"WE SHOULD continue to work to reform the health care delivery system to provide more coordinated care with an emphasis on primary and preventive services," said Linda Katz, policy director at The Poverty Institute.
As policy director at The Poverty Institute, Linda Katz often plays an important, behind-the-scenes role in evaluating the impacts and outcomes of health care policy decisions on the most vulnerable Rhode Islanders. She is member of the newly created board of directors of the R.I. Health Benefits Exchange, where she sees her role as helping to ensure that “what’s best for the consumer” becomes front and center in the decision-making. Providence Business News asked Katz to share her views about the changing landscape of health care in Rhode Island in 2012.
PBN: With the upcoming budget proposals for FY2013, do you anticipate that the R.I. General Assembly will once again try to add fees to the RIte Care program? Last year’s attempts were found to be in violation of federal Medicaid rules.
KATZ: I don’t expect the General Assembly will propose to raise premiums. Under the Affordable Care Act, the state is not allowed to restrict RIte Care eligibility for children. The federal Medicaid agency ruled that the premium increase was an eligibility restriction. So the question of whether Rhode Island can increase premiums has been “asked and answered.” Holding the line on premiums is an important protection for our children’s access to health insurance and health care. RIte Care premiums are already among the highest in the country, and we know from past experience that increasing the premium results in families losing coverage.
PBN: You have been chosen to sit on the new board of directors appointed for the R.I. Health Benefits Exchange. How do you see your role as a consumer advocate helping to shape the exchange’s online marketplace for health insurance?
KATZ: There are a myriad of decisions to be made to ensure that the Rhode Island’s Health Benefits exchange truly helps consumers access quality, affordable health insurance.
These include: deciding on the standards that plans must meet to be sold on the exchange as well as the number of choices that will be offered; creating a website where consumers have the information they need to easily compare health plans so they can choose the one that best meets their needs; creating a Navigator program that helps consumers enroll in health plans; and the development of a grievance and appeals system.
The exchange will also be where Rhode Islanders can learn about and gain access to publicly subsidized coverage, including Medicaid/RIte Care and tax credits to help make commercial insurance more affordable.
I see my role as ensuring that “what’s best for the consumer” is front and center as these decisions are being made.
PBN: What kinds of quality and cost transparency would you like to see in health insurance plans and contracts between health insurers and hospitals?
KATZ: To make an informed choice about health insurance, consumers need to have access to standardized information about benefits, cost-sharing and any limits or exclusions in policies available to them. The information needs to be provided in a user-friendly, simple to understand format.
Under the Affordable Care Act, this information will be available to all consumers – whether they are buying their own insurance, accessing coverage through their employer or purchasing through the exchange. Consumers should also be able to easily compare the quality of health insurance plans through national metrics as well as ratings based on specific health services – such as managing diabetes or asthma.
PBN: Neighborhood Health Plan of Massachusetts recently signed a letter of intent to be purchased by Partners Healthcare, the largest hospital system in Massachusetts. Neighborhood Health Plan of Massachusetts serves mainly low-income customers on government subsidized health plans. Do you think that the General Assembly needs to create some legislative protection to protect Neighborhood Health Plan of Rhode Island from being acquired by a similarly large hospital system in Rhode Island?
KATZ: This a question better addressed to leaders at Neighborhood Health Plan of Rhode Island. Neighborhood Health Plan of Rhode Island has a long track record of ensuring that Rhode Islanders receive high quality health care and is particularly successful at meeting the complex needs of people with disabilities and lower income residents. This is a health plan that continuously tries to improve service delivery and control costs for its own customers as well as contributing to the broader discussion of health care reform in our state. That’s something I’d want to ensure is preserved.
PBN: In making a New Year's list for the coming year, what kinds of investments, programs and changes in the health care delivery system in Rhode Island would you like to see?
KATZ: We should continue to work to reform the health care delivery system to provide more coordinated care with an emphasis on primary and preventive services. Rhode Island needs to have a robust health planning process and should ensure that the recently revitalized Coordinated Health Planning and Advisory Council has the necessary staff and resources to carry out this important work. We should maintain affordable health care coverage for families through the RIte Care program.