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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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 spends more than any other state on its Medicaid program per enrollee, but apparently that’s not because local primary-care doctors are getting a windfall.

Doctors in Rhode Island get paid the nation’s lowest reimbursement rates by Medicaid, the state-federal health insurance program for the poor, relative to what private insurers offer, according to a 2009 Urban Institute study flagged by Forbes.com’s Avik Roy.

Rhode Island and New York both pay primary-care doctors rates that are only 29% of what they’d get from private insurers, the least in the nation, the study found. Rhode Island’s payment rate is far below those of the other New England states: Maine (42%), Vermont (54%), Massachusetts (62%), Connecticut (63%) and New Hampshire (73%).

The federal government limits the ability of states to scale back Medicaid coverage. “So, if states need to reduce Medicaid spending, but can’t make less people eligible for Medicaid, what do they do?” Roy writes. “Pay doctors less.” He suggests the Affordable Care Act will force more states to cut doctors’ rates.

Bloomberg’s Josh Barro counters that “expanded [Medicaid] participation is a good thing. The objective of the Medicaid program – which all 50 states have voluntarily agreed to participate in – is to provide health coverage to poor people. When eligible people do not participate, it is a policy failure.”

• Related: Chart: RI elders cost Medicaid 7 times more than kids, families (March 1)

(chart: Avik Roy/Forbes)

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) – Blue Cross & Blue Shield of Rhode Island is laying off an unspecified number of its employees on Wednesday, WPRI.com has learned.

Read the rest of this story »

There seems to be some confusion about the state of Rhode Island’s unfunded liability for retiree health care.

The shortfalls are $774.8 million for state employees; $80.3 million for state police; $50.6 million for the board of governors; $9.5 million for teachers; $1.8 million for judges; and about $1,000 for the General Assembly. Those numbers come from the latest draft valuation by actuaries Gabriel, Roeder, Smith & Co.

Put it all together and the total unfunded liability for all six groups combined is $916.8 million as of June 30, 2011, up from $822.3 million last time. Again, that’s the state-level shortfall for OPEB (“other post-employment benefits”), which is separate from pensions. (The municipal OPEB shortfall is more than $3 billion.)

• Related: RI taxpayers to pony up $48m for retiree health in 2011 (April 28, 2011)

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)

East Providence’s state-appointed budget commission voted this week to stop offering health insurance to members of its City Council as of Nov. 1, which is expected to save nearly $50,000 a year. Do most Rhode Island communities give their elected officials health benefits?

The answer is no – or at least it was as of July 2006, the last time the state published a survey of salary and fringe benefits offered to municipal elected officials. East Providence was one of nine cities and towns that offered health insurance to their local councilors at the time, the results showed.

Another of the nine was Central Falls, where receiver Robert Flanders ended health benefits for the City Council last June, shortly before the city filed for bankruptcy. The other seven that offered councilors health insurance in 2006 were Burrillville, East Greenwich, Johnston, Newport, Pawtucket, Providence and Warwick.

The generosity of the plans ranged from a “fully paid” family health insurance plan for Burrillville councilors to an annual cap on coverage of $2,700 a year in East Greenwich. All nine cities offered councilors dental coverage, too, and some of them also offered vision coverage, life insurance and retirement benefits.

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:

By Tim White

PROVIDENCE, R.I. (WPRI) – A five-year investigation into a health insurer used by thousands of small businesses in Rhode Island has resulted in a $2.5 million settlement with the state.

The majority of the money from the settlement with MEGA Life and Health Insurance will go to consumers – usually self-employed – who signed up for health insurance when the company began offering services in 2004.

In a press release, Health Insurance Commissioner Christopher Koller said MEGA engaged in several illegal insurance underwriting practices.

Target 12 first reported the investigation into MEGA in 2006. At the time, Koller referred to MEGA as a “telephone poll company” that advertises to consumers directly, rather than through an employer.

Read the rest of this story »

I was reading the other day about how some Republicans want to allow health insurance to be sold across state lines, the idea being that this would give consumers more options and help reduce prices. Liberals say it would cause a “race to the bottom” as health insurers flock to the states with lax regulations.

The progressive wonk Robert Gordon expanded on that critique in this 2008 Slate piece that looked at what happened with credit cards three decades ago:

Until the late 1970s, South Dakota and Delaware didn’t have an outsized share of the credit-card business. Banks had to obey the interest caps of the states where borrowers lived. So, for example, loans to New York residents were always subject to New York’s limits on interest rates. At 12 percent back then, and with high inflation, these laws sharply limited profits on credit cards.

Then in 1978, the Supreme Court said banks should follow the rate cap in their home states. … Following the court’s ruling, Citibank chairman Walter Wriston offered Gov. Bill Janklow a deal: If South Dakota lifted its rate cap altogether and formally invited Citibank to the state (as federal law required), the banking giant would move its credit-card operations to South Dakota—along with 400 good jobs.

The bill was introduced and passed in the space of a day. Soon after, Delaware lifted its cap, too. Voilà, South Dakota and Delaware became the hosts of most credit-card companies.

But here’s my question: Rhode Island is a small state like South Dakota and Delaware – is there some vaguely unsavory industry we could attract here with light regulation? I suppose the other states might be ticked at us, but with 10.9% unemployment, we’ve got to do what we’ve got to do.

Yes, this is meant mostly in jest – but still worth pondering, perhaps.

(photo: MoneyBlogNewz/Flickr)

And you thought pensions were a big problem? Wait till you see the unfunded liability for retiree health care.

That’s the takeaway from our latest Target 12 investigation, a months-long effort to figure out just how many billions of dollars’ worth of medical care Rhode Island cities and towns have promised their retirees – and just how little they’ve put aside to cover it. Here’s how the story kicks off:

Alarm bells have been sounding for years over the shaky status of pension plans in some of Rhode Island’s largest cities and towns. But a Target 12 investigation reveals an even bigger ticking time bomb buried on their balance sheets.

The state’s municipalities have promised to provide nearly $3.6 billion worth of medical coverage to their current and future retirees over the next three decades, but government financial reports show they’ve put aside almost nothing to pay the bill – just $27.5 million, or less than 1 percent of the future cost.

To put it in perspective, the $3.6 billion unfunded liability for city and town retiree health care is significantly larger than their pension plans’ shortfall of roughly $2.2 billion.

As with pensions, communities do not need to come up with the money for these so-called “other post-employment benefits,” or OPEB, all at once. But most have barely begun to grapple with the cost.

“You’ve heard the general treasurer recently say pension reform for state employees and municipal employees isn’t a problem – it’s the problem,” said Dan Beardsley, executive director of the Rhode Island League of Cities and Towns. “Well, I would say OPEB obligations and dealing with those obligations is either equal to or just a notch down from the needed pension reform.”

“That’s how big it is,” he said. “The numbers are staggering.”

There has been some coverage of the retiree health issue before, but this is the most extensive overview of the issue anyone has written up to now. You’ll find out which places owe the most, why the numbers are finally coming to light, why Hopkinton’s town manager says the benefit isn’t even necessary – and why these promises may be easier to break than those made for pensions.

Shorter pitch: We worked hard on this, so read the whole thing. You can also see the amount for your community in our interactive map. The state government has a large but less dramatic liability for retiree health, as well.

Related: Could this be the year for a grand compromise on pensions?

(graphic: Josh Davis/WPRI)

The Projo’s op-ed page surprised me on Tuesday when it published the following statistic (emphasis mine):

Rhode Island’s total unfunded pension liability has reached a staggering $13 billion — roughly $13,000 for every man, woman and child. For a family of four, that’s $52,000 — which happens to be about the median annual household income in the Ocean State. …

There is one way for Rhode Islanders to evade their $13 billion obligation, former state Auditor Ernest Almonte warned last week.

Move out.

That number – $13 billion in unfunded pensions – was a new one to me. I couldn’t find a way to replicate it on my own, so I checked in with Almonte, who informed me it’s incorrect – the details were lost in translation.

Almonte said his $13 billion unfunded liability estimate isn’t just for pensions – it also includes the state and local unfunded liability for other retiree benefits, which is mostly health care. As I reported last week, the state is starting a trust fund this year to save money for those benefits.

That’s an important distinction, because it hasn’t been established that public-sector retirees’ medical benefits carry the same legal protections as their pensions – and therefore those promises may be easier to change, which would reduce the amount taxpayers must pay to provide them.

Here’s how Almonte got to the $13 billion number:

Pensions may get all the headlines, but this year Rhode Island is also taking a major step forward in grappling with the cost of providing health care to state retirees over the decades to come.

