In 2018, Rhode Island did something that felt genuinely hopeful at the time. The state brought together its major health insurers, hospitals, and government administrators and got them all to sign a compact — a voluntary agreement to keep healthcare cost growth below a specific target each year. No lawsuits. No fines. Just a shared commitment to keep costs manageable for Rhode Islanders.
For a while, it worked reasonably well. The pandemic years were an exception, as they were for everything. But the trend in recent years has been harder to explain away.
In 2024, the target was 5.1 percent. Actual healthcare cost growth in Rhode Island came in at 9.1 percent — nearly double. Every single one of the state’s four major commercial insurers blew past the target. Total spending across commercial, private-pay, and government insurance plans reached $10.25 billion — $10,901 per Rhode Islander. And there were no consequences. Because there are no consequences. The compact is voluntary, and voluntary means insurers can miss the target twice in a row and nothing happens…