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Rhode Island health insurance

Ocean State boasts nation's lowest uninsured rate

Rhode Island is a solid “blue” state, and leadership there has taken a proactive approach to healthcare reform, and with wild success.

Yet, 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 5th out of the 50 states and District of Columbia – up four spots from 5th in 2014. 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 15th in the nation in 2014, but it improved from 19th in 2013. Rhode Island’s rating is helped by the fact that the state has readily available primary care physicians, a low incidence of obesity (physical inactivity is also on the decline), and high immunization rates.

Rhode Island struggles with 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 2015 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.

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. Former Gov. Lincoln Chaffee, a Democrat, was an ardent supporter of the law, “fully committed to ensuring that Rhode Island is a national leader in implementing health reform …” Chaffee has since been replaced by Gov. Gina Raimondo, a Democrat who took office in 2015 and is strongly invested in healthcare 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

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. One year later, months after 2015 open enrollment, the uninsured rate plummeted nearly 80 percent from 2013 to 2.7 percent – the nation’s lowest uninsured rate.

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 qualified health plans

Following the first Obamacare open enrollment period, 28,485 people had enrolled in qualified health plans through Rhode Island’s exchange. 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 its potential enrollees in the first open enrollment period.

By the end of 2015 open enrollment, 31,337 Rhode Islanders had enrolled in QHPs through HealthSource RI. Thirty-two percent of them were new customers. By June 30, 2015, the effectuated enrollment was 32,451.

Rhode Island’s exchange started with just two carriers in 2014 and added a third, United Healthcare of New England, in 2015. For 2016 open enrollment, three carriers will offer health plans through Rhode Island’s exchange:

  • United Healthcare of New England
  • Neighborhood Health Plan of RI
  • Blue Crosse and Blue Shield of Rhode Island

2016 rates had been finalized in August, but the RI Attorney General took Rhode Island Insurance Commissioner Kathleen Hittner to court over them, and the case has yet to be settled.

Starting with 2016 open enrollment, an assessment fee will be applied to plans sold through HealthSource RI. They average out to be 2.86 percent for individuals and 0.59 percent for small groups.

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 20 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 2014, Rhode Island’s exchange-based Medicaid enrollment was 70,243. From 2013, before Medicaid expansion took effect, to August 2015, the state’s Medicaid enrollment increased 44 percent – the 9th highest change in the country.

Enrollment in Medicaid continues year-round, so numbers are still increasing, making an ever-growing dent in the state’s uninsured rate.

Medicare enrollment in the state of Rhode Island

Rhode Island Medicare enrollment reached 202,202 in 2015, which is about 19 percent of the state’s population. As such, Medicare enrollment in the state is slightly higher than the percentage of the national population enrolled: 17 percent.

80 percent of Medicare beneficiaries in Rhode Island qualify based on their age, while the other 20 percent are on Medicare as the result of a disability.

Medicare spends about $10,120 per Rhode Island enrollee each year. It is among about 20 states that spend $10,000 or more. However, Rhode Island ranks 41st in terms of overall Medicare spending with $1.8 billion per year.

Those eligible for Medicare in Rhode Island can select a Medicare Advantage plan instead of Original Medicare if they want additional benefits, and about 35 percent have done so. Nationwide, about 32 percent of Medicare enrollees have Medicare Advantage plans instead of traditional Medicare coverage.

Rhode Island’s Medicare enrollees can also select Medicare Part D. About 40 percent have one of these stand-alone prescription drug plans, compared with 43 percent of the U.S. population.

State-based health reform legislation

Here’s a look at state-level health reform bills in Rhode Island: