Now we have the numbers. The cost of health insurance in Rhode Island is going up again. Health Insurance for small employers is going up an average of 3.8 percent; for individuals, bought through HealthSource RI, an average of 12.4 percent; and for large employers, insurance is going up 9.5 percent. These numbers don’t include the increases for employees of self-insured employers, who constitute 60—65 percent of employers the in Rhode Island, but you can expect that they – and you — will see increases of about 10 percent, because those employers experience the same cost drivers as everyone else – the cost of hospitals, drugs, and the overutilization of emergency departments for non-emergent situations.
(Overall inflation has been running at about 3.4 percent. Medical cost inflation has been running about twice general inflation for most of the last 30 years, so health insurance costs, and medical costs generally, now consume a significant portion of the income of families, communities, and states. About one third of all public spending in Rhode Island is devoted to health care via Medicaid, which provides health care for about one quarter of the state’s population – and is supported by the other three quarters of the population. More or less.)
But wait. This year’s cost increases aren’t the real problem. The real problem is that these costs are about to go even higher, in a coming medical costs tsunami, that is predictable but that we are completely unprepared for.
Here’s why. Many primary care doctors are moving to direct primary care, because it makes no business sense for them to continue as employees. (Direct Primary Care is where your doctor charges you directly, outside of insurance, and agrees to limit their practice size to 300-500 so they actually have time to listen and talk to you. Direct primary care practices now cost an average of $100 a month.) When those doctors do that, they reduce the number of people they take care of, from an average of 1700 people to an average of 400 people. Which means lots and lots of people in Rhode Island are about to find themselves without primary care doctors. Which also means that those people, of whom there are likely to be thousands to hundreds of thousands, will be using urgent care and the emergency department instead of seeing their family doctor or NP when they are sick.
But the cost of emergency department care is WAY more than seeing a primary care doctor – about $2500 — a visit vs about $100 a visit for primary care. That cost difference gets paid by their health insurance company or their employer. Who passes that cost on to you, in the form of premiums, copays and deductibles. And that cost difference will send the cost of health insurance through the roof in the coming years.
(Emergency rooms are about to get overloaded in another way: thousands of RIers who bought health insurance through HealthSourceRI –the health insurance exchange –can no longer afford insurance because HR 1 – Trump’s “big beautiful bill” which eliminated the subsidies that made insurance affordable for many people. The HR1/BBBA also kicked a bunch of people — people who had been granted asylum, people who were on parole, and a number of others — off Medicaid. Many others will lose Medicaid in the coming months because HR1 changed the Medicaid re-enrollment process. All those people without insurance will now be using the Emergency Room when they are sick because the Emergency Room can’t turn them away.)
And what happens if Chartercare – Roger Williams and Fatima Hospitals – gets into more financial trouble and can’t continue to operate either their primary care clinics, practices or their emergency departments? Or if anything happens to any of our other hospitals? All this gets worse in a hurry – and the cost of health care becomes sky high as access to both primary care and the emergency room disappears.
What’s crazy about the cost of health insurance in Rhode Island is that we now must expect many more cost increases in the coming years, as the services available to all of us continue to decline. Hold on to your hats. I expect that the cost of health insurance, and the viability of our hospitals, will be the Washington Bridge for the next governor. I hope all three candidates have prepared themselves for what happens next, because it isn’t pretty.
We could have prepared for all of this, of course. We could have been training more primary care clinicians, and getting them up and running in all our communities, for the last twenty years, because when everyone in Rhode Island has primary care, the cost of health care in Rhode Island likely drops, not explodes, and drops by as much as fifty percent. As the public’s health improves.
But we didn’t. That’s crazy.
PS It’s almost flu shot time again. It looks like the flu may hit a little earlier this year, so some people will want a shot in the fourth week of October or early November, because the shot only lasts about three months in the elderly and infirm, and our usual flu spread peak is usually late February to March. Remember, the shot protects against hospitalization and death, not against getting the flu. And the notion that people get the flu from the flu shot is balderdash.
You can find Michael Fine’s commentaries and short stories on
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