Experts respond to how GOP health plan could affect R.I.

March 08--PROVIDENCE -- Rhode Island has a huge stake in what happens to the landmark federal health-care law known as Obamacare -- and not just people who got coverage.

The repeal-and-replace plan unveiled Monday by House Republicans in Washington affects roughly 100,000 Rhode Islanders who gained insurance under the Affordable Care Act. It also could dramatically disrupt insurance companies -- and, in turn, the prices they charge for everyone's coverage -- by eliminating a key provision of the federal law: the mandate requiring people to have health insurance.

Rhode Island is among 31 states, along with the District of Columbia, that adopted the federal law's expanded eligibility for Medicaid, the insurance program for the poor.

Enrollment in the state's Medicaid expansion program during fiscal 2017 is projected to reach about 70,000 people, according to state projections. Another 30,000 residents who don't have access to health care through their employer are enrolled in individual coverage through the state health exchange, HealthSource RI.

Rhode Island's small size, aging population and high percentage of residents on Medicaid means young people are especially important to balancing the insurance rolls and keeping premiums down.

Here are some of Rhode Island's health and industry experts' response to the GOP plan (some responses have been paraphrased for space and clarity):

State Sen. Joshua Miller, chairman of Health and Human Services Committee: It's been proven over and over again that the most expensive way to treat someone is if they are uninsured. It is not only the most expensive, it has the worst health outcomes. Any plan that creates more uninsured people is an expense not only to government but to health care in general.

We're drafting a bill -- The Health Insurance Market Stabilization and Consumer Protection Act of 2017 -- that will be introduced in the General Assembly by the end of the month to preserve the benefits and access we currently have. If we can preserve the subsidy to buy coverage, and a penalty for not having insurance, we would want to do that because it impacts the marketplace. It's whether people want to pay to do it -- that is the big question.

Peter M. Marino, president and CEO of Neighborhood Health Plan of R.I.: Neighborhood has more than 40,600 members who are covered under the Medicaid expansion program. If the individual mandate for coverage is removed with nothing similar to replace it, folks who are younger and healthier would likely choose not to access insurance, which would increase costs for everyone else. But from discussions in Washington, D.C., it's likely the earliest that would happen is 2018 or later.

Zachary Sherman, director of HealthSource RI, the state exchange created under the ACA: The federal financial assistance has been key in making health insurance affordable. That is key to maintaining coverage levels, maintaining enrollment in the exchange and maintaining the great progress we've made in cutting the uninsured rate by more than half, to 4.5 percent, compared with 12 percent in 2013, before the federal law went into effect. It's largely the difference between being able to afford coverage and not.

Monica A. Neronha, a vice president and deputy general counsel for Blue Cross & Blue Shield of Rhode Island: The biggest issue is the subsidies to buy coverage. If the subsidies do not allow individuals to purchase affordable coverage, that would cause instability in the market and that could cause premiums to rise. Sicker people will get coverage and healthier people will opt out. And that means higher premiums for everyone.

Christopher F. Koller, former Rhode Island health insurance commissioner, now president of the Milbank Memorial Fund in New York City: Whether Rhode Island can continue to operate its state health exchange all depends on what bill, if any, gets passed by Congress. Even if no bill gets passed, Rhode Island should be considering how to increase volume through its exchange. For instance, if legislators were really committed to this they would shut down the individual market and send everybody through the exchange.

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