Years of public health funding cuts have left Rhode Islanders vulnerable…
Coronavirus is creating a rapidly escalating disaster in Rhode Island. We need to do everything in our power to minimize the damage that the epidemic is causing to our state’s residents. These emergency measures must include free testing and treatment for Covid-19, free food deliveries to people in self-quarantine, and a moratorium on evictions, foreclosures, and utility shut-offs throughout the entirety of the crisis.
In addition to providing emergency relief, we can’t ignore that the crisis is exposing deep problems in our state’s healthcare system. Although it’s tempting to gloss over these systemic problems right now, it’s more important than ever to examine them openly because Covid has made them unusually visible. The simple fact that everyone’s health is endangered if anyone lacks medical care is more obvious now than ever, as is the equally simple fact that our state consistently fails to provide medical care to all of its residents. Ordinarily, these facts are obscured or ignored, but they cannot be hidden or overlooked during the epidemic. That’s why it’s essential that, as we provide emergency relief, we also think honestly about how to fix the longstanding problems in our state’s healthcare system that have exacerbated our vulnerability to the current crisis.
One longstanding problem is that over forty thousand Rhode Islanders consistently lack health insurance. And those who do have insurance are saddled with enormous co-pays and deductibles. This situation has accelerated the spread of coronavirus throughout our state because people who are unable to afford testing or treatment are far more likely to continue spreading the disease. Rhode Island and the federal government are both taking steps to ensure that people with Covid can afford to see a doctor, but over half of the uninsured lack a reliable place to go to receive medical care, so they may not know where to receive testing or treatment, even if those services become free.
While widespread lack of insurance is making the coronavirus epidemic worse, the reverse is also true: the disease is increasing the number of Rhode Islanders without insurance. Last week alone, about one in fifteen Rhode Island workers filed for unemployment insurance – the single highest rate of any state in the country. Because most people get health insurance through their jobs, many of those newly unemployed people are also newly uninsured.
One of those people is Benjamin Ponchak, a Providence resident who recently lost his job at a parking and valet company that works with a number of Rhode Island hotels including Hilton Providence and the Residence Inn. He had begun receiving health insurance from his job only four days before being laid off. He now doubts he’ll be able afford medical care if he contracts coronavirus. “My financial security is totally gone,” said Ponchak. “I’d definitely have trouble paying for testing or treatment, which is especially worrying because my roommate started feeling sick recently.”
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As the crisis escalates, stories like Ponchak’s will emerge all over Rhode Island. As these stories proliferate, we need to not only ensure that everyone has healthcare throughout the epidemic, but also to look closely at the ways in which coronavirus has revealed deep problems with our state’s decision to link health insurance to employment, instead of providing universal coverage.
Another longstanding problem with Rhode Island’s healthcare system is that our public health programs are chronically underfunded. Our state’s Medicaid budget, in particular, has been cut to the bone. About eight months before coronavirus swept into Rhode Island, the General Assembly passed a budget slashing $8.2 million in general revenue funding from Medicaid. Those cuts pale in comparison to the previous year’s budget, which chopped $32.9 million from the program. Medicaid’s funding dropped particularly steeply in 2016, when the budget cut a full $51.5 million from the program, following the recommendation of a working group established by Governor Raimondo that was instructed to develop a plan to reduce the cost of Medicaid.
It’s not as though Rhode Island lacks the resources to fund public health services like Medicaid. There always seems to be enough money to pass out to the state’s richest residents. In 2006, for example, the General Assembly passed a tax reform package that included a substantial tax cut for the richest 1%, people who make well over $400,000 each year. Since then, this tax cut for the top 1% has cumulatively cost Rhode Island well over a billion dollars in lost revenue.
The choice, year after year, to prioritize tax handouts for the rich, at the expense of public health services like Medicaid, has increased our vulnerability to coronavirus. The reductions to Medicaid spending often include steep cuts to the money that hospitals receive for treating Medicaid recipients. The 2016 budget, for example, cut the total money allocated to hospitals for treating Medicaid patients by $11.1 million. Hospitals depend on the money that the state provides to them for treating Medicaid recipients, so these cuts often mean hospitals and healthcare providers have to downsize.
The very same day that we confirmed the fifth case of coronavirus in Rhode Island, Lifespan – the state’s largest healthcare provider – announced mass layoffs. And in 2018, financial troubles forced Memorial Hospital in Pawtucket to shut down entirely. The General Assembly’s decision to repeatedly reduce the money that hospitals receive for treating Medicaid recipients directly contributes to the financial difficulties of our state’s hospitals.
Coronavirus patients could quickly exceed the capacity of Rhode Island’s beleaguered healthcare system. Providing emergency treatment to these patients will almost certainly require us to open more clinics and hospitals, hire more nurses and doctors, and purchase more medical equipment. A serious response to this crisis will also require us to consider why these things were in such short supply to begin with, and to commit the state to properly funding public health services going forward.
Rhode Islanders now have two tasks. The first is to push tirelessly for emergency measures that are necessary for our state’s residents to withstand the immediate medical and financial hardships of coronavirus. The second is to insist that our elected officials don’t ignore the many ways in which the epidemic is exposing longstanding problems in our healthcare system that must be addressed. That means speaking honestly about the urgent need for universal insurance coverage and a functional, well-funded healthcare system, throughout this crisis and beyond.