Delaware’s Healthcare Metrics: A Triple Medical Miss

By: C.D. Casscells, MD, Guest Contributor

Delaware is going broke over healthcare costs. About 1$ of every 4$ of the State budget is for healthcare. (Normal is 1/6). There is huge fraud in the State Medicaid system and the State Auditor was denied access to audit Health and Social Services which begs the question, “What are they hiding?” Delaware’s hospital costs are higher than the norm, and its quality outcomes are below average. Based on the higher hospital costs, health insurance costs more than in neighboring states. Many companies in Delaware self-insure to better manage their costs but are still subject to the high cost of hospitals in the state.

On the good side, Delaware does not have a shortage of Primary Care providers. There is generally pretty good access tchild birthing care statewide. Delaware specialty care is also good in Delaware.  Malpractice insurance rates are high but not unreasonable like Pa., where rural hospitals are closing in droves. After all, Delaware doesn’t have any rural hospitals. Basically, Delaware has only one hospital system in each county. And Delaware has only one health insurer, Highmark BCBSDe. There is no choice.

Also, the two largest employers purchasing insurance and healthcare in the state are the State itself and Christiana Care Health Systems. Delaware has very few skilled nursing facilities, the 3rd fewest in the nation, to serve our rapidly aging population. To exacerbate this, our best SNF’s have very few if any Medicaid beds, so the Medicaid and Obamacare patients are particularly underserved with very limited access to covered beds.

So, by the three classic metrics of Healthcare Policy, Cost, Quality, and Access, we aren’t doing so well. Why does this matter? Because employers do not want to move here if there is a lousy healthcare environment, any more than they want a lousy school system, which we also have. We used to attract business with our business law and Chancery Court System, but that is no longer as attractive and other states are becoming more appealing. So, if we don’t make cars here anymore, where are the jobs? Well, they are here taking care of retirees from other states like NY, PA, NJ, and MD. where taxes are too high. But will they still want to retire here if healthcare isn’t that good? Our in-migration of retirees with out-of- state pensions and health insurance may be at risk. There goes a cash cow.

What to do? Well, we would all like lower health insurance cost. So, we need more choices to compete. But Health insurers won’t come to Delaware because hospital costs are too high and there is no choice or competition. So, a health insurer cannot make money in this high hospital cost market. Quite obviously the state needs more choices…. providers like hospitals, doctors, outpatient diagnostic and treatment facilities, and nursing homes. More choices mean competition for quality and price, as well as access. Both the private employers and the State need more choices for health insurance and healthcare delivery.

These undeniable economics cannot be fixed by top-down mandate or legislation, rather by removing barriers to entry into the state by the antiquated Certificate of Public Review or a failed office of Insurance Commissioner, or for that matter a newly formed hospital budget review committee. Price-fixing and mandating economics ALWAYS result in untoward unintended consequences. Remove the barriers to competition. Let the supply and demand mechanics do their magic and, by the way, please audit the corrupt and wasteful Medicaid system which is on track to bust Delaware’s budget.

Dr. Casscells is the Director of the Center for Health Policy at the Caesar Rodney Institute. 

Delaware Is In A Fight For Our Role As America’s Incorporation King. We Must Win

By: Ben duPont, Guest Contributor*

Many may not know it, but Delaware is on the verge of crisis.

Multiple major companies incorporated in our state, from The Trade Desk to Dropbox, have announced intentions to move elsewhere, with some, like The Trade Desk, already having left. Others, such as Meta, are on the verge.

For the better part of a century, Delaware has been the incorporation king — the obvious place to anchor your business thanks to our corporate-friendly tax laws, legal system, privacy protections and more. The result is more than $2 billion in annual revenue, more than one third of our state budget. A large corporation that leaves Delaware represents a loss of up to $250,000 in tax revenues per year.

If these losses continue, it will be painful. It will require Delaware to look at other funding sources, such as a sales tax or increases to the state’s personal income tax rates, or it could require cuts to government services. We can’t allow it.

My family has been in Delaware for generations. I want my kids and grandkids to benefit from a thriving state economy and strong government. For that to happen, we need to make changes and make them fast. I applaud our state leaders for doing exactly that.

Gov. Matt Meyer, Lt. Gov. Kyle Evans Gay, and Secretary of State Charuni Patibanda-Sanchez are all former business lawyers, and Senate Majority Leader Bryan Townsend is a business lawyer. These leaders did what any company does: They listened to the customers. Within 30 days of the governor entering office, they put forth proposals to solve the problem with Senate Bill 21.

So will Senate Bill 21 do?

So what is that problem, exactly? First let me tell you what it isn’t. Delaware is still the best state in the country to incorporate a business, bar none. A major reason is our excellent court system, where disputes are decided by judges with extensive experience in corporate law. These judges have been the gold standard of fairness and justice for over 100 years and still are.

The bill before the General Assembly helps our judges and companies by providing greater clarity around what it means to be a controlling stockholder and an independent director. It will ensure more predictable outcomes in disputes. It also draws clearer lines around stockholders’ entitlement to examine books and records, thus limiting lawsuits that are often costly for companies. In recent years, Delaware has been descended upon by plaintiffs’ attorneys and class action firms looking to make a buck off of frivolous lawsuits. This is a cancer on our system, and Senate Bill 21 will cut it out.