Taxpayers will contribute $48.4 million this fiscal year to Rhode Island’s new Retiree Health Care Trust Fund, State Budget Officer Tom Mullaney told WPRI.com. The Chafee administration’s budget proposes putting another $52.1 million into the trust fund during the next fiscal year, which starts July 1.

Those amounts are in addition to state taxpayers’ yearly contributions to the pension fund, which will total $204 million this fiscal year and $238 million next fiscal year, according to Mullaney’s most recent estimates.

The General Assembly created the Retiree Health Care Trust Fund in 2008 to stockpile money to cover state employees’ future medical costs, also known as “other post-employment benefits,” or OPEB. The law also created a new OPEB Board to oversee the trust fund that began meeting last October.

This fiscal year’s $48.4 million payment to the health trust fund marks the first time the state will make the full required contribution determined by its actuaries – state lawmakers voted in 2009 to delay the first full payment by two years because of the state’s budget woes. Up to now, the state has paid retirees’ medical bills as they came in rather than out of savings and investment earnings.

Rhode Island faced a $775 million unfunded liability for retiree health as of June 30, 2009, according to the state treasurer’s office. Few states have put aside significant resources to cover those costs, as shown on this map that the Pew Center on the States released this week:

Rhode Island’s retiree health liability – which includes benefits for state employees, teachers, judges, state police and state lawmakers – is also much smaller than the roughly $7 billion unfunded liability the state faces for pensions.

Retiree health costs are a much bigger issue on the local level. Rhode Island’s cities and towns faced a $2.6 billion unfunded liability to provide employees with medical coverage as of last year, based on estimates by the state and WPRI.com. The New York Times reported last year that governments are more likely to default on their retirees’ health benefits than their pensions because the former come with less legal protection.

The scale of state and local governments’ obligations for retiree benefits has only come to light in recent years, after the Government Accounting Standards Board issued new rules requiring them to account for the future cost of medical, dental, vision and life insurance coverage the same way they do with pensions.

Now here’s something I would not have expected a few years ago:

Labor unions were in open revolt Tuesday against the Democratic leaders of the [Massachusetts] House, promising political consequences for House Speaker Robert DeLeo and other state representatives who voted during a late night session to slash the collective bargaining power of municipal workers.

“What we’ve recognized is that unfortunately, because of the cost of health insurance, that a very large percentage of the monies we commit are unfortunately going to fund municipal health insurance,” said House Ways and Means Chair Brian Dempsey (D-Haverhill). …

The speaker’s modified plan would permit cities and towns to set co-pays and deductible for their workers, but it would provide a 30-day window for labor officials to bargain changes. If the unions and municipal managers fail to agree, the managers’ plan would still take effect, but unions would share in 20 percent of the avoided costs. If they do agree on other plan features, workers would share in 10 percent of the achieved savings.

The proposal also forces all eligible retirees to enroll in Medicare, a plan also endorsed by Gov. Deval Patrick.

Since he took office, Governor Patrick has been encouraging cities and towns to join Massachusetts’ well-regarded Group Insurance Commission, which negotiates health insurance rates for state workers. (I remember getting press releases about the potential savings for cities and towns in Sun Chronicle territory when I was a reporter there.)

Now, with the Bay State facing a fourth consecutive year of budget cuts, DeLeo has decided to play hardball. The debate now moves to the Senate, which has sided with the unions in the past. Patrick is somewhere in the middle, arguing that unions should have a say but not a veto.

Health care costs are squeezing cities and towns in Rhode Island just as much as in Massachusetts, so it will be interesting to see how this plays out in a similarly Democratic-dominated state facing big budget challenges.

Peter Andruszkiewicz

Blue Cross & Blue Shield of Rhode Island’s new president and CEO will get paid $600,000 a year starting out, WPRI.com has learned.

Blue Cross Rhode Island – one of the most dominant health insurers in the country – announced Tuesday that Peter Andruszkiewicz, the president of Kaiser Foundation Health Plan in Georgia, will take over from James Purcell as the nonprofit’s top executive late next month.

Andruszkiewicz will receive a base salary of $600,000, Blue Cross spokeswoman Kim Reingold said in an e-mail. That amount “is slightly less than that of our current CEO and less than other regional, midsize Blue Cross & Blue Shield plans,” she said.

