Talking Politics

Is anyone in R.I. looking at the big picture with hospitals?

By Ian Donnis
Posted 11/7/23

STORY OF THE WEEK: Rhode Island Attorney General Peter Neronha has championed the cause of government transparency, often saying that the state’s public records law should be a floor and not a …

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Talking Politics

Is anyone in R.I. looking at the big picture with hospitals?

Posted

STORY OF THE WEEK: Rhode Island Attorney General Peter Neronha has championed the cause of government transparency, often saying that the state’s public records law should be a floor and not a ceiling. So how transparent is Neronha when it comes to the implementation of his 2021 decision involving California-based Prospect Medical Holdings, the owner of two local safety-net hospitals?

I spent months examining that question. As my story neared completion, Neronha’s office released a document showing capital expenditure spending at Roger Williams Medical Center (RWMC) and Our Lady of Fatima Hospital (OLOF) from 2019 to 2021. It also explained that it’s not yet known how much has been spent on capital expenditures since then, since a report by an independent monitor is still forthcoming.

At the same time, Neronha wins high marks from a private equity watchdog group for using the state’s Hospital Conversion Act to impose accountability on Prospect Medical. Most notably, the AG’s 2021 decision required Prospect to provide $80 million in escrow as a way of leveraging spending on operating expenses and capital improvements. Prospect was initially seen as a savior when it bought RWMC and OLOF in 2014. Over time, the company became known for taking out hundreds of millions of dollars for investors while closing and degrading some of its hospitals across the U.S.

Under state law, Neronha can only regulate a change in Prospect ownership for five years, until 2026. His office appears to be closely monitoring the company, calling it out this week, for example, for failing to meet operating expenses for its two Rhode Island hospitals.

  

BELIEVE IT OR NOT: Given the record, it’s worth remembering how the state Health Services Council, an advisory group to the state Department of Health, approved an ownership change at Prospect Medical in 2021, even after a leading accounting firm raised a warning about the company’s finances.

 

THE BIG PICTURE: AG Neronha and RI House Speaker Joe Shekarchi met Wednesday to discuss Rhode Island’s long-term healthcare challenges and plan to continue discussions. During an interview for my latest story on Prospect Medical, AG Neronha repeated what, for him, has become a familiar refrain: “Somewhere, if not here – I know we’re doing it – we have to get to a place where we’re thinking about long-term strategic thinking in our healthcare system … I’m not convinced it’s happening elsewhere [in state government]. I think until we come up with that kind of strategy we are not going to be in a good place. It’s not just these two hospitals. What really worries me is that some of the hospitals we look at as being in better shape are in better shape only because they have endowments. They’re in no better shape in terms of generating the kind of revenue that allows them to meet their operating expenses and invest back in their hospitals.”

 

THE COST OF MANAGEMENT: One little-noticed aspect of Neronha’s 2021 decision on Prospect Medical required the company to stop charging millions of dollars in annual management fees for its Rhode Island entities. Asked if the fees were for doing nothing, Neronha said, “That’s an accurate statement.”

 

CD1: Barring a surprise, Gabe Amo will take another step in his likely evolution from political staffer to elected official on Tuesday, when CD1 voters pick a successor to former U.S. Rep. David Cicilline. Amo’s general election contest with Republican Gerry Leonard has been a low-key affair, with Amo ducking some debate invites and a small amount of daylight between the candidates on such issues as Israel.

During an interview this week on Political Roundtable, Amo was most emphatic when asked if there’s a place in the Democratic Party for people who support the chant “from the river to the sea.” “Absolutely not,” he said. “I do not believe that we have space for hate in our politics. We don’t have space for hate in our language. We should not have and invite anti-Semitism and certainly not invite Islamophobia. These are real big challenges, and words matter at this moment. And all of our leaders need to be very precise, need to speak with clarity and need to be mindful of the, the people who are hurt by words and actions that often result from those words.”

You can read and listen to my recent interview with Leonard. As far as the looming possible elimination of one of Rhode Island’s two U.S. House seats after the next Census, that’s a story for another day.

