Medicaid – RI Future

September 13, 2016

More Rhode Islanders have health insurance coverage thanks to health care reform

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New Census data show that the percentage of uninsured Rhode Islanders was 5.7 percent in 2015, half the rate it was in 2013, the year before the Affordable Care Act (ACA) went into effect. In 2014, 7.4 percent were uninsured.

Two new avenues for affordable health insurance made available through the ACA have helped significant numbers of Rhode Islanders gain coverage. First, new Medicaid eligibility for adults (Medicaid expansion) allowed around 60,000 single adults with income marginally above the poverty line to have health insurance coverage.

Second, the new state exchange, HealthSourceRI, provided a pathway to coverage for another 35,000 Rhode Islanders who purchase private insurance. Almost 90 percent of enrollees, those with income below four times the poverty level, quality for federal tax credits to help pay their monthly premium. The majority of enrollees (60 percent) have income below two and half times the poverty level ($29,000) and also receive assistance paying for out of pocket costs including co-pays and deductibles. (Source: HealthSourceRI, Open Enrollment 2016)

According to the Rhode Island Annual Medicaid Expenditure Report for SFY 2015, the federal/state Medicaid program provides health insurance to one in four Rhode Islanders. In addition to the 60,000 newly eligible single adults, 150,000 children and families with lower income and 12,000 children with special health care needs have comprehensive insurance through Medicaid. Seniors (19,000) and people with disabilities (32,000) rely on Medicaid for the services they need to live safely in the community or in a facility when home-based care is not feasible.

“Rhode Islanders should be proud that we are 7th in the nation for the percent of residents who have health insurance coverage”, said Linda Katz, Policy Director at the Economic Progress Institute. “With health insurance, people are more likely to keep up with yearly preventive care visits and people with chronic conditions can get the treatment they need to promote their well-being. Besides the obvious benefits for families and individuals, having a healthy work force is a good selling point for our state. Medicaid and coverage through HealthSourceRI are vital to ensuring that thousands of our residents can afford comprehensive health insurance.”

August 29, 2016August 30, 2016

Providence DHS also experiencing problems

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The letter Heather received a week before her appointment with the Department of Human Services (DHS) warned that not showing up for her scheduled appointment could seriously delay approval of her benefits. Having been recently laid off and in search of work, Heather made sure that she was not only a half hour early, but that her paperwork was in order.

Arriving at the DHS offices in Providence on Elmwood Avenue, she got into the line for those with appointments. The other line, for those without appointments, was longer and moved more slowly. Both lines stretched out of the waiting room.

Conditions in the waiting room, Heather told me, were “miserable.”

“People were standing in lines for hours,” said Heather. “A lot of people were turned away. A lot of them were single mothers. It was hot, and there was not a lot of room to sit. Children were running around, crying and screaming.” She said employees appeared to be overwhelmed and frustrated.

Optimally, DHS provides people in need with access to many services such as Medicaid, SNAP benefits, Rhode Island Works (RIW), Child Care Assistance Program (CCAP), LTSS, General Public Assistance (GPA) and access to various energy assistance programs like HEAP, WAP and HSR.

The delays, Heather was told, were because of the new computer system the DHS was using to approve benefits. The new system was supposed to make things more efficient. Instead, workers at the office were facing too many cases and a new system being rolled out without adequate training.

At a press conference on Thursday, DHS director Melba Depeña Affigne said that changes in staffing and the conversion to the new computer system would have “no impact on clients.” Michael DiBiase, director of the RI Department of Administration called the issues that Heather and others have described as “unfortunate.”

After four hours, Heather got her EBT card and was able to leave the DHS offices by 4:45pm. The waiting room was no less full, most of those waiting would have to return the next day to continue the process.

The new computer system, which has no official name, was supposed to be online in July, and is now slated to be fully operational by mid September. The system is supposed to reduce the amount of time prospective clients spend with social workers and has been billed as an “incredible tool for our workforce” that will “enhance customer service.”

Heather disagrees. The system, she says, is “designed to make you feel like shit about yourself.”

August 29, 2016August 29, 2016

New computer system at DHS hurts clients and social workers

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Melba Depeña Affigne, director of the RI Department of Human Services (DHS), was “surprised to hear [that clients] did not get service” at the Woonsocket DHS offices. The clients in question were referred from the Woonsocket offices to the DHS offices in Pawtucket, a four hour round trip by bus.

Michael DiBiase, director of the RI Department of Administration said, regarding the problems at the Woonsocket branch of the DHS that the “break in service was unfortunate” and will last “hopefully less than a month.”

DiBiase and Affigne were holding a press conference to explain the layoff of 70 DHS employees, mostly social workers, as part a major reorganization of the DHS and the launching of a new computerized eligibility system that is projected to save taxpayers millions.

The laid off social workers, said DiBiase, will have a chance to apply for one of the more than fifty job openings at DCYF (Department of Children, Youth and Families). The layoffs are required, said Affigne, because of a “new staffing model” that will allow DHS to make significant cuts. The new model is “task based” and will not require supervisors trained in social work to manage by “case load.”

I asked Sue Pearlmutter, dean of the Rhode Island College School of Social Work if this means that the DHS is moving away from social workers advocating on behalf of clients and towards data entry technicians assisting clients using the computers.

“That has been my impression,” said Pearlmutter. The DHS is moving towards “a very different kind of process. Social workers engage with the client and work with the client.” The application process DHS is instituting makes “people take responsibility for their application at a kiosk or in a library.”

Often, these are “people in crisis” at a time when “completing an application is a daunting process.” Some adults and young adults, says Pearlmutter, “may find the process overwhelming. Removing a level of staff may cause more problems for people facing crisis.”

As for the staff DHS is cutting, saying that there are openings at DCYF is disingenuous. Many of the staff losing their positions at DHS started at DCYF, said Pearlmutter. They took jobs at DHS “because the work at DCYF is so crisis oriented. It’s difficult and emotional work that many found they couldn’t do any more.”

Talking about the jobs at DCYF as being like the work at DHS “shows no understanding of the kind of work social work is,” says Pearlmutter.

The new computer system, which has no official name, it’s just the “New Integrated Eligibility System,” said Affigne, was supposed to be online in July, and is now slated to be operational in mid September. The system will reduce the amount of time prospective clients will spend with social workers. This is “by far the largest technology project that has ever been undertaken by the State of Rhode Island,” said DiBiase.

The new computer system, said Affigne, is an “incredible tool for our workforce” that will “enhance customer service.”

Lucie Burdick, president of Local 580 of the Service Employees International Union (SEIU), disagrees. She told RI Future that “this extremely expensive computer system, if it even works correctly someday, will never provide the quality of service a trained, educated, experienced human being provides. The computer pilot program is failing miserably at this point and costs are rising rapidly. It could have been done better and cheaper. The displacement of staff and the cost of human suffering that it has exacted on the population we serve is unconscionable.

“This fiasco is the 38 Studios of human services. The taxpayers and advocates for the poor should be outraged.”

DHS provides people in need with access to many services such as Medicaid, SNAP benefits, Rhode Island Works (RIW), Child Care Assistance Program (CCAP), LTSS, General Public Assistance (GPA) and access to various energy assistance programs like HEAP, WAP and HSR. Affigne said that about one in five Rhode Islanders use services offered at the DHS, and that they maintain six field offices, like the one in Woonsocket.

“What will be the impact on clients?” I asked.

Affigne replied, “There will be no impact on clients.”

Yet existing clients did not start receiving notifications of reduced services in Woonsocket until August 23, and the Woonsocket DHS began reduced services on the 19th. That’s two or thee days of people arriving at the Woonsocket offices and learning that they were in for a four hour bus ride to Pawtucket from a sign taped to the door.

As Bob Plain and I tried to ask questions to get to the heart of the issue of the actual impact that this transition will have on people trying to access needed state services, Kristin Gourlay, health care reporter for RIPR cut in.

“Presumably,” said Gourlay, “in September, when the system goes live, people won’t have to go to a field office, they can go to- if the have a computer at home they can use that, they could go to a public library and use a computer there or another social service agency…”

“Correct,” said Affigne.

This allowed DiBiase and Affigne to shrug off concerns about social workers and clients as mere “bumps” along the way towards an improved, (read: cheaper) system. Yet, at a time when poverty and income inequality are at all time highs, and the economy of Rhode Island is barely improving, “bumps” in the lives of the one in five Rhode Islanders applying for needed assistance can be catastrophic.

Here’s the video of RIFuture’s questions:

Here’s the video of the full press conference:

August 25, 2016August 27, 2016

Layoffs at DHS have already affected services in Woonsocket

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People in need of social services are being turn away from the Woonsocket branch of the RI Department of Human Services (DHS) as the offices are in the midst of a downsizing and relocation.

On Tuesday some clients went to the DHS offices in Woonsocket and were told that they could not access the services they needed. They were referred to the Pawtucket offices, requiring a four hour bus ride, two hours each way. DHS employees in Woonsocket said their branch right now can only deliver “limited services.” I was told that all questions regarding the move and reduced services needed to be referred to DHS director Melba Depeña Affigne.

The reason for the change in service seems to be related to 70 layoffs at DHS that, according to a news release, is the result of a new software system coming in September.

“Moving from a software system designed more than 30 years ago to a modern, digital system requires different staffing needs,” said Depeña Affigne in a news release from the Department of Administration sent today. There will be a 3pm press conference explaining the layoffs in detail.

“The new eligibility and enrollment software system will make it easier and more convenient for Rhode Islanders to access those vital services,” Depeña Affigne said in the press release.

Woonsocket DHS 002 — Notice on Woonsocket DHS door

DHS provides vital community and family assistance by way of food and cash assistance, child care assistance and Medicaid. DHS manages SNAP benefits, Rhode Island Works (RIW), Child Care Assistance Program (CCAP), LTSS, General Public Assistance (GPA) and provides access to various energy assistance programs like HEAP, WAP and HSR.

The clients DHS serve are among the most vulnerable in the state, who often have difficulty with transportation and access to the internet. Closing offices, downsizing staff and limiting services, even if only for a month, could have catastrophic effects on families.

In a letter to SNAP Advisory Committee members, SNAP Administrator Iwona Ramian wrote that the lease for the current offices expires on August 31, and the effective date for the new offices is September 1, with transition between offices beginning Monday, August 22. Notification of the move was mailed to clients on Monday, meaning many people did not know about the gap in services.

Though Ramian in her letter says that “no gap in services is anticipated” the DHS website says, “The Woonsocket office is providing limited services” and refers clients to other locations.

Further calling Woonsocket DHS services into question is Ramian’s assertion that staffing levels at the Woonsocket office will be reduced from 36 to 14. The 22 employees who will no longer be in Woonsocket are being relocated to Providence.

A drop to 14 staff members is a big reduction. The implementation of a new on-line system for determining eligibility and needs was supposed to be in place before the change in location and reduction in staff, but the new system is experiencing delays.

Ramian notes that “the [new] office space will be shared with a comprehensive multi-service, non-profit, health and human services agency, giving customers a one-stop service location. The office telephone and facsimile numbers will stay the same. She’s referring to Community Care Alliance, a multi-service not-for-profit health and human services provider consisting of the original community mental health center serving the 6-town region, a school, the Woonsocket Family Shelter, the Northern RI Family Visitation Center (for DCYF-involved families), a youth success program, day treatment, partial hospital and acute stabilization for substance use and co-occurring behavioral health disorders and more.

Calls to the DHS offices have not been returned.

March 31, 2016March 31, 2016

Rich people have paid sick days. Poor people do not.

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Rhode Island’s House Committee on Labor is today considering H7633, An Act Relating To Labor And Labor Relations— Healthy And Safe Families And Workplaces Act, legislation that if passed would provide Rhode Island workers with earned paid sick days.

Among the basic provisions of this legislation are the following:

Annual accrual of 56 hours (equivalent to seven 8-hour work days) of earned sick leave.
Ability to make use of paid leave after 90 days.
Rollover of unused sick leave into new calendar year, with option to instead pay employees for unused time.
Protection of earned sick leave time in the event an employee is transferred to a different division of the same company, and in the event that “an employer succeeds or takes the place of an existing employer”.

Until national legislation is passed providing earned paid sick time, state and local provisions can provide this important family-friendly employment standard. As of March 2016, five states have passed earned paid sick time legislation, including three of our New England neighbors, Connecticut, Massachusetts, and Vermont. As well, at least fifteen cities and counties have passed legislation providing earned paid sick leave, including San Francisco, Washington, DC, New York, Philadelphia, Portland (OR), and San Diego.

The experience of those jurisdictions that have been leaders in enacting family-supporting earned paid sick leave is instructive. In San Francisco, the first jurisdiction to introduce earned paid sick leave, employment in the five years after implementation of their earned paid sick leave provisions grew twice as fast in the city than in neighboring counties lacking earned paid sick leave, and grew even faster in the food service and hospitality industries with significant concentrations of workers benefiting from the new provisions.

A report by the Center on Economic and Policy Research found that in neighboring Connecticut, the policy was implemented at little to no cost for business (consistent with findings from an Economic Policy Institute study prior to passage), and that two years after initial implementation, more than three-quarters of employers were supportive of the law.

Provision of earned paid sick days results in significant savings for both employers and government:

Employer savings are considerable, and include savings due to:

increased worker productivity,
Lower turnover rates
Reduced workplace contagion from reduced presenteeism (attending work while sick)
Fewer workplace injuries

Government saves through savings to public health insurance programs, through reduced reliance on emergency rooms for treatment of illnesses. With availability of paid sick time, an employee is able to schedule an appointment with his/her primary care provider for diagnosis and treatment. One recent study shows that extending earned paid sick leave to all currently uncovered would save over $1.1 billion annually, including savings of $517 million to public health insurance programs such as Medicaid. Other savings result from reduced reliance on public assistance, as nearly one in four employees report losing a job or being threatened with job loss for taking time off due to personal or family illness. Earned paid sick leave gives employees much needed economic security, which is critical to family stability.

One significant reason to pass paid sick leave legislation is that failing to do so further exacerbates disparities based on income. The Economic Policy Institute shows in stark terms that “rich people have paid sick days [while] poor people do not.” While only one in five (20 percent) of private sector workers in the bottom 10 percent of wage earners has earned paid sick time, nearly nine in ten (87 percent) of top-five wage earners have earned paid sick time.

The case for providing earned paid sick leave to workers in Rhode Island is strong. It’s good for businesses and workers, making Rhode Island a more family-friendly place to live and work.

February 15, 2016

New standards set for health insurance providers

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Commercial health insurers in Rhode Island will need to have 50 percent of their payments based on quality by 2018 under a new plan announced by the Office of the Health Insurance Commissioner (OHIC) Thursday.

Shared goals between public and private payers are seen as crucial to the success of healthcare reform efforts. The Alternative Payment Methodology Plan is meant to further align commercial insurance payments with those of public payers-Medicare, and the state’s nationally recognized reinvented Medicaid program.

