The federal government is poised to shower billions of dollars on Rhode Island’s health providers over the next decade due to the looming expansion of Medicaid under President Obama’s Affordable Care Act.

The health law expands Medicaid, the joint federal-state health insurance program for the poor, to cover childless adults who make up to 138% of the federal poverty level, currently $15,856. A new study by the Rhode Island Public Expenditure Council projects that roughly 40,000 more Rhode Islanders will sign up for the program between the start of the expansion on Jan. 1, 2014, and the end of 2023.

Yet Rhode Island taxpayers will need to spend just $450 million in local matching funds to get $3.15 billion in federal money (seven times as much) to cover the newly enrolled 40,000, according to RIPEC. That’s thanks to the extremely generous terms of the Medicaid expansion: the federal government will pay at least 90% of the cost for patients added under Obamacare, compared with only 51% for the current members.

Rhode Island’s Medicaid program spent $1.8 billion in federal and state dollars to cover 224,000 people during the 2010-11 fiscal year. Medicaid accounts for roughly a quarter of Rhode Island’s entire state budget.

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U.S. Sens. Jack Reed and Sheldon Whitehouse were among the 79 senators who voted Thursday night to get rid of a tax on sales of medical devices passed in 2010 to help fund President Obama’s health reform law.

The two Rhode Island senators joined 31 of their fellow Democrats and all 45 Republicans in voting to repeal the 2.3% excise tax on medical devices, which took effect Jan. 1. Getting rid of it would cost the federal government $29 billion from 2013 to 2022, according to the Center on Budget and Policy Priorities, a left-leaning Washington think-tank that opposed repealing it.

Whitehouse and another stalwart liberal, Massachusetts Sen. Elizabeth Warren, were among those who sided with the device industry on the repeal measure, which was introduced by Republican Orrin Hatch of Utah and has been the subject of a heavy lobbying effort.

Stephen Lane, chairman and chief venture officer of the Providence-based medical-device firm Ximedica, said at a manufacturing forum last year co-hosted by Congressmen David Cicilline and Jim Langevin that the tax was causing his industry to move production to Asia. Cicilline and Langevin voted to keep the tax, and Cicilline clashed over the question with his Republican opponent Brendan Doherty in a WPRI 12 debate last fall.

U.S. Sen. Sheldon Whitehouse thinks he knows how President Obama can reach a budget deal without reducing Medicare benefits outright: declare exactly how much money the federal government will save by changing how health care is delivered, and then make it happen.

“A clear and specific presidential target will focus federal efforts in an accountable manner, that calls to ‘bend the health care cost curve’ will not,” the senator said in a statement. Whitehouse is a leading congressional champion of what’s known as health care delivery system reform.

The problem, as Whitehouse sees it, is that the Congressional Budget Office won’t “score” savings from changing how health care is delivered because the CBO sees them as uncertain. But if the president puts a dollar amount on the savings, a budget deal can bank the amount.

Whitehouse put forward his idea in a letter to Obama and a Politico op-ed on Wednesday. “Let’s put the full force of American innovation and ingenuity into achieving a serious cost-savings goal for our nation’s health care finances,” the senator wrote in the op-ed. “And in the meantime, let’s resist the urge to cut Medicare benefits and put additional strain on middle-class Americans.”

Meanwhile, Whitehouse is also trying to refocus Washington on climate change as international talks take place in Qatar. “It’s impossible to deny that it really hasn’t been a priority, and now with the fiscal issues all pending and a fairly immediate horizon for solving that, either now or in the first quarter of the year, I think that displaces these other issues,” he told Politico.

• Related: Whitehouse optimistic on filibuster, wary about ‘fiscal cliff’ deal (Nov. 14)

A little-discussed part of last year’s landmark pension law was a section called the Rhode Island Pension Protection Act, which aimed to tackle the concerns highlighted by defined-benefit critics such as Josh Barro, and which won praise from Rhode Island AFL-CIO President George Nee.

The Pension Protection Act says the state Retirement Board or its actuary cannot “change actuarial methods for the sole purpose of achieving a more favorable funding or fiscal result” – as happened in 1990, when former House Speaker Joseph DeAngelis pressured the Retirement Board into raising its investment return forecast so lawmakers could balance the budget with a smaller pension contribution.

“Politics hasn’t been good for the pension fund,” Treasurer Raimondo said at a RIPEC forum in October 2011. “I can’t redo the past. I can make it better going forward. The bill we provide fundamentally restructures it. It puts self-correcting mechanisms into the plan.”

