res24402

R 402

2024 -- H 8332 SUBSTITUTE A AS AMENDED
Enacted 06/25/2024

J O I N T R E S O L U T I O N

RESPECTFULLY REQUESTING HEALTHSOURCE RI (HSRI) TO CONVENE A WORKING GROUP TO STUDY THE ISSUE OF AFFORDABILITY OF COVERAGE IN THE RHODE ISLAND HEALTH INSURANCE INDIVIDUAL MARKET AND TO PROVIDE RECOMMENDATIONS ON THE DESIGN OF A STATE-BASED PROGRAM TO PROVIDE AFFORDABILITY ASSISTANCE TO RHODE ISLANDERS ENROLLED IN PLANS THROUGH THE HSRI EXCHANGE

Introduced By: Representatives Speakman, Kislak, Cotter, McGaw, Fogarty, Boylan, Spears, Cortvriend, Morales, and Potter

Date Introduced: June 05, 2024

WHEREAS, Many Rhode Islanders report serious challenges in accessing health care

services due to high and rising deductibles, out-of-pocket costs, and monthly health insurance

premiums; and

WHEREAS, According to the 2024 Rhode Island Market Summary published by the

Office of the Health Insurance Commissioner, Rhode Islanders enrolled in health insurance

coverage through the individual market pay higher cost sharing than Rhode Islanders enrolled in

health insurance coverage through the small or large group markets; and

WHEREAS, Research studies have demonstrated that higher cost sharing has been shown

to decrease consumers’ utilization of needed medical services, including preventive care and

essential drugs; and

WHEREAS, Increases in consumer cost sharing are seen to influence adverse outcomes

for vulnerable populations, including the elderly, chronically ill, and low income; and

WHEREAS, HealthSource RI (HSRI) documented in its 2022 Health Information Survey

a 21 percent increase in out-of-pocket costs between 2020 and 2022, noting this was “the highest

reported out-of-pocket spending since the [HSRI] survey began in 2012”; and

WHEREAS, In the same HSRI 2022 Health Information Survey, 14.9 percent of Rhode

Islanders reported that, despite having health insurance coverage, they experienced problems

paying medical bills; and

WHEREAS, HSRI reports that after the end of the COVID-19 public health emergency,

at least 14,000 low- and middle-income Rhode Islanders who had retained Medicaid coverage

during the pandemic transitioned to HSRI individual market coverage where premiums and out-

of-pocket costs may result in individuals foregoing needed medical care or face unexpectedly

high bills for medical treatment; and

WHEREAS, The Kaiser Family Foundation has noted that “for people and families with

limited assets, even a relatively small unexpected medical expense can be unaffordable”; and

WHEREAS, Federal enhanced advance premium tax credits were established under the

2021 American Rescue Plan and extended by the 2022 Inflation Reduction Act, helping expand

health insurance premium affordability support for millions of Americans and helping reduce

uninsured rates in Rhode Island to an all-time low of 2.9 percent; and

WHEREAS, Federal enhanced advance premium tax credits are scheduled to expire in

December 2025, potentially jeopardizing years of coverage gains and making health insurance

unaffordable for many middle-income Rhode Islanders; and

WHEREAS, Without this federal support some Rhode Islanders could be expected to pay

up to 36 percent of their income simply to enroll into health insurance, thereafter facing

additional charges for out-of-pocket medical costs; and

WHEREAS, Other states have established successful state-based programs to lower

health insurance premiums and out-of-pocket health care costs for low- and middle-income

residents, including Massachusetts, Colorado, and Washington; and

WHEREAS, The urgency of the potential increase in health insurance premiums for

many middle-income Rhode Islanders, particularly those who have recently lost Medicaid

coverage held through the COVID-19 pandemic, necessitates immediate action to design a Rhode

Island state-based affordability program and the funding mechanism for such a program; now,

therefore be it

RESOLVED, That this General Assembly of the State of Rhode Island hereby

respectfully requests HealthSource RI (HSRI) to convene a working group to study the issue of

affordability of coverage in the Rhode Island health insurance individual market and to make

recommendations on the design of a state-based program to provide affordability assistance to

Rhode Islanders enrolled in plans through the HSRI exchange; and be it further

RESOLVED, That this General Assembly hereby requests that HSRI invites participation

in this working group from members of the Exchange Advisory Board established by § 42-157-7

of the General Laws, and further invites additional participants to ensure meaningful participation

from each of the following groups: the Office of the Health Insurance Commissioner, the

Executive Office of Health and Human Services, health insurance carriers, health care providers

(including primary care providers, behavioral health care providers, and hospitals), health care

consumers and health care consumer advocacy organizations, and businesses which purchase or

otherwise provide health insurance coverage for their employees; and be it further

RESOLVED, That this General Assembly hereby requests that the working group

considers and issues recommendations regarding mechanisms that directly address both the

monthly premium cost of health insurance obtained through HSRI and the out-of-pocket costs

paid by enrollees upon receipt of health care services, currently addressed by federal advance

premium tax credits and cost-sharing reductions, respectively; and be it further

RESOLVED, That this General Assembly hereby requests that in its study and

recommendations, the working group specifically addresses the impact of the expiration of

federal enhanced advance premium tax credits established under the American Rescue Plan and

extended by the Inflation Reduction Act, which are currently expected to expire at the end of

calendar year 2025; and be it further

RESOLVED, That this General Assembly hereby requests that the working group

additionally studies and reports to the General Assembly as to potential funding mechanisms

which could be designed and established to pay for such state-based affordability program and the

positive and negative attributes of each funding mechanism, including, but not limited to, state

general revenue, assessments on health insurance issuers, other assessments on health care

industry entities, special assessments, proceeds from existing or new excise taxes, funds from the

Rhode Island Health Insurance Mandate, and any federal funding source identified; and be it

further

RESOLVED, That this General Assembly hereby requests that HSRI submits a report on

the recommendations delivered by the working group to the Speaker of the House, the President

of the Senate, and the Governor on or before January 31, 2025; and be it further

RESOLVED, That the Secretary of State be and hereby is authorized and directed to

transmit duly certified copies of this resolution to HealthSource RI, the Office of the Health

Insurance Commissioner, the Executive Office of Health and Human Services, and the Honorable

Daniel McKee, Governor of the State of Rhode Island.

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LC006199/SUB A

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