Beginning in 2017, commercial health insurers will be required to direct 40 percent of medical payments through quality and efficiency-based payment models, increasing to 50 percent in 2018.

Along with the alternative payments plan, OHIC also released this year’s Care Transformation Plan, which requires insurers to continue to grow and support patient-centered medical homes.

This all comes out of OHIC’s Affordability Standards, which were first established in 2009 by then-commissioner Chris Koller. Under the direction of the current Commissioner, Dr. Kathleen Hittner, OHIC updated and enhanced the Affordability Standards last summer following a year-long public review and input process.

Included in the new Standards was the establishment of two advisory committees charged with developing yearly plans to reach long-term goals. The Alternative Payment Methodologies Committee is focused on shifting from the old fee-for-service model to payments based on quality and value rather than volume; and the Primary care Transformation Advisory Committee deals with supporting the development of primary care infrastructure and coordinated, high-quality, patient-centered care.

As is usually the case in the Rhode Island health policy world, these advisory committees featured a diverse group of stakeholders. Representatives from the carriers, provider and hospital groups, the employer community, and consumer advocacy organizations were at the table. With support from OHIC staff, they crafted the plans announced yesterday which will guide commercial payers for the next year. Both committees will reconvene in the Fall.

[Read OHIC’s Press Release]

February 11, 2016February 11, 2016

Sleepless nights and cognitive dissonance at the State House

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Speaking at the Greater Providence Chamber of Commerce (GPCC), alongside Senate President Teresa Paiva Weed and Governor Gina Raimondo, Nicholas Mattiello proudly ticked off a list of his tax cutting accomplishments since becoming Rhode Island’s Speaker of the House.

We’ve reduced the corporate tax rate in Rhode Island.

“We exempted sales tax on energy costs to assist businesses.

“We raised the exemption on the estate tax to keep successful folks in the State of Rhode Island.

“We eliminated the social security tax on many Rhode Islanders so we can assist the middle class after a lifetime of commitments so that they can stay and thrive in Rhode Island.

“We eliminated tax on radiology services to assist that industry.”

Acting as the self-appointed Yin to Mattiello’s Yang, Paiva-Weed spoke about how the Speaker and Governor stood with her “to take some of the most difficult votes the General Assembly could take to cut the budget…

One of them was last year… and that was cutting $70 million from Medicaid. That was a hard vote…

“In addition, many of you in this room were not standing here cheering when we had to make those difficult votes to ensure the passage of pension reform. And that was a vote that quite honestly kept me up many nights, because it really did hurt people…”

“It really did hurt people.” Let that sink in for a moment.

“We raised the exemption on the estate tax to keep successful folks in the State of Rhode Island,” the Speaker had said, not five minutes earlier.

The message was as jarring as it was obvious: Tax cuts on the rich hurt people. Our leaders know this, but they don’t want to believe it. It’s called cognitive dissonance.

Beyond just hurting people, poorly targeted tax cuts do nothing to help the greater economy and instead impoverish a government’s ability to maintain infrastructure. Hence, RhodeWorks.

RhodeWorks will shift the financial burden of repairing RI’s roads and bridges onto trucking companies, who will maintain their profits by increasing the price of goods. This will burden the poor and middle class much more than it will the rich, who will be able to manage slight price increases by drawing on the extra money they keep through the tax cuts they’ve been granted.

Despite Paiva-Weed’s protestations, she has not cast “difficult votes”. A difficult vote would be one in which she stood up for those without power and against the money of the connected elite. A difficult vote would be one of compassion and courage.

No, the votes Paiva-Weed made were easy, because the people she hurt have no power to hold her accountable for their pain. Her conscience might bother her, but what good is a conscience when the corporate tax rate needs to be cut?

As for Mattiello, after he proudly listed his accomplishments, he said, “We have been laser focused on moving our economy forward and doing the kind of things that build economic wealth and growth and jobs in the State of Rhode Island.”

“And then I hear,” said Mattiello, pausing as the cognitive dissonance crackled through his brain, “that there’s a consensus that we have the worst roads and bridges in the country and it’s the leading concern of businesses. It’s the number one driving force for businesses in their decision making.” Another pause.

Mattiello’s pauses say it all. All that money he gave away to his well off neighbors was for nothing. All those cuts to pensions and Medicaid were for nothing and all those people hurt by these cuts were hurt for nothing.

Our leaders bought the lies of economic charlatans, gave away millions in tax cuts, impoverished our state and hurt people terribly, only to find that what was really needed was a strong infrastructure, an infrastructure we might have been able to afford if we weren’t crippling our economy by cutting the taxes of dead millionaires.

August 27, 2015

How the smallest state got the smallest uninsured rate

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A recent Gallup poll revealed that Rhode Island has the lowest uninsured rate in the country, at 2.7 percent, as well as one of five states that saw its uninsured rate decline by 10 points or more. But, how did that happen? Anya Wallack, director of HealthSourceRI, was able to provide some answers.

“You come to HealthSource, and right there, you can very easily sign up for coverage regardless of your income,” she said. “We’ve developed an infrastructure that’s really designed for this unified approach.”

Wallack explained Rhode Island decided to create its own exchange because it presented “significant advantages, in terms of local control and customer service.” With a state based exchange, rather than a federal one, they could better tailor their services to the needs of Rhode Islanders.

HealthSourceRI uses what she called a “one door policy,” meaning that customers could come in and not only apply for health insurance, but check to see if they were eligible for Medicaid and other benefits. This is where much of the exchange’s success comes from, since this is a policy only a few states have adopted.

Wallack said that making customers jump through hoops only serves to make things more confusing, and they miss out on important information because of it. Right now, Wallack and her team are expanding their open door policy, and making it possible for customers to begin to apply for other assistance programs like TANF or SNAP.

“When we’re done building our system, you’ll be able to sign up for those with one stop shopping,” she said.

Wallack added that there are a number of ways that customers can use this one stop shopping, that all services are provided online, over the phone, or in person. Face-to-face assistance is also provided right in the community health centers, so customers can sign up for insurance right in their hometown. HealthSourceRI also has enrollment events during the open enrollment period, which is from Nov. 1 to the end of January each year. During open enrollment, a customer can renew, reenroll, or sign up for coverage, or just change their plan. There are two other types of enrollments as well- special enrollment and Medicaid coverage. Special enrollment occurs when a customer’s circumstances change throughout the year and they need to change their plan, and Medicaid coverage happens throughout the year to see if a customer is eligible for Medicaid.

“We try to find any avenue where we can come into contact with people who may be looking for coverage,” Wallack said concerning their community accessibility.

This level of accessibility has worked for the exchange, proved not only by the Gallup poll but the hard numbers that HealthSource has collected so far for this year. In 2015, they have enrolled 32,554 individuals as of July 31. Most people who enrolled were age 55 and over, sitting at 29 percent. 53 percent of enrollees were female, while 47 percent were male. More than half of the enrollees – 59 percent – were eligible for financial assistance in the form of an advanced premium tax credit and cost-sharing reductions. These numbers show an upward trend from last year, with over 7,000 more enrollees. Small businesses are signing up through HealthSource as well, with 542 employers enrolled in 2015, compared to the 381 from 2014.

The Gallup poll found that states that set up their own exchange and expanded Medicaid saw the biggest drop in their uninsured rate, something that the Ocean State has been doing since day one. According to Wallack, as long as they continue with this, Rhode Island can serve as a model for other states and their healthcare exchanges, especially as HealthSourceRI moves forward. Within the next month, HealthSource will be releasing its own survey, which will give more accurate results than the Gallup one, because it will only look at Rhode Island. But, the national survey still shows a trend, and that Rhode Island is headed in the right direction.

