The State Senate has a 25-bill prescription.
By Nancy Lavin, Rhode Island Current
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But the acronym given to the tranche of health care bills laid out by state senators on Tuesday is simple, and easy to remember: the Rhode Island HEALTH Initiative (Holistic Enhancement and Access Legislation for Total Health).
“It is essential as a state that we focus on ensuring the strength of our community hospitals, attracting and retaining primary care physicians and making sure Rhode Islanders can access quality and affordable health care,” Senate President Dominick Ruggerio said, speaking at a press conference at the Rhode Island State House on Tuesday.
The 25-bill package of reforms is not a magic cure for what ails the state health care industry, Senate Majority Ryan Pearson, a Cumberland Democrat, cautioned. Instead, he framed the set of bills as an initial treatment in four key problem areas: consumer protection, workforce shortages, patient costs and the financial stability of the health care system as a whole.
The focus of the legislation is no surprise; lawmakers, health care officials and community advocates have decried crippling workforce shortages that leave patients waiting for hours in hospital emergency rooms or struggling to find doctors, therapists and dentists for routine checkups and procedures. Meanwhile, the state’s health care workforce continues to flounder after a mass exodus during the pandemic, worsened by uncompetitive pay compared with neighboring states.
And the state’s hospital system remains on shaky ground after years of budget deficits and several failed merger attempts. A new proposal under review would sell two hospitals, Roger Williams Medical Center and Our Lady of Fatima Hospital, to an Atlanta-based nonprofit.
The Senate package deliberately steers clear of hospital sales and merger, which are left up to the Attorney General and state health department to review.
“We felt they have the power they need already,” Pearson said in an interview after the press conference. “We wanted to focus on other areas to make the system stronger.”
That includes deciding how to spend state and federal money as part of the fiscal 2025 budget.
Most of the bills within the package do not include a projected cost. Two exceptions are bills both sponsored by Sen. Pam Lauria, a Barrington Democrat and primary care nurse practitioner, which would help recruit new primary care workers.
A $2.7 million allocation in fiscal 2025, with funding in subsequent years to be determined by the General Assembly, would establish a new office within the Rhode Island Department of Health to create and oversee 30 new clinical training sites where physician residents, physician assistant students and nurse practitioners could hone their skills.
A second bill proposes spending $3.6 million — broken into $875,000 chunks over the next four years — to create a scholarship program, giving up to $70,000 a year to students in medical school or studying to be nurse practitioners or physician assistants. Scholarship recipients must work in Rhode Island in primary health care for twice as long as the duration of the scholarship; a medical school student who receives the maximum four-year scholarship must remain in Rhode Island for eight years, for example.
“A shortage of providers across all facets of the health system is an especially urgent concern, and while that starts with primary care, it extends to nurses, specialists, counselors, and beyond,” Lauria said. “To truly ensure everyone has access to quality care, we must have enough providers to meet our needs.”
Multi-state licensure, medical debt relief among priorities
A slew of other bills aim to recruit and retain new health care workers, including five separate interstate compacts that would allow Rhode Island residents to access services and providers of out-of-state licensed, social workers, mental health workers, audiology and speech-language pathology specialists, physician assistants and occupational therapists.
Inextricably linked to the conversation over shortages is the uncompetitive pay that makes health care workers opt for jobs in other states with better reimbursement rates.
Gov. Dan McKee’s proposed fiscal 2025 spending plan included $135 million of state and federal funding to increase rates for certain Medicaid providers, those who work in certified community behavioral health clinics and providers who care for infants and toddlers with developmental disabilities.
However, the budget proposal spreads out the full rate hikes recommended for Medicaid service providers over three years, rather than the shorter timelines recommended by the Rhode Island Office of the Health Insurance Commissioner (OHIC) and Rhode Island Executive Office of Health and Human Services. The proposed rate hike also does not extend to primary care doctors, which have not yet been studied under OHIC’s biennial review.
Other bills within the package offer more potential solutions to the provider rate problem: mandating OHIC to expand its biennial review to include primary care rates, and to look more closely at parity of premiums and rates between Rhode Island, Connecticut and Massachusetts.
Another tranche of bills tackle finances from the patient point-of-view, aiming to regulate and potentially lower costs for prescription drugs, expand insurance coverage to include ambulance services, and put guardrails on medical debt, including wiping out large sums of overdue health bills for low-income Rhode Islanders.
The legislation sponsored by Sen. Mark McKenney, a Warwick Democrat, authorizes the state to spend an unspecified amount of leftover federal pandemic aid to pay off medical debt for low-income Rhode Islanders for “pennies on the dollar,” leveraging bulk buying power.
To be eligible, residents must have outstanding medical payments equal to at least 5% of their annual income, and at least $600 in debt, or have household income below 400% of the federal poverty level — $60,240 for one-person in 2024.
In a nod to the bipartisan support for health care reform among lawmakers, the package also includes one bill sponsored by Senate Minority Leader Jessica de la Cruz, a North Smithfield Republican. De la Cruz’s bill, inspired in part by the lack of clarity on hospital bills she received after giving birth to her children, would require hospitals to publish a consumer-friendly list of “shoppable services,” including prices, along with a machine-readable version.
De la Cruz is the only Senate Republican sponsoring legislation within the package, although she said other Republican senators had proposals that did not make the final cut.
“The health care crisis is a serious issue and one that has bipartisan attention,” she said.
Including the attention of top State House leaders outside the Senate.
Olivia DaRocha, a spokesperson for McKee’s office, said in an email Tuesday that the governor’s office “look forward” to reviewing the package.
“Ensuring better health outcomes for all Rhode Islanders is one of Governor’s McKee’s three top priorities for our state,” DaRocha said. She referenced the money included in the proposed fiscal 2025 budget for reimbursement rates and nursing homes, as well as an executive order inked in February creating an interdepartmental health care planning cabinet.
“We’re ready to work with stakeholders and our partners in the General Assembly to address the challenges facing Rhode Island’s health care system head on,” DaRocha said.
House Speaker K. Joseph Shekarchi said in an emailed statement the Rhode Island House will give “careful consideration” to the legislation after it is reviewed and approved by the Senate.
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