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Blogs and Articles

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.

Inspector General Will Bring Transparency to Delaware Government

By: Jane Brady, Chair, A Better Delaware

The operation of our state government can be complex, confusing, even overwhelming, if you are not directly involved in the day-to-day development and implementation of the expenditures. But there are some basic standards that government should meet in making sure the public is informed about the priorities of their leaders and the way the public’s funds are being spent.  Transparency and accountability are the hallmarks of a government of good integrity.

That is lacking in Delaware today.  Even with regard to how much money the state will spend this year, we are not getting the full story.  The Governor proposed a budget of about $8 million, and the Joint Finance Committee recently released an operating budget of $6.1 million. There are some capital expenditures and financial support for non-profits that will be added. But that is not the entire story.

You may have heard about the more than $4 billion dollars Delaware spent in surplus funds in the past three years, provided by the federal government, largely due to Covid funds.  But Covid did not begin the provision of federal supplements, and they will not end when the Covid funds run out (we are spending the last of them now). According to the National Association of State Budget Officers, Delaware actually spent between $7 and $10 billion more than our “budget” each year since 2019.

And recently we learned that we have not accounted for, or spent, all those funds wisely or appropriately.  Were you aware that nearly $200,000 was embezzled from our state unemployment insurance funds? Neither were the State Auditor or law enforcement.  For over a year, no information was provided by the agency about the loss.  The facts only surfaced when an auditing firm advised they could not perform an audit because the accounting of the funds was in such disarray

In its annual report, Truth In Accounting, which evaluates the 50 states’ financial transparency and scores each state, awarded Delaware 74 out of 100 points, and ranked our state 26th. The Report found that a factor in that ranking was failure to accurately state our assets and liabilities.

If we count on the government “players” to let us know what is going on, we will not learn the facts. We need to have an independent, non -partisan Office of Inspector General (OIG).  According to a report by WHYY, such a concept has been the subject of discussion since 2007.  Amid great fanfare, a bill was introduced to establish such an office. The bill stated that the “sole mission [will be] to investigate and prevent fraud, waste, mismanagement, corruption, and other abuse of governmental resources. The OIG will “protect the health and safety of Delaware residents, assist in the recovery of misspent or inappropriately paid funds, and strengthen government integrity and the public trust in government operations.” That bill has stalled.

You may think that the State Auditor would take care of finding the mismanagement abuse or fraud in the state agencies. After all, the mission of that Office is to provide evaluation of the state’s fiscal accountability and public program performance. But historically, there has been consistent reluctance to share information with our State Auditor when discrepancies are discovered Given that the agencies have not shared information as appropriate with the Auditor, an independent non-partisan position of Inspector General is needed in Delaware, which will have the ability to investigate and issue subpoenas for information relevant to their duties. We urge you to contact your legislator and tell them you want them to vote for SS1 for SB21, the Office of Inspector General.

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.



Delaware: No Longer the First State

By: Jane Brady, Chair, A Better Delaware

The Urban Institute publishes the State Economic Monitor that tracks and analyzes economic trends at the state level.  Recently they published the numbers relating to state gross domestic product.  You may recall, from previous newsletters, that the gross domestic product is the value of the goods and services Delaware businesses produce. For the fourth quarter of 2023, Delaware was dead last. Not only was Delaware last in the nation, but Delaware was also the only state in the country in which the gross domestic product decreased. Every other state in the country grew their productivity in the fourth quarter of 2023.

So, what does that decrease in gross domestic product portend for the state’s economic future? Well, our state’s budget (spending) depends on revenue from business and personal taxes, as well as fees imposed for such things as auto inspections, real estate transfers, etc.  When business isn’t producing and growing, and is shrinking, fewer taxes are owed, fewer employees are paid, and the expectation of future revenue is placed in jeopardy.

Our economic productivity has not improved in some time. Our GDP was expected to remain static before the pandemic, and since, it has repeatedly declined. That reality did not stop Governor Carney from recommending, just a few months ago, a budget with an increase of over 8% in spending.  And among the candidates for governor in this year’s election are several who propose significantly more spending.

Delaware has been on a spending spree that is not supported by our revenue. During the past three years, Delaware has spent nearly $4 billion in surplus money we received because of the federal government’s excessive granting of funds during the Covid pandemic. Indeed, some of the funds for the expanded budget the Governor just recommended comes from residual federal funds.  Much of that federal money went to new programs, or the expansion of some, such as unemployment and Medicaid eligibility, which remain in effect. However, the federal money is now gone, and state revenue will be required to support those programs. That revenue simply is not likely to be there.

