Rhode Island's next governor - whether it's Republican Allan Fung or Democrat Gina Raimondo - will have plenty of challenges to tackle upon taking office. The state's ailing economy will most likely hold the spotlight over the next eight weeks until the general election. But perhaps I could put a few health care items on the agenda for their consideration - and for the general assembly's.
- HealthSource RI: The state's online health insurance exchange will squeak by this year with some remaining federal funding (open enrollment is coming up November 15). But the exchange's survival depends on a reliable source of funding. If Rhode Island can't figure out how to pay the $20 million dollars it could take to keep it going, the state could have to scrap its exchange and default to healthcare.gov. Gov. Lincoln Chafee signed HealthSource RI into existence - a choice states were given under the Affordable Care Act - and the next governor could help keep it alive or kill it. What's at stake? HealthSource RI proponents would say that having a state-based exchange enables us to negotiate better rates with carriers in our state and be more responsive to local needs. Opponents say the exchange hasn't demonstrated enough value to stick around.
- Health care reform: That's a big topic, but what I mean by it is all of the many efforts to bring down health care costs and improve the quality of and access to care that are going on in Rhode Island. And there are lots of those kinds of efforts underway now. Affordable Care Act dollars have flowed into Rhode Island to fund projects that help doctors and health insurers retire the old "fee for service" model of health care in favor of the newer "pay for quality" model. We have a state program called the Chronic Care Sustainability Initiative that helps physicians provide more comprehensive primary care - at lower cost - to people with chronic illnesses. And those are just a couple of examples. The next administration could decide to champion those efforts and move them forward or not. In my humble opinion, it would be a shame to give up on some of these efforts before they've had a chance to prove themselves. None of these efforts are quick fixes, and their value - or lack of value - will take more than a four-year term to emerge.
- Medicaid: Rhode Island chose to expand eligibility for Medicaid under Obamacare. And thousands of people who were previously ineligible for this state-paid health insurance signed up for it. But so did thousands who were already eligible but had simply not yet enrolled. They call it the "woodwork" effect, because it's as if those folks came "out of the woodwork." The federal government is paying for most of the first group, but Rhode Island is on the hook for 50% of the second group's coverage (plus everyone who was already enrolled), and that was an unexpected hit to the state budget. The next administration will have to work with the general assembly to figure out how to continue to foot this bill, or it could decide to find ways to trim those Medicaid rolls.
These are just a few of the next administration's health care challenges and opportunities. But I bet there won't be much discussion of them until a while after the next governor takes office.
What issues do you hope the next administration and general assembly take up when it comes to health care? I'd love to hear your thoughts in the comments section, below.