1. STORY OF THE WEEK: When Attorney General Peter Neronha makes a presentation, he really goes to town. A case in point was the news conference in his office Wednesday, about confronting Rhode Island’s healthcare crisis. It ran almost two hours, Neronha delivered a lengthy setup before getting to the heart of his message, and the seven members of Neronha’s healthcare team each got time to speak, some more than once. While the AG’s critics see him as a showboat, supporters applaud this kind of detailed presentation and the focus on a top issue facing the state. Not to put too fine a point on it, but signs of the worsening healthcare crisis are increasingly abundant: the lack of primary care doctors, Rhode Island’s lagging reimbursement for public and private insurance, the ongoing uncertainty facing Roger Williams Medical Center and Our Lady of Fatima, growing gaps in coverage for patients, and on and on. “We are in a state today of spectacular failure that is literally occurring before our eyes,” Neronha said. The implicit message was that after years of calling for more public leadership on healthcare (and showing a muscular approach on the CharterCARE hospitals), it was time for him to take the bull by the horns. (Gov. Dan McKee released his response to the situation with less fanfare in April.) The AG’s multi-faceted approach includes some immediate steps, such as suing the nation’s three-biggest pharmacy benefit managers. Others are more aspirational, like collaborating with Brown University’s School of Public Health to ponder such possibilities as a single-payer system for insurance, and backing legislation to boost Medicaid reimbursement to the level of Medicare; where the money will come from during the state’s new era of persistent deficits remains unclear. Regardless, Neronha said, the time for studies is over and decisive steps are needed to stop things from getting worse. 

2. THE FIELD FOR GOVERNOR: Speaking of Gov. McKee and AG Neronha -- between whom little love is lost -- a new poll from the UNH Survey Center raises new questions about the campaign for governor next year. While McKee has said he’s running, the poll found McKee’s approval at an all-time low 19% “as majorities of Republicans, Independents, and Democrats disapprove. Few believe McKee deserves re-election.” The 73-year-old incumbent has displayed an uncanny ability to win close races over time, and campaign spokesman Mike Trainor did not respond to a request for comment. But McKee’s slumping approval raises the possibility of Democrats other than candidate-in-waiting Helena Foulkes joining the fray (and whether McKee will still pursue a re-election bid if the Laborers who helped fuel his ‘22 win back away). It’s a bit hard to picture Neronha running for lieutenant governor and now he’s “semi-interested” in the top job. Then there is House Speaker Joe Shekarchi, with $3 million+ in his campaign account and who has maintained a sunny image in what had previously been considered a terminal job.

3. HIGHLIGHTS: Some tidbits from the release by the UNH Survey Center late in the week:

*** President Trump’s approval is at 37% in RI -- the same amount who support his handling of the economy.

*** Among other prospective gov candidates, 32% would like to see Foulkes run, while 26% do not want her to pursue a campaign. The numbers are worse -- a lot worse -- for former Gov. Gina Raimondo (19/77) and ‘22 GOP candidate Ashley Kalus (23/45).

*** 54% of those surveyed say U.S. Sen. Jack Reed gets their vote for re-election.

*** 55% of respondents support banning guns with military-style features. Eighty-three% of Democrats approve of that, while 78% of Republicans are in opposition.

4. BUDGET CRUNCH: The calendar turns this weekend to June -- a sure sign that the General Assembly is approaching the traditional end of session. Lawmakers are expected to wrap up by June 20, and the Statehouse has witnessed years of large deficits being wiped out in the short term by moving money around and other aspects of legislative legerdemain. But the interest of DC Republicans in changing Medicaid -- the mostly low-income insurance program that makes up a third of Rhode Island’s budget -- has cast uncertainty over the process. During a Statehouse interview this week, Gov. McKee told me, “[W]hat we’re doing here is just trying to follow the bouncing ball, and so that we’re not overreacting. But at the same point in time, we are continuously meeting on the most updated information so that we can address the issues.” A significant cut to Medicaid would likely trigger a return to the Statehouse by lawmakers later this year, but answers on how to close an additional budget hole remain elusive.

5. STATEHOUSE: An amended version of the AWB bill is posted for a House Judiciary Committee vote on Tuesday. If it clears the committee -- possibly with Speaker Joe Sheakarchi and Majority Leader Chris Blazejewski making the difference in their ex officio capacity, it will likely move to the House floor Thursday.