To his credit, Governor Carney has supported the Smoothing Fund, which is a stabilization fund into which the government has placed money to help the state through difficult economic times. He did so in the face of opposition from his own party. That program is established by Executive Order.  Governor Carney ‘s legacy to our future financial stability as a state should be to present that concept to the General Assembly in the form of a bill, and secure its passage, before he leaves office.

Much of our state revenue comes from the fees and taxes corporations pay to be incorporated in Delaware.  Many of them do not do business here, but we benefit from their choice of incorporation state.  Recent events threaten that revenue as well. You may have read that Elon Musk moved his corporation from Delaware as a result of some court decisions and the eroding business climate in Delaware.  Additionally, the passage of a bill creating government oversight of hospital budgets – private business entities – has the legal community abuzz with concern about for businesses being subjected to government oversight in order to do business with the government. And concerns even go beyond those which actually do business with the State, to those which choose to incorporate here.

The purported purpose of the oversight bill was to try to cut the cost of health care expenses the State incurs.  The intrusion into private fiscal operations is unprecedented (except for a plan in Vermont that, according to nearly all accounts is failing miserably).  The impact on business and our corporate revenue has not yet been felt, but concern is high.

The answer, of course, is to cut costs if they are not sustainable. The State seems unable to even contemplate that course. Incredibly, at the same hearing at which funding was approved for the previously mentioned oversight committee, the same legislators voted to expand Medicaid coverage and eliminated co-pays for state-insured patients for certain health services.

And, the State has failed to pass on increases in costs to those insured under State plans.  Failure to do so responsibly and periodically has resulted in opposition to huge increases of 25% or more in a single charge. The State owes it to the employees and other insured to be transparent and share the increases fairly.  Everyone understands there are increases in costs for every product and service, and while no one likes to pay more, the reality is they do, every day, everything else.

The state cannot sustain the spending it has incurred with decreasing revenues.  The Governor and the General Assembly need to take a close look at how and where they are spending our money and make some responsible decisions. That is only fair, after all. That is what they expect of the rest of us.

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.











The Myth of “Green and Clean” Renewable Energy

By: Dr. David R. Legates, Advisory Board Member, A Better Delaware

Delaware is embarking on an ambitious plan to reach NetZero—zero emissions of carbon dioxide—by 2050 and reduce emissions by half by 2030.  The Legislature has already begun to propose numerous proposals to enact draconian legislation to achieve this goal including HB99, passed in 2023, which blames carbon dioxide for potentially disastrous climate change.

Some Delawareans, based on a somewhat one-sided information flow, believe that even if carbon dioxide emissions are not responsible for changes in our climate, reducing our dependence on oil, gas, petroleum, and other forms of fossil fuels will be good for the environment.

As a result, Delaware’s farmlands in Kent and Sussex Counties are being covered by solar panels. Proposals to construct offshore wind turbines and to run their new power lines through our state park or Fenwick Island to connect to the electric grid are being proposed.  We are told that, in the end, our environment will be better for the eyesores these proposals would create.

But will it be better?  Since “climate change” was still called “global warming”, media reports have told us that wind and solar—so called, renewable energy sources—are both clean and green.  The truth is, they are neither.

When one looks at a solar panel or a wind turbine, all that is evident is that they supply solar or mechanical (wind) energy to the grid, powering our homes and our businesses.
They seem to do so without producing any harmful byproducts.  Clean and green, right?

Clean energy technology requires a wide range of metals and minerals, such as aluminum, cobalt, copper, lithium, nickel, zinc, as well as rare earth minerals such as Scandium, Yttrium, Lanthanum and a host of others of which you probably have never heard and cannot pronounce.  They are largely obtained from mines in Africa, southeast Asia, and South America.

These mines are not like those for coal, with which you might be familiar.  Open pit mining must be used to extract these metals and minerals.  Such mines are considered very dangerous to both miners’ health as well as to the local ecology and hydrology because of the harmful pollutants that are produced.

Consider lithium, an important metal used in the construction of batteries for EVs.  Mining lithium causes extreme environmental damage since the extraction process requires lots of water.  The result is a toxic lake. which leads to surface- and ground- water contamination.

Diverse places such as the Democratic Republic of the Congo and Rwanda in Africa, China, Inner Mongolia, and South Korea in Asia, and Brazil and Chile in South America are plagued with pollution arising from open pit mining, done to retrieve components of renewable energy.

