Innovation Ecosystem/Opinion

Can you spell regulation?

The McKee administration has inherited a brave new world, in which preserving the status quo may no longer prove to be a viable economic strategy

Image courtesy of Gov. McKee's Twitter feed

The current photo atop Gov. Dan McKee's Twitter feed.

By Richard Asinof
Posted 3/22/21
Gov. Dan McKee may find himself confronting a new wave of regulation by state government to protect the health and well-being of Rhode Island residents, as the status quo keeps falling apart.
What will happen if the toxic content of air from Allens Avenue invades the air filtration system at the Wexford Innovation Complex? What are the lessons learned from the efforts to coordinate getting vaccines into the arms of Rhode Island residents? Will Rhode Island state government make investments in its digital workforce around data interactions and systems design? How far below the normal rate of childhood lead testing has Rhode Island become?
The surge in unmet mental health and behavioral health needs during the COVID pandemic continues to put pressure on an already overburdened system, across all ages and demographic groups. How we measure, screen, and treat high levels of what is known as “toxic stress” in children needs to become a priority, which will require a concerted effort by pediatricians to be supported in screening efforts – as well as offering treatments and solutions to prevent an escalation of symptoms.
The work being done by the Mindfulness Center at Brown, if properly deployed and utilized, could provide some ground-breaking programs for children in the classroom.

PROVIDENCE – The corporate advertising slogan lasted longer than most: “Here with you. Here for you.” Not any more.

The promise by National Grid, a British-owned utility, to always serve its customers in Rhode Island and Massachusetts, a venture begun as part of the new-fangled world of deregulation of the electric utility industry begun in 1997, is, in the infamous words of former Nixon press secretary Ron Ziegler, “no longer operable.”

The electricity business owned by National Grid was purchased last week by PPL, an energy company headquartered ion Allentown, Penn., in a $5.3 billion deal. Turns out, it seems, that as Billy Joel once sang, “We are living here in Allentown.”

And, as R.I. Senate President Dominick Ruggerio posted on Twitter on Saturday, March 20, “This transaction demands due diligence and a very candid discussion about a cleaner, more resilient grid.”

The question is: How do we get there? What kind of regulation will be required to enforce a cleaner, more resilient grid happening?

More importantly, how will Gov. Dan McKee attempt to navigate the choppy waters of utility regulation in Rhode Island?

Taking action on climate change
On Tuesday, March 16, the R.I. Senate, by a vote of 33-4, passed the 2021 Act On Climate, the first major climate and environmental bill to see a floor vote since the Resilient Rhode Island Act in 2014, as reported by ecoRI News. The bill sets mandatory and enforceable targets for greenhouse-gas emissions. The legislation centers equity and justice in the state’s plans for reducing emissions and building climate resistance, according to advocates.

On March 18, the House Environment and Natural Resources Committee, by a bipartisan vote of 13-2, approved its version of the Act On Climate legislation, once again as reported by ecoRI News. The legislation is expected to pass the full House when it comes to the floor on Tuesday, March 23; there are no major differences between the House and Senate versions of the legislation.

If either one of the versions is approved by both chambers, the bill would move to the Governor’s desk to be signed, vetoed, or ignored, as ecoRI News reported.

“The Act On Climate bill provides Rhode Island with the necessary foundation to support the state’s rapid transition away from fossil fuels and to a green economy,” said Meg Kerr, senior director of policy at the Audubon Society of Rhode Island, as reported by ecoRI News.

However, Republicans in the R.I. House are calling the legislation, known as House Bill 5445, an attack on “the fundamental principles of representative democracy,” claiming that the state can “reduce carbon emissions and preserve our representative system at the same time,” according to House Minority Leader Blake A. Filippi, in a news release issued on Sunday, March 21. To quote WPRO’s Steve Klamkin, “Really?”

The backdrop for the skirmish over the Act On Climate bill is the disliked fact that Rhode Island is experiencing more warming than any other state in the contiguous United States, with ocean warming harming the region’s maritime industries as well as placing low-lying communities across Rhode Island at a higher risk of flooding and extreme weather.

