Rhode Island is a solid “blue” state, and leadership there has taken a proactive, successful approach to healthcare reform. There is some concern over Obamacare’s future in the state, however, because President Trump and Republicans in Congress have promised to repeal the Affordable Care Act. House Republicans passed their American Health Care Act (AHCA) in May 2017, but the bill faces a very uncertain future.
HealthSourceRI director Zach Sherman has assured Rhode Islanders that the state’s health insurance exchange is prepared to react to federal changes. Rhode Island currently has one of the nation’s lowest uninsured rates, and has embraced the ACA — expanding Medicaid and establishing a state-run health insurance exchange.
Rhode Island health ratings
Rhode Island’s score was based on health indicators related to five measures: Access, Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity. Some of its highest marks were related to Access, including low percentages of uninsured adults and children, adults who went without a dental visit in the past year, and at-risk adults without a routine doctor visit in the past two years.
Rhode Island’s Scorecard includes more specific details on the state’s performance and details on how the ratings are calculated.
While the state didn’t fare quite as well with America’s Health Rankings, which placed Rhode Island 14th in the nation in 2016, it has been moving up those rankings in the past few years – it was 15th in 2014 and 19th in 2013.
Rhode Island’s rating is helped by the fact that the state has readily available primary care physicians, strong public health funding, and low uninsured rates. Disparity in health status is among its biggest public health challenges.
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 2016 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.
RI 2017 plans and enrollment
Three carriers offered Rhode Island exchange plans in 2016; however, UnitedHealthcare announced its exit from the state’s individual market at year-end.
As such, HealthSource RI offers plans from two carriers in 2017: Blue Cross Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island. Both carriers had the bulk of the market share in 2016 – 47 percent and 49 percent, respectively. That means United’s departure had only a minor impact.
In August, the Rhode Island Office of the Health Insurance Commissioner announced final approved rate changes for 2017. The approved, weighted average rate change per carrier was lower than each had proposed:
- Blue Cross Blue Shield of Rhode Island: 9 percent increase
- Neighborhood Health Plan of Rhode Island: 9 percent decrease
In Rhode Island’s individual market, the final weighted average increase for 2017 was 1.3 percent (if we only consider Health Source RI, and not off-exchange plans, average rates were 0.6 percent lower for 2017, which is dramatically different from most of the country, where rates tended to spike in 2017). Rhode Island is one of three states in which people can enroll as late as the 23rd of the month and still obtain coverage for the following month; in most states, the deadline is the 15th.
29,456 people enrolled in private plans (QHPs) through Health Source RI during the 2017 open enrollment period.
How has the ACA helped Rhode Island?
With a state-based health insurance exchange (HealthSource RI) and Medicaid expansion, Rhode Island has fully embraced the Affordable Care Act. And, the healthcare reform law has been quite effective for the state. Rhode Island has seen the ninth largest reduction in percentage of residents without health insurance since 2013 and now has one of the nation’s lowest uninsured rates.
In 2013, about 13.3 percent of Rhode Island residents were uninsured. By late 2016, that number had plummeted 7.7 percentage points to 5.6 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 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.
Rhode Island’s exchange enrollment grew about 10 percent from 2015 to 2016; 76 percent of enrollees were returning to the exchange, but 7,358 were new. When 2016 open enrollment ended on January 1, there were 34,670 people enrolled in private plans through HealthSource RI; that’s 70 percent of those determined eligible to enroll in a marketplace plan. As of March 31, 84.4 percent of Rhode Island exchange enrollees were receiving premium subsidies that averaged $250 per month.
This success came despite the fact that HealthSource RI’s advertising budget was cut by 80 percent compared with 2015.
Exchange enrollment in 2017 was lower than it had been the year before. A total of 29,456 people enrolled in private plans through Health Source RI during the 2017 open enrollment period.
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 the exchange.
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 19 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 February 2017, the state’s Medicaid enrollment increased 61 percent – more than double the national average of 30 percent.
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 203,289 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.
82 percent of Medicare beneficiaries in Rhode Island qualify based on their age, while the other 18 percent qualify for Medicare as the result of a disability.
Medicare spends about $8,486 per Rhode Island enrollee each year, which is just below the national average of $8,970 per enrollee spending. As of 2009, Rhode Island ranked 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 31 percent of Medicare enrollees have Medicare Advantage plans instead of traditional Medicare coverage.
State-based health reform legislation
Here’s a look at state-level health reform bills in Rhode Island: