'Full speed ahead' on health law in RI

PROVIDENCE, R.I. (WPRI) – Rhode Island officials say it's "full speed ahead" for the state in implementing President Obama's health care law locally after the U.S. Supreme Court upheld it as constitutional on Thursday morning.

"We now don't have anybody second-guessing where we're headed," Lt. Gov. Elizabeth Roberts, who is leading the law's implementation at Governor Chafee's request, told reporters at the State House.

"I think there was a lot of anxiety about how this law was going to be interpreted," she said. "I think a lot of us have been worrying so much because we believe so deeply in the purpose of this law."

Congressional Democrats passed the Patient Protection and Affordable Care Act in 2010. Rhode Island was already ahead of most states in putting together a new health insurance exchange, an online marketplace where consumers will be able to buy subsidized coverage, as the law requires starting in January 2014.

• Nesi: John Chafee laid the groundwork
• Q&A: Roberts on how RI is using the law
• In-Depth: The health care reform battle

"We are ahead of the game," said Steven Costantino, Chafee's secretary of health and human services. "I think this really validates our efforts and really secures what we're trying to do, and that's making health care affordable, having access, and it really changes the entire environment."

An estimated 120,000 Rhode Islanders don’t have health insurance, and officials say about 80,000 of them are expected to be eligible for some form of government-subsidized insurance when the law goes into full effect. Other sections of the law are regulatory changes, such as one allowing almost 8,000 Rhode Islanders to stay insured under their parents' policies until age 26.

The Kaiser Family Foundation estimates up to 53,841 more Rhode Islanders will enroll by 2019 in Medicaid, the program for low-income Americans, under the health law at a cost of $1.9 billion over five years. The state will pay $100 million of that and the federal government will cover the other $1.8 billion or so.

The Obama administration has awarded Rhode Island nearly $65 million so far to fund the technology behind the exchange, which Roberts likened to Amazon.com as an online one-stop shop where residents will be able to access any programs for which they're eligible, such as Medicaid and food stamps.

Christine Ferguson, a former senior health care aide to Mass. Gov. Mitt Romney and the late U.S. Sen. John Chafee, began work Monday as the first executive director of Rhode Island's exchange, which will begin enrolling eligible residents about 15 months from now.

"We are ahead of every other state in thinking these things through," Ferguson said. "A lot of the states have not even started." U.S. Sen. Jack Reed's office estimates Rhode Island has received a total of more than $145 million so far based on the health law's provisions.

Not everyone celebrated the 5-4 decision by U.S. Chief Justice John Roberts and the high court's four liberals. Bill Vernon, state director of the National Federation of Independent Business, called it a "tragedy."

"Rhode Island residents are now at the mercy of politicians from other states and bureaucrats in Washington whose decisions won’t be based on what is best for Rhode Island," Vernon said in a statement, blasting the law for imposing new "mandates, taxes and burdens."

Lt. Gov. Roberts disagreed, saying Congress structured the law so that many key decisions about its implementation will be made by state officials. "The accountability is going to be with us," she said. Costantino argued the law may contain costs by pushing fewer people who lack insurance into emergency rooms.

Ferguson said Chafee and Roberts have instructed her to focus specifically on making the new system easy for small businesses to use. The state estimated 73% of Rhode Island employers offer health insurance in 2011, with the average family plan premium costing $1,322 a month and the average individual plan premium costing $520.

Romney said Thursday he will move to repeal the health care reform law if he defeats Obama in the November election, leaving some doubt about whether it will still be in place in 2014. Roberts acknowledged the law itself remains unpopular even as polls show many of its provisions are widely supported.

"We have a public relations challenge in front of us to remind people this law is actually about direct benefits to people," she said. "It isn't the law itself, it is the political discussion of the law, that has failed us and our challenge is to help people understand how this law helps them."

Vincent Mor, a professor of health at Brown University, said many Americans don't understand how the law has affected them, but also warned it doesn't solve all the nation's health problems. "There is nothing in this law that has anything to do with cost containment, other than some provisions for Medicare," he said.

Judith Bentkover, a health economist at Brown, noted that 20% of private employment in Rhode Island is in health care and social services. "This [insurance] mandate now is going to bring more people into the system and increase the demand for health care workers which will help the Rhode Island economy," she said.

The Rhode Island Center for Freedom and Prosperity, a conservative think tank, said the state should abandon the new health insurance exchange and instead allow residents to purchase policies from providers in other states and let local insurers drop some of the benefits state law currently requires them to offer.

Blue Cross & Blue Shield of Rhode Island, the state's dominant health insurer, said state officials should continue "efforts to improve quality of care and reform the way providers are paid for health care services," citing new contracts it's now putting in place that pay doctors and hospitals based on quality of care rather than quantity.

The Rhode Island Hospital Association also expressed support. "Rhode Island has undertaken a collaborative effort ... to establish state mechanisms to implement health reform," Ed Quinlan, the association's president, said. "Hospitals will continue to serve as active participants in this important work."

Ted Nesi ( tnesi@wpri.com ) covers politics and the economy for WPRI.com and writes the Nesi's Notes blog. Follow him on Twitter: @tednesi