PROVIDENCE – Up until now, two weeks before Election Day, the candidates running for governor have studiously avoided saying anything substantive about health care policy in Rhode Island.

They have been enabled to do this in large part by the Rhode Island news media, which have failed repeatedly to ask the candidates any substantive questions – in interviews, in debates, at news conferences, in columns – about their positions on health care policies.

The avoidance by the candidates – and the myopia practiced by the news media on this important issue – amounts to a denial of the facts:
• The health care industry is the largest private employer in Rhode Island, generating the largest increase in jobs in the last five years, in the period following The Great Recession.

• Rhode Island’s research engine that is the biomedical research industry brings in about $250 million a year – but was left out as a priority target in the state’s new draft plan for its economic future.

• Rhode Island’s small businesses' ability to compete, to innovate and to hire is being strangled by ever-increasing health insurance premiums. Hearings where business owners complained before the R.I. Office of the Health Insurance Commissioner were called “Health Care Groundhog Day.”

• Rhode Island has been in the midst of an epidemic of addiction and substance abuse, resulting in the deaths of 162 Rhode Islanders – 115 men and 47 women from 30 different towns, ranging in age from 20 to 65, from accidental overdoses since Jan. 1, 2014. The recent numbers show no signs of significant curtailment of this epidemic.

• The train that is Rhode Island’s health care reform evolution has left the station and is gaining speed, with more than 220,000 Rhode Islanders now receiving care through patient-centered medical homes – and that number will increase to about 330,000 in the next two years.

• Rhode Island’s health insurance benefits exchange, HealthSourceRI, has proven to be a success, the No. 2 rated exchange in the nation, helping to lower the number of uninsured in Rhode Island, and now focused on creating savings for small businesses.

• Community public health initiatives – such as CHEW programs – are piloting how investments in the front-end of the health care system can reduce costs and improve population health. The connection between a healthy community, educational achievement and a healthy economy is a proven equation.

• Rhode Island is on the verge of being awarded $58 million from the Centers for Medicare and Medicaid Services to transform its health care delivery system. A team that included Dr. Michael Fine, director of the R.I. Department of Health, Neil Steinberg, president and CEO of the Rhode Island Foundation, and Dr. G. Alan Kurose, president and CEO of Coastal Medical Group, met with federal officials on Oct. 15 to present the plan. 

Reality intrudes
That reality may now be changing, as public health issues intrude – in part because of the whirlwind of fear, blame and finger-pointing being stirred up about the spread of Ebola in the U.S., and new questions raised by nurses in Rhode Island about preparedness.

It may also change because of a series of questions delivered today, Monday, Oct. 20, to Gina Raimondo, Allan Fung and Robert Healey, by an ad hoc coalition of health care professionals, advocates, academics, and associations. [Of course, it doesn’t mean that the candidates will answer them.]

Also, the news media may be waking up from its slumber. In an Oct. 17 column, reporter Scott MacKay argued that Fung and Raimondo should have to answer some questions honestly before Rhode Islanders vote for them, including how they plan to handle the future of HealthSourceRI. [One question about the future HealthSourceRI does not translate into a greater comprehension of the connections between health policies and economic policies.]

The questions asked
Here are the questions posed by the ad hoc coalition, which include: the Alpert Medical School at Brown University, the School of Public Health at Brown University, HealthRIght, the North America Family Institute of Rhode Island, the R.I. Medical Society, About Families, the R.I. Mental Health Association, the R.I. Public Health Association, the R.I. Public Health Institute, Louis Giancola, and Paul Block.

The questions seek the candidates’ responses to key policy questions facing Rhode Island’s next governor – health care reform and health innovation, rising health insurance costs, Medicaid costs, access to behavioral and mental health services, and the costs of gun violence.

Health Care Reform. Although the U.S. has the highest per capita health expenditures, we still lag far behind other industrialized nations when it comes to overall health status of our population. Furthermore, despite decades of efforts to control the cost curve in health care, consumers’ burden of health care costs continues to rise.

Rhode Island, however, has received national recognition for the work we have done on health care reform, and for our work to improve our health care delivery system. As a result, we are finalists for additional funding for innovations in health care payment and delivery system reform (an award that would be upwards of $50 million, through the State Innovation Model funding stream of the Affordable Care Act).

  • What do you see are the strengths of Rhode Island’s health care system?

  • How do you plan to leverage those strengths to improve the affordability, quality, and accessibility of health care in Rhode Island?

Medicaid. Consider the following statement: Medicaid provides comprehensive health insurance coverage for close to 200,000 children, parents, seniors, people with disabilities and – with the new Medicaid expansion – single adults. The program has demonstrated consistent improvements in quality, while keeping spending growth to a pace much lower than commercial insurance. Rhode Island’s two Medicaid health plans are ranked in the top 10 of all Medicaid HMOs in the country. [Neighborhood Health Plan of Rhode Island, No. 5; UnitedHealthCare, No. 7]

Medicaid also funds vital long-term care services for thousands of our citizens. For every dollar we spend on Medicaid services, we get more than a dollar in federal spending, making Medicaid a good investment and a significant driver of economic growth.

  • What steps would you take to ensure continued quality improvement and cost-containment in the Medicaid program?

Health care and the state economy. Health care costs are an increasingly large barrier to the growth of Rhode Island businesses, no matter what their size or sector. Nationally, from 2004-2014, health insurance premiums increased by 69 percent, and the growth in worker’s contributions to premiums [81 percent] has dramatically outpaced the growth in earnings [5 percent].

  • How will you support and incentivize improvements in health care without increasing the burden on businesses and consumers?

  • How will you work with the legislature to expand mental health access, support cost-effective management of mental health services, and ensure inclusion of behavioral services in private and public programs intended to improve health care cost-effectiveness?

Heart-breaking deaths due to gun violence have been in the news repeatedly in recent months and years. Gun violence associated with assault includes domestic violence related incidents in addition to street crime. But, more than half of firearms deaths are self-inflicted, with firearms as the leading cause of suicide.

  • What types of controls would you support to make guns less available to individuals at high risk?