“What I take from this, is that those policy decisions, as well as our decisions to take a coordinated approach, was successful for us,” Wallack said.

HealthSource’s next step is to find those last remaining uninsured individuals, and understand why they’re uninsured, as well as work with employers to make sure that they are able to retain coverage. Now, their job is to help control healthcare cost growth, provide support for small business, and provide affordable choices for everyone, especially that last 2.7 percent.

July 31, 2015August 3, 2015

Healthcare workers fight for $15 in Rhode Island

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Over 150 front line medical caregivers rallied on Newport Avenue in Pawtucket yesterday afternoon to demand a minimum wage of $15. The timing and location of the event was carefully considered.

It was the 50th anniversary of Medicare and Medicaid. The location, near Slater Park, is around the corner from two healthcare providers, ARC of Blackstone Valley, which provides services to adults with developmental disabilities and the Pawtucket Center, a Genesis Heath Care skilled nursing facility.

The rally was also just two miles from the Massachusetts border, where home care workers recently won a minimum wage of $15 to be phased in over the next few years. Rhode Island does not pay nearly as much.

SEIU 1199, representing the healthcare workers, released figures showing that at Pawtucket Skilled Nursing & Rehab, the starting rate is $11.75. 63 percent of workers make less than $15. At ARC of Blackstone Valley many direct care staffers earn $10.75 and 94 percent earn less than $15. Meanwhile, two miles up the street, a caregiver could find a job paying $15.

I spoke with two women whose adult, disabled children are cared for at ARC of Blackstone Valley. Both attested to the excellent care their families receive and to the need for paying better wages. The caregivers at ARC are like family, said Pat, whose daughter Rachel has many special care requirements.

Two women who work as personal care attendants in Massachusetts also addressed the rally. Deborah Hahn said, “…if Massachusetts PCAs can win $15, if New York fast food workers can win $15, you can too.”

This event is seen as part of the “expanding #fightfor15 movement” which has been defying expectations and scoring significant wins in recent weeks. The healthcare workers were joined at the rally by a host of labor and community groups, including the AFL-CIO, Unite Here! 217, Jobs with Justice, Fuerza Laboral, NEARI, Teamsters 251, UNAP, UFCW 328, and the RI Progressive Democrats. State Representatives David Bennett, Mary Duffy Messier and Scott Slater were also on hand.

June 10, 2015

House Finance approves budget bill, full chamber to vote Tuesday

The House Finance Committee considers the FY 2016 budget.

After much deliberation, the House Finance Committee gave a unanimous 19-0 vote on the FY 2016 budget late on Tuesday night, which included $37.7 million more than the proposed budget given by Governor Gina Raimondo back in March. The legislative budget proposal is for $8.67 billion dollars, with $3.55 billion from general revenue contributing to that.

“We concur with many of the governor’s initiatives for economic development,” House Finance Chairman Raymond Gallison (D-District 69) said in a press briefing tonight.

According to Gallison, the committee, in large part, accepted Raimondo’s budget, but there were some key provisions that saw change, including Social Security, Medicaid, and sales taxes to businesses.

Those who made between $80,000 and $100,000 will be exempt from paying social security income tax. These tax cuts will give retired Rhode Islanders $9.3 million in tax relief. Businesses are also now exempt from paying the sales tax on corporate utilities. Governor Raimondo had originally proposed phasing it out over five years, but will instead be taken out all at once this year. The earned income tax credit for middle to low income households has also increased from 10 percent to 12.5 percent.

The budget outlines a 2.5 percent Medicaid cut for hospitals, and a 2 percent cut for nursing homes. Gallison said this provides more protection for nursing homes. The House budget cuts Medicaid roughly $67 million, a far cry from the $90 million that the governor had proposed, but the hospital license fee has been increased to 5.862 percent, which would bring in $13 million in additional revenue.

“Funding to maintain HealthSource RI is included in the budget,” Gallison said, outlining the distribution changes to its funding. Now, individuals will pay a surcharge of 2.86 percent on their monthly premiums, and businesses will pay a .59 percent surcharge. The budget allocates $2.6 million for HealthSource RI going into FY 2016. There is also no more additional surcharge for outpatient and imaging services.

Full-day kindergarten is another key provision, with the governor allocating $1.4 million from general revenue to fund programs in the seven communities that don’t offer full-day kindergarten yet. Educational aid was increased by $35.8 million in order to pour money into the educational funding formula. There was also $20 million added for school construction purposes.

Higher education saw an increase of $7 million. The Rhode Island Higher Education Assistance Authority is being downsized, with its responsibilities now being transferred to the Council of Post Secondary Education and the Office of the General Treasurer.

Other major provisions within the bill include cuts to all eight local tourism bureaus, a $2 million increase for RIPTA, and a $0.25 increase in the state sales tax on cigarettes, bringing it up to $3.75 per pack. The tax increase is estimated to bring in $1.7 million in revenue.

What is absent from the budget is just as significant as what is present.

“This budget does not contain anything whatsoever to do with a proposal for a stadium, or any tolls on trucks as proposed by the governor,” Gallison said during the hearing. Also notably absent is the “Taylor Swift tax” on million dollar homes in the state.

Speaker of the House Nicholas Mattiello has gone on the record saying that the proposed budget is business friendly, and will allow for economic development in the state.

“The budget that’s going to be voted on tonight is very pro-business, pro-economy. It’s going to serve as a catalyst for existing businesses as well as working to attract new businesses to the state of Rhode Island,” he told members of the media on Tuesday.

Gallison agreed with that sentiment, giving his own statement at the beginning of the hearing.

“We continue to move Rhode Island onto an economic path to enable businesses to continue to grow,” he said.

The bill is scheduled to go to the House of Representatives floor next Tuesday.

May 14, 2015May 15, 2015

SEIU proposes Medicaid solutions that don’t hurt workers

SEIU 1199, representing about 4,000 health care workers in RI, held a press conference to announce a series of initiatives “to improve the way the state invests in Medicaid-funded programs in long-term care and create a pathway to living wages for caregivers.”

The press conference was part of a “Day of Action” at the State House, and was followed by SEIU members presenting their ideas to their state reps and senators ahead of the day’s legislative session.

“I love my residents like my own family, but at the end of the day, I don’t bring home enough money to take care of my two daughters,” said Nichole Ward, a certified nursing assistant (CNA) at Greenville Skilled Nursing and Rehab in Greenville, who spoke of the difficulty of not earning a living wage. “After working hard, being on our feet, taking care of people for 40 hours a week, I shouldn’t have to choose between my electric bill and school supplies for my kids. We deserve at least $15 an hour.”

Patrick Quinn, executive director of SEIU 1199 and a member of the Reinventing Medicaid working group, outlined the eight points of SEIU’s plan to both cut Medicaid costs and increase wages for frontline medical workers while improving health outcomes. The eight points are expanded upon in a white paper entitled From the Frontlines to the Bottom Line.

1. Create a value based purchasing program to improve care quality and staffing in nursing homes and reduce re-hospitalization.

2. Increase transparency of “related party” finances and reporting, in effort to reduce waste, fraud, and abuse.

3. Target any nursing home rate reductions toward costs unrelated to the provision of direct care, such as Fair Rental Value and “home office” charges.

4. Focus increased revenue and rate restoration initiatives on direct resident care and workforce stability.

5. Claw Back: Recoup Medicaid reimbursements that are not used for their intended purpose, especially in regards to direct labor.

