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Advocacy groups take the stage to promote 2020 priorities

How does the community effort to halt the proposed waste transfer station fit into policy priorities?

Photo by Mike Cohea, used with permission

The view of downtown Providence skyline, including the new pedestrian bridge. Where does housing, children's health and health equity fit into the picture?

By Richard Asinof
Posted 1/27/20
A series of cheerleading events coordinated around 2020 policy priorities will occur in the coming week, focused on housing and early childhood education. The next meeting of the Commission studying insurance reimbursement rates will also occur, without much fanfare. At the same time, the proposed waste transfer station on Allens Avenue continues to fester, like a raisin the sun.
Who will brief the incoming Providence superintendent of schools on the epidemic of asthma occurring in the city, given that it is the leading cause of chronic school absenteeism? What would be the outcry if nearly 200 diesel trucks drove daily through the East Side neighborhoods in Providence? As the threat of the coronavirus spreads from China across the globe, will the federal government seek to deploy the research resources of companies like Rhode Island’s own EpiVax to rapidly develop a vaccine? Will Rhode Island Hospital consider following the lead of other communities, such as Phoenix, and invest in building affordable housing on its property adjacent to its facilities, instead of parking lots? Is R.I. Attorney General Peter Neronha following the reporting by ConvergenceRI on insurance rate reimbursements?
The abusive behavior of Secretary of State Mike Pompeo directed at a woman reporter from NPR who had the temerity to ask good questions is, unfortunately, the kind of behavior all too common that occurs when reporters refuse to serve as mouthpieces for corporate and government messaging.
One of the badges of honor in my career was getting thrown out of the law offices of attorney Alan Dershowitz in 1982, working on a story for The National Law Journal, when he did not like the questions I had asked.
I am still waiting, for more than five years, to conduct a one-on-one interview with Gov. Gina Raimondo, even though she shook my hand and agreed to it, twice, in person. I am both patient and persistent.

PROVIDENCE – This coming week, there will be plenty of oompah oompah oompah and snare drum rolls and cheerleader performances as two influential nonprofit advocacy groups roll out orchestrated shows of support for policy initiatives that are simpatico with Gov. Gina Raimondo’s budget priorities, one focused on creating a dedicated stream of revenue funding for new housing, and a second focused on 2020 policy priorities for young children in Rhode Island, inaugurating a new campaign called “Right from the Start.”

• On Monday, Jan. 27, Rhode Island Kids Count will host a luncheon celebrating young children in the state, introducing its “Right from the Start” campaign, which seeks to ensure a strong start in life for children from birth through age 8.

The luncheon will feature: an introduction by Elizabeth Burke Bryant, executive director of Rhode Island Kids Count; followed by Central Falls Mayor James Diossa, speaking about the importance of counting young children in the upcoming 2020 Census; a data presentation on young children by Leanne Barrett, Rhode Island Kids Count senior policy analyst, on the progress and potential for young children; and then a talk by Courtney Hawkins, director of the R.I. Department of Human Services, who will outline Gov. Raimondo’s priorities for young children.

Cue the first fanfare. Barrett’s presentation will provide the heft of data analysis and evidence behind the advocacy efforts, a feature of every Rhode Island Kids Count awards celebration, framed by the demographic shift occurring both in the nation and the state: minority children are becoming the majority population.

In Rhode Island:

• 41 percent of infants and toddlers [under age 3] live in households with incomes less than twice the poverty level.

• More than 60 percent of mothers of infants and toddlers are working.

• Living in poverty in infancy and the early childhood years is harmful to brain development and can compromise lifetime health, achievement, and employment.

Cue the first snare drum roll. The 2020 legislative policy priorities that Rhode Island Kids Count will be cheerleading for include an extensive menu of “good-sounding” investments. They include:

• Closing racial/ethnic disparities in maternal and infant health

• Community-based doula services

• Paid family leave

• High-quality, affordable child care and pre-K

• Family home visiting

• Health care and infant/early childhood mental health

• Affordable housing, food/nutrition, and economic security

• Effective and supportive public schools

It is hard to argue with any of the worthy policy goals on the advocacy wish list, but in a revenue-constrained budget year [which is every year], which if any policy priorities will receive support from the R.I. General Assembly remain an open question.