What the skirmish exemplifies is a broader conflict over regulation and the future role of government, challenging the status quo, something that new Gov. Dan McKee will be forced to wrestle with across a broad spectrum of public investment and public spending dilemmas – in health care, in education, in economic priorities, and in climate justice.

Simply put, the old way of doing things no longer works – the business model for hospitals, even if consolidated, is unsustainable.

The private equity model for financing health care – and for newspapers and news platforms – is undermining the basic tenets of American democracy.

No digital technology platform or charter school investment in making public education a commodity will be able to rescue public schools, without making an investment in the root causes of poverty and economic and racial injustice, in a place-based approach.

What the coronavirus pandemic has hopefully taught us is this: public health requires a different approach in how we move forward with public education.

And, the nation’s perverse relationship with the fossil fuel industry is rapidly coming to a close – similar to the demise of whale oil as a fuel source in the mid-19th century.

A hopeful dance to spring
I have put in my request to interview Gov. Dan McKee, one-on-one, with the kind of optimism and hopefulness that Jules Feiffer often evoked in his annual cartoon portraying a “dance to spring” – the feeling when anything is possible, as we emerge from the dark COVID winter that has enveloped all of us.

As ConvergenceRI readers may recall, my efforts to conduct a one-on-one interview with former Gov. Gina Raimondo was an “unrequited” affair: in six years, despite her shaking my hand while looking me in the eye and agreeing to do such an interview – twice, she reneged. [See link below to ConvergenceRI story, “The interview that never happened with Gov. Raimondo.”]

The medium is the message
Beginning in March of 2020, ever since the state became awash with the coronavirus pandemic, the favorite tool of “communication” by then Gov. Raimondo and her team had been weekly news briefings, ostensibly to share the latest data and trends. In reality, the press briefings served as a platform for the Governor to communicate her messaging directly to Rhode Island residents, uninterrupted, with the tale end of the briefings reserved for a few questions from the news media [who could be heard but not seen].

It is a tradition that the Gov. McKee has decided to continue, for the moment, with some modifications. More reporters will be allowed to attend future press briefings next week, with more than one reporter from each outlet now allowed. Is a media scrum the best way to cover McKee?

At the most recent press briefing, Gov. McKee appeared to be peeved: he apparently voiced his frustration that the news briefings and, in particular, the questions, took too much time; and he attempted to dismiss the questions asked by Uprise RI’s Steve Ahlquist about Kennedy Plaza as not being relevant to the topic of the coronavirus briefing.

However, the problem may be that the old, worn-out playbook on how to manage the news media – depending on the usual suspects in the news biz to carry the water for the Governor – may not work very well anymore. The reporters are restless.

Can you spell regulation?
In Rhode Island, much of the state’s future prosperity is entangled with the business of government: how serious the R.I. General Assembly will be in providing oversight and accountability when it comes the issues that mean the most to residents: health care, public education, utility management, and violence.

The big merger proposed between Lifespan, Care New England, and Brown promises to open a big can of worms around health care costs. R.I. Attorney General Peter Neronha, who has positioned himself as the public health advocate for the state, will have a lot to say about what happens, independent of the Governor’s wishes and the R.I. General Assembly’s desires. Lobbyists for the big enchilada health systems can only carry the water so far for their clients

• The biggest driver of rising health care costs in Rhode Island is prescription drug prices in both commercial and managed care markets, according to the latest, data-driven research. [See link below to ConvergenceRI story, “Prescription drugs, not utilization, are driving high health costs in RI.”] Nothing about the proposed merger appears to address that conundrum.

• All the efforts by the state to move away from fee-for-service to bundled care, moving toward capitation through accountable entities, has been focused on Medicare and Medicaid health plans. The specialty practices under the control of Brown University, under the umbrella of Brown Physicians, Inc., will still function largely as fee-for-service enterprises in the new consolidated enterprise. Without an audit of the current private firms doing business as managed care organizations in Rhode Island, how much money is being spent by privatizing Medicaid is an unknown quantity.

