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

     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 Senate 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 Senate 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

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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 Senate 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 Senate 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 Senate hereby requests that the working group delivers its

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

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

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

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

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

studies and reports to the Senate 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 Senate hereby requests that HSRI submits a report on the

recommendations delivered by the working group to 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

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Daniel McKee, Governor of the State of Rhode Island.

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