Gencarella: Is RI On A Path To Socialized HealthCare?
Pam Gencarella, GoLocalProv MINDSETTER™
Gencarella: Is RI On A Path To Socialized HealthCare?
When Governors make their appointments, let’s face it, sometimes it’s to pay back supporters. Many think the Laborer’s International Union official, Alviti, was tapped to be the director of DOT in support of the construction trade unions. Other times, appointments actually bring expertise to an area the Governor wants to reform or in which they want to push forward an agenda. While it is not clear where the Governor’s Commissioner of Education appointment of Dr. Wagner will fall, there are those who see him as a reformer and those who see him as a collaborator so it could be a win-win for everyone.
Then there is the appointment of Anya Rader Wallack as Executive Director of RI’s Health Insurance Exchange. According to healthinsurance.org, Wallack was very instrumental in the push for single-payer (socialized) healthcare in Vermont. According to the VT Digger Wallack was instrumental in actually crafting Act 48, first-in-the-nation-legislation that established a health insurance exchange, provided for universal healthcare coverage and provided a path to a single payer system. Subsequently, Wallack helped Vermont Governor Shumlin develop his single payer proposal. Curiously enough, she was chair of the Vermont Healthcare Innovation Project. The purpose of this project was, and continues to be, to change how medical services are delivered and how they are paid by moving away from fee-for-service to a system that compensates providers based on health outcomes. Wallack noted that payment and delivery reform has always been central to Governor Shumlin’s health reform agenda.
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So let’s look back at our Governor. Many people have said that they hadn’t expected her to be so ideologically similar to former Governor Chafee. They see now that she is not willing to cut government spending, particularly where there is known fraud, waste and abuse. But yet, not only is she willing to tax people more, she is willing to come up with new and creative ways to do so, like the new state property tax she proposed, the new fees to pay for the insurance exchange, and her proposed new system of tolling large trucks. Her actions appear to be much more liberal than her public campaign had indicated. The one area in which she has proposed a reduction in spending is Medicaid, but those cuts are not through reductions from rooting out fraud, waste and abuse. Rather, the reductions come from reduced reimbursements to providers. The Governor is implementing many new regulations in an effort to move away from fee-for-service to a system that compensates providers based on health outcomes. Sounds like what Ms. Wallack and the Vermont government were doing on the road to a single payer system.
Governor Raimondo’s Implied Position On Healthcare Parallel’s Some In The General Assembly.
What can we infer from the Governor’s appointment of a woman whose mission has been to implement socialized healthcare? Perhaps that the Governor would like to put RI on the path to socialized healthcare? And when we consider that the RI General Assembly has already begun to introduce legislation that would support socialized healthcare, we as taxpayers should be very concerned.
Last year, H 7819 was introduced. This legislation would have created a RI Healthcare Authority that proposed to aggregate all funding - private insurance dollars, self-funding insurance dollars, Medicaid dollars and Medicare dollars (requiring a state innovation waiver from the federal government for the federal funds) - and place these funds in the hands of state government. This legislation would have mandated that all health insurance, private or government subsidized, be purchased through the Health Insurance Exchange. That means everyone in RI would buy through the state.
H 7819 would also have created annual global spending targets, thereby requiring a mechanism for rationing healthcare. The bill would have established the types of benefits insureds would receive and it would have created a “coordinated health planning and affordability council" (which sounds like a lot of government interference).
Some in RI might see this as the next positive progressive step while others would see it as a government takeover of our personal healthcare. Clearly, the state would be managing our healthcare dollars and ultimately our medical decisions.
It’s Not Just An Isolated Piece of Legislation.
As a result of the 2014 elections, the General Assembly had new players this session and some of them have the same visions for socialized healthcare. This year’s version (H 5387) called it RICHIP, RI Comprehensive Health Insurance Program. A catchy acronym, but it creates a socialized healthcare system as well. And, so as not to appear too over-zealous, S 619 provided for a carve-out of the healthcare market, socialized healthcare for just the primary and preventative healthcare markets.
It’s Not Uncharted Territory.
The parallels between the above pieces of legislation and the Vermont legislation are frightening. According to the website ‘Vermonters for Health Care Freedom,' Vermonters would not be able to purchase health insurance outside the Vermont Insurance Exchange. An appointed board would determine benefits, coverage, funding, deductibles, co-pays, premiums, technology, and provider payments. Additionally, Governor Shumlin is in the process of pursuing the waiver needed to take over control of the federal Medicare dollars.
The First Step To Single Payer?
In other similarities, Vermont is also having a problem paying for their expanded Medicaid. That expansion was set in motion by the Vermont Governor to pave the way for his single payer system. Now Vermont must come up with a way to pay for the cost of expanded Medicaid as it runs over budget and is expected to produce a deficit of $40 million in 2017. Former Governor Chafee happily agreed to expand Medicaid in RI without knowing how he would pay for it and also without having any idea as to how many more people would sign up. Now Rhode Islanders are left holding the bag. Was this the first step toward forcing provider reimbursement reform and toward supporting the false narrative for a single payer system?
Socialized Healthcare in Vermont Crashes And Burns.
Late last year, Governor Shumlin and Ms. Wallack’s dream of socialized healthcare died when the reality set in. According to the Boston Globe, the cost of providing this government-run, single payer system was not high, it was astronomical. A financial report on the proposed government-run program showed the cost of the program would nearly double the size of the state’s budget in the first year alone - that’s the entire state budget. OUCH! But at least Governor Shumlin recognized that the program should be scrapped based on the damage it would inflict on the Vermont economy. Given our government’s history, do you expect that RI elected officials would scrap a plan simply based on its high cost? Or would you expect that they would move full steam ahead and create new funding streams?
Is It About To Take Off In RI?
Governor Raimondo has said they need a leader who can establish HealthSourceRI as a sustainable and affordable organization that provides clear return-on-investment to RI families and employers. With a cost of $30 million a year to maintain the Health Insurance Exchange, Raimondo began taxing all insured people, not just those utilizing the exchange. The current assessments will not cover the entire cost of the exchange in the future. Will moving to a single payer system, one that mandates that all health insurance dollars flow through the exchange, be her answer to the return-on-investment question?
In a July 20, 2015 press release, Raimondo said that “the state’s focus on healthcare innovation will draw on recommendations offered by a group of healthcare stakeholders that Senator Whitehouse and RI Foundation President Neil Steinberg convened ….”. As taxpayers, we need to look behind the curtain; it’s not really the great and powerful Oz behind it. Remember that Neil Steinberg helped bring us the liberal program - RhodeMap RI and Senator Whitehouse is in full support of universal (socialized) healthcare.
We also need to remember that these work groups that are “convened”, in the end, bare little resemblance to the ideas bantered back and forth, but rather reflect a predetermined outcome that fits nicely with the Governor’s agenda. Consider that (then-Treasurer) Raimondo’s pension group was “convened” and produced the pension reform law and Chafee’s State Planning Department’s Economic Development tour that was “convened” produced the Regional Plan for Sustainable Development - RhodeMap RI.
Recently, the Boston Globe went so far as to say that if a liberal state like Vermont, electing a Socialist like US Senator Bernie Sanders, can’t put socialized medicine on the map, then who will? We just hope the answer is not Governor Raimondo and her newly appointed Executive Director, Anya Wallack, who has seemingly left Vermont to try, try again.
