Rep. Morales introduces bill to establish a statewide
‘Medicare for All’ healthcare system


STATE HOUSE – Rep. David Morales (D-Dist. 7, Providence) recently introduced legislation to establish a statewide universal, comprehensive single-payer health care program.

“Health care is a human right,” said Representative Morales (D-Dist. 7, Providence). “Let’s be clear, receiving medical, dental and vision care should not be exclusive, expensive or accessible to only the fortunate. Across Rhode Island, thousands of working people and families lack the medical care and treatment that they need because it is too expensive. It is time we radically transform our local health care system and establish a single-payer Medicare-for-all health care system that guarantees comprehensive health care coverage to all Rhode Islanders free of out-of-pocket expenses or co-payments, regardless of socioeconomic status. And contrary to popular belief, we do not need to wait for the federal government to act on this issue.”

The bill (2023-H 6339) would create a “Medicare-for-all” style single-payer program that would replace multiple “middlemen” insurers with a single coverage provider, the Rhode Island Comprehensive Health Insurance Program (RICHIP).

The program would be funded by consolidating government and private payments to multiple insurance carriers into a more economical and efficient single-payer program and would replace high health insurance premiums, copays and deductibles with progressive taxes on large businesses and federal reimbursements.

Representative Morales’ bill is designed to allow a majority of Rhode Islanders to pay less for health insurance and all Rhode Islanders to have access to comprehensive coverage that includes medical, dental, vision and mental health care, as well as lower-priced prescription drugs.

According to data from the Kaiser Family Foundation, in 2021 the average cost of an individual insurance plan in Rhode Island was $8,125 and the average cost of a family plan was $22,381. Employers paid on average 75% of those costs and employees paid the other 25%, meaning the average employer paid between $6,000 and $17,000 per covered employee and the average worker paid between $2,000 and $6,000. Those costs do not include copays, coinsurance, deductibles or prescription copays, which can add up to thousands or even tens of thousands of dollars if individuals require care.

The program proposed by Representative Morales would be paid for primarily by a 10% payroll tax, with the employer responsible for 8% and the employee responsible for 2%. There would be no copays or deductibles, and prescription medicine would be free. Additional funding would come from federal Medicaid and Medicare reimbursements along with a 10% tax on unearned income, such as capital gains and dividends.

According to the Rhode Island Department of Labor and Training, the average private-sector salary in Rhode Island in 2021 was $60,633. That means that under the Medicare-for-All plan, the average employer would pay $4,851 per year and the average employee would pay $1,213 in total annual health care spending.

The savings come from efficiencies and reducing middlemen profits. Currently, a complex web of regulations and negotiations take place between health care providers and insurance companies and pharmacy benefits managers (PBMs). Hospitals and doctors’ offices expend enormous resources contacting insurance companies and debating over payments owed. And insurance companies and PBMs are among the most profitable corporations in the entire country.

The legislation is supported by Physicians for a National Health Program Rhode Island. Advocates point out that other countries have universal, single-payer systems that provide better health outcomes at lower costs than the U.S. system.

“Canada’s single-payer program began in 1962, in the province of Saskatchewan, which is approximately the same size as Rhode Island. It was so successful, it became a national program within 10 years and continues to be successful today, with better outcomes and lower costs than the U.S.,” said J. Mark Ryan, MD, FACP, chairman of the Rhode Island chapter of Physicians for a National Health Program. “Support for single payer extends across the state and includes businesses, unions and community organizations. Rhode Island can lead the way to a better health care system in the United States.”

“Unfortunately, many of us know from experience, that our current for-profit health care system is not benefitting anyone except the CEOs and stockholders of the corporations that are syphoning money out of the pockets of our workers and small businesses,” said Representative Morales. “It is imperative that we wrest control of this basic human right away from the companies profiting at our expense, and toward an accessible health care system available to everyone.”