Donning white coats and brandishing posters with slogans such as "Health Care 4 All," a group of Alpert Medical School students joined medical professionals and community advocates at the State House Jan. 23 to protest Gov. Donald Carcieri's '65 proposal to lower the maximum income level covered by RIte Care, a Medicaid program that provides health care for low-income families.
Carcieri's proposal, in an attempt to address the state's $150 million deficit, would strip thousands of coverage. Ocean State Action, an advocacy group that opposes the funding cuts, estimates that as many as 9,000 residents could be affected.
The proposed cuts would lower the maximum household income for RIte Care coverage from under 185 percent of the federal poverty level, or $32,560 for a family of three, to 133 percent of the poverty level, or just $23,408 for a family of three.
"This is representative of a larger degradation of Rhode Island state public health care," said Dan Schwarz MD'10 , one of the med students who attended the rally. He echoed speakers at the event who stressed that the budget cuts will have a negative impact on emergency rooms in the state and will increase the burden of uncompensated health care. "Anyone who goes to the hospital will see a diminished level of services," Schwarz said.
Margret Chang, another med school student protesting, said that slashing RIte Care funding would most directly affect children of low-income families, whose coverage would be eliminated by the cuts. Care for certain illnesses that are preventable in childhood, such as asthma, she said, would suffer badly if Carcieri's proposal were approved. The illness, if not treated early on, becomes more and more costly as the child ages, she said.
Facing what will become a $450 million deficit for the 2009 fiscal year, which begins July 1, Gov. Carcieri has said that the RIte Care cuts would save up to $4 million this year. His spokesman, Jeff Neal, told the Providence Journal that while possible long-term cost increases as a result of the cuts were uncertain, "the financial benefits in the short term are very clear and definable."
However, many who attended the State House rally denounced this logic. Victoria Picinich, RIte Care action coordinator at OSA, said that "the so-called savings that the governor and other people think will happen will actually be the worst outcome." Noting a "vicious cycle" of a lack of preventative care and overburdened, undercompensated doctors, Picinich echoed Lt. Gov. Elizabeth Roberts '78, who also spoke at the rally.
Schwarz agreed. "All of those people who would have received that medicine are in fact still humans and will in fact still get sick," he said. "It'll cost a lot more to fix (patients') late stage problems than if you had addressed them at the outset." Schwarz added that the cuts would deprive Rhode Island of federal matching funds, "actively removing money from the health care system."
Schwarz and Chang agreed that the State House protest was successful in its main mission of raising the issue of the RIte Care cuts' potential impact on the state's health care system to the level of public awareness, which Schwarz said is "difficult when the health care system is doing well." Chang said she thought the image of Brown med students in white coats "will hopefully stay with the public."
"What we can contribute at this point is a powerful image of (our) conviction," she said.
Chang said that although Brown med students have taken up universal health care issues for many years, it "really took off" last year when OSA led a tutorial on why and how med students should get involved in lobbying. OSA has been directly involved with Alpert Medical School in health advocacy for several years and asked med students to get involved in the protest. "I think they're fantastic," Picinich said, praising the students' quickness and eagerness to mobilize for the rally.
Chang said that the Med School "invests a lot of time, energy, and resources" in putting medical students in positions to be advocates for patients and communities, noting that she participates in the Advocacy and Activism Scholarly Concentrations Program, which requires students to dedicate four years to pursuing a community health issue.
Associate Professor of Pediatrics Patricia Flanagan, an adviser in the Scholarly Concentrations Program, said she sees "having a voice and speaking up when we see threats to the community" as "part of the culture" in the medical school's program. Although she said she has been discussing RIte Care with her students for the past year, she added that "as things boiled up" to the proposed budget cut, "they really acted very much on their own" in getting involved. "They probably could have done it all without me," she said.
Alpert Medical students will continue to lobby against the RIte Care cuts before the legislative session begins. On Wednesday, Schwarz said, they will meet one-on-one with legislators about the RIte Care cuts, hoping to stress that the proposed cuts will "make or break" Rhode Island health care.
Steve DeToy, director of government and public affairs for the Rhode Island Medical Society, said that "it was really reassuring to have medical students there" at the last rally and that he looked forward to their continued involvement in supporting RIte Care.
Picinich agreed that the students' presence was "invaluable."
"They're the future doctors," she said. "They're the ones who will be at the front lines of this every day."
