The nation-wide debate over health care reform is also contentious in Rhode Island, where a 12.6 percent unemployment rate and an already-strained state budget make questions over health insurance a crucial subject for many elected officials.
Democrats Sen. Sheldon Whitehouse and Rep. Patrick Kennedy, have been vocal in their support of reform, while Governor Donald Carcieri '65 has expressed concerns about the cost to the state.
"Each day, 50 Rhode Islanders lose their insurance," Kennedy said in a statement to The Herald. "Without health care reform, our broken health insurance system will cost the Rhode Island economy as much as $680 million this year alone in lost productivity."
Whitehouse wrote an editorial in the Providence Journal in July, arguing for reform.
"Rhode Islanders have shared their stories with me about how the health-care system has failed them," Whitehouse wrote. "They're going without health insurance because it costs too much, or because they have a pre-existing condition and private insurance is out of reach. They're fighting to keep the coverage they have."
Both Kennedy and Whitehouse emphasized the importance of a plan with a public insurance option that could compete with private plans.
"A strong public option is an essential component to keeping costs down," Kennedy said in his statement. "A public option will increase competition in the market place, keep insurers honest, encourage innovation and improve quality and lower costs."
In a letter to Sen. Jack Reed, D-R.I, a member of the Senate Health, Education, Labor and Pensions Committee and a strong supporter of health care reform, Carcieri expressed doubts about the role of the Medicaid system in the future of health care.
"Federal Medicaid rules often limit the ability of the states to adapt to fiscal realities and the complex and changing needs of beneficiaries," he wrote. "It is difficult to deliver vital services to the beneficiaries and be fair to all taxpayers when the federal government denies us the flexibility to effectively structure and manage a program representing such a significant financial investment."
Carcieri also expressed doubts about the source of funding for the uninsured. While current proposed legislation provides some funding for covering the uninsured in "high need" states, including Rhode Island, Carcieri said he is concerned that full federal funding is not provided for a long enough period.
Rhode Island Health Insurance Commissioner Christopher Koller echoed Carcieri's concerns.
"Most of the uninsured are low-income. They can't afford health insurance on their own and so they're going to need help buying the policy that they have," he said. "Although (the federal government) starts out saying that they'll pay for it, the bill will eventually be passed onto the states through Medicaid."
Carcieri called the Medicaid program "expensive, provider-centered, inefficient, slow to innovate and, as such, ultimately unsustainable."
"For these reasons, the Medicaid program is hardly the best and by no means the most appropriate platform for expanding health coverage to tens of thousands of additional Rhode Islanders and millions of other Americans," he wrote. "The House legislation imposes burdens on state budgets and working Americans that are unacceptable."
In his statement to The Herald, Kennedy said that health care reform should actually save money for working Americans.
"Reform means lower costs for Rhode Island's vibrant health care sector that will save jobs and help taxpayers keep more of their paychecks in their pockets," Kennedy said in his statement. "This bill is not just about providing coverage to the nearly 50 million uninsured, or the 120,000 uninsured in RI. It's about systematically changing the way health insurance and health care delivery operate, so that the health care we each receive is high quality, affordable, and guaranteed to be there when it is needed."