6. BREAKING POINT: After all the ink and pixels that have been devoted to the saga of the Washington Bridge, you could be forgiven for suspecting that there was not much new to report. But as my colleagues Michelle San Miguel and Jeremy Bernfeld reported this week, concerns about the post-tensioning system undergirding the bridge went unaddressed for years after first being flagged more than 30 years ago. Engineers who were interviewed for the story said that special inspection methods could have been used to monitor the post-tensioning components. Engineer Casey Jones -- known in part for his YouTube videos -- said it appears that “people weren’t putting eyes on certain aspects of the bridge on inspection after inspection. And that should be – the reason for that should be addressed.” RIDOT and RIDOT Director Peter Alviti declined interview requests, citing the pending lawsuit over the failure of the bridge.

7. NO REGRETS: Lt. Gov. Sabina Matos campaigned for President Biden last year in Las Vegas and Philadelphia and was an all-around booster for the president. Asked on Political Roundtable if Democrats should be angry about how Biden’s inner circle hid his declining capacity ahead of a disastrous debate with Donald Trump, Matos remained resolutely behind the former president. “I honestly believe that there was not enough time for us to switch candidates and to be able to be successful,” she said. “It was already too late, so I would have been okay having President Biden being at the top of the ticket.”

8. NEW SCHOOL: A draft version of a consultant’s report, funded by $150,000 from the Joint Committee on Legislative Services, found that establishing a public medical school at URI would keep more primary care doctors in the state, bolster the economy and have other benefits. Read my story here.

8. MUNICIPAL FINANCE: It was about 15 years ago, in the aftermath of the Great Recession, when East Providence, Woonsocket and some other municipalities experienced sharp budget distress. There are economic storm clouds now (and to be fair, raising sufficient revenue is a long-running issue in Providence). Nonetheless, Providence Mayor Brett Smiley’s request to the General Assembly for the city to be able to surpass its tax levy could loom as an early indicator of a growing cycle of worsening municipal finance.

9. COLLEGE HILL: Unlike Harvard President Alan Garber -- whose university is under siege by the Trump administration, Brown President Christina Paxson has kept a low profile in recent times. She has declined interview requests, with the university pointing to the volume of such inquiries. A two-year extension for Paxson was announced this week by Brown Chancellor Brian T. Moynihan. In a letter, he said in part: “Now in her 13th year as Brown's president, Christina Paxson has demonstrated exceptional capacity to build and sustain critical support for Brown’s mission of education and research. During a tumultuous time facing American higher education, Brown is fortunate to benefit from President Paxson’s steady and principled leadership. We are excited that the University will continue to benefit from her strategic vision, boundless energy, unwavering dedication and fortitude during periods of momentous change. Our community has been made stronger by her sincere belief in all the good that Brown can do in the world.”

10. BY THE BOOK: My colleague David Wright reports on how local libraries will be affected by cuts from the Trump administration.

11. POLITICAL POLARIZATION: “If you could help heal the divisions in America, would you do it?” That’s the question from The Dignity Index, an effort led by longtime Special Olympics Chairman Tim Shriver, which utilizes “an eight-point scale that scores speech along a continuum from contempt to dignity in as unbiased a manner as possible. By focusing on the sound bites, not the people behind them, the Index attempts to stay true to its own animating spirit: that everyone deserves dignity.” More via this recent PBS NewsHour report.

12. KICKER: Who among us hasn’t wondered what creature lurks in the depths even if we’re just swimming in deep water on a lake? Have we gotten it wrong, due to a Hollywood smash from the ‘70s? Via the BBC: “An endurance swimmer has said ‘we must stop killing sharks’ as he completed a 60-mile (96km) trek around the area where Jaws was filmed. Lewis Pugh, a conservationist from Plymouth, swam in stormy weather around the island of Martha's Vineyard in Massachusetts, which was the main location for the Hollywood blockbuster released 50 years ago. Pugh completed the swim as part of a campaign to protect sharks which he said had become threatened by commercial fishing. The 55-year-old took 12 days to complete the challenge, which he said he hoped would ‘change the narrative’ around sharks and highlight their importance to the seas.”