Most polls show healthcare being one of the most pressing issues facing our country. There are many different groups and individuals affected by healthcare policy, with many of these attempting to shape and influence it. In today’s Common Ground, we’ll be analyzing this subject while trying to capture how it affects residents of our East Bay communities.

It’s no secret that the healthcare system in our country is perceived by many to be in a crisis, with problems ranging from a lack of doctors and other healthcare professionals, to skyrocketing costs of care and prescription medications, and everything in between. We will try to address to what extent this problem has been getting much worse over the years. It’s obvious there are a plethora of opinions out there and an equal number of debatable solutions.

We have got to find a better way: (Mike Proto)

I remember growing up in the 1960’s and 70’s when pretty much everyone had their local family doctor (known today as a primary care physician) and a local pharmacy. That was about it. Specialist physicians were a rarity, and while this was an efficient and affordable system, it lacked the quality and technology that we enjoy today with our modern healthcare system. Unfortunately, with modernization and specialization, costs rise. These days, unless you’re very wealthy or fortunate enough to be a member of a union at your place of employment which provides employer-paid top-of-the-line health insurance plans, you can easily find yourself in a financial bind, or even worse, having to choose between paying for healthcare and prescriptions while not having enough money for basic needs such as food, heat, and shelter.

This is at the top of my list as our country’s most pressing problem, and it’s why politicians such as Barack Obama, Bernie Sanders, and Alexandria Ocasio Cortez have become so popular. They believe as I do that access to affordable healthcare is a right and not a privilege. As the healthcare problem in our country becomes more severe, you’re going to see more liberal, progressive, and socialist politicians getting elected because one of their major campaign platforms is health care for all.

Bring any politician to a town hall type campaign forum, and you can rest assured that affordable healthcare is one of the first subjects that the audience brings up. But unfortunately, due to policies championed by the current administration, the healthcare crisis in our country is getting worse, and until we have enough politicians in the White House and Congress who believe in health care for all, this crisis will continue and in fact get worse.

Let’s limit the focus to fixing access to care: (Craig Evans)

I agree many Rhode Island voters consistently rank healthcare among their top concerns, usually just behind the crushing cost of housing. That ranking reflects a daily reality in which many residents who carry insurance still struggle to get timely appointments, find a primary care doctor accepting patients, or afford the care once they finally receive it. The access problem has two interlocking parts: a shortage of providers (the supply side) and costs that push people to delay or forgo care even when they are covered (the cost side). Understanding the scale of both is the necessary starting point for any serious conversation about what to do next.

Start with the supply of primary care. Rhode Island simply does not have enough primary care clinicians relative to its population. Research cited by the state’s Office of the Health Insurance Commissioner estimates the state has roughly 700 full-time equivalent primary care providers serving just over one million residents—about one clinician for every 1,700 people. Even if every one of those clinicians carried a full panel of 1,200 patients, hundreds of thousands of residents would still lack a regular source of care. Analyses put the shortfall at approximately 300 additional primary care providers.

The consequences show up in the data and in people’s lives. The number of adults who say they cannot get a timely appointment with a primary care physician has risen over the past several years. Access is uneven. Lower-income households and people on Medicaid are far more likely to lack a usual source of care than higher-income residents with commercial insurance. Medicaid managed-care enrollees are less likely to have had a wellness visit with a primary care provider than their commercially insured counterparts. People are turning more often to urgent care as a substitute for ongoing relationships with a doctor or nurse practitioner.

Another problem has been reimbursement rates, particularly from Medicaid. Public programs (Medicaid and Medicare) cover a large share of patients in Rhode Island — often cited as roughly two-thirds of healthcare costs — so rates paid by those programs heavily influence whether practices can recruit and retain clinicians. Up until recently Rhode Island’s Medicaid primary care rates lagged those in neighboring states and fell well below the actual cost of delivering care. That improved in October 2025, when the state raised Medicaid primary care reimbursement rates. A September 2026 report from the Office of the Health Insurance Commissioner found that Rhode Island’s fee-for-service primary care rates now exceed those in Massachusetts, Connecticut, Maine, and New Hampshire and sit above the national Medicaid median. This was a meaningful step forward, yet this report concluded that even at 100 percent of Medicare, current rates still fall short of the cost of providing care. OHIC’s independent rate model recommended further increases bringing physician-led primary care services closer to 150 percent of Medicare rates (and advanced practice provider services closer to 110 percent of Medicare).

It remains to be seen what our new Governor will do about this. Commercial primary care rates remain a separate challenge; they have historically lagged Massachusetts for some common services, though new regulations require commercial insurers to increase the share of medical spending directed to primary care over the next several years.
These supply constraints are not due to a lack of insurance cards. Rhode Island’s uninsured rate is among the lowest in the country—around 2–4.5 percent in recent surveys—thanks largely to early Medicaid expansion under the Affordable Care Act, a functioning state marketplace, and earlier coverage programs. Coverage itself is high. The problem is getting in the door once covered, and reimbursement levels directly affect how many doors stay open and how many new clinicians choose to practice here.

The cost side compounds the difficulty. Even with insurance, many Rhode Islanders put off care because of expense. URI survey data found that nearly one in three residents (or someone in their household) delayed medical treatment in the past year over cost concerns with nearly half saying they simply could not afford it.

When people delay care, problems often become more expensive and difficult to treat later. The combination of scarce appointments and high out-of-pocket exposure creates a practical barrier that insurance coverage alone does not remove. Primary care is the foundation of the system; when it is hard to access, patients end up in higher-cost settings or forgo preventive and chronic-disease management that would keep them healthier and reduce downstream spending.

Common Ground: Take bold yet reasonable steps to improve access

We both agree that Rhode Island’s health care system is not collapsing. It continues to deliver high-quality specialty and hospital care in many areas. The one exception to this being the uncertainty surrounding Charter Care’s viability even under new ownership. Most residents do have a regular doctor and report satisfactory experiences. The state’s low uninsured rate is a genuine achievement that reduces one major source of access failure. Eligibility changes in the offing will certainly challenge this.

Our starting point is simply to acknowledge the dual nature of the supply and cost problem without exaggeration or denial. Coverage is not the same as access. High overall spending does not automatically translate into adequate primary care capacity. Cost growth that exceeds targets strains household budgets and the state budget alike. Residents across political lines experience the same practical difficulties: the inability to schedule a timely visit, the sticker shock of a bill, the decision to wait and hope a problem resolves on its own. Those shared experiences, more than any ranking, explain why healthcare sits near the top of the list of issues Rhode Islanders want addressed.

The next questions—how far to raise reimbursements, how to expand the clinician pipeline, how to make care more affordable within fiscal constraints, and what mix of regulatory and payment policies can move the needle—are harder. They require trade-offs. But those debates become more productive once the scale of the access problem is clear. Rhode Island does not lack insurance cards. It lacks enough accessible, adequately paid entry points into care. That is the practical reality voters are registering when they put healthcare high on their priority list.

These conditions did not occur overnight, and solving them will take time. If there was ever a time in our country where Republicans and Democrats, Liberals and Conservatives, and everyone else along the political spectrum need to come together, that time is now. The United States is among the world’s richest countries, and we have among us some of the most brilliant minds. It’s time for everyone to come together and make our healthcare system one of the best and most equitable in the world.

The Common Ground column has been created to provide readers a thorough examination of issues important to the Bristol community. While often having different opinions, Craig Evans’ and Mike Proto’s passion for improving the dialogue during these partisan times has brought them together in the search for common ground. Please email comments and suggestions to commongroundeastbay@gmail.com.