We Should Support Rhody's Modern Health Insurance Experiment

Sep 30, 2013

Rhode Island’s experiment in crafting a 21st Century health care marketplace begins tomorrow.  Rhode Island Public Radio's political analyst Scott MacKay on why we should be rooting for success.

HealthSource RI, the ocean state's healthcare exchange is set to open this October.

From the Williamette Valley to the Pawtuxet Valley, the debate over the Affordable Care Act, also known as Obamacare, rages among politicians and the media. Some congressional Tea Party conservatives are even threatening to shut down the federal government if Obamacare goes forward.

Rhode Islanders get their first glimpse at the future tomorrow, when our state’s new health care exchange, HealthSourceRI, goes into business. A smart strategy for out small state would be for everyone in this contentious joust to take a deep breath and watch what happens.

The online health insurance marketplace that kicks off tomorrow is designed in the short run to expand health care to those who are currently uninsured. Rhode Island’s version of Obamacare has been in the works for several years and is largely the offspring of Lt. Governor Elizabeth Roberts and its director and health care guru Christine Ferguson.

Ferguson’s vision is a marketplace focused on the needs of Rhode Island’s beleaguered small business community, which has endured a stubborn recession. Among the biggest complaints of leaders of these companies – which employ fewer than 50 workers - is the cost and availability of health insurance.

The research shows that the overwhelming majority of workers of large companies have access to employer-based health insurance. That isn’t the case for small businesses. Just half  of Rhode Island’s small businesses offer affordable health to their workers.

HealthSourceRI aims to change this by setting up a transparent online market that employees, employers and their insurance brokers can use to easily compare competing plans. At this point, the exchange is financed by the federal dollars, so there is no state money involved. This may change down the road, but for now we must be candid about the zero cost to Rhode Island taxpayers.

The debates that have swirled around Obamacare have sprouted more myths than those about George Washington’s youth. It’s socialism, the critics assert. It, of course, isn’t. The marketplaces are run by states, offering private insurance coverage, and have more free market elements than either Medicaid or Medicare, both of which resemble a socialistic, single-payer system more than Obamacare.

Tea Party Republicans have railed against this system and most Democrats have voiced support. What has been lost in the politics and cable television shout fests, are the drawbacks of the current system. Too many Obamacare critics have failed to provide a reasonable alternative to the mess that is our current system, which leaves 11 percent of Rhode Islanders without health coverage.

When these people get sick, which they inevitably will, they get treated at the hospital. Then these costs get shifted to the taxpayer or to those who pay for insurance or get it through their employers.

The media is filled with doomsday stories about businesses hiring fewer full-time workers or dropping employee health coverage to avoid this new health care regime. Yet the experience in Massachusetts, which has had a state-based version of Obamacare since Republican Mitt Romney was governor, tells us that businesses do not stop covering their employees. Facts are stubborn things: what they show is that in the Bay State, employers have increased health care coverage for their workers.

Small business and the working poor will get federal subsidies to help cover the costs of their insurance. Over the long haul, this could be a huge aid to stabilizing the cost of health care. If everyone is insured, it becomes easier for the doctors, clinics and hospitals to figure out how to set up preventative care networks that will keep people with such chronic diseases as diabetes and asthma out of hospital emergency rooms.

The best thing about all this is that if it works, it should lead to a healthier Rhode Island workforce and employees who take fewer sick days. Is anybody really against that?

Let’s turn down the volume on the debate and ramp up the publicity for getting insurance through our new marketplace. And let’s put on hold the ancient Rhode Island attitude of grasping on to nothing so tightly as the status quo. The health of our citizens and the viability of the small business community that is so vital to our economy would be helped much by HealthSourceRI’s success.

Scott MacKay’s commentary can be heard every Monday on Morning Edition at 6:35 and 8:35 and on All Things Considered at 5:50. You can also follow his political reporting and analysis at the `On Politics’ Blog at RIPR.org

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