[As long as the news media continues to frame the legislative budget process as a wearying “tax-and-spend” exercise, rather than a series of investment opportunities for families and children to prosper in Rhode Island, the vacuum in public policy investments in health, in education and community will fall, by default, to private philanthropy led by the Rhode Island Foundation.]

But wait, there’s more. Cue the cheerleaders. Four recipients will be honored with 2020 Young Children’s Champion Awards for making “a critical difference for young children and families in Rhode Island.” They include: the Joyful Hearts Childcare Center, the Happykids Home Childcare, Children’s Friend, and the Woonsocket Education Center.

A really big show
On Tuesday afternoon, Jan. 28, Homes Rhode Island will host perhaps an even more impressive policy advocacy gathering at the State House to reinforce the coalition’s 2020 legislative priorities around affordable housing.

As ConvergenceRI reported in its Dec. 16, 2019, edition, the Homes Rhode Island held its first summit and forum on Dec. 11, 2019, at Rhode Island College. [See link below to ConvergenceRI story, “The path to opportunity begins at the front door of your home.”]

The coalition, two years in the baking, has received support from HousingWorks RI, the Housing Network of RI, United Way of Rhode Island, the Rhode Island Foundation, numerous community development corporations and housing authority partners, among others.

The Homes RI coalition had carried on an extensive “private” conversation with Gov. Gina Raimondo, including letters and phone calls, with specific asks to be included in the FY 2021 state budget, including the creation of a dedicated funding stream to support housing creation. The Governor apparently listened, because her proposed budget made such housing funding a priority.

Translated, the reality is that housing is where jobs go to sleep at night. It is hard to attract new businesses and new talent to relocate to Rhode Island if there is no affordable place to live.

The Tuesday afternoon gathering will feature a powerhouse lineup of speakers. Cue the trombones. They include: R.I. Senate President Dominick Ruggerio; Secretary Stefan Pryor, of the R.I. Commerce Corporation; Carol Ventura, the CEO and executive director of Rhode Island Housing; Kathryn Power, the director of the R.I. Department of the Behavioral Healthcare, Developmental Disabilities, and Hospitals; Cali Babbitt Spears, Sisters Overcoming Abusive Relationships [SOAR], Rhode Island Coalition Against Domestic Violence; Alexandrea Gonzalez, Voices of Homelessness, RI Coalition for the Homeless; and Joshua Guzmán, Youth Speaker, Foster Forward. The event will be emceed by Angela Bannerman Ankoma, executive vice president of the United Way of Rhode Island.

In its advocacy prescription attached to the media advisory, Homes RI defined its mission and vision: “Our homes and neighborhoods shape our lives. Our home and surrounding environment matters to our health, well-being, and economic stability. When we each live in a safe, healthy, and affordable home, we thrive. When our neighbors live in a safe, healthy, and affordable home, our neighborhood and community thrives.”

The statement continued: “We believe Rhode Island can and should be a state where all residents are able to live in safe, healthy and sustainable homes in thriving communities.”

The mechanics of change
With little fanfare and no cheerleaders in sight, the next day, on Wednesday afternoon, Jan. 29, in one of those critical but unheralded events, the R.I. Senate Special Legislative Commission To Study the Impact of Insurer Payments on Access to Health Care will convene its third meeting, chaired by Sen. Josh Miller.

At the first two meetings, Convergence was the only reporter in attendance, at which the nitty-gritty behind the barriers to accessing health care – the imbalance in reimbursement rates paid to providers – was on full frontal display. [See links to ConvergenceRI stories below, “Open wider,” “Facts, nuance and narrative,” “Breaking down the news silo,” and “Will anecdotal and data evidence converge into legislative health remedies?”]

Will another health care reporter venture into the den of facts, figures and crunching numbers? Good question.

