2022 -- S 2769
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LC005371
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S TATE OF RHODE IS L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2022
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A N A CT
RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE HEALTH INSURANCE
PROGRAM
Introduced By: Senators Bell, Calkin, Mack, DiMario, Anderson, Mendes, Valverde,
Kallman, Acosta, and Quezada
Date Introduced: March 24, 2022
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
1 SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby
2 amended by adding thereto the following chapter:
3 CHAPTER 97
4 THE RHODE ISLAND COMPREHENSIVE HEALTH INSURANCE PROGRAM
5 23-97-1. Legislative findings.
6 (1) Health care is a human right, not a commodity available only to those who can afford
7 it;
8 (2) Although the federal Affordable Care Act (ACA) allowed states to offer more people
9 taxpayer subsidized private health insurance, the ACA has not provided universal, comprehensive,
10 affordable coverage for all Rhode Islanders:
11 (i) In 2019, about four and three-tenths percent (4.3%) of Rhode Islanders had no health
12 insurance, causing about forty-three (43) (1 per 1,000 uninsured) unnecessary deaths each year;
13 (ii) An estimated forty-five percent (45%) of Rhode Islanders are under-insured (e.g., not
14 seeking health care because of high deductibles and co-pays);
15 (3) COVID-19 exacerbated and highlighted problems with the status quo health insurance
16 system including:
17 (i) Coverage is too easily lost when health insurance is tied to jobs - between February and
18 May, 2020, about twenty-one thousand (21,000) more Rhode Islanders lost their jobs and their
1 health insurance;
2 (ii) Systemic racism is reinforced - Black and Hispanic/Latinx Rhode Islanders, more likely
3 to be uninsured or underinsured, have suffered the highest rates of COVID-19 mortality and
4 morbidity;
5 (iii) The fear of out-of-pocket costs for uninsured and underinsured puts everyone at risk
6 because they avoid testing and treatment;
7 (4) In 2016, sixty million (60,000,000) people separated from their job at some point during
8 the year (i.e., about forty-two percent (42%) of the American workforce) and although this act may
9 cause some job loss, on balance, single payer would increase employment in Rhode Island by nearly
10 three percent (3%);
11 (5) The existing US health insurance system has failed to control the cost of health care
12 and to provide universal access to health care in a system which is widely accepted to waste thirty
13 percent (30%) of its revenues on activities that do not improve the health of Americans;
14 (6) Every industrialized nation in the world, except the United States, offers universal
15 health care to its citizens and enjoys better health outcomes for less than two thirds (2/3) to one-
16 half (1/2) the cost;
17 (7) Health care is rationed under our current multi-payer system, despite the fact that Rhode
18 Island patients, businesses and taxpayers already pay enough to have comprehensive and universal
19 health insurance under a single-payer system;
20 (8) About one-third (1/3) of every "health care" dollar spent in the U.S. is wasted on
21 unnecessary administrative costs and excessive pharmaceutical company profits due to laws
22 preventing Medicare from negotiating prices and private health insurance companies lacking
23 adequate market share to effectively negotiate prices;
24 (9) Private health insurance companies are incentivized to let the cost of health care rise
25 because higher costs require health insurance companies to charge higher health insurance
26 premiums, increasing companies' revenue and stock price;
27 (10) The health care marketplace is not an efficient market and because it represents only
28 eighteen percent (18%) of the US domestic market, significantly restricts economic growth and
29 thus the financial well-being of every American, including every Rhode Islander;
30 (11) Rhode Islanders cannot afford to keep the current multi-payer health insurance system:
31 (i) Between 1991 and 2014, health care spending in Rhode Island per person rose by over
32 two hundred fifty percent (250%) rising much faster than income and greatly reducing disposable
33 income;
34 (ii) It is estimated that by 2025, the cost of health insurance for an average family of four
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1 (4) will equal about one-half (1/2) of their annual income;
2 (iii) In the U.S., about two-thirds (2/3) of personal bankruptcies are medical cost-related
3 and of these, about three-fourths (3/4) had health insurance at the onset of their medical problems.
4 In no other industrialized country do people worry about going bankrupt over medical costs;
5 (12) Rhode Island private businesses bear most of the costs of employee health insurance
6 coverage and spend significant time and money choosing from a confusing array of increasingly
7 expensive plans which do not provide comprehensive coverage;
8 (13) Rhode Island employees and retirees lose significant wages and pensions as they are
9 forced to pay higher amounts of health insurance and health care costs;
10 (14) Rhode Island's hospitals are under increasing financial distress i.e., closing, sold to
11 out-of-state entities, attempting mergers largely due to health insurance reimbursement problems
12 that other nations do not face and are fixed by a single-payer system;
13 (15) The state and its municipalities face enormous other post-employment benefits
14 (OPEB) unfunded liabilities due mostly to health insurance costs;
15 (16) An improved Medicare-for-all style single-payer program would, based on the
16 performance of existing Medicare, eliminate fifty percent (50%) of the administrative waste in the
17 current system of private insurance before other savings achieved through meaningful negotiation
18 of prices and other savings are considered;
19 (17) The high costs of medical care could be lowered significantly if the state could
20 negotiate on behalf of all its residents for bulk purchasing, as well as gain access to usage and price
21 information currently kept confidential by private health insurers as "proprietary information;"
22 (18) Single payer health care would establish a true "free market" system where doctors
23 compete for patients rather than health insurance companies dictating which patients are able to see
24 which doctors and setting reimbursement rates;
25 (19) Health care providers would spend significantly less time with administrative work
26 caused by multiple health insurance company requirements and barriers to care delivery and would
27 spend significantly less for overhead costs because of streamlined billing;
28 (20) Rhode Island must act because there are currently no effective state or federal laws
29 that can provide universal coverage and adequately control rising premiums, co-pays, deductibles
30 and medical costs, or prevent private insurance companies from continuing to limit available
31 providers and coverage;
32 (21) In 1962, Canada's successful single-payer program began in the province of
33 Saskatchewan (with approximately the same population as Rhode Island) and became a national
34 program within ten (10) years; and
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1 (22) The proposed Rhode Island single payer program was studied by Professor Gerald
2 Friedman at UMass Amherst in 2015 and he concluded that:
3 "Single-payer in Rhode Island will finance medical care with substantial savings compared
4 with the existing multi-payer system of public and private insurers and would improve access to
5 health care by extending coverage to the four percent (4%) of Rhode Island residents still without
6 insurance under the Affordable Care Act and expanding coverage for the growing number with
7 inadequate health care coverage. Single-payer would improve the economic health of Rhode Island
8 by: increasing real disposable income for most residents; reducing the burden of health care on
9 businesses and promoting increased employment; and shifting the costs of health care away from
10 working and middle-class residents."
11 23-97-2. Legislative purpose.
12 It is the intent of the general assembly that this chapter establish a universal,
13 comprehensive, affordable single-payer health care insurance program that will help control health
14 care costs which shall be referred to as, "the Rhode Island comprehensive health insurance
15 program" (RICHIP). The program will be paid for by consolidating government and private
16 payments to multiple insurance carriers into a more economical and efficient improved Medicare-
17 for-all style single-payer program and substituting lower progressive taxes for higher health
18 insurance premiums, co-pays, deductibles and costs in excess of caps. This program will save
19 Rhode Islanders from the current overly expensive, inefficient and unsustainable multi-payer health
20 insurance system that unnecessarily prevents access to medically necessary health care. The
21 program will be established after the standard of care funded by Medicaid has been raised to a
22 Medicare standard.
23 23-97-3. Definitions.
24 As used in this chapter:
25 (1) "Affordable Care Act" or "ACA" means the Federal Patient Protection and Affordable
26 Care Act (Pub. L. 111-148), as amended by the Federal Health Care and Education Reconciliation
27 Act of 2010 (Pub. L. 111-152), and any amendments to, or regulations or guidance issued under,
28 those acts.
29 (2) "Carrier" means either a private health insurer authorized to sell health insurance in
30 Rhode Island or a health care service plan, i.e., any person who undertakes to arrange for the
31 provision of health care services to subscribers or enrollees, or to pay for or to reimburse any part
32 of the cost for those services, in return for a prepaid or periodic charge paid by or on behalf of the
33 subscribers or enrollees, or any person, whether located within or outside of this state, who solicits
34 or contracts with a subscriber or enrollee in this state to pay for or reimburse any part of the cost
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1 of, or who undertakes to arrange or arranges for, the provision of health care services that are to be
2 provided, wholly or in part, in a foreign country in return for a prepaid or periodic charge paid by
3 or on behalf of the subscriber or enrollee.
4 (3) "Dependent" has the same definition as set forth in federal tax law (26 U.S.C. § 152).
5 (4) "Emergency and urgently needed services" has the same definition as set forth in the
6 federal Medicare law (42 CFR 422.113).
7 (5) "Federally matched public health program" means the state's Medicaid program under
8 Title XIX of the Social Security Act (42 U.S.C. Sec. 1396 et seq.) and the state's Children's Health
9 Insurance Program (CHIP) under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et
10 seq.).
11 (6) "For-profit provider" means any health care professional or health care institution that
12 provides payments, profits or dividends to investors or owners who do not directly provide health
13 care.
14 (7) "Medicaid" or "medical assistance" means a program that is one of the following:
15 (i) The state's Medicaid program under Title XIX of the Social Security Act (42 U.S.C.
