CRANSTON – On a crisp, bright morning, looking north toward Providence, the view of the capital city’s skyline was hazy but unimpeded, offering an optimistic landscape of the world and everything that is Rhode Island, two days before Thanksgiving.

Sitting down to talk with Sen. Jack Reed, there was an aura of positive vibrations that pervaded the room, as Sen. Reed welcomed ConvergenceRI into his cozy office. ConvergenceRI sat in the armchair, and Sen. Reed sat down on an antique sofa, which turned out to have once been his mother’s.

Sen. Reed talked in a slow, soft cadence, taking the time to choose his words carefully, delivering answers to questions in a reflective manner. Reed simply will not be rushed. We might have been sitting down, in a much earlier time, on his front porch for a neighborly chat, drinking our morning coffee, ConvergenceRI imagined.

And, in contrast to ConvergenceRI’s long, involved, often rambling questions about health care and innovation policies, Sen. Reed’s responses were short, pithy, and direct.

ConvergencRI: Have you been briefed by Attorney General Neronha about his plans for finding solutions to Rhode Island’s health care crises?
Sen. REED: I think that briefing is too expansive a term. We chatted.

ConvergenceRI:  He said that he briefed you; are you saying it was more of a conversation?
Sen. REED: It was a really good conversation. In fact, we actually sat down; we were doing a press event together. And, we went back and forth, generally speaking. It could be interpreted as a briefing. He was interested in learning about what more we could do at the federal level. Obviously, Peter is involved in this area as the State Attorney General.

Miles to go before we sleep
A half-hour spent talking with Sen. Jack Reed was, in many ways, a history lesson, engaging with someone well versed in the political ins and outs of Rhode Island for the last three decades, who could remember a time when a sense of bipartisanship ruled the nation’s politics – when good ideas mattered more than partisan rhetoric, and when political savvy translated into the ability to bring home the bacon in the form of more federal dollars to the Ocean State coffers.

When discussing the continuing standard of excellence that Rhode Island had achieved in providing health insurance for children [in 2023, 98 percent of all children have health insurance], including the success of the most recent initiative, “Covering All Kids,” an initiative that had been celebrated at a Rhode Island KIDS COUNT luncheon on Monday, Nov. 20, the day before the interview, Sen. Reed made the point of giving credit to the late Sen. John Chafee, a Republican. Chafee, Sen. Reed explained, “was one of the instigators. He was able to structure a lot of [federal] programs [providing health insurance for children] that enrolled more children each year.”

And, when addressing the need in Rhode Island for more affordable housing, a cause for which Sen. Reed has been an indefatigable champion, he simply cut to the chase:  “First of all, we have to build more housing,” Sen. Reed said, in his straightforward manner. “We slowed down dramatically over the last decade or more. We have a disconnect between housing supply and housing demand.”

In turn, Sen. Reed often displayed a dry wit with a simple turn of phrase. When discussing innovation policy and investments, and the difficulties that Rhode Island faced in competing with Boston and Massachusetts, he talked about the state’s ability to marshal resources around investments in scientific research supporting the Blue Economy – such as the decision by NOAA [National Oceanographic and Atmospheric Administration] to relocate its regional headquarters known as Marine Operations Center for the Atlantic to Newport, R.I. “I think we’re going to be very competitive with Massachusetts,” he began. “We don’t have the traffic that they do.”

Here is the ConvergenceRI interview with Sen. Jack Reed, who is a powerful voice championing what’s best for Rhode Island in the U.S. Senate, displaying a healthy dose of wisdom, wit and political savvy.

Sen. REED: This is my mother’s couch [sitting down for the interview].

ConvergenceRI: Your mother’s couch? Wow.
Sen. REED: She was very proud of it.

ConvergenceRI: And, you preserved it.
Sen. REED: I have it here in the office, a little touch of home.

ConvergenceRI: That’s great. It’s probably an antique.
Sen. REED: This is an old fashioned piece from the 1940s and maybe before that.

