Rhode Island’s health care path cloudy
Whatever the Supreme Court decides on President Obama’s health care plan, Rhode Island plans to forge ahead with a state program. RIPR political analyst Scott MacKay says things could get even more complicated.
It seems that the joust over health care, like the uninsured poor, has always been with us. Since Harry Truman’s era, federal and state governments have had tortuous debates over the shape of our health care system.
Whatever the court decides will affect the delivery of medical care from California to our tiny slice of southeastern New England.
Rhode Island is taking the first steps toward setting up a new marketplace to buy health insurance. But as our local state’s health care guru, Lt. Gov. Elizabeth Roberts says, little in this muddy debate will become clear until we know the outcome of both a high court decision and the federal elections.
The reason: This issue splits conservatives and liberals like none other. Some liberals are never going to be satisfied with anything less than a single-payer, Canadian-style government run health regimen. And many conservatives want nothing les than removal of the government from the medical industry, which makes up one-sixth of the American economy.
Rhode Island has about 120,000 uninsured adults who would likely be eligible for coverage if the president’s plan survives. But repeal of either of two hot button provisions could endanger our state’s efforts to extend health coverage to the uninsured. The first is the so-called `individual mandate’, which requires people to buy health insurance or get it from their employer. The second is the millions in federal dollars that are targeted to help insure those too poor to afford coverage.
So far, Massachusetts is the only state to establish a plan like President Obama’s. It has not been without problems, but for the most part it has worked well, especially in providing coverage to those who didn’t have it. Opponents of the mandate peddled a fear in Massachusetts that has not been realized: That employers, rather than offer coverage, would choose to pay the state penalties and let low-income workers get coverage through the subsidy plan. In reality the number of Massachusetts employees who get coverage from their employer has increased from 70 percent to 77 percent.
The Massachusetts plan has relied on the individual mandate and hefty subsidies from state and federal governments. And is it only beginning to stabilize insurance prices in a state with some of the nation’s highest medical costs. But then again, other states, private insurers and the federal health programs – including Medicare and Medicaid – have not been able to stanch medical inflation either. (Costs are increasing more slowly among the government programs than with private insurers).
Republicans, most famously Mitt Romney and former Rhode Island Sen. John Chafee, our governor’s father, once supported the individual mandate as a paragon of personal responsibility. If you get sick, goes this theory, you have the responsibility to be insured. Under federal law, hospitals must treat the sick, so if you go to an emergency room after an accident, you get treated. If you aren’t insured or can’t pay, your treatment is borne by the taxpayer in the form of uncompensated care reimbursements to hospitals. Or it is shifted in inflated costs to other hospital patients who pay for insurance or get it from employers.
Nowadays, Republicans, even Romney, father of the Massachusetts program, are against any national plan that requires people to buy health coverage. Congressional Republicans pledge to repeal the president’s plan, which means the fate of both the mandate and the federal subsidies rest with voters this November. The reigning Tea Party attitude seems to be that individuals should be able to buy whatever coverage they believe they need, if any, rather than what the government says they need. And some on the conservative side even want to privatize Medicare, the popular program that covers the elderly.
Conservatives lambaste Obamacare as socialized medicine, but it is difficult to see how Karl Marx would approve of a medical system that relies heavily on private and even for-profit insurers.
Rhode Island faces many challenges, but things would be much easier if so-called Obamacare survives the court and the elections. Our state has already harvested more than $60 million in federal money to help set up a new insurance marketplace. This would also give Rhode Island an opportunity to stabilize the soaring cost of medical care, says Governor Lincoln Chafee, a supporter of the president’s model.
Without Obamacare, Rhode Island will probably be left behind in any program to overhaul delivery of medical care. Our state’s economy is not nearly as robust as Massachusetts and one can’t envision the General Assembly raising taxes to support an extension of health insurance to the poor. A state with communities on the brink of bankruptcy and lawmakers unwilling to raise taxes to pay for schools and road repairs just can’t afford a big new health program.
Scott MacKay’s commentary can be heard every Monday on Morning Edition at 6:40 and 8:40. You can also follow his political reporting and analysis at the `On Politics’ blog at RIPR.org.