6. Cap Medicaid reimbursement for executive compensation based on facility size.

7. Realize Medicaid savings though more energy efficiency initiatives.

8. Expand Rhode Island’s Paid Family Leave Program from 4 to 6 Weeks.

Speaking in support of the SEIU’s effort was Jenn Steinfeld of the Women’s Fund of Rhode Island, who sees this as both a social justice and gender equity issue.

It’s a gender issue on two fronts, says Steinfeld, because women live longer, and therefore make up 74 percent of the elderly patients in the Medicaid system and women make up 90 percent of the direct care workforce. Additionally, the over representation of minorities in the field makes this a racial justice issue, notes Steinfeld.

CNAs Dawn Auclair and Manoucheka Robert both spoke about the attachment they have to their patients, the importance of their work, and their difficulty in performing this valuable work for such low pay.

Sarah Nolan, who works for the SEIU International Policy Department in Washington DC, said that the white paper they have released focuses on both short and long term solutions to the problems in Medicaid quality and cost. She also stressed the importance of front line medical workers playing a role in these discussions.

Near the end of the press conference, CNA Nichole Ward explained that experience is key when dealing with patients. Cutting costs and worker turnover can raise the stress level of front line health care workers, and residents in nursing homes can sense that stress, even if healthcare workers think they are hiding it.

Such an environment cuts against the efforts to improve health care.

May 13, 2015May 14, 2015

Frontline caregivers to hold Medicaid ‘Day of Action’ at State House

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Health care workers and allies will host a press conference and policy brief at the State House on Wednesay to advocate for Medicaid changes to improve the system of long term care and support a living wage for caregivers. SEIU District 1199NE, which represents approximately 4,000 health care workers in RI, will be issuing a new policy brief with proposals to improve the way the state invests in Medicaid funded programs in long-term care and create a pathway to living wages for caregivers (including staffing policies to improve quality of care and reduce re-hospitalizations).

A recent poll conducted by Fleming and Associates found that 69% of Rhode Islanders support paying a living wage of $15 per hour for frontline workers in nursing homes and community based agencies caring for those with developmental disabilities. Copies of the poll results will be available at the event.

WHO: Frontline caregivers (including CNAs and Direct Care Staff) and Leaders of SEIU 1199NE and Women’s Fund of RI
WHAT: Policy Brief & Press Conference about Medicaid changes that strengthen the system of long term care and support a living wage for workers
WHEN: Wednesday, May 13, 2015 at 2:15pm (Press Conference and unveiling of Medicaid policy brief) followed by lobbying visits at 3:30pm
WHERE: State House, Room 101

Caregivers have an important voice and perspective in the current debate about improving Medicaid funded long term care system in Rhode Island. Frontline health care workers provide compassionate care and in many instances play the role of family for their residents and clients; despite this many CNA’s and Direct Care Staff are not earning enough to support their own families.

A 2013 analysis using survey data from a nationally representative sample of 1174 nursing homes demonstrated that nursing homes with high CNA turnover had more than triple the odds of resident pain, and approximately double the odds of both pressure ulcers, and urinary tract infections. Also, a Kaiser Family Foundation report suggests that improving staff-to-resident ratios and reducing turnover is one strategy to assist in lowering avoidable re-hospitalizations.

While Rhode Island spends a comparable amount on Medicaid as Connecticut and Massachusetts, compensation for caregivers lags behind our neighbors (see chart below). Many health care workers in Rhode Island are joining the growing national #Fightfor15 campaign demanding a living wage of $15.

May 12, 2015May 13, 2015

Medicaid on the Move

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The 7th Annual Budget Policy Conference, a fundraiser for the Economic Progress Institute (EPI), had a timely theme: “Medicaid on the Move.”

Since Governor Gina Raimondo announced a Medicaid crisis in February and the creation of a working group of “27 members from across health care, business, state government and community and nonprofit organizations” to deal with the crisis, the idea of “Reinventing Medicaid” has become a central part of the state’s 2016 budget process.

Medicaid is a state and federally supported system of health care that targets the most vulnerable and least represented people in our community, i.e. children, low income adults, the elderly and those with mental or physical handicaps. So special attention must be paid to the process of “reinventing” the system and therefore an appropriate target for a progressive economic institute such as EPI to address.

Governor Raimondo gave the opening address to the breakfast crowd, mostly made up of medical policy wonks and EPI supporters. She used the opportunity to press for a $10.10 minimum wage and for an increase in the earned income tax credit from 10 to 15 percent, possibly her two most progressive ideas in her 2016 budget proposal.

Moving onto Medicaid, Raimondo insisted that her goal in pulling together the working group is “not about kicking people off Medicaid” but “getting people cared for in the lowest cost environment.”

Raimondo acknowledged that the EPI and many of those in the audience are more concerned with social justice and economic justice than they are with short term budget fixes when she said, near the end of her speech, “Your stubborn idealism is a good thing for Rhode Island, so don’t lose it.”

Linda Katz, policy director and co-founder of the EPI, spent 14 minutes introducing the audience to the basic facts about Medicaid. In the video below I’ve combined the slides from her presentation with the talk she gave.

Katz is a member of the Reinventing Medicaid working group. The first weeks of work by the working group, Katz suggested, was preliminary. Now, as the working group prepares to move ahead and plan the implementation of the ideas presented, Katz says that she’s “looking forward to part two, where we take a deeper dive into Medicaid.”

Cindy Mann, former Medicaid Director in the Obama Administration, began her talk noting that this July will mark the 50th anniversary of Medicaid. Medicaid, says Mann, “is constantly reinventing itself.”

Over the course of her talk Mann explained exactly who Medicaid serves, and why Rhode Island is in many ways both an outlier and a leader in the way we administer the program. In the video below I’ve combined the slides from her presentation with the talk she gave.

For instance, “Rhode Island has, as a population, more elderly and disabled” than many other states, said Mann. Three percent of our Medicaid enrollees account for 70 percent of our Medicaid spending.

Mann made a special point to mention the medical care of the incarcerated, surely the population our society seems least vested in. When people in our prisons require outpatient care, that is, medical services the prison hospital is unable to meet, Medicaid covers the expense. Mann maintained that the state should make sure that “no one leaves jail without being assessed for health care coverage.”

Former Lt. Governor Elizabeth Roberts, who Governor Lincoln Chafee tasked with setting up the state’s health care exchange and who Raimondo put in charge of the working group, spoke last.

Roberts said that she and the working group instead worked to reform the system. “We did not remove benefits,” said Roberts. In addition to the recommendations of the working group, Roberts feels that there needs to be a pay increase for certified nursing assistants and home health care workers, who are being squeezed economically.

Roberts also agreed with Katz about the second phase of the working group’s mission. The “next 2 months,” said Roberts, “will be more important than the last 2.” The working group issues its final report in July.

April 29, 2015April 30, 2015

NBC10 Wingmen: How RI was sold on reinventing Medicaid

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What’s so bad about Medicaid consuming 30 percent of the state budget? Caring for anyone is expensive, and the indigent are certainly no exception. My question is how did we reduce the care and welfare of our most vulnerable neighbors down to a mere 30 percent of overall state spending.

And what’s so bad about having the second highest Medicaid enrolee costs in the country? Don’t we want the enrollees to enjoy good benefits? If so, and I think that’s a major league if, wouldn’t the more actionable number be the cost per resident, or per taxpayer? In total Medicaid spending, RI is the 13th lowest in the nation.

