Spring has arrived after a confusing winter – I hope our crocuses can emerge without being buried in a late snowstorm. This week’s letter discusses the coming “unwinding” of the State’s expanded Medicaid program and the choices that are emerging for alternative voting systems.
1. “Unwinding” Expanded Medicaid
This past Tuesday night, the Senate Finance Committee reviewed the budget of the Department of Health and Human Services to discuss, among other things, the State’s capacity to serve vulnerable Rhode Islanders receiving Medicaid benefits. Prior to the pandemic, residents enrolled in Medicaid were required to “re-certify” their eligibility each year to remain on the program, often with the assistance of case workers. As part of its response to the pandemic three years ago, the federal government suspended the re-certification process, allowing all Medicaid recipients (including more than 300,000 Rhode Islanders) to remain in the program without having to establish their continued eligibility. With the federal government’s conclusion of the COVID emergency this May, the State will “unwind” the COVID expansion of benefits and resume re-certification, under which recipients must establish their continued eligibility or else lose their coverage.
This presents a serious challenge for Medicaid recipients, who may not be aware of the renewed requirement, and who may lose life-preserving coverage as a result. This “unwinding” also presents a steep challenge for the State, which must find ways to contact every Rhode Island recipient to ensure they re-apply. This will require a comprehensive strategy, beginning with mass communications (mail, telephone calls, social media, etc.), followed up with intensive individual case management where necessary. Unfortunately, the Department has been chronically understaffed with more than 100 current vacancies of funded and authorized positions at a time when it will need “all hands on deck.” This issue is one of management rather than resources. I am worried about the Department’s ability to prevent individual tragedies that can arise over the next year from a problem it has known about for over a year.
2. Bringing Majority Rule to Multi-Candidate Elections
At its second meeting last Wednesday, the Non-Plurality Voting Systems Commission heard two presentations. Deb Otis from FairVote, a national advocacy organization, focused its Presentation on the advantages of ranked-choice voting. Ben Williams from The National Conference of State Legislatures offered a broader presentation on alternative systems, including approval voting and “star” voting. Ms. Otis informed us that it is typical for states to incorporate two years of voter education and planning before changing voting systems, and that post-election audits are capable with ranked choice voting. Mr. Williams informed us that states change their voting systems for different reasons, but that no change is “perfect” in the sense of solving all perceived problems. I would like the Commission to find a solution to the problem resulting from my 2021 primary, in which I received fewer than one-third of the votes, leading many to question whether my selection was legitimate.
Ranked choice voting can address that issue either at a primary (where the problem may be multiple candidates claiming a significant share of votes) or at a general election (where there may be a strong third-party candidate), but requires investments in voter education, implementation and ballot design. A run-off voting system (in which the strongest two candidates advance to a final round) avoids the complications of ranked choice voting and can guarantee a majority in the second round, but does not address the problems of a multi-candidate race in the first round. At the Commission’s next meeting (currently scheduled for Wednesday, April 26), we expect the Commission to hear from The People’s Primary, a citizen’s group that supports a form of run-off elections. I expect the Commission to hold a total of five meetings this Spring, and to return this Fall for discussions leading to the publication of a report in time for next year’s legislative session.