The total size of Andruszkiewicz’s compensation package would be higher if the value of benefits and other perks were included.

Andruszkiewicz’s $600,000 salary is $100,000 more than the half-million dollars Purcell got starting out in 2005, his first full year as Blue Cross’ permanent CEO. Purcell’s predecessor, Ronald Battista, was earning a salary of $546,500 annually before he resigned in controversy in May 2004.

Blue Cross Rhode Island insures roughly 600,000 Rhode Islanders and employs more than 1,000 people. The insurer says it lost $14 million in 2010 and $100 million in 2009.

Andrew Dreyfus, who took over as Blue Cross Blue Shield of Massachusetts’ CEO last year, earns an $800,000 base salary – an amount he described last month as “rock-bottom-of-the-market” compensation.

“I will be one of the lowest paid Blue Cross executives in the country,” Dreyfus told Statehouse News Service – which implies that Andruszkiewicz’s $600,000 places him even closer to the bottom of the list.

Blue Cross of Massachusetts has come under fire for its compensation practices in recent months after revelations that it gave an $11 million golden parachute to ex-CEO Cleve Killingsworth, who left in 2010, and provided five-figure annual payments to its board members. The board suspended its own pay last month under pressure from Attorney General Martha Coakley.

Blue Cross of Rhode Island does not compensate its 17 board members, unlike its Bay State counterpart, a spokeswoman told WPRI.com last month.

In his column today, The Pawtucket Times’ Jim Baron included this nugget that was news to me:

While we are at it, take away the paid health care for the General Assembly. The General Assembly is always moaning about being a part time legislature and they must have day jobs as well. Correct, so why are they burdening the taxpayers with their health insurance costs? That should come from their real jobs. Believe it or not, we would have to amend the state constitution to take away legislators’ paid health benefits. Of course, if that notion could get anywhere near a ballot, it would pass in a landslide. It’s a tiny dollar amount, but if we are going to cut fat and waste out of the budget, that seems like a place to start.

Health insurance for legislators is in the constitution? This I needed to see for myself.

Lo and behold, there it is in Article VI, Section 3 of the state constitution:

Senators and representatives shall receive the same health insurance benefits as full-time state employees.

That seems like a weirdly specific thing to mandate in the supreme law of the land. I did a quick check of the U.S. Constitution, and as far as I can tell all it says about lawmaker compensation (other than the 27th Amendment) is the following:

The Senators and Representatives shall receive a compensation for their services, to be ascertained by law, and paid out of the treasury of the United States.

So the federal constitution gives wide discretion to Congress to set its members’ compensation as it sees fit, while the General Assembly gets quite specific instructions (including dollar amounts and COLAs).

Back in 2007, the Projo’s Kathy Gregg noted that lawmakers, unlike other state workers, don’t contribute any of their salaries toward the cost of their health insurance premiums:

House Speaker William J. Murphy and Senate President Joseph A. Montalbano both take this position: the state Constitution entitles the part-time lawmakers to the same health benefits as full-time state employees, but says nothing about having them pay for it. …

Most full-time state employees in Rhode Island are required to pay a portion of their salaries or a percentage of the premiums for their health benefits. …

Asked last week why lawmakers alone should be spared [co-pays], Murphy issued this statement: “In 1994, the voters approved an amendment to the Rhode Island Constitution that provided health insurance benefits for Representatives and Senators. I am a firm believer that the members of the Legislature are entitled to these fully paid health benefits as established by the voters.” …

Why not legislators too?

House spokesman Larry Berman elaborated on Murphy’s thinking: “At the time of the vote in 1994 when this was changed, there was no co-share and there is no provision in the Constitution that discusses a co-share.”

Montalbano agrees with “the interpretation of the Constitution that says: if you want to change the law as to our compensation, which includes health benefits, you have to change the Constitution.”

I’m no lawyer, but that seems like a stretch on Larry’s part. Again, all the constitution says is:

Senators and representatives shall receive the same health insurance benefits as full-time state employees.

There’s nothing about co-pays one way or the other, and nothing about pegging the rules to the situation at the time of the amendment’s passage. I bet if they really wanted to implement co-pays, they could present a credible case to the Supreme Court.

Was anybody around for this debate back in 1994? Why was this put into the constitution in the first place?

(photo: King for Treasurer campaign)

Rhode Island saw the nation’s fifth-largest rise in the share of adults without health insurance between 2008 and 2010, a new Gallup poll shows.

The percentage of Rhode Islanders lacking medical coverage spiked from 9.2% in 2008 to 12% in 2009, then rose again to 13.1% in 2010, the poll found. Gallup surveyed 1,294 adult Rhode Islanders over the course of last year.

The state’s unemployment rate rose from 7.9% to 11.3% during the same time frame.

Rhode Island’s 3.9-percentage-point increase was larger than every state except Kentucky (+4.9 points), Utah (+4.3), Florida (+4.1) and Louisiana (+4.0) over the last three years.

But those four states’ uninsured rates are much higher than Rhode Island’s – 21% of adults lack health insurance in Kentucky, 18.5% in Utah, 22.8% in Florida and 23.7% in Louisiana.

Texas has the most uninsured adults in the country at 27.8%, according to Gallup. ”Southern and Western states have a disproportionately large percentage of uninsured residents, as they did in 2009 and 2008,” Gallup said. “This geographic pattern is likely tied at least in part to these states’ larger Hispanic populations.”

Next-door Massachusetts has the lowest share by far at 4.7%, in part because of its 2006 universal coverage law. Connecticut’s uninsured rate is second-lowest at 9.9%. Nationally, 16.4% of adults lacked insurance in 2010.

(map: Gallup)

In October, the U.S. Department of Justice filed an antitrust lawsuit against Blue Cross Blue Shield of Michigan for abusing its position as the state’s dominant health insurer. This morning, The New York Times raised the question of whether the same tactic could be used against other Blue Cross chapters – including Rhode Island’s:

The case is viewed as a test for the Obama administration’s introduction of the federal health care law, which is aimed at spurring competition and driving down costs.

About half the states in the country, including Alabama, Rhode Island and Iowa, share circumstances similar to Michigan’s, in their relationships with a big single insurance carrier. Proponents of the new legislation have long argued that these dominant companies could subvert the competitive goals of the exchanges planned for 2014, which are intended to foster new business and cheaper coverage.

Officials “have been struggling for a while with the fact that in health insurance markets, small players are not able to enter and expand in a way to make them significant competitors,” said Jonathan M. Grossman, an antitrust lawyer at Cozen O’Connor. “Nobody can look at the suit against Michigan and say they didn’t put everybody on notice.”

Blue Cross and Blue Shield of Rhode Island, which employs more than 1,000 workers, provides insurance to roughly 600,000 people here.

In 2007, that amounted to roughly 79% of the state’s insured population, according to estimates by the American Medical Association; UnitedHealth was No. 2 with just 16%. That made BCBSRI the second-most dominant insurer in the nation – the only one with more market share was Blue Cross and Blue Shield of Alabama, at 83%.

By comparison, Blue Cross Blue Shield of Massachusetts controls 50% of the insurance market there, with No. 2 Tufts Health Plan having 17%.

Earlier this month, I suggested Lt. Gov. Elizabeth Roberts was poised to take on a more prominent role in her second term thanks to the election of Lincoln Chafee, someone closer to her ideologically and with whom she already had a decent relationship. Perhaps, I mused, he would task her with overseeing the implementation of health reform in Rhode Island.

Well, Tim White and I just confirmed that Chafee will hold a press conference later today where he’ll announce that Roberts will lead a task force charged with implementing the health reform law here. Our story is up on WPRI.com. You heard it here first, folks!

Roberts seems like a solid choice for this job. She’s been working on health care for years and knows the issue as well as anyone in state government. Plus, in September her office released a lengthy report [pdf] laying out how Rhode Island could get the most out of the new law, which includes a big role for the states. Check out my interview with her about it to learn more.

Here’s a graphic from the report showing when different provisions of the law take effect over the next few years:

The U.S. Census Bureau released state-level data today on poverty, health insurance, income and other household characteristics in 2009. It’s a fascinating snapshot of how the Great Recession and its aftermath are affecting local families. Here are a few quick hits.

(Caution: Rhode Island is small, which makes it hard to sample, and these numbers are all estimates. Also, this is data from an annual survey, not the formal 10-year Census count that was done during the spring; that information won’t be released until December.)

Households: There were 406,000 households in Rhode Island in 2009, with an average of 2.5 people each. Families made up 63% of households.