Putting aside the proposed Medicaid cuts and potential efficiencies, which Bill Rappleye discusses with Health Secretary Elizabeth Roberts, Jon Brien and I debate how Rhode Island debated reinventing Medicaid on the most recent edition of NBC10 Wingmen:

News, Weather and Classifieds for Southern New England

April 28, 2015May 1, 2015

Progressives, conservatives unite to fight downtown ballpark

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An unlikely coalition of opponents to the proposed downtown Providence stadium deal greeted new PawSox owner Jim Skeffington as he exited his chauffeured ride and quickly entered the Rhode Island Commerce Corporation (RICC) offices at 315 Iron Horse Way.

Representatives and members of the RI Tea Party, The Republican Party, the Progressive Democrats of Rhode Island, The Green Party, Direct Action for Rights and Equality, Occupy Providence, The Rhode Island Sierra Club, RI Taxpayers, The Rhode Island Libertarian Party, and the Capital Good Fund stood side by side to take a stand against corporate welfare.

This event was put together by Coalition Radio’s Pat Ford and David Fisher, with help from Lauren Niedel of the Progressive Democrats. Ford acted as emcee for the event, in which 13 speakers and one poet spoke to a crowd of about 80 people. Inside the RICC offices, more than 100 more people attended the meeting where Skeffington and other PawSox owners revealed that they were amenable to negotiating a better deal.

Gina Raimondo essentially rejected the first deal offered, which would have, in the words of more than one speaker, “socialized the risk and privatized the profits” of the new venture.

Pat Ford spoke first, saying that “it is not the role of government to subsidize risk for private enterprise.”

Lauren Niedel of the Rhode Island Progressive Democrats put the deal into stark economic relief: As Rhode Island prepares to carve $90 million out of Medicaid, how can we justify giving away millions of dollars to millionaires?

Andrew Posner, executive director of the Capital Good Fund, said that “every day I look at families that are hungry, that are poor, that don’t have jobs… that’s what we should be spending our time and money talking about.”

The Tea Party’s Mike Puyana said that the deal is “something called crony corporatism, it’s as far from equality under the law as it’s possible to get.”

“I don’t think I ever imagined that i was going to be at a rally with the Tea Party on the same side,” said Fred Ordonez of DARE, “but here we are!”

On a more serious note, Ordonez said, “Every time we see a huge development get all kinds of tax breaks and tax subsidies, the poor communities in providence get poorer and poorer.”

Larry Girouard, of Rhode island Taxpayers, said that a new stadium downtown is the last thing we need to spur economic growth. “The issue is taxes, regulation, infrastructure. This is just a diversion from the real problems.

The Green Party, represented by Greg Gerritt, brought up some of the environmental concerns, such as the risks of moving the new sewer line. “When you do things like that, you can do it right, but often it introduces more leaks into a system.”

“The state of Rhode Island has no business taking money out of the hands of taxpayers and giving it to millionaires,” said Gina Catalano of the Rhode Island Republican Party, “to be expected to make that investment with zero return, is ludicrous.”

Representing the Sierra Club, Asher Schofield, owner of the small business Frog and Toad, hit the crowd with a baseball metaphor, and tried to inspire us all towards something better.

“Providence is not a minor league city. We are what we dream ourselves to be. What we want to be. And we want to be major league. These are antiquated notions, the idea of public financing of private enterprise. This [deal] is not the grand notion that we need to have as a city moving forward… These minor league aspirations are beneath us.”

This deal, says Rhode Island Libertarian Party leader Mike Rollins, “is the exact opposite of everything we stand for.”

Occupy Providence’s Randall Rose made excellent points, and even read from a textbook about how bad it is for cities to invest money in minor league baseball teams. Rose read from the book Minor League Baseball and Local Economic Development, noting that, “there have been books on this, the scam is run so often.”

“The economic impact of a minor league team,” read Rose, “is not sufficient to justify the relatively large public expenditure for a minor league stadium.”

Steve Frias of the Republican Party, noted that the assembled crowd was comprised of people with “different viewpoints, but we all agree that this is a stupid deal.”

Roland Gauvin, an independent political activist, promised politicians who support such efforts that “a vote for this is the last time [politicians] will ever be voting, because we will vote them out of office.” Gauvin had especially choice words for Speaker of the House Nicholas Mattiello, saying, “And I will be willing to go to any district in Rhode island, starting in Mattiello’s district, and work my way down.”

Finally, before the crowd moved inside to join the RICC meeting already in progress, Cathy Orloff lead the crowd in a participatory poem against the stadium, with five baseball references built in.

April 10, 2015

Home care workers squeezed by inconsistent messaging/policy

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Since two-thirds of minimum wage earners are women, Governor Gina Raimondo says that raising the minimum wage to $10.10 is an important way to help women and their families in Rhode Island. But Nicholas Oliver, executive director of Rhode Island Partnership for Home Care, Inc., a group that advocates for the home health care industry here in Rhode Island, says that the governor is “being a bit disingenuous, and we’ve seen that her messaging is a bit inconsistent.” More than 88 percent of home health care workers are women, and Raimondo’s budget isn’t helping them.

The governor is “saying that she wants to be an advocate for home care,” continues Oliver in a phone conversation, “particularly with this working group Reinventing Medicaid, but frankly we haven’t seen her put her money where her mouth is. She put into her budget proposal last month a freeze on home health care for another consecutive fiscal year.”

In testimony before the Senate Labor Committee hearing on the $10.10 minimum wage, Oliver explained that “Medicaid home and community based service rates have been frozen for the past seven consecutive fiscal years. However, much of that last rate increase in 2008 was rescinded the following fiscal year due to state budget constraints. So what we’re really talking about is 13 years since a rate increase…”

Medicaid reimbursements for home health care services are $17.68 an hour in Rhode Island. In addition to the worker’s salary, that money has to cover insurance, licensing, utilities, compliance and other expenses. “Many of our direct care staff, CNAs and home makers are earning wages at or slightly above the minimum wage. At current reimbursement rates we cannot afford to provide them a wage that is adequate, let alone competitive to their counterparts in nursing homes and hospitals that have received increases by the General Assembly almost every year.”

Medicaid reimbursements for similar services in Connecticut and Massachusetts are $24.40 and $24.64. “Why would someone work for minimum wage in a position that requires licensing by the Department of Health, continuing education to maintain that licensure, perform services that include toileting, bathing and feeding patients, at the same wage as someone working in retail or hospitality?” Oliver asked the Senate Committee, “The job market is responding with a resounding ‘no’ as many provider industries are having trouble hiring and maintaining direct care staff to fill the growing need for these services by Medicaid beneficiaries.”

The problem in finding workers for the money available is especially acute outside Providence, in places like southern Rhode Island and Woonsocket. Many workers are simply crossing the border into neighboring states where the money is better.

“We don’t want to oppose increasing the minimum wage,” says Oliver, “We’re really disappointed that the governor is proposing to increase the minimum wage and wants to be an advocate for minorities and women and single parents, but at the same time her message is inconsistent when it comes to health care because she’s saying, ‘Let’s increase wages for these folks, but not you, even though you’re a representative of the same work force I try to advocate for.’”

In her 2016 budget proposal, Governor Raimondo has suggested a 3 percent cut to nursing homes and a 5 percent cut to hospitals. The Reinventing Medicaid working group will issue its report and suggestions for additional cuts later this month. You can view Oliver’s testimony before the Senate Labor Committee below:

April 2, 2015October 17, 2016

Neighborhood Health Stations are better than cutting Medicaid

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Imagine a plan sitting at the RI Department of Health (RIDOH) that would reduce health care spending in Rhode Island by 15 to 30 percent. A plan with the added benefit of improving health care outcomes “with a cutting edge technology that brings every Rhode Islander into world class care – as they need it, where they need it, when they need it, in a way that builds community instead of building profit for others.”

