PROVIDENCE – On Tuesday, November 26, the Rhode Island Public Expenditure Council (RIPEC) released “HealthSource RI: Status Updates.” The report describes HealthSource RI (HSRI), compares HSRI’s rates and deductibles in the individual/family marketplace to exchanges in other New England states, explores exchange funding mechanisms, and offers areas for consideration. HSRI is central to the Affordable Care Act’s (ACA) goal of expanding health insurance coverage by reforming the individual and business insurance marketplace. How Rhode Island chooses to address unresolved details related to HSRI, such as sustainable financing, its codification into law, and the distribution of HSRI enrollment numbers will go a long way toward determining how affordable and accessible health insurance will be under the ACA for Rhode Islanders in the short- and long-term.
Despite national delays of the employer mandate and out-of-pocket maximums, Rhode Island opened the two components of its exchange, the individual/family marketplace and its Small Business Health Options marketplace (SHOP), without delay and with minimal technical malfunctions. A comparison of HSRI’s premium rates and deductibles for health insurance plans within HSRI and in other New England states suggests that Rhode Island’s premium rates within the family/individual marketplace are among the lowest in New England (second-lowest to New Hampshire), and its deductibles are among the highest in the region. For instance, Rhode Island’s Silver plan deductibles average $2,900, the second-highest in New England, below Connecticut ($3,000) and above Maine ($2,617). In addition to these relatively lower rates and higher deductibles, Rhode Island is one of seven states offering full employee choice among all plans, carriers, and categories, to employees within SHOP.
Key decisions directly impacting HRSI’s functionality and accessibility have yet to be made. As the 2014 legislative session approaches, both codification of HSRI into law and sustainable funding of the exchange will be of immediate concern, as federal funding ends in 2015. While HSRI is currently a public entity incorporated into the Department of Administration, codifying the exchange into law through legislative action is likely necessary, as the legal ability of the governor to create a revenue source for exchange maintenance through executive order has yet to be determined. Rhode Island should evaluate potential exchange organizational structures within state government. Additionally, Rhode Island should consider the implications of all possible exchange funding options for making HSRI financially sustainable by 2015.
Policymakers should also consider the implications of extending SHOP eligibility to businesses with 50-100 employees before federal law requires it in 2016, as the potential consequences of this decision could be mixed. Further, publicly articulating intended outcomes with specified outcome measures will mark a crucial step in HSRI’s progress. Lastly, evaluating the distribution of HSRI’s enrollment numbers (3,213, or 72.9 percent, enrolling in Medicaid compared to 1,192, or 27.0 percent, enrolling for private insurance through HSRI) in terms of its potential state fiscal implications will help the public and HSRI leaders gauge HSRI’s success (as increased Medicaid enrollment among those previously-eligible will likely increase total state Medicaid costs).