Hundreds of millions of dollars have flowed into Rhode Island thanks to the Affordable Care Act, or Obamacare. That money has helped people afford health insurance through HealthSource RI, cover more people under Medicaid than were previously eligible or signed up, and funded hospital innovation and public health programs.
At a joint hearing of the Senate Committees on Finance and Health and Human Services Tuesday evening, state health officials briefed lawmakers on what the law has accomplished in Rhode Island and what its loss could mean.
The bottom line, they say, is that tens of thousands of Rhode Islanders could lose health insurance coverage, and health care reform efforts, like improved coordination of care and enhanced electronic medical records, could slow.
Expanded health insurance coverage
Secretary of the Executive Office of Health and Human Services Elizabeth Roberts said it’s “clear the ACA is working” in Rhode Island and “we want it to stay.” She says implementing the Act has cut the uninsured rate in Rhode Island by 100,000 (that includes people who signed up for coverage through HealthSource RI, people who gained coverage under Medicaid who were previously ineligible, and people who signed up for Medicaid who were previously eligible but hadn’t yet signed up). She said recent signs that Republican-led repeal of the law could be pushed off are encouraging, but the concern is still there.
Lower premiums, stable insurance markets
Dr. Kathleen Hittner, insurance commissioner, told lawmakers that the law has worked to help reduce the cost of health insurance premiums in Rhode Island. That’s been driven in part by the commissioner’s ability to regulate premium increases and to negotiate rates for HealthSource RI. The difference, she said, between what health insurers asked for in terms of premium increases and what she approved adds up to about $220 million in savings for Rhode Islanders.
Hittner said repealing the law could destabilize insurance markets. That’s because without the law’s mandate that everyone carry insurance or pay a fine, healthier people might not buy insurance, leaving sicker patients to make up the bulk of the market. That would raise premiums. It’s the mix of healthy and sick people that makes insurance affordable, she said. The threat of a repeal is also causing, she said, uncertainty for health care providers, who may decide to hold off on investments in innovations currently funded by the Affordable Care Act.
However, Hittner said, Rhode Island does have several state laws in place that offer consumer protections covered by the Affordable Care Act. Rhode Island requires insurers to cover people with pre-existing conditions, to offer coverage for dependents up to age 26, and to cover mental health and substance abuse treatment, on par with medical treatment.
Public health programs
Health department director Dr. Nicole Alexander-Scott said Obamacare also includes $40 million over five years for public health programs in Rhode Island. Those include free cancer screenings, sex education, and tobacco prevention efforts, among others. If that money dries up, her hope, she said, is that the funds will still be available through the Centers for Disease Control and Prevention, although that’s uncertain.
Sen. Josh Miller asked state health officials whether offering a “public option,” or state-sponsored health insurance, is a possibility too offset the potential impacts of the repeal of the ACA. Officials said they felt the state could not afford to extend Medicaid-like insurance to everyone who might want to sign up.
Most Rhode Islanders receive health insurance through their employers; that coverage is not necessarily at risk. Although the ACA does mandate that employers with 50 employees or more offer insurance. A repeal could lift that mandate.
