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The debate over Sundlun and RIte Care

July 29, 2011

Last week, following the death of former governor Bruce Sundlun, I wrote a quick blog post describing how Sundlun created the first form of RIte Care, Rhode Island’s health insurance for low-income children and families.

I got the idea from Projo reporter Felice Freyer, who was around at the time, and followed up with Christy Ferguson, the former director of the RI Department of Human Services, who credits Sundlun for forming the foundation of the program.

I even had a quote from Sundlun’s former speech writer, who remembered his devotion to making RIte Care happen.

A nice little side story about one of Rhode Island’s leaders, right? Not so easy. This is the first post I’ve written where readers have told me I’m flat out wrong. Among the comments-

Not sure about this, it came out of the legislature.

And another note-

One should not begrudge the elegaic context of the piece on the heels of Bruce Sundlen’s passing….but success (of Rite Start) as they say has many fathers… It wasn’t Bruce.

Even at a neighborhood barbecue I was told that Christy Ferguson was merely being a “good lieutenant for Sundlun” when she gave him credit for starting RIte Care.

I didn’t totally understand that comment, given that Ferguson is a Republican and Sundlun was a Democrat. She actually served under Governor Almond, the man that succeeded Sundlun. Why would Ferguson want to be Sundlun’s lieutenant?

Either way, I was surprised at the controversy my post created, so I checked back in with Felice Freyer.  She sent me this article, dated July 21, 1994 titled “Sundlun puts the word out: RIte Care to start Aug. 1.”  I found this part of Felice’s article interesting-

Absent were the advocates for the people to be served by RIte Care, who have long been critical of the plan.

“Let’s not be fooled by the festivities here,” said Daniel Kertzner, coordinator of the Campaign to Eliminate Childhood Poverty, in a statement issued later. “. . . With the current state of RIte Care, what’s predictable is that many of Rhode Island’s disadvantaged children will continue to go round and round in a life of poverty.”

Kertzner objected to starting RIte Care before the community health centers get their HMO license, and questioned whether the program had enough doctors and translators.

According to Felice’s article, Neighborhood Health Plan, the health insurance company in RI that now only serves RIte Care patients wasn’t exactly excited about the program.

Neighborhood Health Plan of Rhode Island, the HMO recently formed by 14 community health centers, cannot enroll patients until it receives its license. Those who choose the health centers’ group before it is licensed can still use the health centers, with Medicaid paying on a fee-for-service basis.

But Chris Shea, president of Neighborhood Health Plan, said most patients won’t choose a plan “because there’s too many other things going on in their lives.” Those who fail to choose will be assigned to one of the four other HMOs, putting the health centers’ group at a disadvantage until it gets a license.

So, a lot of members of the advocacy community were originally opposed to RIte Care. To figure out why, I called Linda Katz from the Poverty Institute.

She says when Sundlun proposed the creation of RIte Care, it involved offering insurance on a managed care versus a fee for service model. Other states had tried to do the same thing in an attempt to save money, but the shift often resulted in cuts to services for kids. That’s what the advocates in Rhode Island were worried about.

Katz says it was the combined effort of Neighborhood Health Plan looking out for the best interests of low-income Rhode Isalnders, the work of DHS under Christy Ferguson to demand health outcomes for RIte care and require things like transportation and interpreting services, and the efforts of the RIte Care Consumer Advisory Committee that turned what could have been another managed care nightmare into an effective program.

One of the co-chairs of that Consumer Advisory Committte, Marti Rosenberg, told Felice Freyer in another article ten years later that one particular meeting made advocates decide to start working with RIte care, not against it.

One of those advocates, Marti Rosenberg, recalls meeting in 1993 with Dr. Barbara A. DeBuono, who was then the director of the state Health Department. DeBuono didn’t mince words. “This is going to happen,” she told the advocates; they would be wise to stop fighting it and, instead, work to make it better.

Perhaps that’s why there was such an outcry when I said Sundlun created RIte Care. Technically, he did. But it took the work of a lot of Rhode Islanders to make it the program we know today.

6 Comments leave one →
  1. Bruce McIntyre permalink
    July 29, 2011 11:04 pm

    I was counsel at the time. There was plenty of internal dissent at HEALTH over its role. One manager even quit over being the technical advisor. But Bruce Sunldun appointed Dr. DeBuono and told her to make it happen. And she did. But there were lots of lands on the ladle that stirred the pot.

    • August 1, 2011 3:30 pm

      Bruce- Who knew RIte care was so contentious? Was the debate over at DOH about the managed care model as well?

  2. July 30, 2011 1:20 pm

    As an advocate for kids with special health care needs – and a parent – I can say that I strongly opposed the concept of RIte Care in those early days for the reasons that Linda Katz referred to, especially as it could have negatively impacted kids with disabilities. Now, some 17 years later, I am a very strong supporter of this program for every Rhode Islander it serves, including those with special needs. RIte Care has been recognized nationally as a leader in health care and, to be honest, it doesn’t really matter who happened to be where at the time. The truth of the matter is that the design, implementation, oversight, evaluation and continued quality improvement of this health insurance model is something we can all be proud of and work to strengthen and expand – if quality health care for RI is still our primary goal! In fact, for those of us with commercial insurance, a plan modeled on RIte Care would be a dramatic improvement!

    • August 1, 2011 3:29 pm

      Thanks for chiming in on the discussion! It’s interesting to see that so many folks who opposed the program manged to shape it into something they’re now proud of.

  3. August 1, 2011 2:55 pm

    Good post, Megan. Thanks for illuminating me and your many other fans!

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