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From Transparency to Quality: A Better Path for Delaware’s Health

By: Jane Brady, Chair, A Better Delaware

This is the first in a series of articles that will take a look at how the policy principles and legislative priorities of A Better Delaware fared in the last legislative session, which ended on June 30.  We have written over several years now about our perspective on healthcare, education, energy, the economy and workforce in Delaware, as well as the need for more accountability and better transparency in the way government works in Delaware. 

In this series, we will look at how the action the legislature took promotes or inhibits achievement of those policy objectives we feel are important to make Delaware a better place for families, workers, businesses and the community at large.

Healthcare Policy

Our principles at A Better Delaware regarding healthcare include promoting more competition, assuring better billing transparency and eliminating the obstacles to quality of care and lower costs.

The primary healthcare focus of the General Assembly and the Carney administration in this past legislative session was the cost to the State. Two primary initiatives addressed the state’s cost to provide health care to employees and retirees.

The first was HB 350, which placed a panel of 5 persons, selected through a political process, in a position of oversight of hospital budgets. While initially opposed by every hospital in the state, ultimately, the bill was amended slightly, and the hospitals were silent. The bill passed.

There are serious issues with this approach. The impact of a legislature prepared to put a political panel in charge of finance decisions in a private or non-profit business cannot be understated. During session, legislators were discussing what other businesses contract with the state and whether a financial review of their profits and spending choices might be appropriate.  Imagine a builder bids on a project and a panel of political appointees ask, “This price is awful high. How much compensation did you take home last year?”

The Governor was squarely behind this bill but should have appreciated the chilling effect this will have on new businesses locating in Delaware. And, when over a third of our revenue depends on our corporate friendly business climate, that impact can affect all of state services.

The second issue was the initiative to thwart the Governor’s plan to move retirees to a Medicare Advantage Plan from the current state health care plan.  There was a loud and effective resistance, and the General Assembly responded with a bill to prevent such a move. The Governor vetoed the bill, and in a rare, bi-partisan moment, the General Assembly voted to override the veto.

There are real shortcomings to the State’s approach to health care costs.  Rather than take an overall perspective of what procedures the state is covering, what contributions the insured are making, and whether those contributions are fair and comparable to what privately insured individuals pay as a portion of their premiums to employer plans for instance, Governor Carney determined to use a sledgehammer on hospital budgets and force retirees into an alternative plan to the one the state already provided

There are so many options the Administration did not advance or consider. First, pass along increases in health care as they occur. State insured individuals have never paid comparably to private employees. Everyone knows costs go up, and expects to pay more for healthcare, like every other commodity. Waiting until there is a dire need and imposing a huge increase all at once is not responsible management.

Second, remove the need for a certificate of need (now called a Certificate of Public Review in Delaware), which studies have repeatedly shown increase the costs of, and limit access to, health care.  That law requires that some of the very people who provide health care services in Delaware approve new facilities and services by their competitors. Why wouldn’t that restrict competition and limit options? The result?  The very same procedures can cost 30% less in neighboring states, that have competition.

The State should enforce and expand the laws we already have in place requiring transparency in billing and allow for patients to choose who provides their MRI, knee replacement or heart surgery. Costs vary widely between providers right here in Delaware, but patients cannot easily find the costs. It is expected, if you buy a couch or beef roast, that you will know the cost before you seal the deal. But you don’t know what a procedure will cost you before you undergo it. That does not make sense, particularly when there are differences in price between qualified providers.  The State could cut health care costs by providing that information to its insureds.

Finally, the State should take responsibility for the choices it makes regarding what procedures to cover, and for what amount.  At the very same hearing at which nearly $700,000 was appropriated for the costs of establishing the hospital budget review panel, the Committee voted to expand coverage to include all abortion and related services and to eliminate all copays for all such services, thereby increasing, in one vote, the costs to the state for health care insurance. Without comment on the subject that was covered, the reality is that you cannot continue to expand coverage without increasing costs, yet they did not, while in the same breath, blaming the hospitals for the high costs to the state for health care.

Jane Brady serves as Chair of A Better Delaware. She previously served as Attorney General of Delaware and as a Judge of the Delaware Superior Court.





Unlocking Education Freedom: A Call for Real Choices

By: Jane Brady, Chair, A Better Delaware

This week we celebrate freedom. Freedom from the oversight of a King far away. Freedom of speech, religion and assembly, and the other freedoms protected in the bedrock of our nation, our Constitution.

But we can celebrate no such freedom in education.  There are restrictions on our freedoms in education, outdated and unnecessary, intruding restrictions.

Think about it. The government does not tell you where you have to get your car fixed, but they do tell you where you have to send your child to school. Imagine if the mechanic you were assigned didn’t have all the parts you needed and some were delayed, but eventually you leave the garage with a car that performs at 50%. Sadly, many of our kids graduating high school in Delaware are not performing in reading and math at even 50%.

And this is not a new situation. For at least a decade, the academic performance of Delaware students has been declining.  Are these students any more prepared for the long journey of their careers, their lives, than a car that is operating at 50%?  Clearly, the quality of the journey is compromised.

So, what are our options?  As a parent, an employer or a customer, we all have an interest in a confident community. A community in which everyone can realize their potential, give and contribute to the well-being of others and find personal satisfaction from their life.  A sound education provides the foundation to make those objectives a reality.

How can your child break free of this system that is not serving them well? Currently, there are a few options.  If you have the means, you can choose to send your child to a private or parochial school. If you have the time, energy and skill, you can home school your children.  If you are lucky, your child can be selected in a lottery and attend a charter school. And you can apply to get your child transferred to a different public school. SchoolchoiceDE.org has all the specifics.  Of course, the deadline to apply for the 2024-2025 school year expired on January 10, 2024, so if you want to choose a different public school through the current choice program, be sure to plan quite far ahead!

Are you satisfied with these choices? Probably not.  Do they really give you the freedom to assure your child gets the best education for them? Definitely not.

We at A Better Delaware believe that parents should have real choices about where to send their kids to school. And there is a way to provide choice – Opportunity Scholarships.  Although not currently available in Delaware, these scholarships are provided either by the State, directly to the student’s choice of school, or through donations to a scholarship fund by individuals and businesses who would receive a portion of the amount they donate as a credit against the taxes they owe the State.

Pennsylvania has such a program to which businesses can donate, and which provides, among other things, tens of millions of dollars to low- and middle-income families to attend the school of their choice.  The program is so popular, there is a waiting list to donate.

The sad reality is that there are nearly a dozen schools in Delaware with academic performance in the single digits. That means, out of 100 students, fewer than 10 can read or do math at grade level.  Yet, the Department of Education recently reported that the State spends an average of over $20,000 per public school student per year. Delaware is in the top 10 states in the nation in spending, and yet we are 4th from the bottom in student academic performance.

That is not acceptable. Clearly the current education system, with the alternatives currently available, is not working for the students of Delaware. They deserve better. Parents deserve the opportunity to provide a better education for their children. Delaware deserves a better prepared, work- ready community of educated young people.

We have tried to just spend more, repeatedly, and that is clearly not the answer. A new alternative, Opportunity Scholarships, is needed to give the children of Delaware their best chance at success, not only in school, but in life.

Jane Brady serves as Chair of A Better Delaware. She previously served as Attorney General of Delaware and as a Judge of the Delaware Superior Court.