Neighborhood Health Stations, developed by the RIDOH under the leadership of Dr. Michael Fine, is that plan.

Neighborhood Health Stations are “basically community hospitals without walls,” says Dr. Fine in conversation with Richard Asinof of ConvergenceRI. Dr. Fine planned to build one station for every 12,000 Rhode Islanders, between 75 and 100 such stations in all. The first one was to be built in Central Falls.

Neighborhood Health Stations would locate pediatricians, internists, family physicians, dentists, nurse practitioners, licensed and registered nurses, advanced practice nurses, physician assistants, mental health and social workers, physical therapists and occupational therapists, pharmacists, emergency medical technicians and paramedics, registered dietitians, home health workers, promotoras, health coaches, navigators and other healthcare workers under one roof, in a facility that would also offer programs such as “nutrition courses, Zumba classes, or group counseling sessions.”

According to Dr. Fine, if we implemented this plan, we could shrink the hospital system in our state. “When you build out the full delivery system of one neighborhood health station for every community of 12,000 people,” says Dr. Fine, “it is very likely that we can reduce the total number of hospital beds by 40 to 45 percent. That means dropping [the number of hospital beds in Rhode Island] by about 900 beds.”

Governor Gina Raimondo’s budget proposes cutting $88 million from Medicaid’s $2.7 billion in spending, a 3 to 6 percent reduction. Since “Reinventing Medicaid” is being presented as an answer to an imminent disaster, improving the quality of health care or paying adequate wages to health care workers is taking a back seat to saving money.

That’s a shame, because a fully realized health care system of the kind imagined by Dr. Fine would attract business and investment to Rhode Island, while draconian cuts in services to our most vulnerable will have the opposite effect. If we could build Neighborhood Health Stations and make them work, “then health care spending becomes a business magnet. People come and locate businesses here, just because of our health care,” says Dr. Fine.

It’s a great idea, but not one that’s likely to happen. Since Dr. Fine’s departure, Neighborhood Health Stations seem in jeopardy. The new head of the RIDOH, Dr. Nicole Alexander-Scott, has yet to comment on the plan. But a more immediate reason for the plan’s quiet demise can be intuited.

“…if I have had one failure [while serving as director of the R.I. Department of Health],” said Dr. Fine, “if I want to be self-critical, [it’s] that I haven’t made it clear enough to people that we don’t have a problem with insurance, the problem is insurance. That thinking, that insurance, as a financial mechanism, can impact health, is a fundamental, categorical mistake.”

Dr. Fine saw his Neighborhood Health Stations as saving money by cutting out for profit insurance companies, and actually reducing the size of hospitals. The Reinventing Medicaid working group is comprised of a diverse group of people, but for-profit insurers and health-care providers have a prominent seat at the table. Timothy Babineau, MD, president and CEO of Lifespan, Peter Andruszkiewicz, president and CEO of Blue Cross Blue Shield of RI and Helena Foulkes, executive vice president of CVS Health and president of CVS/pharmacy will ensure that their corporate, for-profit interests are protected.

To Dr. Fine, Neighborhood Health Stations are the future of health care. “…if we don’t do it, all we’re doing is perpetuating a costly infrastructure that doesn’t work.” An infrastructure that will remain immeasurably profitable to those sitting at the top of certain health care empires.

The “artwork was created by Roger Williams University students, in consultation with students at Rhode Island College School of Nursing, to illustrate how Neighborhood Health Stations could enhance well-being in Rhode Island communities.”

March 31, 2015March 31, 2015

Raimondo cherry picks data, overstates issues in Reinventing Medicaid

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Two single-payer advocacy groups, Rhode Island Chapters of Physicians for a National Health Program (PNHP) and HealthCare-Now, have prepared a report that is highly critical of Governor Gina Raimondo’s Reinventing Medicaid initiative.

The PNHP/HCN-RI report identifies five areas of concern and concludes that “Governor Raimondo has made it impossible” to achieve the goal of developing “a plan to improve the quality of care Rhode Islanders receive and reduce the costs for Rhode Island taxpayers.” The areas of concern cited in the analysis are:

1. presenting faulty and misleading data and analyses
2. misidentifying “problems;”
3. requiring unjustified budget cuts within preselected “six major strategies’”
4. not permitting consideration of the actual problem: private health insurance companies generating enormous administrative costs and improperly rationing care
5. not permitting consideration of an effective solution: a comprehensive single payer health care program for all Rhode Island residents such as that proposed by H5387, a single-payer health care bill introduced by Representative Aaron Regunberg.

The report says Raimondo overstates the percentage of the Rhode Island budget spent on Medicaid. She uses 31 percent, but the PNHP/HCN-RI report says the actual number is 22.1 percent. Further, Rhode Island’s expenditures are below the national average of 23.7 percent. And it should not be forgotten that most Medicaid expenses are reimbursed by the federal government dollar for dollar. Every dollar cut from state expenditures is two dollars cut from services.

The PNHP/HCN-RI report also accuses Raimondo of cherry picking data to paint the worst possible picture to create a false Medicaid crisis.

When Raimondo considers the drivers of high Medicaid costs, she ignores key problems. While Raimondo blames “High Utilization,” an “Aging Population” or “fraud, waste and abuse,” the PNHP/HCN-RI analysts note that her supporting data are questionable and we should be looking at the fact that “multiple payers create enormous excessive administrative costs and unfairly ration care.”

The report concludes by making the case for single-payer healthcare. Adopting such a program, says the PNHP, will:

Provide comprehensive health care coverage to all Rhode Island residents with most Rhode Islanders paying less for health care than they are currently paying;

Improve access to health care;

Save approximately $4000 per resident per year by 2024 and put more money into the Rhode Island economy.

Significantly reduce health care dollars spent on administrative costs and shift these dollars to actual provision of health care (providers would save almost $1 billion in administrative costs in the first year);

Decrease administrative burdens on health care providers and allow them to spend more time providing health care;

Eliminate the burden of health insurance costs and administrative obligations on Rhode Island businesses and thereby make them more competitive and profitable. In the first year, payroll contributions to the single payer plan would be over $1.2 billion less than current private health insurance premiums.

Contain health care costs (reduced administration and control over monopolistic pricing) would save 23% of current expenditures in the first year with larger savings in subsequent years.

Create a significant economic stimulus for the state by attracting businesses to and keeping businesses in Rhode Island because of reduced health insurance costs, a particular boon to small businesses and their employees.

Chair of the RI PNHP, J. Mark Ryan, MD., will be presenting some of this data at the next Reinventing Medicaid Town Hall Meeting at the East Bay Family Health Center, 6 John H Chafee Blvd, Newport at 6pm on April 1. You can see my coverage of the Providence Town Hall meeting here. For more on PHNP and single payer, see here.

March 19, 2015March 19, 2015

Reinventing Medicaid should be about values, not dollars

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Near the end of the public commentary period of the Reinventing Medicaid Town Hall Meeting held in Providence, Bonnie Holder observed that, “The measure of a society is based on how we treat our most vulnerable… How did we ever get to the point where we accept it as a society where 1 percent of the population can have enormous wealth and the rest of us here are fighting?”

What the standing room only crowd of nearly 200 people gathered in the foyer of the Providence Community Health Center on Prairie Avenue were fighting for was the funds needed to provide care and sustenance for children, the elderly, the poor and the homeless. Governor Gina Raimondo is seeking to cut $90 million out of Medicaid, an item that takes up about a third of the budget. Because the federal government matches state medicaid spending, the total of lost dollars to medical services in our state could be nearly double that number.

