the health-benefits exchange. “Under the strong leadership of the governor and the lieutenant governor, it is a model for the nation on how to construct a platform for the exchange,” he said. In a statement issued after the ruling, Blue Cross & Blue Shield of Rhode Island, the state’s largest commercial health insurer, said: “Blue Cross has a longstanding belief that all Rhode Islanders should have access to high-quality, affordable health care coverage. [The] Supreme Court decision does not change our commitment to help moderate the long-term cost of health care and health-insurance premiums by transforming the delivery system in Rhode Island. We believe that Rhode Island has made great strides moving forward on health care reform, but there is still a lot of progress to be made.”
Members of the state’s congressional delegation also weighed in on the court decision.
Sen. Jack Reed said: “Today’s decision is good news for all Americans. In upholding the law, the Supreme Court acted not only in accordance with the Constitution, but in the best interests of the nation and our economic future.”
Rep. James R. Langevin said the decision “affirms the efforts of so many who have fought hard to ensure all Americans have access to a doctor when they’re sick, control rising health costs and adapt our system of care to focus on early detection and prevention.”
Sen. Sheldon Whitehouse said: “By upholding the law, the court validated the principle that all Americans should have access to health care.”
The partisan political debate over the health care reform law will certainly continue, both nationally and here in Rhode Island. The conservative think tank, the Rhode Island Center for Freedom and Prosperity, had promised in advance of the ruling that it would recommend that the R.I. Health Benefits Exchange be replaced with a Healthcare Freedom Act, legislation that is part of the playbook of the American Legislative Exchange Council, supported by the brothers Charles and David Koch, to fight against the health care reform law.
Nationally, Republican presidential candidate Mitt Romney has promised that if the law was upheld, “we’re going to have a president – and I’m that one – that’s going to get rid of Obamacare. We’re going to stop it on Day One.” •

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