Rhode Island is a solid “blue” state, and leadership there has taken a proactive approach to healthcare reform. But a wide range of issues play a role in the overall health of a state’s residents. For Rhode Island residents, there are numerous factors that could impact health outcomes and that might be of interest in terms of the state’s approach to healthcare and healthcare reform. Here’s a summary:
Rhode Island health ratings
The Commonwealth Fund’s 2014 Scorecard on State Health System Performance rated Rhode Island 9th out of the 50 states and District of Columbia – down four spots from 5th in 2009, but still solidly in the top quartile of states. Rhode Island’s Scorecard includes details on how the ratings are calculated.
But the state didn’t fare quite as well with America’s Health Rankings, which placed Rhode Island 19th in the nation in 2013. Rhode Island’s rating is helped by the fact that the state has a low incidence of obesity (physical inactivity is also on the decline), high immunization rates, and readily available primary care physicians.
But the state has a high rate of drug deaths and preventable hospitalizations, and there’s also a significant disparity in health outcomes based on education level: nearly 58 percent of residents 25 or over with a high school education reported that their health was excellent or very good, versus just over 26 percent of those who had not completed high school.
Trust for America’s Health has also summarized information on the prevalence of various illnesses and health indicators in Rhode Island. The specifics are available in the 2014 listing of Key Health Data About Rhode Island.
Within the state, there are differences in health factors and outcomes from one county to another. You can see Rhode Island health data for the state’s five counties with this interactive map created by the Robert Wood Johnson Foundation.
Rhode Island and Obamacare
In 2010, Rhode Island’s U.S. Senators – Democrats John Reed and Sheldon Whitehouse – both voted yes on the ACA. In the U.S. House, both of the state’s Representatives were also Democrats – Patrick Kennedy and Jim Langevin – and voted yes.
Kennedy has since been replaced by another Democrat, David Cicilline, who is also supportive of the ACA and has stated that “protecting the programs created through the recent health care reform is one of [his] top priorities in congress.” Thus the entire U.S. congressional delegation from Rhode Island is Democratic and supportive of healthcare reform.
Rhode Island’s state legislature also has a very strong Democratic majority, and Democratic Governor Lincoln Chaffee is an ardent supporter of the law, “fully committed to ensuring that Rhode Island is a national leader in implementing health reform …” The state has been fully on-board with ACA implementation from the get-go, opting for a state-run exchange (HealthSource RI) and agreeing to expand Medicaid to cover all of the state’s legal residents with incomes up to 138 percent of poverty.
In late spring 2014, there was some talk in the legislature about switching to a federally-facilitated exchange in order to be more cost-effective, but that ultimately did not happen and the state is still running its own exchange heading into the 2015 open enrollment period.
How did the ACA help Rhode Island?
In 2013, about 13.3 percent of Rhode Island residents were uninsured. By mid-2014, six months after the bulk of the ACA was implemented, that number had fallen by four percentage points, to 9.3 percent.
The Rhode Island exchange enrolled about two and a half times as many people in expanded Medicaid than in private plans during the 2014 open enrollment period, so Medicaid expansion has played a key role in reducing the number of uninsured residents in the state.
Rhode Island enrollment in QHPs
The exchange in Rhode Island has just two carriers participating in 2014, but a third – United Healthcare – is joining the exchange for the 2015 open enrollment period that begins in November. Blue Cross Blue Shield of Rhode Island garnered the bulk of the exchange’s 2014 enrollees, and Neighborhood Health Plan of Rhode Island got just a small slice of the market.
But NHP is reducing its premiums for 2015, while BCBS will have a small premium increase. The increased competition from a third carrier and the rate changes may result in a bit more even distribution of enrollees across the carriers next year.
28,485 people had enrolled in private plans through the exchange by mid-April when the 2014 open enrollment period ended. In late 2013, the Kaiser Family Foundation estimated that 70,000 residents in Rhode Island would be potential customers for the exchange, and that 40,000 of them would be eligible for premium subsidies. So the state signed up about 40 percent of it’s potential enrollees in the first open enrollment period.
Rhode Island Medicaid/CHIP enrollment
Rhode Island’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has been a key factor in the state’s success with Obamacare. (The ACA provided for Medicaid expansion in all states, but in 2012 the Supreme Court ruled that states could opt out, and 22 states have thus far avoided any type of Medicaid expansion.)
In early 2014, the Kaiser Family Foundation estimated that about 43 percent of the 126,000 non-elderly uninsured residents in Rhode Island would be eligible for Medicaid or CHIP under the expanded eligibility guidelines created by the ACA. As of mid-April, 70,243 people had enrolled in Medicaid through the Rhode Island exchange. Enrollment in Medicaid continues year-round, so that number is still increasing, making an ever-growing dent in the state’s uninsured rate.
State-based health reform legislation
Here’s a summary of recent Rhode Island bills related to healthcare reform: