At 1:00 p.m., this afternoon, the House Finance Committee in the Rhode Island General Assembly will be hearing (among other bills) 7819, submitted by Rep. Frank Ferri (D, Warwick).  It is perhaps the most dangerous legislation I’ve yet seen considered in a legislative committee.  Yes, at bottom, the government agency that it creates is essentially an advisory committee, but there’s reason to believe there’s more to it, and anyway, what it seeks to do ought to be one of those political third rails about which elected officials are afraid even to make hints.

Consider its core intention:

It is hereby declared to be the official state policy to adopt an active purchaser health insurance and health services model which aggregates all funding of such insurance and services, including, but not limited to, private insurance, Medicaid, and Medicare, through HealthSource RI or its successor agency.

An “active purchaser” policy is opposed by the American Medical Association (AMA), and it isn’t difficult to understand why.  What “active purchaser” means is that the government will grab an even stronger role in everybody’s healthcare and use the fact that all health-related activity ultimately must pass through the government-controlled gate in order to force price controls, cost controls, and ultimately rationing.  In its efforts to control costs, the government will push out providers and limit available care.

That’s the policy.  Here’s what the bill actually does:

• It creates a new health care commissioner appointed by the governor (with advice and consent of the Senate, but without it, temporarily, if the assembly is not in session).  The commissioner is not given any explicit duties, except to assist the supposed advisory board in developing a report.  If that’s the only intention of creating this new high-level appointed position, it’s a pretty unusual step.
• It creates a “health care authority,” with 15 representatives of special interests.  The legislation does not say who ultimately appoints the members of the authority, what the process for nominating them would be, or even what their terms are.  As far as this legislation is concerned, in other words, Governor Chafee would unilaterally appoint the members of the authority for life-time terms.
• It requires an annual report from the authority, starting January 2, 2016, “of all recommended legislative and/or regulatory actions that would be required to” (emphasis added):
• Get an innovation waiver from the federal government.
• Make HealthSource RI the “sole hub for securing insurance or health services coverage for all Rhode Island residents.”
• “Aggregate all state, federal, and private medical funding for health insurance and/or health care services.”
• Implement policies for an environment that “dissociates private insurance funding from employment status and provides possible alternative to funding of health insurance, one of which shall be funding through the payroll tax.”
• “Establish an annual global spending target for all health care expenditures in the state… with explicit enforcement of compliance by health care providers.”
• “Incrementally shift one hundred percent (100%) of all hospital revenue received from a fee-for-service model to a global payment model over five (5) years.”
• “Establish a standard set of benefits to meet the health care needs of Rhode Island residents.”
• Put together a “coordinated health planning and affordability council” that would develop “a comprehensive five (5) year state population health improvement plan.”

There is a section that says “nothing in this chapter shall be construed to limit the choice and number of plans provided for the consumers,” but that’s a dishonest statement. This chapter only establishes the infrastructure to study and make recommendations, so it would be subsequent legislation or regulation that limits “choice and number of plans.” But even with that “technically true” consideration, it is an integral part of “active purchasing” to “limit choice and number of plans.”  That’s what it does.  That’s how it works.

According to a spokesman for Speaker Nicholas Mattiello (D, Cranston), Representative Ferri did not submit a written request for a hearing, under House rule 11(e), but he did make “a verbal request.”  Although responding to the request for a hearing on the bill, the speaker “is not committed to its passage.”

Be that as it may, this sort of overture is too serious (and too much a goal of people who want to take control of our lives) for Rhode Islanders to be complacent.

 

ADDENDUM (6/18/14 12:21 p.m.):

Responding to a question about separation of powers, John Marion, of Common Cause RI, suggests on Twitter that the legislation “might indeed violate the Appointments Clause in Art. 9, Sec. 5.”  That section vests the governor with all appointment powers for all offices that wield executive power.  Because the commissioner and the authority will have “staff, space, and funding,” and will be located within the executive branch, their function is to some degree executive, even if the activity they’re executing is advisory.

By appointing the speaker and the senate president to the body, the legislation preempts the governor’s constitutional authority.  In a follow up email, Marion suggests that even the restraints placed on other members of the body (e.g., “One representative of a labor union”) would violate the constitution, but that hasn’t stopped the General Assembly in the past.  However, Marion is not convinced that this body clearly has “executive powers,” which would be the key to its being unconstitutional.