As part of the reporting effort, ConvergenceRI engaged in a dialogue with Sen. Miller about the possibilities of presenting testimony before the commission, breaking free of the traditional role that journalists play in listening, recording, asking questions and reporting on what was said, and instead, offering a series of reported facts that sought to break down the silos of coverage and content.

The response was an invitation to participate not as a witness or as a presenter, but instead, to offer public comment at the scheduled Jan. 29 meeting, from an invitation extended by Molly McCloskey, a R.I. Senate Policy Analyst, as well as to share relevant reporting on the commission’s activities.

Unfortunately, the Jan. 29 commission meeting conflicted with a scheduled dental appointment, making it impossible to attend. The details of the dental appointment and the connection to rate reimbursement barriers in accessing care, ironically, underscored the problematic reimbursement rates provided by dental insurance health plans in Rhode Island.

At a scheduled dental cleaning in December of 2019, x-rays discovered that there was a problem with decay under a temporary crown. While I had paid for extra dental coverage under my Medicare Advantage plan, and while I had some $1,500 in my dental insurance account, authorization for the work to be done in December was denied by my dental insurance plan because of the fine print in the policy: work on repair of pre-existing crowns was not allowed in the first year of the policy. [Money not used during that calendar year reverts back to the dental insurer.]

My dentist reapplied for authorization in January of 2020, when such work would be covered. The dental predetermined notification for the work for a “porcelain ceramic crown," however, went like this: The provider charge was $1,200; the allowed amount was $950; the approved amount was $475, putting me, as the patient, as responsible to pay the “missing” $475 as a co-pay.

Despite having money to use in my dental insurance plan, I was to be responsible for paying half of the cost of the crown. Really?

My own experience seemed to directly confirm some of the disturbing trends identified by Dr. Andrew Gazerro III, D.M.D., chair of the Council on Dental Benefits for the Rhode Island Dental Association, in testimony before the commission on Tuesday, Dec. 17, 2019. As reported by ConvergenceRI:

• The health insurers Delta Dental of RI and Blue Cross Blue Shield of RI have a virtual monopoly on commercial dental insurance health plans in the state; “other dental benefit companies have minimal if any market share in Rhode Island,” according to Gazerro. Delta Dental of RI is the dominant insurance carrier, with eight times as many subscribers and has market control over its competition and its providers, according to Gazerro.

• This lack of competition has resulted in nearly identical rates of reimbursement by both health insurers “because there is no true competition between them and none from other companies,” according to Gazerro.

• The last provider fee allowance increases by the two dental plans, according to Gazerro, occurred in March of 2008, 11 years ago. “Do you know of any other industry that will provide its services at a rate that is over a decade old? Gazerro asked in his presentation, and then answered: “Ask Cardi Corp. to pave the roads at a 2008 rate and see what you get.”

The question is: Will R.I. Attorney General Peter Neronha consider investigating the apparent collusion around market control of pricing by the two major dental health insurance plans in Rhode Island?

ConvergenceRI will plan to participate in the public comment on the Feb. 25 meeting, when it will be possible to attend in person and to submit copies of articles and a presentation to the commission members.

Among the issues I expect to be addressed in my presentation:

• Reporting on the continuing gaps in Medicaid coverage related to rates and reimbursement payments. Nearly four years after the Unified Health Infrastructure Project, or UHIP, was launched on Sept. 11, 2016, the backlog in processing Medicaid eligibility applications remains a disaster zone of snafus, in apparent violation of state law. The latest data provided by the R.I. Executive Office of Health and Human Services as of Jan. 24, 2020, was: “There are 838 overdue [Medicaid] Long Term Support and Services pending state action [longer than 90 days].

While that is an improvement from August of 2019, when there were a total of 1,228 pending applications for longer than 90 days, and also from June of 2019, when there were 1,305 pending applications for longer than 90 days, the delay in process Medicaid eligibility applications is more than a statistic: it creates an avalanche of unintended, harmful consequences, in which skilled nursing facilities are pushed to budgetary limits because of delayed payments for care that they are already providing, limiting their ability to pay and retain a workforce.