Gender and race: Rhode Island’s population of 1.1 million was slightly more female than male, with 542,000 women and 511,000 men. The median Rhode Islander was 39.4 years old in 2009, and 83% of the state’s residents were white.

Poverty: The estimated number of Rhode Islanders living below the poverty line fell slightly, from 12% in 2008 to 11.5% in 2009. The national average was 14.3%. A total of 116,378 Rhode Islanders lived in poverty last year.

Income: The median household income in Rhode Island was $54,039 in 2009, down 1.4% from the year before. Rhode Island was less unequal than the national as a whole, with a Gini coefficient of 0.457, compared with 0.469 for the U.S. (A 0 is perfect equality, while a 1 is perfect inequality.) Social Security benefits worth an average of $14,968 flowed to 29% of Rhode Island households.

Insurance: In Rhode Island, 11.3% of residents were uninsured last year. Of those who did have health insurance, 72.2% had private health insurance and 28.9% had government health insurance, such as Medicare and Medicaid.

Transportation: While 3.2% of Rhode Islanders walked to their jobs last year, the vast majority of us – 80% – drove alone to work.

Immigration: As of 2009, 13% of Rhode Islanders were born outside the U.S., and 21% of people ages 5 and up spoke a language other than English at home.

Education: In 2009, 85% of Rhode Islanders ages 25 and up had a high school diploma, with 31% having a bachelor’s degree or higher. A total of 90,000 people were enrolled in college or grad school.

Housing: The state had 542,000 housing units in 2009, though 10% of them were empty. The median cost of housing was $1,879 for homeowners with a mortgage; $890 for renters; and $637 for homeowners with no mortgage. Half of renters spent at least 30% of their incomes on housing.

(image credit: U.S. Census Bureau)

Elizabeth Roberts

Update: For more on the health reform provisions taking effect today, check out this slideshow we’ve posted on WPRI.com.

Today marks six months since President Obama signed the Patient Protection and Affordable Care Act – better known as health care reform – into law.

This morning, a task force convened by Lt. Gov. Elizabeth Roberts released a report on implementing the law in Rhode Island. Yesterday afternoon, Roberts spoke with me about what the report found.

My plan was to transcribe the interview and post it here. But then when I went to type up our conversation, my recorder didn’t work. So instead, let me do my best to summarize what she said.

First, I asked why her office jumped on this so quickly, particularly when some Republicans are still talking about repealing the law altogether. Roberts pointed out that the law has now been in effect for six months, and some provisions have already been implemented – like the high-risk insurance pools – with more coming down the line.

Here’s a timeline of key provisions and when they take effect included in the report (click for a bigger version):

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Congressional Democrats and the Obama administration are not pleased to see health insurers around the country tacking on what they describe as “health reform” surcharges to their insurance policies:

Senate Finance Committee Chairman Max Baucus and Senate Commerce Committee Chairman Jay Rockefeller sent letters warning five insurance companies against telling consumers their rates are going up because of new mandates in the health law. “This level of misinformation is not acceptable,” the Democratic senators wrote.

Lots of volleys have gone back and forth since The Wall Street Journal reported earlier this month that insurers were partially attributing a batch of rate increases to the new law’s mandates. …

This letter specifically asks the insurers to explain how adding some new benefits – like allowing children to stay on their parents insurance until their 26th birthday – costs so much more than the Obama administration predicted. State regulators have said that some insurers seem to be guessing at the additional costs.

One of those state regulators is R.I. Health Insurance Commissioner Chris Koller, who sent a stern letter to Tufts Health Plan and Blue Cross & Blue Shield of Rhode Island earlier this month after learning they were preparing to impose surcharges of 2% to 3% that he had not approved. Koller found out about it from my former colleague Marion Davis, who broke the story over at Providence Business News:

The charges are showing up on quotes from Tufts Health Plan and Blue Cross & Blue Shield of Rhode Island for policies starting Oct. 1, when many small businesses typically renew their coverage. They are not itemized or even described in footnotes, but built into medical costs.

UnitedHealthcare of New England does not appear to be adding the surcharges, but it has filed a request with Health Insurance Commissioner Christopher F. Koller to begin doing so. …

The surcharges are separate from the 6 to 9.9 percent rate hikes that Koller approved for plans renewed this year (he approved additional hikes effective Jan. 1), and from standard adjustments for each group.