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The end of the year is often a time when news stories that might otherwise receive a lot of attention get overlooked while people are busy with the holidays. That’s even more true in a year like 2014, when Rhode Islanders were recovering from a huge election season and preparing for new leadership.
One example of this phenomenon was health care. While the future of HealthSource RI continues to get a lot of attention, three other things that happened in December deserved a closer look than they got. Together, they give some sense of what public and private leaders in the local health sector are expecting to focus on in 2015.
Here they are.
1. The $20-million federal health-care grant
Governor Chafee and the congressional delegation announced Dec. 16 that the U.S. Centers for Medicare and Medicaid Services had awarded Rhode Island $20 million for a State Innovation Model initiative. The eight-figure grant garnered headlines, but relatively little attention was paid to how it will be spent.
It seems as if Rhode Island has been losing manufacturing jobs for about as long as anybody can remember. But it looks like that bit of conventional wisdom needs to be updated.
The number of manufacturing jobs in Rhode Island fell to 39,200 in January 2012, the lowest level since records began in 1990. However, manufacturing employment in the state has increased by 2,000 jobs over the nearly three years since then, and has now returned to the same level as in July 2009, a WPRI.com review of U.S. Labor Department data shows.
Certainly, adding 2,000 manufacturing jobs may not seem like a particularly big deal when you consider that Rhode Island has lost more than 56,000 manufacturing jobs since 1990. Yet what’s noteworthy is that this marks the first time in the last quarter-century that the seemingly endless slide in local manufacturing employment has come to a halt, as this chart shows:
As the saying goes, flat is the new up.
By Ted Nesi
PROVIDENCE, R.I. (WPRI) – Warren Equities Inc., a closely held Rhode Island petroleum retailer whose late founder left $100 million to Brown University’s medical school, has been sold to a Massachusetts firm.
Global Partners L.P. said it is paying about $383 million for Providence-based Warren Equities, whose three divisions include the XtraMart convenience store chain and which has regularly made Forbes magazine’s annual list of the largest private companies in the United States. Founder Warren Alpert died in 2007.
My WPRI.com piece Monday on 12 things to know about Medicaid in Rhode Island has – happily! – gotten a lot more clicks and feedback than I expected. Thanks to all who read it.
The most interesting feedback I received was from Kali Thomas, an assistant professor of health services, policy and practice at Brown University, who thinks there are ways Rhode Island can reduce its far-above-average Medicaid spending on elderly residents:
I wanted to point out some interesting information about those highest spenders you referenced (particularly those in nursing homes).
One disappointing statistic is that we are ranked 43rd out of the 50 states with almost one-fifth of our population of nursing home residents identified as having low-care needs. These “low-care” residents are those who do not necessarily require the level of care provided in nursing homes. Specifically, they do not require assistance with any of the four late-loss activities of daily living – eating, bathing, toileting, or transferring – and they are not classified as needing extensive rehabilitation or identified as “clinically complex.” This suggests that were we able to provide them with supportive services in the community, they may be able to be cared for and sustained in a less restrictive and more appropriate setting. Focusing on efforts to reduce the numbers of low-care residents in our state is a great opportunity to reduce the excessive spending in our Medicaid program.
Previous work I have conducted with colleagues at Brown’s School of Public Health suggests that increased spending on home- and community-based programs, like home-delivered meals, is related to a lower proportion of low-care residents. Further analyses have suggested that increasing capacity in the home-delivered meals program can potentially result in savings to states’ Medicaid programs. However, despite legislative testimony I gave this past year highlighting the beneficial effects we could recognize by reinstating previous funding levels for our state’s Meals on Wheels program, the cuts that were made to the program have sadly remained in place.
I would like to draw attention to A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers, produced by AARP, SCAN Foundation and the Commonwealth Fund. It lists specific domains related to long-term care where we could use improvement and how we compare to other states. For example, Rhode Island ranks second to last in our efforts to re-balance Medicaid long-term care spending. As a state, only 16% of our Medicaid long-term care spending goes toward services provided in people’s home and in the community. Investing in relatively more affordable supportive services that enable people to remain in the community rather than being placed in costly nursing homes is one way we can lower overall costs. I believe that our state’s residents and policymakers need to have a better awareness of why we are among the highest spenders on long-term care and what we can do about it.
There is so much we can learn from other states and with our size, we are ideally positioned to enact changes to improve our system of long-term services and supports. Thank you for spreading awareness about our state’s Medicaid spending “problem.” Now, let’s focus on solutions!
Another interesting point was made by Secretary of Health and Human Services Steven Costantino, who pointed me to this July study by Pew looking at state Medicaid costs nationwide.
The Pew study shows Medicaid spending growth in Rhode Island averaged just 2% from 2000 to 2012, the third-lowest growth rate in the country and only half the national average of 4.1%. That’s far below the 7% growth rate for Medicaid spending projected last month by the House Fiscal Office.
The study also shows Medicaid spending per enrollee rose 13% in Rhode Island between 2000 and 2010, more than twice the national average of 13%. Also interesting: 33% of Rhode Island’s Medicaid enrollees were elderly and disabled, tied for fifth-highest share in the country.
Finally, if you want to dig in further on all these issues, you’ll want to read this 2007 “Future of Medicaid” report conducted by the Carcieri administration. It’s a very good overviews of the issues Medicaid was facing in Rhode Island pre-recession and pre-Obamacare, and has some terrific charts. For example, here’s another look at how Medicaid costs breakdown across elderly beneficiaries during the state’s 2005-06 fiscal year:
One of the many challenges noted in the report: “Medicaid beneficiaries in mandatory coverage groups tend to be high-need, high-cost service utilizers. As is explained elsewhere in this report, by contrast, beneficiaries in the optional coverage groups are primarily children and families – e.g., RIte Care enrollees – who have less complex service needs and are less costly to cover.” It goes on to say:
Of critical importance is that recent efforts by the state to improve services to the adult populations “carved out” many of the high cost beneficiaries and focused instead on managing the care of users at the middle and lower ends of the cost distribution curve. This includes the soon to be implemented health plans for both elders and adults with disabilities. Yet, as these distribution curves reveal, care management is necessary for all beneficiaries and, in particular, for those who are high cost users, to ensure that the right services are being provided in the most appropriate setting.
And here’s another chart from that report, this one showing how fast RIte Care and RIte Share, the managed-care insurance program for lower-income children and adults, expanded during the Almond administration:
On Tuesday, for the first time since 1960, Rhode Island Democrats managed to win all nine major offices on the ballot: governor, lieutenant governor, secretary of state, attorney general, general treasurer, U.S. senator, 1st District congressman, 2nd District congressman, and Providence mayor, according to a WPRI.com review of past election results.
Democrats have had big years before – Republicans won no federal races in 2012, 2008, 2004 or 1996, for example – but it’s been 54 years since the party won all nine of those top offices in a single November election.
Democrat Gina Raimondo won the governor’s race by a slightly wider margin than first thought.
The R.I. Board of Elections updated its count on Wednesday to include the results from roughly 15,000 voters who used mail ballots. Those mail ballots increased Raimondo’s total number of votes to 131,452, a jump of about 8,000 from the preliminary results.
Republican Allan Fung’s total votes rose to 117,106 and Moderate Bob Healey’s rose to 69,070 with mail ballots included. Raimondo received more than half the votes for governor cast by mail ballot. Fung received about 2,000 more votes than John Robitaille did in 2010, a 2% increase. Robitaille was running in a four-way against a former Republican U.S. senator (Lincoln Chafee) and two other candidates with moderate policy priorities (Frank Caprio and Ken Block).
The results in the governor’s race now round to Raimondo 41%, Fung 36% and Healey 21%.
Overall Raimondo defeated Fung by a decisive 4.5 percentage points, or more than 14,000 votes, the biggest vote margin in a governor’s race since Don Carcieri’s first election in 2002.
Raimondo’s victory was entirely thanks to the city of Providence, which she took by a plurality of about 16,000 votes; in Rhode Island’s other 38 cities and towns, Fung beat her by nearly 2,000 votes combined. Turnout in Providence was higher than four years ago as voters decided the high-profile mayoral race.
Raimondo won with more votes than Lincoln Chafee, who received 123,571 in 2010. Excluding Chafee, however, Raimondo received the smallest number of votes for a victorious gubernatorial candidate in Rhode Island since 1930, when Republican Norman Case won with 112,070, historical records show.
Here are the margins in all the big races with mail ballots included:
- Governor: Raimondo 41%, Fung 36%, Healey 21%
- Providence Mayor: Elorza 52%, Cianci 45%, Harrop 3%
- Lt. Governor: McKee 54%, Taylor 34%, Gilbert 8%, Jones 3%
- Secretary of State: Gorbea 60%, Carlevale 39%
- Attorney General: Kilmartin 57%, Hodgson 43%
- General Treasurer: Magaziner 57%, Almonte 43%
- U.S. Senate: Reed 71%, Zaccaria 29%
- 1st District: Cicilline 60%, Lynch 40%
- 2nd District: Langevin 62%, Reis 38%
In Cranston, despite the presence of the city’s mayor on the ballot, turnout this year was the lowest in the past four gubernatorial elections, with only 26,935 ballots cast for governor there. Fung won Cranston with 14,820 votes or 55% of the total, above Lincoln Chafee’s 9,499 (35%) in 2010 but lower than Don Carcieri’s 16,938 (52%) in 2006 or Carcieri’s 16,959 (58%) in 2002.
Eight Rhode Island communities have voted Republican in the last four gubernatorial elections: Coventry, Exeter, Foster, Hopkinton, Lincoln, Narragansett, Richmond and Scituate.
Only one community voted Democratic for governor all four times: Central Falls. Three others voted in 2010 for Lincoln Chafee (then an independent, now a Democrat) and for Democrats the other three times: East Providence, Pawtucket and Providence.
This post has been updated and expanded.
The sizable shortfall in Providence’s pension system for retired city workers has become a major topic of discussion in this year’s race for mayor, with facts and figures flying fast and furious.
To help you sort out facts from fiction, here are three charts that give an overview of the city pension fund’s finances over the last two decades under three mayors: Buddy Cianci (1991-2002), David Cicilline (2003-2011) and Angel Taveras (2011-present). The numbers come from the annual city audit.
First off, here’s a look at what’s called the “unfunded liability” in the pension fund – the official shortfall between how much the city has socked away and how much it would need to pay out promised benefits in full, as reported by the city’s actuary. For a variety of reasons, the shortfall grew from $137 million in 1991 to $759 million in 2012. (The latest audit isn’t out yet, but the shortfall rose to $832 million in 2013.)
I owe Buddy Cianci a correction.
Numbers were flying fast and furious during Tuesday evening’s Providence mayoral debate, and I got mixed up during the section on pensions when Cianci was talking in calendar years as I was looking at city audits that are in fiscal years.
It happened when Cianci said the city “finally got up to 80% funded in 2002,” meaning that the city made 80% of its annual required contribution (ARC) to the pension fund that year. Knowing the numbers somewhat (and recalling that Cianci incorrectly said on a recent Newsmakers that he made 100% contributions in his final years), I said the city’s contribution was actually around 60% that year.
Cianci then clarified that the final budget he put together before his September 2002 resignation was for the fiscal year that ran from July 1, 2002, to June 30, 2003. And indeed, the city audit shows Providence did make 80.25% of its annual required contribution to the pension fund in the 2002-03 fiscal year, which is the budget Cianci was putting together in the spring of 2002.
(To compound things, as I tried to separate calendar from fiscal years on the fly I misread the 2002 and 2003 numbers when I looked down at the pension page from the city audit, and incorrectly said he only made a 60.6% contribution in 2002 and a 64.18% contribution in 2003; that was in fiscal 2001 and fiscal 2002.)
On this point Cianci was right, and I was wrong: the Cianci administration did indeed increase Providence’s annual required contribution (ARC) to the pension fund from 60.6% in the 2000-01 fiscal year to 64.18% in the 2001-02 fiscal year and 80.25% in the 2002-03 fiscal year, his final budget.
Mea culpa, mea culpa, mea maxima culpa.
• Related: Providence’s troubled city pension fund, in four charts (Oct. 1)
Rhode Island may have 39 cities and towns, but the state doesn’t have an Electoral College, so it doesn’t matter how many different municipalities a candidate wins – run up the score enough in a few and you could conceivably win an election while losing a majority of the 39.
That’s not what happened in last week’s Democratic and Republican gubernatorial primaries; both Gina Raimondo and Allan Fung came out on top in a majority of the 39 cities and towns, with Raimondo winning 36 of them and Fung winning 28 of them.
But a closer look at the results shows a majority of Raimondo’s votes came from just seven cities and towns, while a majority of Fung’s votes came from only eight.
Raimondo’s top three cities for votes matched the state’s top three cities for population precisely: Providence (9,738 votes), Warwick (4,387) and Cranston (3,593). Her fourth-best community was Cumberland, only the eighth-biggest by population, which gave her 3,150 votes. Add in Pawtucket (2,912), North Providence (2,599) and East Providence (2,527), and you have a majority of Raimondo’s 54,041 accounted for. Her biggest outlier was probably Central Falls, which ranks 19th by population but was 30th for Raimondo votes. (Angel Taveras won the city with help from Mayor James Diossa.)
Raimondo got 50,041 votes total; here are the rankings with cumulative percentages:
- Providence: 9,738 (18%)
- Warwick: 4,387 (26%)
- Cranston: 3,593 (33%)
- Cumberland: 3,150 (39%)
- Pawtucket: 2,912 (44%)
- North Providence: 2,599 (49%)
- East Providence: 2,527 (54%)
Fung’s vote totals don’t match up as precisely with population centers. His top cities were his hometown of Cranston (3,040 votes) and Warwick (2,428), which together contributed almost one in three Fung votes. But his third-best town was North Kingstown (834), which ranks 13th by population, whereas the state’s biggest city, Providence, gave him only 616 votes, even fewer than Coventry (734). Another town with outsized impact was East Greenwich (512 votes), 26th by population but sixth for Fung votes. The rest of his majority came from South Kingstown (506) and East Providence (477).
Fung got 17,531 votes total; here are the rankings with cumulative percentages:
- Cranston: 3,040 (17%)
- Warwick: 2,428 (31%)
- North Kingstown: 834 (36%)
- Coventry: 734 (40%)
- Providence: 616 (44%)
- East Greenwich: 512 (47%)
- South Kingstown: 506 (49.5%)
- East Providence: 477 (52%)
The results in Central Falls were even more striking for Fung than for Raimondo. He won more votes on Block Island (36) than he did in Central Falls (26), even though the latter has 18 times more residents.
I know blogging has been rather – ahem – light here on Nesi’s Notes in recent months, with primaries and polls and debates keeping me cranking out main-site stories and TV coverage. But I never forget you, loyal NN readers, and I hope to get back to more regular blogging post-primary and particularly post-election.
For now, though, I have to take a moment and direct your attention to an exciting career milestone by my ace WPRI.com colleague Dan McGowan, who has been a huge asset to WPRI 12 and Nesi’s Notes since joining the team last year.
Politico Magazine – the political news site’s newish long-form-focused offshoot – just posted McGowan’s first-ever national story, a 3,000-plus-word look at the latest comeback attempt by Buddy Cianci. Click here to read it – a great tale, well told by Dan for locals and out-of-towners alike.
1. Mark your calendars: WPRI 12 and The Providence Journal will release a new exclusive Campaign 2014 poll next week. We asked Democratic primary voters whether they support Angel Taveras, Gina Raimondo, Clay Pell or Todd Giroux for governor, whether they could still change their minds, and how they plan to vote in the other statewide primary races. We’ll release the first results live on WPRI 12 and WPRI.com Tuesday at 5 p.m. Tune in!
2. It’s safe to say this was not the best week of the campaign for Republican gubernatorial candidate Allan Fung. Filming a TV ad in Ohio is a rational decision even if it opens you up to attacks; refusing to answer a reporter’s phone calls for 48 hours after he finds out you did so is just silly. Also interesting is the controversial Ohio consulting firm Fung is using: Strategy Group for Media, which BuzzFeed’s McKay Coppins described in 2013 as “a campaign and strategy clearing house for the uncompromisingly conservative wing” of the House GOP. Indeed, nine Strategy Group employees – including founder Rex Elsass – donated a combined $6,850 to Fung’s campaign between May 29 and June 3, which will boost the candidate’s state matching funds if he makes it to the general election. (Fung allies were quick to point out that his rival Ken Block is using New Jersey-based Jamestown Associates, another controversial firm in Republican circles, but they’ve filmed Block’s ads locally.) Block criticized Fung as well for backing out of a cable-access debate scheduled for this week, which Fung’s campaign attributed to the candidate’s initial plans to attend the Asian American Journalists Association conference in Washington. (In the end, though, Fung decided to stay in Rhode Island.) These sorts of stories are hardly fatal to Fung’s campaign in and of themselves – few if any voters are going to pick a candidate based on his TV ad locations. But the negative headlines are an unwelcome distraction just three weeks before the primary. Plenty of Republicans seem open to Block despite his previous apostasies – he is, after all, a fiscally conservative businessman who rails against the Democratic General Assembly and played an instrumental role in killing the master lever. The result could come down to how high Fung can drive his vote totals in Cranston and Warwick.