ConvergenceRI: Let’s jump right in. As you know, I do a lot of reporting on the health care front, and also on innovation. According to Attorney General Peter Neronha, he said he has briefed you on what he called the first tier of his plans to solve some of the ongoing problems in health care in Rhode Island… [See link below to ConvergenceRI story, “AG Neronha to offer bold prescription to solve RI health care crisis.”]

Sen. REED: I think that briefing is too expansive a term. We chatted.

ConvergenceRI:  He said that he briefed you; you are saying it was more of a conversation?
Sen. REED: It was a really good conversation. In fact, we actually sat down; we were doing a press event together. And we went back forth, generally speaking. It could be interpreted as a briefing. He was interested in learning about what we could do at the federal level. Obviously, Peter is involved in this area as the state’s Attorney General.

ConvergenceRI: There are many parts to the health care equation. One of the things that have become clear is that there is a need to raise the rates for providers under Medicaid, which is really under the state’s provenance to do that.

 For whatever reason, it has been very difficult for legislators to do that, because it probably means spending money, and the state doesn’t want to spend money, because they will have to raise taxes to do it.

At the same time, it has become the linchpin. By raising the rates for what people are being paid, you will increase the number of people in the workforce; you will improve the quality of care by the providers, because they can do more, and it can relieve a lot of the pressure points within the health care system – the overcrowded emergency rooms, the hospitals that don’t have enough staff, the community agencies who don’t have enough staff, the increasing demands for services that are not being met. It all seems to come down to raising those rates.

 There are apparently ways that the state could do things differently in order to get more federal money through the Medicaid system. According to what the Attorney General told me that he had been discussing with you, you were aware of ways that the state could leverage more money from the federal system.Sen. REED: We have been trying to do that for a long time. The basic thought is that if the state raises the Medicaid reimbursement, then the federal government will provide $2 dollars of federal money for every dollar in state money.

And that would be a tremendous [boost] for all the activities you described – for staffing purposes, for research purposes, attracting doctors to the state.

The traditional way has been that the state, the state-initiated, they set their basic rate of reimbursement and the federal government will match that and sometimes go further than that match.

With respect to Medicare, that is a federal problem. And we have been fighting for as long as I have been [in Congress] to increase the compensation that is provided in Rhode Island.

What happened was, apparently in the 1960s, when the Medicare program was first put into place, in 1965, they did surveys on reimbursements and costs. And, at that time, there really weren’t [the same levels of] tertiary care [in Rhode Island]. We didn’t have a medical school.

Massachusetts, they started off with a higher level of support [from Medicare] because of all their activities, mostly in Boston, and that’s been baked in now for 60 years.

We are seeing a situation where we have tried on the edges to change the formula, and we have had some success, but there is still a dichotomy between getting reimbursements in Massachusetts and getting reimbursements in Rhode Island.

ConvergenceRI: Another development in the health care sector which may involve federal jurisdiction is the way that private equity has been buying up hospitals and then gutting them, with the hospitals then being forced to close down. 

The Attorney General has been involved with Roger Williams Medical Center and Our Lady of Fatima hospitals.  Is this a national issue in terms of how the private equity industry runs? It’s not just the for-profit private equity Prospect Medical Holdings, which owns two CharterCARE hospitals in Rhode Island.

Is the increasing dilemma of private equity ownership of hospitals something that there is a federal answer to, rather than just state regulation? Do hospitals need to be seen as a public utility rather than a private business?
Sen. REED: First, in terms of private equity, you are exactly right. And, it’s not just the hospitals, We have legislation pending that would require the biggest private equity concerns to publicly disclose, much like a public company does, what their assets, their liabilities, and their investments are. And that will help, I think, open conversations about what they are buying and what are their assets.

Generally speaking, hospitals are regulated by state health agencies, except through Medicare and Medicaid systems, where they have a lot of federal regulatory applications.

[States] are the ones who determine whether they are performing well. In fact, the Attorney General’s options [include] reporting about the hospitals’ fiscal health of not being able to pay vendors and other things. I must say that the Attorney General has done a remarkably good job in this area. …He has been fighting very hard to protect the workers at [the Prospect Medical-owned hospitals] and their pensions.

