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Health Care Commission: Lack of Independence from the Governor

By: Alexandre Kittila

The Delaware Healthcare Commission (DHCC) is the executive authority on healthcare in the state of Delaware. When it was established in 1990, the founding legislation stated that the Commission shall “serve as the policy body to advise the Governor and General Assembly.” To meet the DHCC’s important duties, members are “to collaborate with other state agencies and the private sector, to initiate pilots, and to recommend policy changes to the Governor and General Assembly.”

A substantial addition to that mission occurred in 2022, when the legislature granted additional authority to the Commission to “be responsible for establishing and monitoring the State of Delaware Health Care Spending.” Giving the Commission direct control over establishing pilot programs and affecting spending, grants what was an advisory board much more influence than the term “commission” would lead you to believe.

A real concern is not the establishment of the DHCC, nor its duties, but, rather, the fashion in which its board members are selected, and who is selected to serve. An executive commission separate from the branches of the Delaware government to establish pilots and spending could encourage decisive action and less entanglement in the bureaucracy; in its current state, however, it simply works as an extension of the Governor’s power over the healthcare industry in Delaware. Separation of the commission from the influence of bureaucrats in our government is crucial to ensure its proper function and fidelity to the goal of meeting the health care needs of Delawareans.

There are eleven members of the Commission. They are: the Insurance Commissioner, a representative of the Speaker of the House, a representative of the President Pro Tempe, the Secretary of Finance, the Secretary of Health and Social Services, the Secretary of Services for Children and Youths, and five individuals who are chosen by the Governor. Therefore, fully eight out of the eleven members are directly selected by the Governor. This compromises the independence of the Commission and can lead to the Commission becoming simply a rubber stamp for the Governor’s preferred policies and spending priorities.

If we truly want the best outcome for Delaware citizens who seek health care, the Commission should be a think tank to consider how we can best provide timely access and quality care at a fair and reasonable price. That is, the best way to spend the taxpayers’ money.

There is potential for independence of the Commission from the Governor in a provision of the Delaware Code that requires that “no more than 3 of the Commission members appointed by the Governor shall be of the same political party.” Of course, in Delaware, for nearly a decade now, the leadership of the House and Senate, and the Insurance Commissioner, have all be of the same political party as the Governor, And, given that the three cabinet members are appointed by the Governor, they will likely be of the same political party.  So, while the law may seem to create balance, consider that, even adhering to this requirement, the balance of the Commission could be 9-2. And, even if the Speaker of the House, the President Pro Tempe of the Senate, and the Insurance Commissioner are all of the opposite party of the Governor, and two of the five individuals selected by the Governor are of the opposite party, the balance would still be a majority of the Governor’s party, 6-5.

So, has the government followed their own laws? Currently, the cabinet members and government officials holding the designated positions are all members of the Democrat Party, and 4 of the 5 persons named by the Governor are Democrats, the only exception being the former Democrat mayor of Lewes, Theodore Becker, who is now registered as a “NO PARTY.” There clearly is no balance.

Additionally, many members of the Commission have a vested interest in the outcome of the decisions the Commission makes because they are affiliated with a health care provider or service in Delaware.  The Commission is mandated, in 16 Del. C.  §9903(e)(3) to act “in such a way that fosters creative thinking and problem solving.” A commission in which a nearly singular policy affiliation reigns does not “foster creative thinking”, but rather becomes an echo chamber effect, not receiving or considering competing or alternative viewpoints.

An executive authority on healthcare is not inherently a bad idea but the fact that nearly every member serves, for all practical purposes, at the pleasure of the Governor makes it dangerous. It allows the Governor and the government a more heavy hand into places it ought to be restrained. The Commission needs to be nonpartisan and independent, and motivated by the best interests in meeting the health care needs of our citizens.

So, what would be the best solution?  Perhaps we should make the five Commission members currently chosen by the Governor, selected and voted on by the General Assembly. Perhaps adopt an ethics rule to eliminate self-interest. Maybe allow a single selection by the Governor, other than his cabinet members, similar to the ones for the President Pro Tempe and the Speaker of the House.

All of those ideas will improve the Commission’s ability to meet the statutory mandate. But the most important takeaway is that since the DHCC is meant to be for the people, it should also be by the people. Establishing the DHCC in a more balanced structure will not only lead to more ideas, but also better ideas, hopefully leading to better healthcare for everyone in the state of Delaware.

.Alexandre Kittila is Senior at Tower Hill School. Kittila served as an intern for A Better Delaware in the summer of 2023.