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J Mark Ryan: Healthcare in Rhode Island at risk



I read the text of Rhode Island Governor Gina Raimondo’s State of the State address in which she says “the ACA [ACA] is working in Rhode Island” and the real threat comes from Washington. She seems to believe that Rhode Island mainly needs to pass laws protecting the ACA to properly protect Rhode Islanders’ healthcare. A closer examination says otherwise.

Health insurance premiums have risen about five percent per year for the last 40 years – more than double the rate of inflation. When President Donald Trump cut the ACA’s cost-sharing reduction (CSR), payments the federal government gave directly to insurance companies, Blue Cross of Rhode Island raised the premium of their ACA silver plans 12 percent for 2018. So, the ACA subsidizes private insurance middlemen and cannot actually control skyrocketing costs. About 1/3 of every dollar spent on “healthcare” in the United States goes to administrative costs and corporate profits. Why not instead use that money to pay for actual health care under a Medicare-for-All single payer program?

Medical costs are still the most common cause of personal bankruptcy in America. In Massachusetts, two years into RomneyCare, the system upon which the ACA is modeled, bankruptcy due to medical bills stayed at about 62 percent of all bankruptcies. A Kaiser Family Foundation study in 2015 found over a million bankruptcies nation-wide due to health care costs, five years after the ACA was passed. The number of bankruptcies due to medical costs in other industrialized countries with single payer universal health insurance?


Over the past 5 years, in order to balance the budget, Governor Raimondo has cut state funding for Rhode Island Medicaid twice, putting even greater financial burdens on families and upon the state’s nursing homes, 60 percent of whose income comes from Medicaid. The governor says the number of uninsured has fallen 50 percent, but most economic analyses show the rate of underinsurance, defined as the number of families who pay greater than 10 percent of their income for health care, has actually risen.

The system we have is financially unsustainable, unstable and crashing. In 2017, VNA of Rhode Island, the state’s largest visiting nurse service, went bankrupt and ceased operations. Last year, Memorial Hospital in Pawtucket went bankrupt and closed. Of the state’s other hospitals, only the Lifespan system and South County are financially viable, but these are also taking aggressive measures to reduce costs and cut staff. Care New England is so financially weak, it is seeking to be bought by Partners Healthcare of Boston. Roger Williams and Fatima/Saint Joseph’s have already been bought by Prospect Medical Holdings, a for-profit California company that has been cited for health and safety violations in its home state because of its cost-cutting methods. To say that the ACA is “working” in Rhode Island is at best, disingenuous.

The most efficient, equitable and sustainable system is the system that most other industrialized countries have already: a single-payer national health program. In multiple polls, the majority of Americans are in favor of this idea, and in a Gallup poll, even 4 out of 10 Republicans were in favor of replacing the ACA with a Medicare-for-All system. Three of our four federal legislators (Senator Sheldon Whitehouse, Representatives David Cicilline and James Langevin) have signed their names on to national bills that would create such a system. Canada started its reform by passing it in the province of Saskatchewan, which, with a million people ran an efficient and effective health care system for about 10 years until Medicare for All was nationalized in 1972. Rhode Island has a million people.

Our governor and legislature should at least be willing to study a state single payer Medicare-for-all program now, before our existing system collapses completely. So far, they have not. They should at least be willing to urge our federal delegation to push harder for a national Medicare-for-all program. So far, they have not.

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Rhode Island single payer legislation and resolutions to form a Rhode Island study commission and urge federal legislators to push for national Medicare-for-All will again be introduced in the General Assembly in 2019. I urge everyone to contact their legislators to express their support.

For more information, see here.

About the Author

J. Mark Ryan, MD, FACP, is the chair of the Rhode Island Chapter of Physicians for a National Health Program (PNHP).

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