 

MEDIA: The Call of Woonsocket and The Times of Pawtucket – with close to 300 years of history between them as independent media entities – this week were combined to form a single newspaper, the Blackstone Valley Call and Times. While this consolidation is unsurprising given the familiar challenges facing newspapers, it underscores how the amount of hyper-local coverage in many communities outside Providence has sharply declined in recent decades. RI House spokesman Larry Berman, who spent 17 years at The Call as sports editor and city editor before joining Patrick Kennedy’s congressional campaign in 1994, recalled how the paper once had more than 15 reporters (some with beats in such nearby towns as Cumberland, Lincoln and Burrillville, a handful each of sports reporters and people on the copy desk and so on). “It was an institution in the community,” Berman said. “Those were the days when people bought a few newspapers,” including The Providence Journal in the morning and The Call, then an afternoon paper, later in the day.

Some of those who cut their teeth at The Call include media critic Dan Kennedy and Karen Bordeleau, a future executive editor of the ProJo. The Times has its own rich history. Many of us fondly remember the late Jim Baron, the paper’s incisive political reporter and columnist, who died in 2015.

 

FALLOUT: Whether the move by Gov. Dan McKee’s administration to cut Miguel Sanchez’s job, after pro-Palestinian tweets, was highly arbitrary or completely unsurprising depends on one’s point of view. The RI ACLU asked McKee to elaborate on the reasons for the move, Sanchez’s supporters cried foul, and some others found it not noteworthy that an at-will employee would face fallout for sounding off in a way that’s at odds with the boss.

 

PARTY POLITICS: Longtime state Rep. Joe McNamara of Warwick is getting ready to yield the chairmanship of the RI Democratic Party to Liz Berettta-Perik of Jamestown, who currently serves as party treasurer. McNamara, a retired teacher, said he plans to spend more time on the issue of education, including in his role as chairman of the House Education Committee. A party meeting is planned for Nov. 15, and Beretta-Perik has the support to become the first female chair for R.I. Democrats. In a statement, she said she is excited “to lead the party which champions the issues most important to Rhode Islanders: education, health care, housing, jobs, a cleaner environment, preserving a woman’s right to choose, and protecting the rights of all. To advance these issues, it is imperative that we elect Democrats in every city and town and from the State House to the White House.”

 

TAKES OF THE WEEK: A mix of views from various Rhode Islanders.

 

ROBERT A. WALSH JR., former executive director of the National Education Association Rhode Island: “On Sunday, we will set the clocks back, and exactly one year later voters will determine if we set the country back, which is my way of introducing today’s scary Halloween-themed topic: can Donald Trump actually win? To narrow things down for this brief analysis, a few starting assumptions are necessary – Trump will be the Republican nominee and President Biden will decide whether he or a substitute is the Democratic Party’s strongest nominee and proceed accordingly. Readers should not become too distracted by national polling (although trends are useful) – the presidency is determined by Electoral College math. The starting point for the Democrats (after re-allocating electoral votes post-Census) is if Joe Biden simply wins where he won last time, he would secure 303 electoral votes, versus 235 for Trump. The consensus forecast, with a year to go, puts 62 electoral votes ‘in play’, with a slight edge of 241 to 235 for the Democrats. Both sides will focus significant attention on Pennsylvania (19 votes), Georgia (16), Arizona (11), Wisconsin (10) and Nevada (6), all of which were won by Biden last time. Analysts believe the Trump base vote is secure. Clearly, the electoral math shows this shaping up to be a close race.

“As Hillary Clinton found out, candidates cannot take even the presumed base for granted as the so-called ‘blue wall’ had vulnerabilities that the first Trump campaign successfully exploited. External factors also impact close elections. If I told you that an incumbent Democratic president faced a scenario in which Iranian-backed militants were holding Americans hostage, home mortgage interest rates had skyrocketed, a member of the Kennedy family was making noises about challenging him, and a third-party candidate could be taking significant votes away from Democrats, you might remember President Jimmy Carter’s multiple challenges. President Biden may face a similar scenario, combined with the ability of virtually unlimited dark money and other externalities to impact modern elections, especially close ones, with deep focus on the handful of states that will actually swing the race.