In addition to the environmental concerns, the mining process in these countries should also raise flags for those concerned with social justice issues.  Slave and child labor are often used by the Chinese Communist Party which owns the mines in the Democratic Republic of Congo.  Even those who willingly work in the mines suffer from extreme health hazards.

And we may not even know the true extent of the negative impact on our environment.  Italian researcher, Enrico Mariutti, examined the true carbon footprint of solar panels, wind turbines, and batteries and found that the extraction, production, and transportation associated with these so-called “green” energy technologies produce significant amounts of greenhouse gases into the atmosphere. The nature and amount of the pollution created by these mines is reported by the mining companies themselves. Mariutti asks whether we would trust car manufacturers to certify emissions from their combustion engines or pharmaceutical companies to certify the safety of their drugs. Not likely.

He wrote “we are investing hundreds of billions of dollars a year in technologies that are low carbon only because someone wrote it down somewhere … there aren’t any national or international authorities who have bothered to understand on what basis and how this ‘paper knowledge’ was assembled.”

So, next time you see a wind turbine, a large solar panel, or an electric vehicle, think about the environmental damage that was wrought to mine the metals needed for their production, the energy that went into the mining and transport of the raw materials, and the health and social consequences of the miners who extract the necessary metals and minerals.

Are wind and solar energy really clean and green energy sources, or are they simply unreliable and expensive sources of intermittent energy?

Dr. David R. Legates is an Emeritus Professor at the University of Delaware and is the Director of Research and Education at the Cornwall Alliance for the Stewardship of Creation.  He also is an Advisory Board Member of A Better Delaware.

Retail Theft Costs All of Us

 By: Dennis Godek, Advisory Board Member, A Better Delaware

Delaware residents and businesses continue to suffer from the consequences of retail theft. In 2022, the total revenue lost to retail theft in Delaware was $285,000,000.00. Nationally, retail theft losses increased by 10.5% in the same year. When combined with losses from “Return Fraud”, Delaware businesses lost a total of $547,000,000.00 in 2022. While Delaware’s retail theft per capita rate is a little lower than the average among all states, the numbers are beyond unacceptable.

The ability of retailers to reduce retail theft has been seriously impacted by their reluctance to have employees apprehend and detain suspects due to the increase in violence directed towards employees. Many retailers, including national chains, now prohibit their employees from intervening during a shoplifting. In fact, across the country, employees apprehend shoplifters only 2% of the time.  As a result, it is not unusual to see criminals casually walk into an establishment, pick up whatever merchandise they want, and walk out of the store unabated.

Organized Retail Theft Crime is a major challenge for retailers, and for law enforcement. The retail crime epidemic has led to the initiation of criminal enterprises dealing in the purchase and sale of property stolen in retail thefts. Arrests have been made in Delaware, but the activity continues. In January and March of 2024, the Delaware State Police charged individuals with Organized Retail Theft in three separate cases in New Castle County and Sussex County. One of those charged was tied to multiple thefts in three states through surveillance camera footage. Three of those charged in Sussex County were found to be in possession of over $20,000.00 worth of stolen property. All three were from New York City. In 2017, the Delaware Department of Justice civilly sued multiple individuals for Racketeering for operating a $6,000,000.00 business which purchased property stolen in retail thefts, and then sold it to individuals.

Our criminal justice system has not adapted adequately to this serious crime problem. Incidents are often not reported and the consequences fall to the employees and business owners who bear the burden of these crimes. We have seen Target and Walmart, as well as Walgreens and CVS, close multiple stores in Delaware and across the country with retail theft as the primary reason. People lose their jobs, maybe their homes, and the taxpayers see an increase in unemployment compensation along with other economic effects.

The State of Pennsylvania saw an increase in retail theft between 2021 and 2022. The Pennsylvania Legislature took definitive action and passed a law in 2024 which indicates a sea change in the approach to retail theft prosecution. The law requires the appointment of a Deputy State Attorney General and the hiring of a team of prosecutors specifically focused on retail theft throughout the state.  The law also elevates Retail Theft to a felony level crime based on the amount of value of property stolen. This includes a Class 1 Felony for property stolen valued at more than $50,000.00. Under the law in Pennsylvania, a Class 1 Felony is punishable by a prison term of up to 20 years and a fine of up to $25,000.00. In the case of the NYC thieves captured in Sussex County, under the new Pennsylvania law, they would be guilty of a Class 2 Felony and would be subject to a prison term of up to 10 years and a fine of up to $25,000.00. This is the type of commitment to addressing retail theft we must see in Delaware.

