The East Bay Chamber of Commerce hosted a breakfast meeting with legislators earlier this month, with topics ranging from healthcare crisis to bridge crisis, from affordable housing to the minimum wage. Following are some of the key topics discussed during the nearly 90-minute discussion.

Primary care crisis

Chamber board member Andy Arruda asked the legislators about a looming crisis in the medical field, specifically the shortage of primary care physicians. Arruda talked about recent events in his family, where one of his children was unable to find a primary care doctor who is accepting new patients.

Sen. Pamela Lauria took the lead in responding to this topic, since she is a nurse practitioner who provides primary care services.

“This has been a looming problem for quite some time, and the reasons are multi-factorial,” Lauria said. “The modicum is that primary care providers can’t find primary care providers for their own family members. That’s how big of an issue this is.”

Lauria described some of the drivers of the physician shortage. She said Rhode Island’s Medicaid reimbursement rates (the rates physicians are paid for treating patients with Medicaid coverage) are “abysmally” low, and the commercial rates (the rates paid by Blue Cross, Tufts or United Health to providers) are much lower than they are in Massachusetts or Connecticut.

“You [a medical provider] can live in the East Bay and go across the border quite easily to work in Massachusetts and make 20% to 30% more, and the same is true at the southern border with Connecticut,” Lauria said.

She also said that medical students today finish their years of education with so much crippling debt that they are compelled to specialize in niché fields that pay more. “Primary care is one of the lower-paying jobs in healthcare,” she said.

What can Rhode Island do about it? Lauria said she and the General Assembly are working on several fronts. “There’s a bill in the Senate, that I expect is going to pass both chambers, that will require a rate review for those Medicaid rates. That’s what the state can control, those Medicaid rates,” she said. Other pending bills would encourage commercial carriers to increase their reimbursement rates as well.

Lauria is working to promote two others bills that would address the crisis. One would create up to 30 primary care training sites throughout the state, and the other would provide full scholarships for medical students, or physician’s assistants and nurse practitioner students, if they commit to coming back to Rhode Island to practice primary care for a minimum of eight years.

Rep. Linda Ujifusa also spoke from the perspective of someone directly involved in the field of primary care. “My husband is a primary care physician who is not taking any new patients, and it is not because he is not getting reimbursed enough — that might be the case for younger folks coming in to the field, but he’s 65 and he’s about to retire. What’s really killing him is burnout, and the burnout is not from just working too hard, it’s from spending probably three to four hours a day dealing with the paperwork that’s imposed on him by the private insurance companies. And we are the only industrialized nation in the world that has this problem, as well as the medical debt.”

Rep. Jason Knight joined the conversation to point out that this problem is not just the General Assembly’s to solve. “We have an entire executive branch of government to run the state day to day. We have an entire health care infrastructure, with EOHHS [Executive Office of Health and Human Services] and DHS [Department of Human Services], and their entire purpose is to help manage and keep an eye on the healthcare industry and the delivery of healthcare to Rhode Island citizens,” Knight said. “In a perfect world, they would keep an eye on the market. They would anticipate problems, and they would come to us with suggestions, ‘hey we need to do this, we need to do this.’ ”

Arruda followed up to ask why those state agencies aren’t doing their jobs the way Knight suggested they should. Rep. Knight replied, “There has been a trend in Rhode Island state government to cut down our staffing in our agencies, to basically lower our costs of doing business, such that most of our agencies are essentially keeping the lights on, but they have no bench. We have to rethink what we’re willing to spend money on, and instead of thinking about it as just spending money to maintain large executive staffs, we need to think about this an an investment to make sure that when we give those agencies a mission, they are staffed well enough to do it effectively, and they handle the next mission that comes up.”

Weekly paychecks

Moderator Steve Primiano, of the chamber board of directors, asked legislators about a bill that would require all employers to pay their employees weekly, forcing companies that pay every-other week to change practices.

Rep. June Speakman said, “That bill was heard, and it is being held for further study. That can mean one of two things — it can move forward, or it won’t. My guess is this bill is in the latter category. Just a hunch.”

Minimum wage

Primiano asked if any minimum wage bills seem to have momentum at the General Assembly right now. Rep. Knight speculated that the answer is “no.”

Rep. Knight said, “I know in the House there’s been a big push, by a few reps, on tipped minimum wage, and that doesn’t seem to be going anywhere … I think the consensus, at least on the House side, is that it’s not something we want to mess with right now.”

Four-year terms

Legislators were asked about the state’s current election cycle, where all senators and representatives run for office every two years at the same time.

Rep. Susan Donovan talked about the demands of the job. “I’m just fortunate that I’m retired,” she said. “Especially as the chair of a committee, it’s just a tremendous amount of work. I didn’t even have a committee meeting last night, and I was there until 8 or 9 o’clock, just working.”

Rep. Knight suggested that the state should at least talk about having a four-year election cycle, because the current system is highly inefficient.

“When the entire body, both the Senate and the House, are in a two-year cycle, there tends to be a pattern where … if it’s not an election year, we can do certain things, and when it is an election year, then we can do other things. And then the whole system just comes to a grinding halt while everyone works on elections. That is inefficient, and I don’t think you get bang for the buck, as a citizen, because you don’t have a general assembly that is working all the time. Frankly, there are a lot of issues that we need to have conversations on — deep and meaningful conversations — and it’s super hard to lay those down in June pick them up again in January … So Rhode Island could use a conversation about this.”

Legislators also talked about the challenges of both campaigning, and raising money, so frequently.

“We are a part-time legislature. Most of us have day jobs. It is a lot to run every two years,” said Sen. Lauria.

