2021 -- H 5019

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LC000016

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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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

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

can afford it; and

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

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

comprehensive, affordable coverage for all Rhode Islanders; and

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

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

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

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

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

insurance system including:

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

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

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

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

morbidity; and

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

because they avoid testing and treatment; and

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

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

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

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

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

one-half the cost; and

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

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

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

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

unnecessary administrative costs and excessive pharmaceutical company profits due to laws

preventing Medicare from negotiating prices and private health insurance companies lacking

adequate market share to effectively negotiate prices; and

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

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

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

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

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

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

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

insurance system:

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

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

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

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

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

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

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

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

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

increasingly expensive plans which do not provide comprehensive coverage; and

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

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

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

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

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

and

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

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

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

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

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

information"; and

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

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

able to see which doctors and setting reimbursement rates; and

     WHEREAS, Health care providers would spend significantly less time with

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

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

billing; and

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

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

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

savings are considered; and

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

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

further study" each year; and

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

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

program within ten years; and

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

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

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

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

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

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

number with inadequate health care coverage; and

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

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

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

middle-class residents"; now, therefore be it

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

it further

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

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

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

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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

***

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

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

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

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

passage.

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