16 Sec. 1396 et seq.); or
17 (ii) The state's Children's Health Insurance Program under Title XXI of the Social Security
18 Act (42 U.S.C. Sec. 1397aa et seq.).
19 (8) "Medically necessary" means medical, surgical or other services or goods (including
20 prescription drugs) required for the prevention, diagnosis, cure, or treatment of a health-related
21 condition including any such services that are necessary to prevent a detrimental change in either
22 medical or mental health status. Medically necessary services shall be provided in a cost-effective
23 and appropriate setting and shall not be provided solely for the convenience of the patient or service
24 provider. "Medically necessary" does not include services or goods that are primarily for cosmetic
25 purposes; and does not include services or goods that are experimental, unless approved pursuant
26 to § 23-97-6(b).
27 (9) "Medicare" means Title XVIII of the Social Security Act (42 U.S.C. Sec. 1395 et seq.)
28 and the programs thereunder.
29 (10) "Qualified health care provider" means any individual who meets requirements set
30 forth in § 23-97-7(a)(1).
31 (11) "Qualified Rhode Island resident" means any individual who is a "resident" as defined
32 by §§ 44-30-5(a)(1) and (a)(2) or a dependent of that resident.
33 (12) "Rhode Island comprehensive health insurance program" or ("RICHIP") means the
34 affordable, comprehensive and effective health insurance program as set forth in this chapter.
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1 (13) "RICHIP participant" means a qualified Rhode Island resident who is enrolled in
2 RICHIP (and not disenrolled or disqualified) at the time they seek health care.
3 23-97-4. Rhode Island health insurance program.
4 (a) Organization. This chapter creates the Rhode Island comprehensive health insurance
5 program (RICHIP), as an independent state government agency.
6 (b) Director. A director shall be appointed by the governor, with the advice and consent of
7 the senate, to lead RICHIP and serve a term of four (4) years, subject to oversight by an executive
8 board. The director shall be compensated in accordance with the job title and job classification
9 established by the division of human resources and approved by the general assembly. The duties
10 of the director shall include:
11 (1) Employ staff and authorize reasonable expenditures, as necessary, from the RICHIP
12 trust fund, to pay program expenses and to administer the program, including creation and oversight
13 of RICHIP budgets;
14 (2) Oversee management of the RICHIP trust fund set forth in § 23-97-12(a) to ensure the
15 operational well-being and fiscal solvency of the program, including ensuring that all available
16 funds from all appropriate sources are collected and placed into the trust fund;
17 (3) Take any actions necessary and proper to implement the provisions of this chapter;
18 (4) Implement standardized claims and reporting procedures;
19 (5) Provide for timely payments to participating providers through a structure that is well
20 organized and that eliminates unnecessary administrative costs, i.e., coordinate with the state
21 comptroller to facilitate billing from and payments to providers using the state's computerized
22 financial system, the Rhode Island financial and accounting network system (RIFANS);
23 (6) Coordinate with federal health care programs, including Medicare and Medicaid, to
24 obtain necessary waivers and streamline federal funding and reimbursement;
25 (7) Monitor billing and reimbursements to detect inappropriate behavior by providers and
26 patients and create prohibitions and penalties regarding bad faith or criminal RICHIP participation,
27 and procedures by which they will be enforced;
28 (8) Support the development of an integrated health care database for health care planning
29 and quality assurance and ensure the legally required confidentiality of all health records it
30 contains;
31 (9) Determine eligibility for RICHIP and establish procedures for enrollment,
32 disenrollment and disqualification from RICHIP, as well as procedures for handling complaints
33 and appeals from affected individuals, as set forth in § 29-97-5;
34 (10) Create RICHIP expenditure, status, and assessment reports, including, but not limited
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1 to, annual reports with the following:
2 (i) Performance of the program;
3 (ii) Fiscal condition of the program;
4 (iii) Recommendations for statutory changes;
5 (iv) Receipt of payments from the federal government;
6 (v) Whether current year goals and priorities were met; and
7 (vi) Future goals and priorities;
8 (11) Review RICHIP collections and disbursements on at least a quarterly basis and
9 recommend adjustments needed to achieve budgetary targets and permit adequate access to care;
10 (12) Develop procedures for accommodating:
11 (i) Employer retiree health benefits for people who have been members of RICHIP but go
12 to live as retirees out of the state;
13 (ii) Employer retiree health benefits for people who earned or accrued those benefits while
14 residing in the state prior to the implementation of RICHIP and live as retirees out of the state; and
15 (iii) RICHIP coverage of health care services currently covered under the workers'
16 compensation system, including whether and how to continue funding for those services under that
17 system and whether and how to incorporate an element of experience rating; and
18 (13) No later than two (2) years after the effective date of this chapter, deve