Rep. Donovan added, “The other thing that I really hate — and boy do we need campaign finance reform — is I hate raising money. I just hate asking for money. I hate getting money from lobbyists. I just hate the whole thing. And I wish there was a mechanism where I could run for office and not have to do that … I mean, if you’re in a competitive race, to keep this seat costs more than $20,000. My friends will give me 25 bucks, 15 bucks. They don’t want to give me $100 dollars. Who wants to do that? It’s just really hard, campaigning, and when we have to campaign every two years, it’s exhausting.”

Small stuff, big stuff

The panel was asked whether the priorities of some legislators have changed over the years — whether “old school” politicians used to go to Providence to fight and claw for their districts, to secure grants, public works projects and funding for their hometowns, while a new wave of politicians are focused on larger issues impacting everyone, like climate change, women’s reproductive rights, and gun control. Everyone responded with the belief that they do both.

“I think we’re doing both,” said Rep. Jennifer Boylan. “The inquiries I get from constituents, they range the spectrum. I get emails about, you know, helping with a sidewalk issue on a state road, and those are important and I work on all those issues.”

She continued, “But we’re a Blue state … and those big issues are important, especially on the climate issues. Our kids are thinking about these issues and the gun issues as well. I mean many of these issues, kids are learning about them. There’s anxiety about them. There’s worry about them. Our planet is not in good shape, in so many ways, and we have the ability to change that. I personally spend a lot of my own energy trying to improve the world, and the reason I wanted to be a lawmaker is because what one person can do is just not enough. We need to tackle these big issues.”

Sen. Lauria said, “I think you don’t see the constituent work. It’s not as visible as some of these other bills, but we all get emails from constituents with issues every week, and we are absolutely working on them, whether it’s trying to connect them to the right person inside government, or pushing government to do something better for our constituents. But that’s not what’s going to make the news, because that’s all happening in the background … Don’t think for a moment that we’re sleeping on our community or not constituents.”

Rep. Donovan said, “A lot of the constituent work I do, you don’t talk about it, because it’s confidential. They might have problems, where they need you, where you help solve the problem, but it’s not something where you go out and say, ‘Look at me, I helped so-and-so do that. You can’t say those things because it’s very personal. I’ve had some real tough issues with constituents, trying to solve a problem with their age, or with an agency in the state.”

Sen. Walter Felag agreed that legislators are still doing the things they always have done to improve quality of life in their districts. As an example, he pointed to the Mary V. Quirk School in Warren, which is used as a recreation center in the evenings, requiring many families to park on the opposite side of Main Street, a state road, and cross to the entrance of the building. “We’re going to be putting in a push button, so that individuals coming out of practices, like CYO basketball practices, can have a stop [signal], because even though there’s signage there, it’s not working.” He said he and Rep. June Speakman (who was sat the breakfast meeting but had to leave early to teach a class at Roger Williams University) and Rep. Knight worked together to get a signal installed in the fall.

Felag continued, “There are other things. On Metacom Avenue and Child Street [in Warren], we were able to get DOT to fund paving, which was not on their TIPS program. So those types of things are taking place, in the background, but we don’t get credit for them,” Sen. Felag said.

The Washington Bridge

Arruda asked about the defunct Washington Bridge on I-195 West, specifically about the investigation into what happened and why. “I’m afraid this is going to get swept under the rug,” Arruda said. “I’d like to find out why money was spent and yet the work wasn’t done, and how this got to the point where we could have been killed if we were going on that bridge and it dropped.”

Lauria responded, “We’re getting briefed on things with the bridge, but that’s a relative term. The governor didn’t tell us he was going to pull back from releasing the [engineers’] report. Originally, we were told that report was going to come out pretty close in tandem with the plan of what to do about the bridge. Then we were told there was going to be a little bit of a delay. And then we found out, with everybody else, that the governor had decided to hold that report back … We weren’t briefed by the governor, but in the press he said he wants to hire his own attorneys to be ready to deal with the aftermath of that report. You can be sure that there’s oversight in both Chambers. They’ve met together. They will continue to meet. There will be a push that, no matter what happens legally, we believe that the Rhode Island public deserves to know what happened there.”

Housing vs. zoning laws

Legislators were also asked about tensions between the state and its cities and towns with regards to the creation of affordable housing. New state laws are trying to encourage the development of more housing, and they can sometimes trump local zoning codes.

Lauria responded, “Unfortunately, sometimes local zoning is used to prevent more housing too, whether it’s keeping a community the way that it’s always been, or whatever. The fact is that we are grossly under-producing housing right now, and we need to be nimble and efficient in finding ways to do that.”

Lauria continued by describing her own family and their challenges. “I have two kids in their twenties, and I don't know how they can aspire to independent living on their own with the way housing costs are. Honestly, I would love to have an empty nest at some point, and I want my kids to be able to live in the community that they grow up, but it is flat out impossible right now.”

Rep. Knight talked about how state leaders, by nature, may have different agendas than city and town leaders. “When a city or town council is elected, their job is to look after the city and town. The Warren Town Council is concerned about Warren and not concerned about Bristol or Barrington. But the state has to look out for all of Rhode Island, and we just need more roofs. It is what it is.”

Rep. Donovan jumped in to describe how housing challenges can thwart economic growth. “We want to build a medical park in Providence. Oh, yeah? So we’re going to bring all these professionals in? They need someplace to live. Why would they come here? There’s no place to live. There’s literally no place to live. You want to live in suburbia, there’s no place to live. You want to live in downtown Providence, there’s no place to live. It’s really a big problem for us.”

Running for office

All seven of the legislators were asked if they plan to run for re-election this year, and all said they are.