I think that is probably the most effective way to go about things. For the federal government to start to regulate, to go in and basically determine who can own them and who can’t (is wrong), I think that is best left up to the state regulators and the Attorney General.

ConvergenceRI: One of the concerns about the future financial sustainability of hospitals is about the payer mix – it’s about 70 percent from federal insurance programs, Medicaid and Medicare, and 30 percent from commercial health insurance.

This is a forward-looking question: what is the best way to create a more sustainable financial future for health care, leveraging what the federal government can do through Medicare and Medicaid, to improve health outcomes?
Sen. REED: Most of the efforts we took on were through the Affordable Care Act, where we dramatically expanded coverage, increasing Medicaid benefits and making it more affordable to apply for commercial insurance.

As the years go on, the Affordable Care Act [has proven to be] even more beneficial to covering children. We have really come a long way in covering children, particularly in this state. It is one of the best things you can do for prolonging life and for reducing costs of health care.

In terms of dynamics, the hospital systems in Rhode Island are traditional and still operate under [the jurisdiction] of the state. What we have seen here in Rhode Island are attempts to reorganize our hospitals, and the Attorney General [and the FTC] opposed the proposed merger to prevent a monopoly.

Since then, the other thing that has developed is the collaboration between Brown University and the two major hospital systems to [engage in] joint research efforts. Research provides other resources for the hospitals. Those research dollars also attract specialists, so you improve health care that way.

And, I think there is lots of potential for the state of Rhode Island to help unify the efforts of hospitals and make them more solid [financially]. Both Lifespan and Care New England are not-for-profit, which is a good sign.

I think that the overall approach to fitness and diet and those kinds of issues – and again, if problems are spotted early in life, the children will be better off… We have the potential in Rhode Island to do really good things because of our size and our ability to cooperate.

ConvergenceRI: I was just at the RI KIDS COUNT celebration yesterday, where they touted the success of the “Cover All Kids” initiative, which I believe is a major reason why 98 percent of all children in Rhode Island have health insurance.
Sen. REED: …The Affordable Care Act, I think it is the biggest difference between a decade or more ago and today. [It has provided] access, particularly for low-income families, to health care that is affordable.

I think the community health care centers have done a tremendous job. We were down last night at Wood River [Health Services in Hope Valley], where a new facility was being dedicated, which will increase [the community health center’s] ability to treat people. Also, they have increased their ability to treat mental health, all in one spot and location. 

Not that many years ago, there weren’t major medical facilities in that part of the state. Now, you’ve got community health care centers; Westerly Hospital is part of Yale New Haven, and South County Hospital has done remarkably well.

The biggest factor has been the Affordable Care Act, together with making sure that the community health care centers play a big role in the delivery of affordable care.

ConvergenceRI: Community health care centers are truly the glue that enables communities to be served. Without them, the rest of the health care delivery system would become overwhelmed. Related to that, and something you’ve been very involved with, is providing access to safe, affordable housing. The phrase people often use today is that “housing is health care.”

 Yet, according to the most recent 2023 Housing Fact Book produced by HousingWorks RI, it’s difficult to find any place in Rhode Island that’s affordable to rent or to buy in. Because you have been so involved in helping to create more development of affordable housing in Rhode Island, what are the changes that you would like to see happen?
Sen. REED: First of all, we have to build more housing. We historically slowed down dramatically over the last decade or more. We have a disconnect between housing supply and housing demand.

The other aspect, I think, is that you have restricted zoning in many parcels – or difficult zoning in many parts of the state to do construction. I think one of the things that we have been trying to do is to get construction moving again. As you know, we put $250 million in federal COVID money for housing. And that’s going to hit the streets as quickly as we can.

Also, now, for the first time in Rhode Island, we’ve got a cabinet member [Housing Secretary] Stefan Pryor, who is in charge of housing.

We are beginning to understand that we have build more housing, and we have to build it in every community.

There are areas where you can get a quicker start, because you’ve got neighborhoods with old industrial buildings that can be converted into affordable housing. And, there are other areas where you’ve got to keep the appropriate pressure on to get affordable housing constructed.