In an effort to prevent future lawmakers from allowing a funding gap to grow, the act says that if a pension plan’s funding level falls below 50.1% or declines for five years in a row the actuary must provide the Retirement Board with five to 10 options for getting it back on track. The General Assembly must choose one of them by June 30; if lawmakers don’t act, the default option will take effect automatically.

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Nearly one-third of doctors in Rhode Island won’t take new patients covered by Medicaid, according to a new study that also shows the state’s reimbursement rates are among the lowest in the country.

Last year 68.9% of Rhode Island doctors were accepting patients covered by the government health insurance program for low-income people, on track with the rate nationally, according to a study by Sandra Decker, a National Center for Health Statistics economist, newly published by Health Affairs.

Across all states, Decker found that doctors were more likely to accept new Medicaid patients in states where the program’s reimbursement rates were closer to those offered by Medicare. Rhode Island’s 68.9% Medicaid acceptance rate was higher than in the two other states with especially low rates, New Jersey (40.4% acceptance) and New York (61.6%).

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Rhode Island is one of the few states that could wind up spending more money on health care once President Obama’s health care law is fully implemented instead of reaping savings.

The key question: how much will the new law reduce uncompensated care at Rhode Island hospitals?

With a 50% decline in the cost of uncompensated care, the Affordable Care Act would reduce state-level spending on health care by $64 billion between 2014 and 2019; with a smaller decline of 25%, state-level spending would actually rise by $44 billion, according to an Urban Institute study [pdf].

Rhode Island “would see increased costs under the low scenario and reduced costs under the high scenarios, with the magnitude of savings under the high scenario being greater than … the additional costs under the low scenario,” the study’s authors explained.

Federal spending on health care in Rhode Island over the five-year period will increase by an estimated $1.96 billion to $2.12 billion depending on the scenario, including nearly $962 million for subsidies to residents who buy coverage through the new health insurance exchange, according to the study.

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By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island officials say it’s “full speed ahead” for the state in implementing President Obama’s health care law locally after the U.S. Supreme Court upheld it as constitutional. More than 50,000 more residents are expected to sign up for Medicaid at a cost of $1.9 billion over five years.

Read the rest of this story »

• Related: Q&A: Lt. Gov. Roberts on what’s next for health reform in RI (June 28)

Ferguson (r) with Costantino and Roberts

“Is this the happiest day of my life? Pretty much!”

That’s what a smiling Christine Ferguson told me at a press conference this morning when I asked how it felt Thursday to see the health policy she developed as a senior aide to the late U.S. Sen. John Chafee upheld as constitutional by the U.S. Supreme Court.

Ferguson, who started working for Chafee’s son on Monday as head of Rhode Island’s new health insurance exchange, said unequivocally that President Obama’s signature accomplishment is what she drafted for Republicans two decades ago. ”It is based on the John Chafee bill of 1993,” she said. “It is pretty much exactly how we envisioned it.” She added: “I think it’s a great day.”

Ferguson was a key architect of the Health Equity and Access Reform Today Act of 1993, introduced by the senior Chafee that year as the Republican alternative to the Clinton administration’s so-called “Hillarycare” proposal. (Oddly enough, Hillary Clinton’s 1993 proposal was crafted in partnership with a Rhode Islander, too – Ira Magaziner of Greenhouse Compact fame.)

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There may be no bigger health wonk in Rhode Island politics than Lt. Gov. Elizabeth Roberts. Now in her second term, the Democrat was tasked by Governor Chafee shortly after he took office with overseeing the state implementation of the federal health care law, and she’s moved quickly to do so.

After this morning’s U.S. Supreme Court ruling upholding the health law, I sat down with the lieutenant governor in her State House office to discuss what comes next. The transcript has been lightly edited for length and clarity.

This decision just says, OK, Rhode Island, keep doing what you’re doing with implementing the health care law, right?

It says keep doing what we’re doing and with a sense of confidence that the federal government is going to be our partner in this going forward. We also have a lot of regional conversations going on, and there’ll be more consistency from state to state – we now know that as a country we are moving forward with this law. That will change a lot of the politics, and also a lot of the practical work that we’re doing.

Take me through – at 30,000 feet – the big benchmarks and milestones ahead in implementing the law for Rhode Island.

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The justices are expected to release their opinion shortly after 10 a.m. This post from Monday will get you up to speed. Lt. Gov. Elizabeth Roberts, who’s leading the health law’s implementation in Rhode Island, will discuss what the outcome means for the state at an 11:30 a.m. news conference.

