2009 Report Predicted Troubles with RI Health Exchange

2009 Report Predicted Troubles with RI Health Exchange

A 2009 healthcare consultant report by the Robert Wood Johnson Foundation predicted that the development of a full health insurance exchange in Rhode Island would not result in goals of "increased access and affordability."

See Report HERE

Now, five years later, one of the report authors says that she still does not believe a state based exchange in Rhode Island is viable, at a time when state officials are taking a closer look at the costs associated with maintaining HealthSource RI.

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"Personally, I do not think a state-based exchange can be sustainable in a state the size of Rhode Island and with so few carriers I am not sure that it offers a lot of value," said report author Amy Lischko, who was a key architect of former Massachusetts Governor Mitt Romney's 2005 health care reform legislation, and is currently an Associate Professor of Public Health at Tufts University. 

Consultants' Critical Look at State Exchange

The 2009 RWJF report was released after Lt. Governor Elizabeth Roberts' attempt in 2008 at establishing a state exchange -- "HealthHub RI" -- and prior to the passage of the federal Affordable Healthcare Act in 2010.

"The highest priority goal for HealthHub RI, as defined by stakeholders, was cost containment. Yet stakeholders agreed that implementing HealthHub RI would not, by itself, constrain the growth of health care costs in Rhode Island," wrote the report authors.

Roberts' Communications Director Maria Tocco pointed out that as the report was done prior to Obamacare, the federal legislation presented a new set of parameters for consideration.

"When the [ACA] laws hit, then we had the tools needed to build the exchange as identified in that report -- subsidies, mandate, and access to funding, so it completely changed the landscape," said Tocco.

One of the three report authors, Deb Faulkner with Rhode Island-based Faulkner Communications, was the project lead for the Affordable Health Insurance Initiative at the time of research, and currently counts HealthSource RI among her clients, along with Medicaid, and received $1.2 million in consulting vendor payments from the state in 2013. 

Old Report Raising New Questions

Mike Stenhouse with the Rhode Island Center for Freedom and Prosperity, who testified in front of the House Finance Committee on the proposal to move Rhode Island's health exchange to federal government control, questioned the current arguments for keeping the exchange in the state.

"This report shows that cost containment is not a viable goal, which is what [HealthSource RI]  talked primarily about the hearing," said Stenhouse.  "That's what they talked about for maintaining local control.  Based on this study - and empirical evidence from Massachusetts -- that's just a myth."

Josh Archambault with the Foundation for Government Accountability, who testified along with Stenhouse, spoke to his knowledge of the rollout in Massachusetts.

"I think its important that people look to [Massachusetts] as guidance as to what to expect under federal law," said Archambault.  "What I've learned -- and I spent years and years looking at the law -- is a couple of things.  The direct relevance to Rhode Island today is that the promises being made by the Rhode Island leadership at Healthsource aren't backed up by the example.  You can't expect dramatic impact with a statewide exchange of 28,000 people."

Archambault continued, "It's been very expensive to run an exchange here -- and it's still very expensive.  Massachusetts remains the most expensive state to purchase insurance in country."

Forecast for Rhode Island

"Rhode Island has been exploring options for containing health care costs for a number of years and reports such as the one you reference have informed the conversation," said Dara Chadwick, Chief of Strategic Communications at HealthSource RI.  "This conversation has changed over time based on state leadership, passage and implementation of the Affordable Care Act, and policy choices made by numerous healthcare stakeholders. HealthSource RI is an implementation of the policy decisions outlined in the strategic plan and Executive Order establishing the Exchange.

Stenhouse questioned why the findings of the RWJF report hadn't come to light until now -- but that he saw it as a start. 

"We are continuing to raise questions here," said Stenhouse.  "We're just now getting the debate and evaluation [the health exchange]  should have had in Rhode Island years ago."