By providing clarity and predictability, the legislation will help assuage the concerns of businesses. I know because I run a business myself and work with many large multinational companies. They love our state, but the truth is that they have options. Delaware is no longer a monopoly. Other states such as Texas and Nevada are actively trying to lure them away from us.

Other states want to dethrone Delaware

In fact, on March 5, Texas’s Gov. Greg Abbott, published an opinion piece in The Wall Street Journal, “Forget Delaware – ‘Y’ all Street’ Is Open for Business” which states, “Businesses domiciled in Delaware have a choice to make. They can stay [in Delaware] and be subjected to increasingly unpredictable theories of liability. Or, like Americans before them, they can come to Texas. Unlike Delaware, the Lone Star State is open for business.”

The message from Abbott is clear: Delaware needs to compete for the corporation business.

It’s no wonder these states want a piece of the action. Our incorporation industry is brilliant for how it brings in revenue without causing resource strain. In virtually every other state, the leading industry brings money but also huge numbers of people that place strain on the schools, infrastructure, and government services that the industry helps to fund. We get the benefits for our existing residents without many of the costs.

I am both a Delawarean and a client of our incorporation system. I have looked at both sides of the debate and have heard from those who say the proposed changes will disadvantage minority stockholders and risk financial ruin for Delawareans. Only one side makes sense. This bill won’t “rebalance” the system by tipping the scales in any direction; it will simply stabilize the balance that has long existed. Its intent is to clarify rather than change, and that’s exactly what we need.  With Senate Bill 21’s adoption, corporations and their shareholders will want to be in Delaware, as they have for more than 100 years, bringing continued revenue to the state, and maintaining a legal industry that supports the state’s economy with jobs and ancillary businesses.

We can’t afford to get distracted by headlines and polarizing figures on either side of this conversation. This isn’t about any one person or business; it is about preserving the future of our state for the sake of our kids and grandkids. It is about defending our crown as the incorporation king. Long live.

Ben duPont is a long-term Delawarean, a venture capitalist and a philanthropist.

*This article was originally published in the Delaware News Journal, March 7, 2025.

A Closer Look at Delaware’s Education Budget: Challenges and Solutions

By: Jane Brady, Chair, A Better Delaware

It’s a popular argument that education funding in Delaware is “broken.” Our average annual spending per student is among the highest in the country while our student performance is well at the bottom. The data are scattered and not in a readily comparable format, but there is a bill in the General Assembly to make the information more accessible on the Department of Education’s website. We also need to be more transparent about the actual money spent and where it is going.

For those who claim that funding is not going to the neediest students, in terms of learning performance, that is not true. According to the Delaware Department of Education website, spending per pupil in Delaware, on average, is a little over $21,000.00. But, as the Caesar Rodney Institute has published, in some of the schools with the weakest student performance, the expenditure is over $30,000.00 per student. We are moving money to the students assessed to need more instruction. But we do them no service if we do not produce results for them and their futures.

Teachers, educational support service workers and administrators do not come to work in the morning looking to create inefficiencies or cause poor student performance. It is not the goodwill or the effort of teachers, parents and students that is lacking. It is a lack of leadership and of specific objectives and outputs that is hampering results.

We suffer from a teacher shortage. That may be, in part, as a result of our pay scale, as many in state government seem to think.  But an overriding issue relates to discipline and safety.  When asked by their union, of all the issues teachers have identified as concerning and affecting their ability to teach, those two concerns are among the most significant cited.  We need to address the policies that displace entire classes when one student acts out, and which have resulted in physical altercations, not only between students, but also between students and teachers and other staff.

Heritage Foundation did a study which measured aspects of education and policy in all 50 states. Once again, Delaware ranked in the bottom (47) overall. But Heritage also evaluated “teacher freedom” – the ability to move into and around within the Delaware teaching community.  Delaware ranked dead last, at 51 (the District of Columbia was included).  Heritage suggested Delaware consider adopting policy changes that allow teachers alternative routes into the classroom (other than university degrees in education), expanding reciprocity of teacher licenses between states and reducing obstacles to qualification to teach in Delaware, giving the hiring of teaching staff over non-teaching staff priority and making the decision to revise or eliminate our alignment with the Common Core standards.  All of these actions can help alleviate the teacher shortage and improve teacher morale, and do not cost a lot of money. Some cost none.

That is important because public education funding makes up a third of Delaware’s state operating budget and is now the largest spending category for the First State, totaling 36% of operating appropriations at over $2 billion.

The Delaware Department of Education was awarded $2.16 billion for the current fiscal year and is now requesting additional funds of nearly $200 million, largely to support personnel salaries, enrollment growth and positions for school mental health professionals. Yet, a recent Pew study suggested that we are going to see student enrollment go down, and indeed, there are ample examples of near-empty schools and classrooms in our current facilities.

There is a new interest in government spending spreading across the country.  Citizens are making unprecedented inquiries into how much of their money the government is spending and what the government is spending it on. Given the low rate of return on our consistent high spending on education with very poor student performance results, everyone, not just parents of children in school, but every taxpayer, should demand that the state adopt policies that will improve education outputs, not just throw more money at the problem.

Candidly, it is hard to say no to giving more money to try and help our children gain the skills they need to succeed. Political pressures are significant. So, get involved! Let your legislator know that you will support them if they insist on better policies, not more money.  Advocate for more parental authority over education choice, better flexibility for educators to teach in Delaware, and objectives and targets that reflect real effort to reach specific goals in student performance.

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.