It’s something that I’ve been trying to do for a long, long time. We’ve made some progress. We’ve created the Affordable Housing Trust Fund, which is a national supporter of affordable housing. We did that years ago.

And, I think the central solution is that we build more housing. The solution is that we build more housing, and there are also different ways to approach construction of housing, such as pre-built housing, that you can move in much cheaper than to construct. Again, we want to go ahead and stimulate the market and get things going.

ConvergenceRI: When we look at Rhode Island as a place of innovation, it seems that there are opportunities to promote and invest in innovation. But it seems we often imagine Rhode Island as an entity by itself, rather than part of a region. If we try and compete with Boston, it may prove to be a difficult competition.

Rhode Island has a clear niche. Dr. Jim Padbury, who used to be head of Pediatrics at Women & Infants, once described Rhode Island as a scalable research lab in a regional universe. The goal was to figure out where Rhode Island’s strengths were, and invest in the innovation research that happens here.

I know that you have probably been briefed about the efforts to set up a new RI Life Sciences Hub.
Sen. REED: Correct.

ConvergenceRI: I was involved in Massachusetts, working as a communications consultant with the John Adams Innovation Institute, and I wrote many of the materials that were used when they were developing the $1 billion Massachusetts Life Sciences Initiative, working with Pat Larkin, the director at the Innovation Institute.

The Innovation Institute’s work was based on what is known as “The Index of the Massachusetts Innovation Economy,” which provided a fact-based foundation for making decisions. I have not seen that same type of development of a fact-based Index of the Rhode Island Innovation Economy, which would support the RI Life Sciences Hub. Would the federal delegation be interested in trying to create this index for the Rhode Island innovation economy?
Sen. REED: My own particular interest is getting funding for research. We were able to get $90 million for the state for the new public health laboratory. And, that is going to be located in the [Innovation District in Providence]. We are seeing a much more coordinated effort, principally led by Brown but including the other universities, to figure out what the next great wave of research is, and then to attract the talent they can bring.

We’re seeing a much more comprehensive and thoughtful approach to innovation. The other area of innovation which is not related to medicine but is something very important is the fact that NOAA [the National Oceanographic and Atmospheric Administration] is moving their Atlantic Ocean [regional] headquarters up to Newport, investing in the Bay Campus, with the arrival of the EOI [Earth-Ocean Interactions] Lab.

We’re going to be one of the research centers for the Blue Economy. We are going to be able to do the research there, and I think, like Boston, if you start attracting investments in both the health care system and also in the Blue Economy, you’re going to start growing, based on important topics that are absolutely critical, such as global warming and ocean warming. Oceanography is going to become more and more important. If we are successful in pulling together these efforts on the research, then I think we’re going to be very competitive with Massachusetts. We don’t have the traffic that they do.

ConvergenceRi: What questions haven’t I asked, should I have asked, that you would like to talk about?
Sen. REED: Going back to the issue of health care and children, one of the best things, we did recently was to expand the federal child tax credit [under the 2021 American Rescue Plan Act], which was unfortunately not extended by my Republican colleagues.

It (empowered) families, by giving them real money that they could decide on how to spend it. That is something that could help us tremendously, if we reinstated it.

We have also invested in infrastructure to literally get the lead out of water pipes.

To improve the quality of life, the housing effort is the first, big problem. We have very little supply and a huge demand, which we have to address.

College debt is so severe. Young people are paying off debt, but there is not [a supply] of simple, single-family starter homes.

ConvergenceRI: The Cape house from the 1950s, built in developments, where the houses were the same, except that the garage was either on the left or the right.  
REED: We need to do multiple things to get back to the situation where housing is affordable, where housing is safe, with access to health care.

In South Providence, the families were living literally a 15-minute walk from two hospitals, but they didn’t have access to health care. Now they have two new health care centers [built by Providence Community Health Centers].

The scheduler intervenes
There is a knock on the door and Sen. Reed’s staffer enters to remind the Senator that his busy morning schedule beckons.

The promise is made to do this again, soon.