Nesi’s Notes: April 22

The Saturday Morning Post | Quick hits on politics and more in RI

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Happy Saturday! Here’s another edition of my weekend column for – as always, send your takes, tips and trial balloons to and follow @tednesi on Twitter.

1. Rhode Island’s hospital sector is undergoing a striking transformation. A decade ago all 14 private hospitals were locally owned by not-for-profit groups. Now, if Partners HealthCare succeeds in acquiring Care New England, 10 of the 14 will have out-of-state owners, leaving only Lifespan’s four and independent South County Hospital controlled by Rhode Islanders. (And even South County tells me it’s begun talks with Yale New Haven.) Health care’s importance to the state economy has only grown over that stretch, with the sector’s share of total jobs rising from 15.3% in 2007 to 16.5% today. Talking up his pact with Partners, Care New England CEO Dennis Keefe argues that bringing in the management and money behind Mass. General and the Brigham could pay big economic-development dividends for Rhode Island, insisting it’s a comparable if not bigger deal than GE Digital opening an office in Providence. There’s certainly little doubt Partners has the financial wherewithal to stabilize Care New England, especially with Memorial out of the equation. Yet critics fear Rhode Island will be an afterthought to out-of-state owners who could siphon patients, capital and expertise out of the state. Lifespan CEO Tim Babineau – who said Thursday it’s “unclear” to him why Care New England didn’t accept his alternative proposal – has been fanning those flames, saying, “I continue to believe that health care is best delivered locally.” Keefe counters that Lifespan’s offer was inferior to Partners’, and questions whether federal antitrust regulators would even allow one hospital system to dominate a state the way a Lifespan-CNE combination would dominate Rhode Island. (He may have a point, considering the FTC’s recent success in blocking hospital mergers.) Presuming Partners and Care New England reach a definitive agreement by their self-imposed July deadline, attention will turn to Attorney General Peter Kilmartin and Health Department Director Dr. Nicole Alexander-Scott, who both need to sign off on the transaction for it to go through.

2. Lifespan and Care New England are the Ross and Rachel of Rhode Island hospitals, so it’s no surprise a lot of attention has been focused on how CNE spurned Lifespan’s advances this time. In reality, though, Lifespan wasn’t Partners’ chief rival for CNE’s affections – that would be Prospect Medical Holdings, the California for-profit that took over Roger Williams Medical Center parent CharterCARE in 2014. Whereas Lifespan acknowledged being out of the loop about CNE’s thinking in recent weeks, Prospect remained in active talks until late in the game. “While CharterCARE conducted proactive and thoughtful meetings recently with Care New England, we regret that we couldn’t reach a mutual agreement,” spokesman Otis Brown told me Friday, adding that Prospect “continues to be interested in strategic partners.” He added, “We do believe that locally managed health resources are, at the end of the day, in the best interests of our state’s health system.”

3. The political reaction to the Partners-CNE deal has been muted so far. Perhaps because of her Health Department’s role in vetting the transaction, Governor Raimondo had little to say. “I look forward to learning more about this proposal as it moves forward, to ensure that it continues to provide quality health care and does not result in significant job losses for Rhode Islanders,” she said in a statement. Speaker Mattiello was out of town and unavailable for comment. The congressional delegation did not speak out. On Friday’s Newsmakers, though, Senate President Dominick Ruggerio and Majority Leader Mike McCaffrey both gave the deal a favorable early review. “I think it’s a good thing for Care New England,” McCaffrey, who represents a city with a CNE hospital, told us. “Obviously it’s going to give them more resources to be available to the community.” Added Ruggerio, “On face value, I think it’s a good thing.” As for the reaction in Massachusetts, Boston-based consultant David Williams told me, “I’m not certain how things will turn out. But my guess is that Massachusetts regulators will be relatively easygoing about it because it is unlikely to have a major impact on our market.”

4. Partners wasn’t the only Massachusetts health company making local news this week. Tufts Health Plan, which rejoined Rhode Island’s insurance market in 2009, won approval this week to start selling plans to the state’s Medicaid enrollees, joining Neighborhood and UnitedHealthcare. Blue Cross may seek to rejoin Medicaid next time around, too, after quitting the program in 2010.

5. The Democratic Governors Association is serious about its very early efforts to buttress Governor Raimondo ahead of her re-election campaign. The DGA’s affiliated nonprofit just committed another $52,000 to continue airing its pro-Raimondo ad on local TV stations through the end of the month, bringing the total local TV buy to $139,000 since March 23. As of last week the total spend on the campaign so far was about $175,000, including digital and cable – so the new local TV buy should put the number well above $200,000. DGA officials may think they’re getting results, too, with surveys showing Raimondo’s job approval up and free tuition polling well.

6. State government’s number-crunchers fired the starting gun Friday on the General Assembly’s end-of-session race as they kicked off the meetings that will determine just how much revenue lawmakers have to spend when they write the state budget. Speaker Mattiello has left no wiggle room on his promise: $40 million to cut the car tax will be in there come hell or high water. But Senate President Ruggerio isn’t so sure. “I’m concerned about whether that $40 million would exist for that particular proposal,” Ruggerio said on this week’s Newsmakers. The Senate president, who represents high-car-tax Providence and North Providence, emphasized he agrees the tax is a problem. But he suggested it may be tough to find the $40 million Mattiello wants for the car tax along with the $10 million Raimondo wants for free tuition. “Obviously the governor and the speaker have competing proposals,” he said. “I’m not sure we can fund both those proposals and sustain it down the road. … I am cautiously optimistic that we could probably do both programs, but obviously it’s dependent on the revenues.” (Leader McCaffrey also said he thinks there’s a strong appetite for placing more restrictions on the free tuition plan.)

