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Apr172014

ProJo: 2 Bills Focus on Streamlining Health-Care Agencies in Rhode ISland

A big thank you to Felice J. Freyer for this coverage. We could not have been more pleased with the turnout for our bill's hearing.

BY FELICE J. FREYER

Original source

The General Assembly is facing two bills this year that would reorganize all the state agencies involved with health care, and potentially lead to a centralized system for obtaining all forms of health coverage.

Still in committee but facing little opposition so far, the bills signal a readiness to tackle what some call the next necessary step after the federal Affordable Care Act — a state-based effort to get a grip on the cost of health care.

“The ACA extended coverage. It’s done very little to address costs,” Betsy Stubblefield Loucks, director of the advocacy group HealthRIght, told the Senate Health and Human Services Committee on Tuesday. Loucks said that if costs continue rising at their current rate, by the time her 4-year-old twins are old enough to buy a family plan, it will cost more than the median income.

“This is something that’s going to affect generations to come,” she said. “It blows me away that we don’t have a 15-year plan for health-care spending.”

The bills — likely to be rewritten and combined — start out by addressing what Loucks called the “spaghetti map,” a puzzling multicolored chart that she held aloft. The chart depicts the vast tangle of state offices, agencies and commissions concerned with health care, from Medicaid to private health insurance to hospital safety.

Both bills would organize that twisted pile into one agency.

One bill, sponsored by the committee’s chairman, Sen. Joshua Miller, D-Cranston, would create an Office of Health Policy, described as “a comprehensive health policy and management system.” The office would develop a statewide health plan, coordinate data collection and analysis, regulate health insurance and run the state’s health insurance exchange, known as HealthSource RI.

The other bill, sponsored by Sen. Gayle L. Goldin, D-Providence, and promoted by HealthRIght, would create the Rhode Island Health Care Authority, an agency merging all state functions concerning health insurance and health-care delivery, currently split among at least six agencies. As with Miller’s bill, HealthSource RI would become part of this authority.

The Goldin bill then goes beyond the Miller bill by directing the authority to adopt a plan by the end of 2016 that could include some specific, far-reaching actions.

Chief among them is a proposal to have HealthSource RI serve as a central “hub” through which everyone buys coverage. HealthSource RI now serves only small businesses and people buying insurance on their own. Under this plan state and municipal employees, large employers and people on public assistance would all also obtain coverage through this one agency. HealthSource RI would theoretically have greater clout to negotiate on behalf of citizens for better, lower-cost insurance.

This “active purchaser” proposal is similar to a “single payer” system, such as that being tried in Vermont, but it differs in one important way: it does not involve the government paying providers directly.

The authority would also establish an annual spending target for all health-care expenditures in the state and move hospitals toward living within a preestablished annual budget.

The bill does not require these actions, but merely directs the authority to consider them and make a proposal by 2016.

“This establishes the authority to do the work to find the right solution,” Loucks said.

Miller noted that the health policy office created in his bill could also undertake the same actions. “My bill creates a structure where you could arrive at those goals,” he said.

Both bills have the support of Lt. Gov. Elizabeth H. Roberts, but Governor Chafee has not yet weighed in. Lobbyists for hospitals, doctors, unions and Blue Cross & Blue Shield of Rhode Island spoke in favor of the bills’ concept of streamlining state health-care agencies. No one spoke against either bill on Tuesday.

“This bill takes some major steps toward controlling costs,” Mark S. Deion, a small-business owner and member of HealthRIght, told the Senate committee, referring to the Goldin bill. “It’s bold. It’s visionary. But in Rhode Island, it’s extremely do-able.”

The committee voted to hold the bills for further study.

Twitter: @felicejfreyer

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