Retail Theft may be considered a “non-violent” crime, even absent physical assaults, the consequences to businesses and employees are serious and life changing. Many of them will be sentenced to probation in our courts.  While some are attempting to legislate any consequences out of violating probation, and weakening probation to near irrelevance, we must advocate for holding criminals accountable for their actions.

Advances in technology, training for employees, collaboration with law enforcement, and efforts through business associations are all contributing to the battle against retail theft, but the criminal justice system must not be able to excuse their way out of their duty to effectively prosecute these criminals.

Dennis Godek previously served as a New Castle County Police Officer and as Assistant Chief of Career Services at the Christiana Fire Company. He currently serves as Chair of the New Castle County Fire and Ambulance Advisory Board, which is the liaison between county government and the Fire/EMS service in New Castle County. Godek is a founding member of the Delaware Statewide Active Assailant Committee, which includes Law Enforcement and Fire/EM

Navigating the Offshore Wind Minefield

By: Jane Brady, Chair, A Better Delaware

Remember the old western movies in which there’s been a drought, people are starving, the cows are dying, and the crops won’t grow? The hero would come in and “seed” the clouds to make it rain. The movie may have ended well, but the reality was, those efforts were never very successful. What is rain? It is an intermittent resource, provided by nature and which we cannot generate or control.

So, as well, are solar and wind intermittent resources. We cannot generate them; we cannot control them. When, and where, it blows or shines is outside our ability to control.

And yet, Delaware’s policy makers are feeling pretty super-human these days. In an effort to eliminate all sources of carbon dioxide (which we will not debate in this article), bills and policies are requiring our electric providers to utilize a greater and greater percentage of the power we use from wind and solar. The result is less reliable and more expensive electricity. Currently, these intermittent resources are backed up and supported by reliable sources such as coal, natural gas and nuclear power. But Delaware’s government wants that to end. To help ease the cost of compliance with these restrictive policies, the State is providing significant subsidies to the companies who provide this “green” electricity. They are putting our money where their mouth is.

Delaware used to generate much of the electricity we used here in our state. Now, because we are required by our policy makers to use an ever-expanding percentage of “green” sourced energy, we get nearly 90% of our electricity from outside the state, losing much of what we pay for as it dissipates in the distance it is transmitted. So, we are paying not just for the electricity we use, but also the electricity we lose as it travels to our state.

Recently, Senate Bill 265 was introduced to create a framework for wind farms off the coast of Delaware. There are promises of cost constraint, but we have seen how that has gone before. Additionally, there is little regard for what we, the citizens, want. As with the EV Mandate, there is a great deal of opposition to looking off our coast at 140 or so wind turbines. The Department of Natural Resources promises public hearings on the proposed regulations, but they, and the Governor, did not listen to us when they went right ahead with the EV Mandate, and they are just as focused on getting this wind farm. That was evident at an informational meeting I attended at Indian River High School this past week.

Speakers at the event confirmed the Governor’s stated intention to allow 4 large transmission cables to come ashore in our beloved state park at Three Rs beach. The Governor essentially offered that specific alternative because he can bypass public opposition and won’t need to secure the consent of any of the coastal towns that will be affected by the sight of offshore wind turbines and the transition of their beach into an industrial site.

What makes the Governor’s offer so much less palatable is that the cables that he proposes to bring ashore in our state park are for a Maryland wind farm project. And, apart from the destruction of a portion of our beautiful coast, the cables are intended to go to the old Indian River power plant, traveling only 3-7 feet below the ground, or should I say, mud of the bay. Boaters beware!

Our leaders no longer represent our views. They seem poised to disregard our concerns about our beautiful shoreline, property value losses, loss of tourism, and the costs. They are not dealing with the realities of the available technology (at least eight offshore wind projects have been pulled because they could not be commercially successful even with significant government subsidies), not looking at alternatives that are more cost effective and promote significant environmental advantages (onshore wind, carbon capture and nuclear), and intentionally disregard the fact that Delaware is meeting all federal air quality requirements.

And they are being careless with our money. Estimates are that household electric bills will rise by $230-$350 per year, and businesses will see costs rise by many thousands, even millions of dollars.

There will be public hearings on the wind farm proposed regulations. Prior to that, an informational session is scheduled for June 5, 2024, from 4-7 pm at Beacon Middle School. Plan to attend, Be seen. Be heard.

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.


Hospital Intrusion is not a lifesaving infusion of capital for Delawareans

By: Ruth Briggs King, Board Member, A Better Delaware

For years I was the only member of the Delaware General Assembly with any medical education or experience. I brought my insight and ideas to improve the quality of care, access to care, and avoid unnecessary interference that is costly or unnecessary.

