2024 -- S 3157

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LC006267

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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S E N A T E   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: Senator Joshua Miller

     Date Introduced: June 11, 2024

     Referred To: Placed on the Senate Consent Calendar

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

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

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premiums; and

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

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

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

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

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

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

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essential drugs; and

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

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

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

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

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

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

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

 

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paying medical bills; and

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

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

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

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

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high bills for medical treatment; and

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

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

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

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

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

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

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

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

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unaffordable for many middle-income Rhode Islanders; and

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

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

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

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

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

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residents, including Massachusetts, Colorado, and Washington; and

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

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

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

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

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therefore be it

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     RESOLVED, That this Senate of the State of Rhode Island hereby respectfully requests

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

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

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

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

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     RESOLVED, That this Senate hereby requests that HSRI invites participation in this

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

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

 

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

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

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primary care providers, behavioral health care providers, and hospitals), health care consumers

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

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

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     RESOLVED, That this Senate hereby requests that the working group considers and

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issues recommendations regarding mechanisms that directly address both the monthly premium

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cost of health insurance obtained through HSRI and the out-of-pocket costs paid by enrollees

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upon receipt of health care services, currently addressed by federal advance premium tax credits

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and cost-sharing reductions, respectively; and be it further

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     RESOLVED, That this Senate hereby requests that in its study and recommendations, the

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working group specifically addresses the impact of the expiration of federal enhanced advance

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premium tax credits established under the American Rescue Plan and extended by the Inflation

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Reduction Act, which are currently expected to expire at the end of calendar year 2025; and be it

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further

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     RESOLVED, That this Senate hereby requests that the working group delivers its

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recommendations as to the design of such state-based affordability program based on a total

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funding amount of $20 million, and to additionally deliver recommendations as to how such

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design would be modified if the total funding amount were to be halved (i.e. $10 million) or

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doubled (i.e. $40 million); and be it further

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     RESOLVED, That this Senate hereby requests that the working group additionally

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studies and reports to the Senate as to potential funding mechanisms which could be designed and

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established to pay for such state-based affordability program and the positive and negative

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attributes of each funding mechanism, including, but not limited to, state general revenue,

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assessments on health insurance issuers, other assessments on health care industry entities, special

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assessments, proceeds from existing or new excise taxes, funds from the Rhode Island Health

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Insurance Mandate, and any federal funding source identified; and be it further

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     RESOLVED, That this Senate hereby requests that HSRI submits a report on the

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recommendations delivered by the working group to the President of the Senate and the Governor

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on or before January 31, 2025; and be it further

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

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

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

 

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Daniel McKee, Governor of the State of Rhode Island.

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LC006267

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