Further, the new facility being opened this week in Warwick by Ortho RI, a non-hospital-centric business model, with patients at the center of its mission, offers a new kind of innovative business model.

• The tipping point to create a Medicare For All pilot program in Rhode Island is moving closer, particularly after Blue Cross and Blue Shield of Rhode Island decided to change its policy around co-pays for COVID care, at the same time announcing a large bonus for the former president and CEO of the health insurer. [Editor's Note: The health insurer went back to its previous policy to waive co-pays after a withering response; the decision taken on Jan. 1 to reinstate co-pays for thigns such as physical therapy does not seem to have changed, although the insurer had waived them in August in response to the pandemic.]

• The ongoing labor dispute between the Providence Public School District and the teachers’ unions keeps escalating, with R.I. Education Commissioner Angélica Infante-Green and Superintendent Harrison Peters attempting to sow divisions between parents and teachers. The R.I. General Assembly’s plan to enact a halt on charter school expansion, even with the apparent threat of a veto by Gov. McKee, will put the spotlight on how much the state is spending money in education – and on what. All the good will generated by Gov. McKee by including teachers and staff as a higher priority to receive vaccines may soon dissipate.

• The attempt to reorganize the Eleanor Slater Hospital as a cost-saving measure will continue to run into stiff headwinds in the R.I. General Assembly, in part because of the way that state money was doled out to a private consulting firm to plan the transition. Under the preliminary analysis of the proposed McKee budget, the new governor seems to have bought into the plan put into motion by former Gov. Raimondo. Quite simply, the R.I. General Assembly may be forced to invest more money in caring for the mentally ill, without being able to bill Medicaid. Health care is not a zero sum game.

• While COVID infections in skilled nursing facilities have fallen as a result of vaccines being given to residents and workers, the costs of Medicaid for long-term supports and services are unlikely to go down, given the state’s demographics and its high number of “old old” residents. The financial damage done to the nursing home industry by the botched rollout of UHIP, using a faulty software system designed by Deloitte, has never been fully calculated. Those most responsible, including the former R.I. Director of Administration, Michael DiBiase, have never been held accountable.

• The proposal to rebuild Kennedy Plaza in Providence using bond money as a way to reroute bus traffic from the center city, remains a controversial plan, favored by real estate developers but adamantly opposed by public transportation advocates. It promises to be a flashpoint for the new McKee administration in budget conversations and debate. The bottom line is that the coronavirus pandemic has totally changed the dynamics of the workplace, particularly for big office buildings. The ghost of Jane Jacobs is alive and well in Kennedy Plaza.

Not a mouthpiece
For sure, ConvergenceRI has made it a point not to serve as a mouthpiece for corporate interests, avoiding the practice of reprinting news releases as news, and instead, publishing in-depth interviews, focusing on the exchange of ideas, rather than messaging campaigns.

Last week’s top story, for instance, featured Dr. Beata Nelken, a pediatrician with her own private practice on Broad Street in Central Falls, Jenks Park Pediatrics. She was honored by Central Falls Mayor Maria Rivera as part of the celebration of International Women’s Day. Nelken’s work has been featured in a number of articles in ConvergenceRI.

If she were invited to give a presentation to one of the subcommittees working on the statewide health plan under the coordination of the Rhode Island Foundation, her point of emphasis might be quite different that those who currently hold top administrative positions in the health care industry, talking about how “word of mouth” was the best way to communicate with the patients she serves, and the importance of providing culturally competent care as a way of building trust with patients.

The work of Dr. Annie De Groot, volunteer medical director at Clinica Esperanza, Dr. Andrew Saal, chief medical officer at Providence Community Health Centers, and Jennifer Hawkins, executive director of ONE Neighborhood Builders, the backbone agency for the Central Providence Health Equity Zone, might provide another important voice not often heard or broadcast – about the ways that community health workers have become the backbone of outreach into the neighborhoods.

At the same time, the idea discussed during an interview with Linda Perri, the chair of the Washington Neighborhood Association, about creating a “toxic bus tour” along Allens Avenue and inviting Gov. Dan McKee, might provide for a fascinating discussion at the next CommerceRI board meeting.


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