Healthcare

Medicaid is a lifeline for our most vulnerable neighbors. Unfortunately, time and again, the General Assembly has chosen to slash its funding. These cuts affect all of us, not just Medicaid recipients. Cutting Medicaid reimbursements drives providers out of business, creating the shortages that limit everyone’s access to care.

• On an up-or-down vote on the provision, Rep. Ajello voted to slash Medicaid reimbursements for critical medical supplies such as wheelchairs, walkers and oxygen tanks, which has made it more difficult for senior citizens and people with disabilities to access the equipment they need to survive.

• In 2015, she voted for Gina Raimondo’s devastating Medicaid cuts, which not only included reimbursement cuts for nursing homes and hospitals but also accelerated our transition from fee-for-service to managed care, a model that adds time-consuming, paperwork-heavy prior authorization processes and makes it easier for insurance companies to deny patients lifesaving care.

Now, the Trump “Big, Beautiful Bill” is cutting many of our healthcare funding streams, including limiting the state’s ability to fund its share of Medicaid with provider taxes and restricting state-directed payments (SDPs) that unlock federal matching funds at rates favorable to the state. (Every dollar the state spends on covered programs is matched by at least $1.35 in federal funds.)

• In response, the House voted to eliminate rate increases (effectively making cuts by allowing inflation to outpace compensation) for residential treatments for substance abuse disorder and authorize the Secretary of the Executive Office of Health and Services (EOHHS) to pursue blanket Medicaid cuts. Rep. Ajello voted yes. The proposal is expected to pass the Senate and be signed into law by Governor McKee.

• Keeping funding flat or increasing it by less than inflation is effectively making a cut, and reducing reimbursements will increase the underinsured and uninsured populations—as will the fact that an estimated 33,000 Rhode Islanders are expected to lose Medicaid eligibility because of new federal restrictions. That, in turn, will raise healthcare costs for everyone, as providers incur higher levels of uncompensated care and insurers charge higher premiums to compensate. We must stand firm against the pressure to make healthcare even more unaffordable and inaccessible. Instead, we need to increase Medicaid reimbursements (especially for treatment for substance use disorder and other mental health conditions), and, ultimately, transition to Medicare for All.

Reproductive rights are under attack, and we must resolutely defend them. I firmly believe that abortion is healthcare and that no Democrat should support any anti-choice legislation. Unfortunately, it appears that Rep. Ajello disagrees.

• In 2015, she voted for a budget article that removed over 9,000 Rhode Islanders from healthcare plans with full abortion coverage and reassigned them to plans that only allowed it in cases of rape, incest, or risks to the life of the mother. If the people who were affected wanted to switch to a more expensive plan that included coverage for reproductive care, they were made responsible for covering the premium increase.

• Then, in 2023, after the Dobbs decision, she voted for a tax break for an anti-choice “crisis pregnancy center” that shames people seeking abortions and attempts to block them from doing so.

• As your State Representative, I will have a 100% pro-choice voting record.

Our state is facing an acute shortage of space in assisted living facilities, forcing our aging neighbors to choose between remaining at home without the level of care they need and entering nursing homes, which are substantially more expensive and offer services beyond what is necessary for someone who would benefit from assisted living. Increasing our assisted living capacity will strengthen our senior housing stock and allow more Rhode Islanders to receive Medicaid-funded Home and Community Based Services (HCBS), unlocking more federal matching funds for care services and limiting costlier nursing home placements to those who need the full support of that level of care.

Strengthening our assisted living system also means holding providers accountable for code violations. In 2023, Rep. Ajello sided with the industry against senior citizens, voting for a law that makes the dispute resolution process more convoluted and increases the burdens on regulators seeking to prove wrongdoing.

Governor McKee’s budget proposes a cap on the amount that health insurance companies can spend on care, effectively setting a floor for profits rather than a ceiling. We should create incentives to prioritize patients over profits, and this proposal misses the mark.

I also support updating health insurance anti-discrimination laws to match what our civil rights laws provide elsewhere. Currently, people are only protected from health insurance discrimination on the basis of “race, color or creed.” We must expand these protections to ban discrimination on the basis of identity characteristics such as ethnicity, nationality, gender identity/expression, and sexuality.

Finally, we must protect our transgender neighbors and the doctors who take care of them. Vermont’s trans healthcare laws, which protect providers from facing lawsuits for administering gender-affirming care (a “shield law”) and require all state-regulated plans to cover such treatment, are considered the gold standard. We have already passed a provider shield law in Rhode Island but still need to mandate that every Rhode Islander on a healthcare plan under the jurisdiction of the state can access the care they need to feel comfortable and safe in their own body.

The crisis at Fatima and Roger Williams hospitals is evidence of the need to overhaul our hospital financing system. Our healthcare Affordability Standards have succeeded in reducing patient expenses but need to be reformed in order to ensure that our safety net hospitals have the resources necessary to keep providing lifesaving care to low-income patients. The current rule limiting hospital contract rate increases for commercial insurers to 1% above the rate of inflation should be adjusted to allow for more flexibility for hospitals at risk of insolvency while retaining guardrails to prevent unnecessary increases that will result in excessive premium rises. If the Health Insurance Commissioner is unwilling to act, the General Assembly must take matters into its own hands.