2021 -- H 5019

========

LC000016

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

____________

J O I N T   R E S O L U T I O N

CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY AND ASSESS THE

IMPLEMENTATION OF AN IMPROVED MEDICARE-FOR-ALL-TYPE SINGLE PAYER

PROGRAM IN THE STATE OF RHODE ISLAND

     

     Introduced By: Representatives Lombardi, Potter, and Morales

     Date Introduced: January 13, 2021

     Referred To: House Health, Education & Welfare

1

     WHEREAS, Health care is a human right, not a commodity available only to those who

2

can afford it; and

3

     WHEREAS, Although the federal Affordable Care Act (ACA) allowed states to offer

4

more people taxpayer-subsidized private health insurance, the ACA has not provided universal,

5

comprehensive, affordable coverage for all Rhode Islanders; and

6

     WHEREAS, In 2019, about 4.3 percent of Rhode Islanders (43,000), had no health

7

insurance, causing about 43 (1 per 1,000 uninsured) unnecessary deaths each year; and

8

     WHEREAS, An estimated 45 percent of Rhode Islanders (450,000) are under-insured

9

(e.g., not seeking health care because of high deductibles and co-pays); and

10

     WHEREAS, COVID-19 exacerbated and highlighted problems with the status quo health

11

insurance system including:

12

     • Coverage is too easily lost when health insurance is tied to jobs - between February and

13

May, 2020, about 21,000 more Rhode Islanders lost their jobs and their health insurance;

14

     • Systemic racism is reinforced - Black and Hispanic/Latinx Rhode Islanders, more likely

15

to be uninsured or underinsured, have suffered the highest rates of COVID-19 mortality and

16

morbidity; and

17

     • The fear of out-of-pocket costs for the uninsured and underinsured puts everyone at risk

18

because they avoid testing and treatment; and

19

     WHEREAS, The existing U.S. health insurance system has failed to control the cost of

 

1

health care and to provide universal access to health care in a system which is widely accepted to

2

waste 30 percent of its revenues on activities that do not improve the health of Americans; and

3

     WHEREAS, Every industrialized nation in the world, except the United States, offers

4

universal health care to its citizens and enjoys better health outcomes for less than two-thirds to

5

one-half the cost; and

6

     WHEREAS, Health care is rationed under our current multi-payer system, despite the

7

fact that Rhode Island patients, businesses and taxpayers already pay enough money to have

8

comprehensive and universal health insurance under a single-payer system; and

9

     WHEREAS, About one-third of every “health care” dollar spent in the U.S. is wasted on

10

unnecessary administrative costs and excessive pharmaceutical company profits due to laws

11

preventing Medicare from negotiating prices and private health insurance companies lacking

12

adequate market share to effectively negotiate prices; and

13

     WHEREAS, Private health insurance companies are incentivized to let the cost of health

14

care rise because higher costs require health insurance companies to charge higher health

15

insurance premiums, increasing companies’ revenue and stock price; and

16

     WHEREAS, The health care marketplace is not an efficient market and because it

17

represents only 18 percent of the U.S. domestic market, and significantly restricts economic

18

growth, thus the financial well-being of every American, including every Rhode Islander; and

19

     WHEREAS, Rhode Islanders cannot afford to keep the current multi-payer health

20

insurance system:

21

     • Between 1991 and 2014, health care spending in Rhode Island per person rose by over

22

250 percent rising much faster than income and greatly reducing disposable income;

23

     • It is estimated that by 2025, the cost of health insurance for an average family of four

24

will equal about one-half of their annual income; and

25

     • In the U.S., about two-thirds of personal bankruptcies are medical cost-related and of

26

these, about three-fourths had health insurance at the onset of their medical problems - in no other

27

industrialized country do people worry about going bankrupt over medical costs; and

28

     WHEREAS, Rhode Island private businesses bear most of the costs of employee health

29

insurance coverage and spend significant time and money choosing from a confusing array of

30

increasingly expensive plans which do not provide comprehensive coverage; and

31

     WHEREAS, Rhode Island employees and retirees lose significant wages and pensions as

32

they are forced to pay higher amounts of health insurance and health care costs; and

33

     WHEREAS, Rhode Island’s hospitals are under increasing financial distress – i.e.,

34

closing, sold to out-of-state entities, attempting mergers – largely due to health insurance

 

LC000016 - Page 2 of 6

1

reimbursement problems that other nations do not face and are fixed by a single payer system;

2

and

3

     WHEREAS, The state and its municipalities face enormous other post-employment

4

benefits (OPEB) unfunded liabilities due mostly to health insurance costs; and

5

     WHEREAS, The high costs of medical care could be lowered significantly if the state

6

could negotiate on behalf of all its residents for bulk purchasing, as well as gain access to usage

7

and price information currently kept confidential by private health insurers as "proprietary

8

information"; and

9

     WHEREAS, Single payer health care would establish a true "free market" system where

10

doctors compete for patients rather than health insurance companies dictating which patients are

11

able to see which doctors and setting reimbursement rates; and

12

     WHEREAS, Health care providers would spend significantly less time with

13

administrative work caused by multiple health insurance company requirements and barriers to

