PROVIDENCE – A group of health care policy wonks, lawmakers, doctors and academics gathered Wednesday, Feb. 11, at South Street Landing to discuss challenges facing health care in Rhode Island.

The gathering, called The Summit on the Future of Health Policy in Rhode Island, was organized by Brown University’s Center for Advancing Health Policy through Research. It featured panels on the state of primary care, the intractable problems that beset health care affordability and the looming impacts of the federal reconciliation bill on the state’s Medicaid program.

Here are some of the key takeaways from the summit.

Measuring Rhode Island’s supply of primary care providers is tricky

It is no secret that Rhode Island has a shortage of primary care providers. Exactly how bad the shortage is, however, is tricky to determine.

Jason Buxbaum, an assistant professor at Brown’s School of Public Health, said data quality on Rhode Island’s primary care supply is “bizarrely bad and shockingly bad.”

According to an analysis of state licensure records by the Kaiser Family Foundation, Rhode Island has 2,500 primary care providers. But, Buxbaum noted, “That’s not anybody’s experience here. There’s no way that this figure accurately represents what’s going on.”

Part of the problem with the foundation’s analysis is how it counts internists, or first-year residents.

Other organizations, such as the American Association of Medical Colleges, list Rhode Island as one of the top states when it comes to primary care supply.

Complicating matters is the fact that hundreds of primary care doctors in Rhode Island are nearing retirement age, and the state is not refilling its physician supply. Caroline Richardson, who heads the family medicine residency at Brown’s Warren Alpert Medical School – the only family medicine residency in the state – said only five of 15 residents were planning on staying to practice in Rhode Island.

Addressing administrative burden requires give and take

If you want to see a doctor grimace, just mention “prior authorization.” It is a burdensome process that insurers require doctors to often complete before providing treatment or requesting an MRI scan or other procedure. It contributes to physician burnout, adds layers of administrative costs and can delay care.

In an effort to reduce burnout and improve efficiency, the Office of the Health Insurance Commissioner issued a rule last year to reduce prior authorization. Blue Cross Blue Shield of Rhode Island, the state’s largest private health insurer, for its part, cut prior authorization requirements by 65%.

Richardson, who is a practicing family medicine doctor, said the efforts are welcome, but implementing the rules can be complicated and these do not apply to Medicare and Medicaid patients, who account for about two-thirds of Rhode Islanders.

“The actual number of patients that this applies to is small, but the complexity of the law is real, and now we have our staff trying to figure out who has to be prior off and who doesn’t,” Richardson said.

The discussion inspired a lively debate over prior authorization, which is intended to discourage overutilization but which doctors find onerous.

RI is going to start feeling the side effects of federal benefit cuts

Last year’s passage of the federal budget reconciliation bill, known as the One Big Beautiful Bill Act, generated heated debate because of the cuts it will make to health care benefits and food assistance in the state.

The national conversation has largely moved past it, focused instead on issues such as the federal government’s immigration enforcement actions.

But those taking the pulse on the state of health care in Rhode Island haven’t lost sight of the consequences it will bring. Nearly 300,000 children and adults in Rhode Island are covered by Medicaid, according to Kristin Sousa, director of the state’s Medicaid program.

Medicaid covers 43% of births in the state, 51% of people with disabilities and 54% of nursing home residents.

But cuts to Medicaid and new work rules and citizenship requirements threaten the coverage many depend on.

Sousa estimated that between 7,000 and 9,000 enrollees will lose access because of their immigration status. Starting in the fall, under new rules from the One Big Beautiful Bill, non-citizens who are refugees, asylees or victims of domestic violence will no longer be eligible for Medicaid benefits.

More than 70% of adults on Medicaid work full-time or part-time, according to Sousa. But starting on Jan. 1, 2027, an estimated 24,000 are expected to lose coverage because of new work requirements. And this isn’t counting thousands more who will likely lose insurance coverage due to a spike in insurance premiums from the expiration of enhanced federal tax credits for the Affordable Care Act.

Hayden Rooke-Ley, a senior fellow at the Brown University School of Public Health, estimated that by 2030, about 50,000 Rhode Islanders will lose insurance coverage and Medicaid will lose about $400 million in funding.

This article originally appeared on The Providence Journal: Brown University health care summit tackles RI challenges