Rhode Island Lt. Gov. Elizabeth Roberts (D) on Tuesday unveiled a health care reform plan that would require most residents to purchase health coverage and would implement cost-cutting strategies, the Boston Globe reports. Roberts' plan would require all state residents with annual incomes above 400% of the federal poverty level to purchase insurance by July 2009. Businesses that do not provide insurance would be required to pay $1,000 for each uninsured employee, which the state would use to fund insurance products beginning in 2012 if enough funds are collected. The state also would expand Medicaid and SCHIP (Dembner, Boston Globe, 2/13). In addition, the state would establish an agency, HealthHub, to coordinate the purchasing and regulation of health plans (Needham, Providence Journal, 2/13).

Roberts' plan also would emphasize primary care over emergency care, implement procedures to better control chronic diseases, pay physicians based on outcomes, and establish a database of health care treatments, outcomes and costs to help medical providers deliver high-quality care at low cost.

According to the Globe, the plan "acknowledges that Rhode Island cannot afford, financially or politically," to establish universal coverage unless it can make health care delivery more efficient and raise funds through taxes on businesses that do not offer coverage. That approach "represents a significant shift" from Massachusetts' health insurance law, which sought to "expand access to care first and address costs later," the Globe reports (Boston Globe, 2/13).