The second leg of the broken chair supporting rates and reimbursements under Medicaid is the failure to create an accountable entity for long-term supports and services for the managed Medicaid population, as required under the Reinventing Medicaid law enacted in 2015. Five years later, no such accountable entity yet exists, even though Medicaid expenses for long-term support and services represents about 60 percent of the overall state and federal spending under Medicaid. Why is that?

It would, of course, be a good idea to suggest that the director of the R.I. Medicaid office testify before the Commission, or at least be available to answer questions. However, the current Medicaid director, Patrick Tigue, will leave his office as of Jan. 31, 2020, moving to the private sector, having taken a job with Health Management Associates as a principal in its Boston office, a national health care research and consulting firm headquartered in Lansing, Mich., with a focus on publicly funded health care.

Connecting the head, the body politic and the world we live in
The continuing saga of the proposed waste transfer station on Allens Avenue in Providence took another turn when angry residents attended the scheduled Jan. 21 meeting before the City Planning Commission only to find that their attempts to be heard frustrated by commission members, who tabled the discussion to a later meeting in March and refused to allow the community members to speak on the record, apparently because their was no stenographer present to record what they had to say.

The strategy to appear at the City Planning Commission had been an outgrowth of organizing efforts that followed a community meeting. [See link below to ConvergenceRI story, “We are not the dumpster.”]

No one, really, disputes the evidence that asthma is at epidemic proportions in Providence, that asthma is the major cause of chronic school absenteeism in the Providence pubic schools now under state control, or that a major contributing factor in the onset of asthma is air pollution from highway traffic.

The new proposed waste transfer station on Allens Avenue is projected to bring some 2,500 tons of waste per day into the community, and with it, an estimated 188 diesel trucks in and out every day, kicking up a storm of dust, debris and diesel fumes on an already overburdened community.

The new facility is to be located nearby the campuses of Lifespan’s Rhode Island Hospital and Hasbro Children’s Hospital as well as Care New England’s Women and Infants Hospital. Will the extra burden of air pollution put patients, doctors and nurses at greater health risk? Will any testing or studies be conducted to evaluate that health risk? Good questions.

The bigger question is: How does preventing asthma and opposing the new waste transfer station on Allens Avenue fit into the 2020 legislative priorities of Gov. Raimondo, Rhode Island Kids Count, Homes Rhode Island, and the Senate commission on reimbursement rates paid by health insurers?

Will the advocates who participate in the cheerleading events on Jan. 27 and Jan. 28 take a public stand against the proposed waste transfer situation when they speak at the podium?

ConvergenceRI reached out to two of the unions that represent nurses and workers at the two hospitals, United Nurses and Allied Professionals [UNAP] and SEIU, to ask if the unions had taken a position on the proposed waste transfer station. UNAP’s Linda McDonald did not return an email. Emmanuel Falck, director of Rhode Island SEIU, did return ConvergenceRI’s phone call, but said the union had not yet taken a position on the proposed waste transfer station but might consider the question in the future.

What would happen if some 188 diesel trucks a day were to drive nearby the homes of members of the Providence City Planning Commission, say, for a week? Would their neighbors be up in arms? Would this be a good organizing tactic?

Missing, it seems, from the ongoing legislative policy priorities by advocacy coalitions is the connection between the world we live in and the world to come – as our lives and habitats are reshaped by the environmental and health threats from man-made climate change.

Perhaps, at the heart of the missing dialogue is an unspoken reality between investing in prevention and investing in clinical care, a sense of how health equity and community-based solutions are central to developing solutions. Will the R.I. General Assembly consider investing $1 million in Health Equity Zones in Rhode Island, even if Gov. Raimondo chose not to?

You don’t know what you got ‘til its gone
Elizabeth Rush, author of Rising Dispatches from the New American Shore, which was recently selected as the 2020 choice of “Reading Across Rhode Island,” now in its 18th year, said in an interview with The Providence Journal, “I see climate change as a catalyst for the creation of new coalitions of vulnerable people across class and race and other social lines.”

Or course, the challenge is putting that thought into political action: supporting the creation of new coalitions of vulnerable people across class and race and other social lines here in Rhode Island.

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