• Stephanie de Abreu (on behalf of Tim Archer), UnitedHealthcare
• Dr. Peter Hollmann, Rhode Island Medical Society
• Mark Jacobs
• Cory King, Office of the Health Insurance Commissioner
• Nick Lefeber, Blue Cross Blue Shield Rhode Island
• Dr. Pat Flanagan, CTC-RI
• Heather Beauvais (on behalf of Peter Marino), Neighborhood Health Plan of Rhode Island
• Dr. Ed McGookin, Brown University Health Primary Care
• Sam Salganik, Rhode Island Parent Information Network
• Michael Sroczynski, Hospital Association of Rhode Island
• Scott Boyd, Amica Mutual Insurance Company
• David Cicilline, CEO, Rhode Island Foundation
• Michael DiBiase, Rhode Island Public Expenditure Council
• John Fernandez, CEO, Brown University Health
• Diana Franchitto, Hope Health
• Dr. Michael Wagner, CEO, Care New England
• Larry Warner, United Way of RI
• Larry Wilson, and
• Patrick Crowley, RI AFL-CIO
Perhaps one of the most telling items from the Committee’s April minutes, in ConvergenceRI’s opinion, was this: “Ed McGookin asked for public comments. No member of the public offered comment.” Among the members of the public present were consultant Michael Bailit, Dr. Beth Lange, and John Minichiello, according to the minutes. No news media were apparently in attendance.
What could make this upcoming meeting of The Steering Committee on May 18 different is the opportunity for a wide-ranging discussion during the gathering of what a public option plan being proposed by Attorney General Peter Neronha would mean for Rhode Islanders. Will it happen? Probably not — unless there is a breaking national story about the efforts by Rhode Island to launch its own public option health plan, steering clear of federal entanglements.
Here is PART Three of the ConvergenceRI reporting on plans now underway to launch a public option health plan, under the leadership of Attorney General Peter Neronha and his legal team. It features an interview conducted by ConvergenceRI and Hannah Levintova, an editor with Mother Jones, with Deputy Attorney General Adi Goldstein and the AG’s Health Director Lee Staley.
In PARTS One and Two, the focus of the reporting was on sketching out the parameters of what a public option health plan would potentially mean for Rhode Islanders and the timetable needed to establish such an innovative approach to health insurance.
In PART Three, Goldstein and Staley attempt to explain how and why the proposed public option health plan is cutting edge, compared to other states’ plans.
GOLDSTEIN: Another way that this could impact is one of the problems that we’re trying to solve for is this cliff that is looming out there, with a lot of folks who may be losing their health care insurance coverage — as a result of changes under the (alleged) Big Beautiful Bill, and the Affordable Care Act subsidy expiration.
There are a significant number of people who stand to lose their health insurance and health care benefits. Presumably, at least some of those people are going to be experiencing health care emergencies in the future, just as they have in the past.
And they are going to end up at the (Emergency Departments of) hospitals. And somebody is going to have to foot that bill. And there is going to be (an increase in) uncompensated care.
And, to the extent that we can systematically, in an organized fashion, ensure that this very large percentage — not an insignificant percentage of the population — can be covered, that is going to provide a lot of financial stability for these hospitals.
STALEY: That’s a huge piece, and thank you for mentioning it. Depending on the estimates you see out there, there are a couple bodies that have been estimating the coverage (that) will be lost. The estimate that we’ve been using is roughly 52,000 Rhode Islanders will lose health indurance coverage sometime over the next three years.
And, Rhode Island has benefited historically from very high insurance coverage, although there is significant uncompensated care.
GOLDSTEIN: If you have high out of pocket costs, people are going to, if they have high deductibles, they are going to perhaps be less willing to go to see doctors, specialists, whatever, outside of the hospital context.
And good preventative medicine is a major component to reducing overall hospital costs.
LEVINTOVA: You brought up the dramatic loss of insurance in Rhode Island and some of the other places, when Medicaid is cut.
I think Adi mentioned in the beginning (of the interview) that your proposal is cutting edge, even compared to some states that have been doing something similar.
A two-part question: What about it is cutting edge?
And, two, are you seeing other markets, other states, that maybe you are in contact with, or maybe you’re modeling after, that are also trying to do something public option-y to pre-empt this problem that is kind of rolling down hill towards everyone?
STALEY: I would say, on the cutting edge front, the big kind of top-line message is: We want a public health option that is truly public, one that has as little involvement from private insurance companies as possible.
What our proposal looks to do is to really have the state issuing insurance plans. And making all of the core coverage decisions and payment decisions.
Obviously, because this is a huge infrastructure to set up, there are opportunities to get expert advice on that over the course of the implementation.
And there are models, where the state could still rely on an entity to help process claims and do some of the backend work.
GOLDSTEIN: Why should there be a different plan for individuals? Or, why should there be a different plan for state employees from other individuals? Why shouldn’t employers be able to opt into this (public option) plan?
There could be a plan that is a single plan that is the same plan for state employees, right?
The state effectively does this now, right? All of its employees have health insurance, through a contract with Blue Cross Blue Shield to provide them with health insurance.
To expand that, it could be expanded to all other individuals who choose to purchase and participate in that plan. Employers could also be incentivized to buy into this plan, through subsidies, through competitive rates, competitive coverage, where they can conclude: “Hey, it’s going to cheaper for me to allow my employees to just sign onto this plan than to provide them with my own.”
The more you expand that risk pool, right, the better off you are going to be. I’m not the health care expert, but that has been the downfall for some of these Affordable Care Act plans, where the risk pool has been the downfall.
STALEY: The goal is to grow the risk pool in this public option plan for Rhode Island as wide as possible.
And, there is a lot of research around the benefits of that— being able to pull in people who are currently covered in employer-sponsored coverage.
Historically, the risk pool for employer-sponsored coverage has been broadly healthier than the Medicaid risk pool and, in many cases, the ACA plans’ risk pools as well.
Diversifying that would also have benefits from a financing perspective, because you are able to insure a more stable pool of people over time. So, growing that is really important.
And then, Hannah, to answer your second question around what are other states doing, there have been a number of proposals, including some in Rhode Island, to backstop in some limited fashion, the loss of subsidies at the federal level.
So, when HR 1 went into effect, there was this expiration of the enhanced advanced premium tax credits. Some states have decided to inject state funds to cover some portion of the population that will be losing subsidies there.
The really key differentiator in this proposal (for a public option) is that we would not only aim to provide a backstop for that population but also the population losing coverage due to the Medicaid cuts that are coming down the road, which is actually a much more significant financial injection.
