Today, November 15, 2010, the Rhode Island Public Expenditure Council (RIPEC) released a report reviewing the impact of federal health care reform on Rhode Island State and municipal governments.  The report also describes some of the key decisions the state will need to make as part of the implementation process. 

The Patient Protection and Affordable Care Act (PPACA), which became law in March 2010, includes significant changes to the way health care financing and delivery are administered in the United States.  The State of Rhode Island must implement many of the law’s provisions before 2014, including the expansion of Medicaid to people with incomes up to 133 percent of the Federal poverty level, as well as the creation of health exchanges for consumers to compare and purchase health insurance plans.  State and municipal governments must also adjust existing health care coverage for their employees to ensure minimum standards of coverage.  The decisions made by the state will not only affect existing health care programs such as RIte Care and RIte Share, but may also have a major impact on the way health care is administered, delivered and paid for in Rhode Island.  

RIPEC recommends that Governor-elect Lincoln Chafee, the General Assembly leadership and other elected state officials collaborate with key stakeholders and begin the planning process now.  By establishing a strategic vision of how health care in Rhode Island should be structured, administered and evaluated, policymakers can lay the groundwork for health care reform that best meets the needs of state residents.  The process may also serve as an opportunity to address long-term trends in health care, promote economic development and improve the competitiveness of our state.  Early planning will encourage smoother implementation and minimize disruption to Rhode Islanders while also strengthening the state’s position when applying for competitive federal grants in the coming years.   
Some of the questions the report raises include:

• Medicaid expansion – How will the State adapt existing programs to accommodate new enrollees starting in 2014, and what additional capabilities will state programs require to ensure that Federal mandates are being met?
• Creation of health care exchanges – Should the state operate its own exchange, and if so, who should administer it?  Which services should it provide to individuals and small businesses, and how should it be coordinated with both private insurance and existing state health care programs such as RIte Care and RIte Share?
• Changes to private health insurance – What must State and municipal governments do to ensure that their employee health plans comply with federal mandates?  Is the State prepared to implement federal mandates in the private insurance market with regard to eligibility, benefits and cost controls?
• Administration and oversight – What impact will federal health reform have on State and municipal budgets, and how can policymakers begin estimating future costs and savings?  Do existing State programs have the appropriate administrative structure, personnel and resources to implement the changes required under law?

The State has developed some innovative efforts to improve access to affordable health care for its residents, but it risks falling behind other states that have already begun PPACA implementation.  RIPEC encourages policymakers to use PPACA implementation as an opportunity to develop a long-term plan for health care in Rhode Island.