“So yes, as a Democrat, and as an American, I am concerned that Donald Trump has a path to victory if he secures the nomination. Ironically, if he doesn’t, he could be the outside player who harms the Republican nominee by pelting them with sour grapes as only he can. Obviously, that is my best-case scenario.

“Finally, since all roads lead to Rhode Island, when the inevitable ‘winning with exactly 270 electoral votes’ analysis is discussed (a possibility, as Democrats keeping the assumed base vote and winning only Pennsylvania and Wisconsin among the five swing states would do it). Remember that Rhode Island’s successful census count means we not only kept two Congressional seats, but the accompanying four electoral total votes. So we have that going for us.”

 

RI Senate GOP Leader JESSICA DE LA CRUZ of North Smithfield: “The recently released RICAS scores showed Rhode Island students edging closer to pre-pandemic levels of proficiency in Math and English, but let’s not forget that the pre-pandemic scores were far from acceptable. R.I. students need legislators and policy makers to act with a sense of urgency. It’s unacceptable that R.I. is 30 years behind neighboring Massachusetts in implementing effective education reform. Even under the best of circumstances, it will take years to see the true effect of any newly implemented policy.

“In the interim, school choice is vital for students who are trapped in failing schools. It should be viewed as a supplement to, not a replacement for, public schools. Long-term improvement plans should encourage both collaboration and competition to accelerate change and provide all students with alternatives and opportunities.

“The Senate Minority Caucus has introduced legislation which would permit choice including, but not limited to Education Savings Accounts, open enrollment and education revitalization funds – and, in the near future, innovation zones. These school choice ideas are not acts of hostility toward public schools.

“Further, educational choice puts the focus on the best option for individual students. Shifting to a student-centric focus is fundamental for success. Improving educational outcomes is a decidedly difficult task, but it can be accomplished. R.I. students deserve better from the institutions charged with their education. There is, however, the perennial question of political will.”

 

State Rep. DAVID MORALES (D-Providence): “Every fall, each state agency (e.g., Department of Health) submits an ‘agency budget request’ to the Governor’s Office and the Office of Management Budget (OMB). Thereafter, the Governor’s Office and OMB review these proposals and work with each agency to ensure that the administration is prepared to introduce its full state budget proposal to the public in mid-January. While this is an important process, more often than not it does not receive much public attention. This year, however, there appears to be a more intentional push from advocacy groups and the media to gather this information and share their thoughts (which I think is great!).

“Based on the information that has been gathered, some positive and concerning findings from agency requests include: an $80.5 million increase for Medicaid reimbursement rates proposed by the Executive Office of Health and Human Services (a bulk would be covered with federal funds), a proposed bond of $50 million for the development of ‘affordable housing’ from the Department of Housing, an increase in eligibility for the Child Care Assistance Program to 261% of Federal Poverty Level, from the current 200%, and on the flip side, a disastrous $1.6 million proposal from the Department of Human Services to purchase income verification data from Equifax, which could result in the termination of Medicaid services for over 5,500 Rhode Islanders.

“Ultimately, it is Gov. McKee who will have the final decision on the details of Rhode Island’s FY25 Budget proposal, which we legislators will then vet and vote on heading into June 2024. So if you ever wondered how our state budget is processed, here you go!”

 

KICKER: As a kid, this future reporter was once puzzled by a message in a fortune cookie that read, “No news is good news.” Of course, the volume of news these days – between Israel, Ukraine, China’s rise and tumult and disarray in U.S. politics – can be measured in dog years. That’s why it’s concerning, according to Pew, that Americans are paying less attention to the news than just a few years ago. Of course, a lot of what happens in the world isn’t exactly cheery, and that may influence some people to tune out. That leaves unanswered, however, the question of how Americans will make informed choices if they’re not well-informed.

 

Ian Donnis can be reached at idonnis@thepublicsradio.org.

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Mike Rego has worked at East Bay Newspapers since 2001, helping the company launch The Westport Shorelines. He soon after became a Sports Editor, spending the next 10-plus years in that role before taking over as editor of The East Providence Post in February of 2012. To contact Mike about The Post or to submit information, suggest story ideas or photo opportunities, etc. in East Providence, email mrego@eastbaymediagroup.com.