14

care delivery and would spend significantly less for overhead costs because of streamlined

15

billing; and

16

     WHEREAS, A single payer program would, based on the performance of existing

17

Medicare, eliminate 50 percent of the administrative waste in the current system of private

18

insurance before other savings achieved through meaningful negotiation of prices and other

19

savings are considered; and

20

     WHEREAS, Legislation has been proposed since 2015 to establish a single payer

21

program for the state, including a funding mechanism, and this legislation has been "held for

22

further study" each year; and

23

     WHEREAS, In 1962, Canada's successful single payer program began in the province of

24

Saskatchewan (with approximately the same population as Rhode Island) and became a national

25

program within ten years; and

26

     WHEREAS, The proposed Rhode Island single payer program was studied by Professor

27

Gerald Friedman at UMass Amherst in 2015 and he concluded that:

28

     • “Single payer in Rhode Island will finance medical care with substantial savings

29

compared with the existing multi-payer system of public and private insurers and would improve

30

access to health care by extending coverage to the 4 percent of Rhode Island residents still

31

without insurance under the Affordable Care Act and expanding coverage for the growing

32

number with inadequate health care coverage; and

33

     • Single payer would improve the economic health of Rhode Island by increasing real

34

disposable income for most residents, reducing the burden of health care on businesses and

 

LC000016 - Page 3 of 6

1

promoting increased employment, and shifting the costs of health care away from working and

2

middle-class residents"; now, therefore be it

3

     RESOLVED, That a special legislative commission be and the same is hereby created

4

consisting of nineteen (19) members: two (2) of whom shall be physicians who are board certified

5

in their fields and primary care providers, one of whom shall be appointed by the President of the

6

Senate and one of whom shall be appointed by the Speaker of the House; two (2) of whom shall

7

be representatives of the community who represent diverse populations (e.g., minorities), one of

8

whom shall be appointed by the President of the Senate and one of whom shall be appointed by

9

the Speaker of the House; two (2) of whom shall be university professors of economics familiar

10

with health care finance, one of whom shall be appointed by the President of the Senate and one

11

of whom shall be appointed by the Speaker of the House; one of whom shall be the Medicaid

12

Director of the Rhode Island Executive Office of Health and Human Services, or designee; one of

13

whom shall be the Director of the Department of Behavioral Healthcare, Developmental

14

Disabilities, and Hospitals of the Rhode Island Executive Office of Health and Human Services,

15

or designee; one of whom shall be the Executive Director of the Rhode Island Dental Association,

16

or designee; one of whom shall be the President of the Rhode Island Chapter of Physicians for a

17

National Health Program, or designee; one of whom shall be the Executive Director of the Rhode

18

Island State Nurses Association, or designee; one of whom shall be the President of the Hospital

19

Association of Rhode Island, or designee; one of whom shall be the President of the Mental

20

Health Association of Rhode Island, or designee; one of whom shall be the Dean of the Brown

21

School of Public Health, or designee; one of whom shall be the Dean of the URI College of

22

Pharmacy, or designee; two (2) of whom shall be representatives of organized labor, one of

23

whom shall be appointed by the President of the Senate and one of whom shall be appointed by

24

the Speaker of the House; and two (2) of whom shall be representatives of Rhode Island

25

businesses, one of which is a business that employs less than fifty people and one of which

26

employs more than fifty people, one of whom shall be appointed by the President of the Senate

27

and one of whom shall be appointed by the Speaker of the House.

28

     The purpose of said commission shall be to make a comprehensive study to determine the

29

pros and cons of implementing a single payer program in Rhode Island.

30

     Vacancies in said commission shall be filled in like manner as the original appointment.

31

     The membership of said commission shall receive no compensation for their services.

32

     All departments and agencies of the state shall furnish such advice and information,

33

documentary and otherwise, to said commission and its agents as is deemed necessary or

34

desirable by the commission to facilitate the purposes of this resolution.

 

LC000016 - Page 4 of 6

1

     The Joint Committee on Legislative Services is hereby authorized and directed to provide

2

suitable quarters for said commission and/or make arrangements to hold online meetings; and be

3

it further

4

     RESOLVED, That the commission shall report its findings and recommendations to the

5

Senate and House no later than one year from the date of passage, and said commission shall

6

expire two (2) years from the date of passage.

========

LC000016

========

 

LC000016 - Page 5 of 6

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

J O I N T   R E S O L U T I O N

CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY AND ASSESS THE

IMPLEMENTATION OF AN IMPROVED MEDICARE-FOR-ALL-TYPE SINGLE PAYER

PROGRAM IN THE STATE OF RHODE ISLAND

***

1

     This resolution would create a nineteen (19) member special legislative commission

2

whose purpose it would be to study and assess the implementation of an improved Medicare-for-

3

all-type single payer program in Rhode Island, and who would report back to the Senate and

4

House one year from the date of passage, and whose life would expire two years from the date of

5

passage.

========

LC000016

========

 

LC000016 - Page 6 of 6