Update: The law stands, for the most part, as a number of experts predicted.

“The bottom line,” SCOTUSblog writes, “the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.” Much more to come.

The issue of the Medicaid funds is one that matters locally, since it affects what the federal government can and can’t do to Rhode Island’s budget. But for now, looks like implementation of Obamacare moves ahead.

Update #2: The Medicaid is apparently largely irrelevant to Rhode Island because our current leaders support expanding Medicaid and weren’t looking to buck the feds on it.

Coming up this afternoon, I’ll have a one-on-one with Lt. Gov. Roberts about what this means for Rhode Island, Christine Ferguson’s reflections on John Chafee’s framework getting upheld, and more on what happens next. Also catch my interview with Congressman Langevin on WPRI 12 at 5:30 p.m.

Heads up – the U.S. Supreme Court could decide as soon as today whether all or part of the Patient Protection and Affordable Care Act, President Obama’s health care law, is unconstitutional.

The justices are scheduled to release opinions at 10 a.m. this morning, but they could hold off on issuing their health care ruling until later in the week. (No TV cameras and no leaks.)

If you want to understand what Obamacare does and what the justices are considering, read Sarah Kliff’s Wonkblog overview. If you want to watch today’s decisions as they come in, follow SCOTUSblog’s live blog this morning.

And if you want coverage on the Affordable Care Act and Rhode Island – which has moved faster than most other states to implement the law – here are some highlights from the Nesi’s Notes archive:

• John Chafee’s ghost haunts high court debate over Obamacare (June 18)

• How RI could become an island of ‘Obamacare’ in Romney’s US (Jan. 19)

• RI awarded $64.8M, most in the US, to start its health exchange (Jan. 18)

• Watch ‘Newsmakers’ with Lt. Gov. Elizabeth Roberts on health care (Jan. 1)

• Health insurance exchanges a bipartisan affair in Rhode Island (April 1, 2011)

• How John Chafee paved the way for ‘Obamacare’ in the 1990s (March 23, 2011)

• Talking health care reform with Lieutenant Governor Roberts (Sept. 23, 2010)

Update: No health care decision today (though there were some other big ones). NYT’s Jeff Zeleny says the Obamacare ruling is “likely Thursday.”

There’s some irony in Governor Chafee’s appointment on Thursday of Christine Ferguson as director of Rhode Island’s new Health Benefits Exchange, the agency that will run the state’s Affordable Care Act health insurance marketplace.

In the 1990s, Ferguson worked for Chafee’s father, Republican U.S. Sen. John Chafee, as a health policy advisor. In that role, she was a key architect of the Health Equity and Access Reform Today Act of 1993, Chafee’s GOP alternative to President Clinton’s health reform legislation.

“Christine Ferguson of my staff and Sheila Burke of Senator [Bob] Dole’s staff have been absolutely essential in preparing this legislation,” Chafee said on the Senate floor when he introduced the bill in November 1993. “Without their knowledge and drive and energy, we would not have this bill today.”

At the center of Chafee’s 1993 bill was a provision requiring every American to purchase health insurance by January 2005 – an individual mandate. The same policy has now become anathema to conservatives, who are hopeful the U.S. Supreme Court will rule it unconstitutional before the end of this month.

Ferguson may be one of the few constants in the two-decade health care debate – someone who put forward an individual mandate as a Republican aide in the 1990s and will now run an insurance exchange reliant on the mandate, put into law by a Democratic president and implemented by a center-left independent governor.

• Related: Today marks the first anniversary of – ‘Chafeecare’ (March 23, 2011)

The late John Chafee makes a prominent cameo in this week’s New Yorker, as Ezra Klein writes about how the individual health-insurance mandate went from Republicans’ preferred policy to conservative heresy.

Klein notes the mandate made its first legislative appearance in the Health Equity and Access Reform Today Act of 1993, which Rhode Island’s Republican U.S. Senator proposed in November 1993, during the fight over President Clinton’s health care bill – and it’s been part of the debate ever since:

After the Clinton bill, which called for an employer mandate, failed, Democrats came to recognize the opportunity that the Chafee bill had presented. In “The System,” David Broder and Haynes Johnson’s history of the health-care wars of the nineties, Bill Clinton concedes that it was the best chance he had of reaching a bipartisan compromise. …

Ten years later, Senator Ron Wyden, an Oregon Democrat, began picking his way back through the history — he read “The System” four times — and he, too, came to focus on the Chafee bill. …

What is notable about the conservative response to the individual mandate is not only the speed with which a legal argument that was considered fringe in 2010 had become mainstream by 2012; it’s the implication that the Republicans spent two decades pushing legislation that was in clear violation of the nation’s founding document. …

Senator Orrin Hatch, who had been a co-sponsor of the Chafee bill, emerged as one of the mandate’s most implacable opponents in 2010, writing in The Hill that to come to “any other conclusion” than that the mandate is unconstitutional “requires treating the Constitution as the servant, rather than the master, of Congress.”

Now, 19 years after John Chafee first proposed a federal individual mandate for health insurance, the country is waiting to find out whether the U.S. Supreme Court will declare his idea unconstitutional.

• Related: Today marks the first anniversary of – ‘Chafeecare’ (March 23)

No state has moved faster than Rhode Island to grab the federal money available under President Obama’s 2010 heath-care law. Washington has awarded Rhode Island $64.8 million, the most in the country, to get the new insurance exchanges up and running by 2014.

Apparently the state has been less energetic in taking action to get local health insurers to comply with the law’s new regulations. A Commonwealth Fund study out Thursday lists Rhode Island as one of 11 states where ”regulators were actively reviewing insurer filings for compliance with the reforms even though the state had not otherwise passed a new law or issued new regulations or other guidance.”

Every state except Arizona has taken some action to push insurers to implement 10 of the law’s major changes, such as the ban on lifetime benefit limits and the extension of dependent coverage for Americans up to age 26. The Commonwealth Fund put Rhode Island in the lowest of four levels of action states have taken.

But that isn’t necessarily a problem. “States have adopted a range of pragmatic approaches to help ensure that their residents receive the full benefits of the consumer protections promised under the Affordable Care Act,” Katie Keith of Georgetown University’s Center on Health Insurance Reforms said in a news release.

• Related: How Rhode Island could become an island of ‘Obamacare’ in Romney’s US (Jan. 19)

(map: Commonwealth Fund, via Wonkblog)

If Mitt Romney wins the presidency in November, could Rhode Island wind up implementing President Obama’s health care reform law while other states don’t? A new TPM report suggests it’s possible.

Rhode Island has already received more money than any other state - $64.8 million – to create the law’s new health insurance exchanges. And even if Romney wins, the officials driving the effort here – Governor Chafee and Lt. Gov. Elizabeth Roberts – will be in office through 2014, when the exchange will start up:

A closer look reveals that chipping away at Obamacare, or even repealing it altogether will be a daunting challenge ….

For instance, because so many state governments are unprepared or unwilling to build out the architecture of the law by 2014, Obamacare empowers the federal government to set up, or help set up, insurance exchanges in lagging jurisdictions. But a GOP President could put a stop to that. …

Absent Congressional action, that would leave in place many of the law’s reforms, but no way to realize them in many states — in other words, health care reform for some, and not for others.

• Related: Lt. Gov. Elizabeth Roberts talks health reform on ‘Newsmakers’ (Dec. 30)

Rhode Island has received more money than any other state to implement President Obama’s health care law, the White House said Wednesday.

The federal government has awarded $64.8 million to Rhode Island since September 2010 to help the state create its new health insurance exchange, an online marketplace where residents will buy subsidized coverage starting in 2014 under the Affordable Care Act.

The bulk of Rhode Island’s money – $58.5 million – was awarded Nov. 29, when it became the first state to get a second-round grant to fund “development, design and technology procurement” for the exchange through 2014. No other state has advanced that far yet.

The White House said $729.5 million has been awarded across the 50 states and Washington, D.C. Oregon has received the second-most money, at $58 million. Governor Chafee has said he’s “extremely pleased” with how fast Rhode Island is moving.

The White House report singled out Rhode Island and nine other states to explain the steps they’re taking to implement the law. Rhode Island is in discussions with Massachusetts and Vermont about whether to share technology and make purchases jointly, according to the report.

• Related: Lt. Gov. Elizabeth Roberts talks health reform on ‘Newsmakers’ (Dec. 30)

Happy New Year! … and look who’s guest hosting:

Obama signs the health care law

The Providence Journal’s great medical writer, Felice Freyer, has been diligently tracking Rhode Island’s initial steps toward creating a health insurance exchange as part of President Obama’s health reform law.

The exchange will be a regulated Web-based marketplace where consumers without health coverage can compare and choose between different insurance plans. The idea is modeled on the Massachusetts Health Connector created by Gov. Mitt Romney and the legislature there as part of its universal coverage law.

A Senate bill to establish Rhode Island’s exchange passed a Senate committee unanimously on Wednesday, Freyer reported:

The unanimity extended to the people who packed the hearing room of the Health and Human Services Committee, all of whom said they supported the bill. Many decided not to speak at all, asking chairwoman Rhoda E. Perry, D-Providence, to merely read out their names as supporters. Supporters included health insurers, hospitals, advocates and providers. …

Christopher F. Koller, state health insurance commissioner, urged quick action. The state could be in line for “tens of millions” of federal dollars for planning, he said, but only if the bill is signed into law and its governing board seated before the legislative session ends this spring or summer. …

Sponsored by Senate President M. Teresa Paiva Weed, D-Newport, the legislation would merely establish the governance structure for the exchange. It says nothing about how the exchange will work. Instead, the exchange’s governing board will hammer that out and make a recommendation to the General Assembly next year.

I checked in with Freyer on Twitter, and she reiterated that no one expressed opposition to creation of the exchange at Wednesday’s hearing, but one of the bill’s co-sponsors is a Republican: Sen. Beth Moura, R-Cumberland.

[Update: My error - Freyer did not say Sen. Moura was a co-sponsor, as I now see I implied; an e-mail correspondent working on the legislation told me that. Freyer corrects me that Moura is not a co-sponsor. My apologies.

The General Assembly's website does list a Republican co-sponsor, though: Senate Minority Leader Dennis Algiere, R-Westerly. And Moura did vote in favor of the bill in committee - so the exchange remains a bipartisan issue here.]

The situation in Rhode Island presents a stark contrast to the partisan battles being waged in other states over the exchanges, where Tea Party activists are moving to block their implementation – despite the fact that the federal government will do it if the states do not, as Politico reported this week:

In South Carolina, tea party activists have been picking off Republican co-sponsors of a health exchange bill, getting even the committee chairman who would oversee the bill to turn against it.

A Montana legislator who ran on a tea party platform has successfully blocked multiple health exchange bills, persuading his colleagues to instead move forward with legislation that would specifically bar the state from setting up a marketplace.

And in Georgia, tea party protests forced Gov. Nathan Deal to shelve exchange legislation that the Legislature had worked on for months.

The moves have buoyed some health reform opponents, who contend that states cannot both challenge the law while laying its foundation.

Moreover, the protests underscore a widening rift within the Republican party, between those who say states should implement the law, retaining more power as it moves forward, and others who favor completely opting out of a law they because they believe it to be unconstitutional. Critics say that strategy runs the risk of turning control over to the feds.

Update #2: Speaking of health care, a programming note – Tufts Health Plan CEO Jim Roosevelt will be Tim White’s guest on the first half of WPRI 12′s “Newsmakers” this week. (The second half will be a political roundtable with Tim, WRNI’s Ian Donnis, Arlene Violet and yours truly.) The show will be posted online later today and air on Fox Providence at 10 a.m. Sunday.

(photo: Chuck Kennedy/The White House, via Flickr)

A year ago today, President Obama signed the late U.S. Sen. John Chafee’s health care reform plan into law.

Sure, most people know the legislation as the Affordable Care Act – or, in less supportive circles, “Obamacare.” But when you get away from all the partisan bickering over the law, its actual nuts and bolts bare a striking similarity to the Health Equity and Access Reform Today Act of 1993, which the Rhode Island Republican proposed during the heat of President Clinton’s fight over health policy.

Don’t believe me? Check out this Kaiser Health News chart comparing John Chafee bill’s with competing Republican and Democratic proposals from 2009. As Kaiser’s Maggie Mertens pointed out in a February 2010 interview with one of Chafee’s co-sponsors, former Sen. Dave Durenberger of Minnesota:

In fact, the key provisions in the Chafee bill may seem familiar, as they bear a strong resemblance to those in the current Democratic Senate bill, and now in President Barack Obama’s proposal. A mandate that individuals buy insurance, subsidies for the poor to buy insurance and the requirement that insurers offer a standard benefits package and refrain from discriminating based on pre-existing conditions were all in the 1993 GOP bill.

Durenberger says the reason many of these ideas have been shunned by today’s Republicans, even called unconstitutional by some, is that political times have changed. “The main thing that’s changed is the definition of a Republican,” he said.

The bill Chafee crafted wound up being Democrats’ last, best hope for passing something comprehensive by the summer of 1994. “I trust John Chafee,” Sen. Ted Kennedy told fellow Democrats even as the legislation’s prospects dimmed. In the end, though, his bill died along with every other effort to pass major health legislation during that Congress.

Chafee’s ideas didn’t die, though – his top health policy aide, Laurie Rubiner, went on to work for Hillary Clinton, helping shape the health plan that Clinton unveiled during her presidential campaign – which also influenced Obama’s.

The American Enterprise Institute’s Norm Ornstein, an authority on all things congressional, emphasized the link between Chafee’s proposal and Obama’s amid the long legislative battle of 2009-10. “It is basically a marriage between Mitt Romney’s Massachusetts-care, and even more the John Chafee-David Durenberger-Chuck Grassley-Bob Dole alternative of 1993-’94 built around managed competition,” he told PBS’s Charlie Rose. (Orrin Hatch and Richard Lugar were also Chafee co-sponsors, at least initially.)

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Rhode Island’s Jack Reed and Sheldon Whitehouse are taking some heat on Anchor Rising and WSJ.com for being among the 17 senators who voted against the legislation that repealed the health reform law’s 1099 reporting requirement, which has small businesses up in arms.

Reed and Whitehouse did vote in favor of an alternative proposal that would have replaced the lost from 1099 repeal by eliminating tax breaks for oil companies. The version that finally passed will offset the 1099 repeal with $44 billion in unspecified funds already appropriated by Congress but not yet spent; It will be up to the White House to decide what to cut.

The two senators say their big concern with the version that wound up passing comes down to one thing: the floods.

Specifically, Reed and Whitehouse expressed fears that some of the money the administration will shift to offset the 1099 repeal could be funds they secured to help pay for the cleanup after last spring’s flooding here in Rhode Island.

“Senator Reed voted for a responsible 1099 fix, but he voted against the Stabenow amendment because it jeopardizes Rhode Island’s flood recovery funding and could lead to significant cuts to road and bridge improvement, school upgrades, and a host of other programs the state needs to help it emerge from the recession,” his spokesman Chip Unruh said in an e-mail.

Whitehouse’s press secretary pointed to this statement his boss made on the Senate floor during the debate over the 1099 fix, which acknowledged the outcry against the law:

Since passage of the bill, I have heard from hundreds of Rhode Island small business owners about the paperwork and record-keeping costs of complying with the new 1099 standards. The provision, which was intended to cut down on fraud and generate revenue, has simply proven too burdensome on small businesses. I support the repeal of the new 1099 provision and am pleased to have voted in favor of the Levin amendment which would do so.

But, Whitehouse went on to say, “Senator Reed and I fought hard to bring federal help to Rhode Islanders struggling to rebuild after the worst flood in 200 years, and I simply am not willing jeopardize that relief.”

Well, nobody ever says he wants to raise taxes. The question is whether you do despite that.

The Pawtucket Times’ Jim Baron has a lengthy interview with House Speaker Gordon Fox that’s well worth a read. Here’s what Fox has to say about Gov.-elect Lincoln Chafee and his proposal to levy a new 1% sales tax on items that are currently exempt from the 7% sales tax as a way to help close next year’s $295 million budget deficit:

Fox says he sees Chafee as someone he can deal with.

“I can already say I like the guy,” Fox said of the incoming governor. “I find him to be a straight shooter and he shows compassion for folks. You can’t always say that about people in this building.” …

The Speaker said he is ready to sit down and talk budget with Chafee when he gets his fiscal team in place.

Nonetheless, he repeats: “I don’t want to raise taxes on anyone, especially the sales tax, because that can hurt the lower and middle income people. I won’t say no, but it may take a lot of convincing,” for him to embrace Chafee’s 1 percent plan. There may be room to maneuver, however, because Fox says, “We have gone from having an economy based on goods to a service-based economy and our sales tax has never reflected that.”

Fox’s warm comments about Chafee personally and as a colleague fit with what most observers have suggested – the General Assembly’s leadership will likely find it easier to deal with the governor-elect than with Carcieri because Chafee’s policy views are more in line with their own. But that doesn’t make them any more enthusiastic about the idea of enacting a new broad-based tax on their constituents, budget deficit or not.

Among other highlights, Fox told Baron he wants the General Assembly to take an active role in implementing President Obama’s Affordable Care Act; hopes to use Central Falls to create a template for how to aid ailing cities and towns; thinks the time may be right to legalize gay marriage here; and he plans to keep a close eye on Massachusetts’ next moves when it comes to casinos.