7. Worth reading: a new Penn study on Tennessee’s free tuition program. The Atlantic’s Ron Brownstein also has a look at why such programs are spreading.

8. Time to stick a fork in marijuana legalization for this year? Speaker Mattiello and Governor Raimondo have already voiced their hesitation about taking the step this session, and now President Ruggerio and Leader McCaffrey are sounding the same note – even though they’re sponsors of the bill. A study commission “would be a better option at this point in time than legalization,” Ruggerio said on Newsmakers, adding: “If I was a betting man, I would have to say it would be turned into a commission and we’ll be studying that issue.”

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9. Our weekly dispatch from’s Dan McGowan: “City officials have generally been tight-lipped when it comes to details on the budget proposal Mayor Elorza will deliver to the City Council next Wednesday, but we know a few things are certain. For one, Elorza has already committed to not raising taxes, a promise that will likely be made again next year when he’s seeking re-election. We also know he’s going to propose increasing the city’s contribution to the school department for the first time since 2011. The district currently receives $124.9 million a year from the city – that’s on top of all the state and federal funding it gets – and that number is expected to grow by more than $1 million in the mayor’s proposal. And then there are the raises. Most of the unions in the city already have pay increases coming under existing contracts with the Elorza administration, and with the Providence Teachers Union’s deal set to expire to June 30, it would be surprising not to see additional funds set aside for the next agreement. One of the big question-marks will be how much the administration expects to receive from the state budget. Aside from education funding, Governor Raimondo’s budget proposal sets aside nearly $53 million for Providence, but the mayor has asked lawmakers to further boost the city’s coffers by approving an increase in the hotel tax and a new tax on nonprofits along with several bills that would increase fees. The mayor’s aides always brush off questions about their confidence in the city’s legislative agenda, but Elorza’s budget should provide some clues about their expectations.”

10. The Senate is set to vote next week on about half its package of mental-health bills, a key Teresa Paiva Weed priority that Dominick Ruggerio has pledged to act on. Phil Eil tackles some of the underlying concerns in a recent Vice article headlined, “Why Do So Many People in Rhode Island Try to Kill Themselves?”

11. Can IT help solve the opioid crisis?

12. With labor leader Bob Walsh loudly proclaiming his hope of finding a candidate who can beat Dan McKee in next year’s Democratic primary for lieutenant governor, the incumbent is getting an early start on his re-election campaign. As a first step, this week McKee unveiled a new website highlighting his work in the state’s No. 2 office. “The campaign will lay out a persuasive record of initiatives to motivate voters and will also serve as our low-dollar donation platform,” McKee adviser Mike Trainor tells me. “We have launched an aggressive social media campaign on Facebook, Twitter and other platforms to drive traffic to the new site.” Asked whether McKee has learned someone is definitely planning to run against him, Trainor said, “The lieutenant governor is not aware of any potential primary candidate at present and believes an aggressive fundraising, Web and social media campaign beginning now will lessen the possibility of a primary challenge.”

13. Two local mayors, Jorge Elorza and New Bedford’s Jon Mitchell, have both been named to the latest class of NewDEAL Leaders. South Bend Mayor Pete Buttigieg, a party rising star and a member of the group since 2012, summarizes its mission this way: “It’s clear that we need new voices with fresh ideas and an ability to get things done to reinvigorate the Democratic Party and address the challenges that have the greatest impact on our constituents – in education, job creation, and more effective government services.”

14. Read Bob Plain’s eye-opening article on “lunch shaming.”

15. Ezra Klein writes up a surprising new paper co-authored by Brown’s Jesse Shapiro that suggests social media is not actually driving political polarization.

16. Did you know Medicare was first proposed in 1957 by a Rhode Island congressman, Aime Forand? That comes from this interesting 2014 paper by Princeton academic Paul Starr, in which he also challenges some of the conclusions reached by Brown’s Jim Morone in his book on the subject. “The Medicare and Medicaid programs helped to give the United States the most costly and inequitable health-care system in the advanced democracies,” Starr argues. “There can be no exempting [Lyndon] Johnson or his administration from responsibility for the resulting damage to the public welfare and the national interest.”

17. The FT argues, “since 2008 we have basically swapped a housing debt bubble for a student loan bubble.”

18. Sunday’s French election is a big deal – get up to speed.

19. The popular Providence-Newport Ferry will return on June 16.

20. Today’s Record Store Day, and a bunch of local LP shops are participating.

21. Set your DVRs: This week on Newsmakers – Senate President Dominick Ruggerio and Majority Leader Michael McCaffrey. This week on Executive Suite – Dr. Rajiv Kumar, founder/CEO of ShapeUp and president of Virgin Pulse; Nick O’Hara, founder of Charging Chair. Watch Saturday at 10:30 p.m. or Sunday at 8 p.m. on myRITV (or Sunday at 6 a.m. on Fox). Catch both shows back-to-back on your radio Sundays at 6 p.m. on WPRO-AM 630 and WEAN-FM 99.7. And you can subscribe to both shows as iTunes podcasts – click here for Executive Suite and click here for Newsmakers. See you back here next Saturday morning.

Ted Nesi ( covers politics and the economy for He writes Nesi’s Notes on Saturdays and hosts Executive Suite. Follow him on Twitter, Facebook and Instagram

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