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Gov. Raimondo’s 2015 budget caused consternation with advocates for abortion access.
Rhode Island Governor Gina Raimondo is obviously someone President-elect Biden’s team wants to place in a high-ranking position. She was vetted for vice president. Before the election there was talk of her becoming Biden’s Treasury Secretary; that position eventually went to former Federal Reserve chair Janet Yellen.
Now Raimondo is back in the conversation. Politico reported on Wednesday that she is the leading candidate to take over the Department of Health and Human Services (HHS). Previously, New Mexico Governor Michelle Lujan Grisham and Obama’s Surgeon General Vivek Murthy were seen as the top contenders. But Lujan Grisham, at least, has taken a step back, according to officials in the transition.
Despite the clear affinity for Raimondo, Biden would be taking a gamble with one of the most powerful constituencies in the Democratic Party: the reproductive rights movement. Thanks to a series of efforts that added restrictions on choice and cost women abortion coverage in Rhode Island, Raimondo was downgraded to “mixed-choice” in 2016 by NARAL Pro-Choice America, the long-running abortion rights advocacy group.
She has kept that mixed-choice designation through 2020. In its most recent report, NARAL considered Rhode Island a state with “restricted access” on abortion, after half a decade with Raimondo in the governor’s mansion. “Restricted access” is the same designation placed on Wyoming. Thirty-six percent of women in the state live in a county with no abortion clinic (though of course the state is small).
In 2018, a group of high-profile activists, including Gloria Steinem, endorsed Raimondo’s opponent, Matt Brown, in the primary campaign for her re-election. “I don’t think voters in Rhode Island really know what Governor Raimondo’s done that has really violated the reproductive rights of women and threatened their health,” said former NARAL president Kate Michelman to UpriseRI. A letter that accompanied the endorsement stated that Raimondo “has joined the attack on reproductive freedom.”
The Democratic Party has grown bolder in recent years in stating its unequivocal support for reproductive rights. Biden, after years of support, was forced during the presidential primary to renounce the Hyde Amendment (which bans federal funding for abortions) and state that he would seek to reverse it. Given that backdrop, hiring an HHS Secretary with a mixed record at best on choice would break faith with a critical Democratic interest group, and is almost completely untenable.
The Governor’s office has not yet responded to a request for comment.
Raimondo, a Catholic, professes to be pro-choice, received endorsements from Planned Parenthood and EMILYs List when she first ran for governor, and last year signed legislation codifying Roe v. Wade into state law, which she said “preserves the status quo” at a time when legal abortion is under attack from the judiciary. Her issues with abortion rights stem from a June 2015 budget bill, her first as governor. They point more than anything to Raimondo’s struggles with technocratic management.
The budget bill included a provision that required any health insurance company offering plans on the Affordable Care Act exchanges in Rhode Island to also offer at least one gold, silver, and bronze plan that excludes coverage for abortions. Federal law required that, by 2017, one plan on state exchanges must exclude abortion. But Raimondo’s budget deal went quite a bit further, leading to nine separate abortion-free plans.
The provision came out of a settlement in Doe v. Burwell, a case brought by an anonymous litigant against Rhode Island for not having an abortion-free option on its exchanges. Fearing losing in court, the state made a special abortion-free plan for the litigant, paid his back premiums, and agreed to institute new abortion rules in the budget that went well beyond federal law. The budget codified this settlement, and was negotiated behind the scenes without public input.
The way exchanges in Rhode Island worked, individuals already signed up for coverage the prior year would be “mapped” to the same health plan or a comparable one for the following year. But the comparable plans often were ones that excluded abortion coverage, and individuals had to know to ask for abortion coverage to retain it. According to Rhode Island Public Radio, 9,000 families were put into this predicament, placed into a new health plan that cancelled their abortion coverage without their knowledge.
Under the law, employers using the exchanges have the ability to determine for their employees what kind of abortion coverage they would get in their health plans. Workers could still obtain abortion coverage, but once again, they would have to know it was excluded, affirmatively ask for it, and pay for the coverage out of pocket.
The National Catholic Register called the measure a “pro-life win.” The state ACLU called it the “first anti-choice legislation passed in Rhode Island in more than 15 years.” NARAL gave the state an F that year for abortion access.
The Rhode Island ACLU called Raimondo’s 2015 abortion coverage provision the “first anti-choice legislation passed in Rhode Island in more than 15 years.”
The 2015 budget was not the only health-related matter where Raimondo presided over a setback. The $617 million Unified Health Infrastructure Project (UHIP) was a computer system intended to easily accept resident eligibility for anti-poverty programs like Medicaid. Raimondo launched it in 2016, contracting the work to Deloitte Consulting on a lucrative multi-million-dollar deal.
UHIP didn’t work from the start, randomly denying payments to eligible beneficiaries, mistakenly classifying living children as dead, removing Medicaid recipients from the system, and generally fouling things up for low-income residents. Yet Raimondo continued to pay Deloitte and even extended the contract. The state agreed to not sue the consultant over the flawed work, in exchange for a discount on its prior fees.
Despite the UHIP and abortion access debacles, Biden transition officials have stated that Raimondo has the proper “management experience” to handle HHS. But it would be unusual to see a Democratic administration install someone at that agency with less than a peerless record on reproductive rights.
There are also a series of issues where Raimondo appears to be at odds with Biden’s stated healthcare goals. Raimondo has made significant Medicaid cuts in Rhode Island repeatedly, including a measure in 2018 that added co-pays, characterized by state officials as “an effort to stop people from using Medicaid services unnecessarily.” Biden has defended Medicaid and put forward a public option plan that would cover low-income residents in states that have not expanded Medicaid. During the COVID outbreak, Raimondo shielded nursing homes in Rhode Island from liability lawsuits related to the virus. Biden has said his first priority is to protect people from COVID-19.
Rhode Island has suffered one of the highest nursing home death rates in the nation. More than 70 percent of all deaths in Rhode Island have come from long-term care facilities. After Raimondo earned plaudits over the summer for coronavirus response, the state is now suffering through its worst outbreak of the pandemic. There have been 1,380 deaths and 57,906 cases in the small state.
An earlier version of this story said that 36 percent of Rhode Island counties have no abortion clinic. That was a misreading of NARAL's 2019 report. The statistics has been corrected.