A steady stream of commentators took the microphone to say that our medical system is already straining to meet the needs of our community. Wages are stagnant, demand is only going to grow, and the money needed to get the job done right is already too tight.

Undoubtedly there are savings to be had. Where those savings are to be found is a question of values and priorities. Are we going to force front line caregivers to work longer hours for less pay? Are we going to ask people to give up medical care and prescriptions that will enhance their quality of life? Or are we going to take a serious look at the salaries and compensation packages of some of the best paid CEOs in New England?

The Town Hall in Providence was the second of four meetings. The first was held in Woonsocket on Monday night. The next one is scheduled for March 23 at the Peace Dale Library in Kingstown and the last one will be held on April 1 at the Portsmouth Fee Public Library in Portsmouth.

Stay tuned.

Former Congressman Ed Beard was the first speaker. Now a patient in a nursing home, Beard, now 74, suffers from Parkinson’s and was confined to a wheelchair. At one point a nurse’s assistant came forward to steady his hand so that he could hold the microphone. “I know cuts will be damaging,” he said, “Just be very cautious when you talk about the seniors. The seniors are a forgotten lot.”

“I am one of hundreds of CNAs in this state who provide personal, bedside care to elders in our nursing homes. My job is physically and emotionally demanding but highly gratifying… I am really concerned that the nursing homes are going to funding cuts again this year…”

“If we don’t have enough to help these people, to pay our nurses, what are we going to do? In our nursing homes, if we have 2 nurses for 6 patients now, what’s going to happen if we have a bunch of cuts?”

“It’s not pleasant to be poor. To wonder whether or not one will eat today, or have enough heat to heat one’s house or even to have a house to live in…”

“If my wife went to a nursing home, in three years I would be broke. I would have to go on welfare…”

“The corrections department is actually the largest provider of behavioral healthcare in the state…”

“These are people dependent on others for 24 hour care. They cannot safely remain at home, they’re aged and frail, they may have lost their independence, many of those closest to them have died, they rely on us for everything…”

“As a person living with mental illness and working in the mental health field, I want to stress the idea of peer support. Peer support is important to people living with mental illness… Medicaid should support peer supporters in the mental health system…”

“Permanent supportive housing is an inexpensive way to really effect some true Medicaid savings.”

“A ton of money is saved by being able to point them to either a health center or to a primary care doctor…”

“When we think about cutting some of the costs in Medicaid, home care only accounts for 5 percent of the money that is being spent…”

“Many executives make over six figures, and other executives make millions. Governor Raimondo has set an excellent example with taking a 5 percent pay cut to her salary. Perhaps our hospital and nursing home executives should do the same…”

“We have many patient cases where they cannot afford their medication, they stretch out their medication or split their pills or take their medication every other day. We then see that when these same patients become eligible for Medicaid, their compliance increases, and they become advocates in their own health care.”

“The nurses… throughout the state providing home healthcare, reimbursement rates have been frozen for eight years now…”

“I specifically want to talk about the significance of non emergency medical transportation…”

“Here’s what Medicaid pays for nursing home care: $6.30 an hour…”

“It’s just not what one does that matters, it’s how one does it. And how we choose to reform Medicare will have an impact for generations to come…”

“It’s established that the single greatest that reduces mortality among seniors is isolation…”

“More than 28,000 children in providence receive RICARE benefits…”

“I was distressed to hear about the Medicaid fund reductions. I know the federal government is making cuts…”

“I take care of children who, if there’s no nurse in the home, those parents don’t go to bed. And if there’s no nurse in the home for a couple of days, those parents cannot take care of that child…”

“If you have to increase what you provide in a healthcare setting and your dollars are being cut, there’s only a few places that money is going to come from. Labor and staff, food and medication. So if that’s what we’re looking at cutting, labor, food, staff and medication, shame on everybody in this state…”

March 13, 2015March 14, 2015

Raimondo budget: cuts to Medicaid, taxes on vacation homes

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Governor Gina Raimondo’s proposed budget would cut funding to the poor, fully fund the state education aid formula and create new taxes on high-end second homes and rental properties. You can read her full address to the House and Senate here.

Most significantly, Raimondo seeks to cut about $91 million from Medicaid, socialized health programs for poor people, and has already appointed a high profile task force to “reinvent” the program. It costs $2.3 billion a year, but about half of that is paid for through the federal government. Raimondo has already identified about $45 million in cuts and her budget executive summary says the task force is expected to find another $46 million.

But the poor aren’t the only ones who will pay to balance the budget. So will the state’s beach culture, as she’s proposing a new tax on million dollar second homes and AirBnB-style rentals.

The proposal calls for what has quickly been dubbed the “Taylor Swift tax”- a property tax levied on second homes worth more than $1 million. It will raise $11.8 million in new revenue, according to this briefing.

She’s also proposing an “AirBnB tax” that would raise $7.1 million in new revenue. From the executive summary: “The budget also closes an existing loophole that exempts vacation houses and small bed and breakfasts from paying the sales and lodging taxes. Finally, the budget would apply sales and local lodging taxes to unlicensed rentals, which have increasingly become an alternative to hotels, bed and breakfasts and other licensed lodging.”

Both these taxes will disproportionately affect the touristy areas of Rhode Island – the islands and South County. But Senate President Teresa Paiva Weed, of Newport, where untaxed vacation rentals and million dollar second homes are commonplace, didn’t seem to mind.

“I think it’s a bold and brave look across the spectrum,” Paiva Weed said. “Just as she is asking for $90 million in Medicaid savings she is also reaching out to our wealthiest citizens to also assist us in moving forward.”

Even House Speaker Nick Mattiello, who never met a tax he didn’t want to cut, gave some early – though conditional – support to the Taylor Swift tax. “It’s an interesting initiative,” he said. “It seems like something I’d be inclined to support but right now I want to look at the details of it.”

As did her predecessor, she is fully funding the state education aid formula – for an overall increase of $34 million from the previous year.

Raimondo also called for statewide all-day kindergarten, and an end to the school construction moratorium. Through refinancing debt, she proposes a $20 million “to create a capital fund to help address school facility needs.”

According to the executive summary, “Lifting the moratorium and setting the annual construction aid appropriation at $80.0 million starting in FY 2017 will create fiscal stability with predictable funding and allows for projects to be prioritized.”

Raimondo would like to see the Earned Income Tax Credit increased from 10 to 15 percent in one or two years, depending on the early summer revenue predictions. Massachusetts Earned Income Tax Credit is 15 percent and Connecticut’s is 27.5 percent.

Her proposed budget would raise an additional $7.1 million by increase by 25 cents the tax on a pack of cigarettes.

To promote construction, Raimondo proposes, “a package of real estate tax incentives will encourage construction of job-producing projects, with a focus on development near transit hubs and historic structures. The package includes Rebuild Rhode Island tax credits, tax increment financing, and partial assistance for local tax stabilization agreements that will make investing in construction and development in Rhode Island a compelling proposition,” according to the executive summary.

She’s also proposing what she calls the Anchor Tax Credit. “This tax credit incentivizes our largest employers —the anchors of our economy — to attract their suppliers and affiliates to Rhode Island. These employers will benefit from proximity to their suppliers, while the state gains new jobs and develops industry clusters,” said the executive summary.

As well as a Job Creation Tax Initiative. “There is strong support in the General Assembly for a competitive tax

initiative to incentivize employers to create new jobs. The Governor will work with leaders in the General Assembly to enact a package to promote job creation in Rhode Island. Any such initiative must include rigorous accountability provisions and a requirement that the investments’ benefits outweigh their costs,” the executive summary said.

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