As a result of my experience, I am very concerned about S1(Substitute 1) for HB 350, now pending in the General Assembly. This misguided legislation purports to create control over the State’s health care costs. What it clearly demonstrates is that some State law makers have misdiagnosed the problems with existing health care costs in Delaware. They are proposing to try to control the finances of a complex entity and private, non-profit community hospital which, by any other unqualified individual, would be considered malpractice. This bill will create a chilling effect on quality and patient centered care in our State. I call on our legislators to consider the ramifications of HB 350 and to vote “No” on this bill.

First and most importantly, the legislation has misplaced the blame for increasing health care costs on the hospitals. This effort is clearly simply a look at the bottom line and not intended to address many other significant issues in the delivery of health care in Delaware.

A candid look at past performance demonstrates that the State cannot appropriately manage the health care services it currently seeks to deliver, and therefore should not, in any way, intrude into our private health care system. There has been much media coverage and internal discussion about the problems and woes in the State run hospitals, such as the home for the chronically il, the veteran’s home and the correctional facilities health care. Despite years of poor performance, the State has not fixed their own health care delivery problems.

Hospitals do not operate in a vacuum or an isolated environment. They are not immune to the impact of escalating energy costs; wage increase demands and government regulation imposed by multiple State and Federal agencies. Additionally, our hospitals provide emergency care at no cost to those who are uninsured. And we, the people who are served by these hospitals, expect the best care, the latest technology, and the best outcomes. This all comes at a cost.

The legislators are blind to the impact the very legislation they pass has on the cost of healthcare and, therefore, the hospital community. Delaware’s expanded Medicaid eligibility provisions have forced Delaware taxpayers to pay $20-30 million more each year for the last 4-5 years. At the same time, the Medicaid reimbursement to the hospitals, as well as long term care facilities, has not accelerated to cover the costs. For example, a small community hospital in Sussex County loses money on each Medicaid newborn delivery. And they lack the volume of deliveries to make it “balance” the cost. Should they stop delivering babies? No, in fact, the hospital voted to continue the service at significant loss. Will the State cover the “loss” on those services? No. The State expects the hospitals to do more with less and then is critical of their budgets.

Let us be specific. Hospitals have to plan for increased demand. They hold aside reserves in anticipation of future construction and equipment needs. Would the proposed legislation affect these, and other, capital budgets or simply operational budgets? And what happens when real-time operational decisions have to be made? How could this arrangement “manage” a 20-car pileup on I95, or, worse, a pandemic, such as COVID?

Our current hospital boards are, generally, well governed and represent the community in which they are located. The remedy for increasing healthcare costs is less government intrusion and for lawmakers to understand how their decisions impact the cost of care and services. Healthcare and hospitals are not in a cloistered environment that protects them from escalating costs.

Hospital boards face complex decisions and need skill and expertise to make the sophisticated analysis to develop a strategic plan to serve the community. They anticipate population growth and need. Our Sussex County community hospitals recently established residency programs to address the lack of supply and high demand for primary care physicians. Furthermore, it is the hospitals that have sought and funded consulting firms to discuss the need for a medical school in Delaware. The State’s medical resources, including at DHSS, are severely inadequate and rely on the professionals and the local community boards to be the driving force for superior health care. Why would legislators seek to cripple a system that is not on life support?

Did anyone consider that hospitals get bonds to fund their projects based on operational performance and balance sheets? Legislative interference would stifle a hospital’s ability to grow and demonstrate the need for bonds to invest in healthcare expansion when needed.

No one is mentioning the liability and potential detriment of care. The hospitals absorb the risk and liability resulting from poor decisions or inadequate care. Will the new Commission accept the risk if their approved budget affects the hospital’s ability to provide the care, they believe is necessary?

Further, consider the message and effect on health-related industries, such as pharma and biotechnology industries in Delaware. After all, who is next?

Healthcare is more than a balance sheet. Our hospitals are forward thinking and continually investing in current and emerging issues. Did the legislators listen to the healthcare industry or work with hospital leadership to develop a path forward? If not, beware. Government intervention in our hospitals’ budgets is a slippery slope that will require emergency intervention, and resuscitation at a far greater cost to Delawareans than, I believe, the legislature anticipates.

Ruth Briggs King just retired from the Delaware General Assembly, where she served the 37th District, and the State, since 2009. She has extensive experience in finance, banking and organizational development and owns Workforce Solutions Today, LLC with her business partner. She recently joined the Advisory Board of A Better Delaware.



Are Health Care Benefits Intended for Veterans Being used to Benefit Illegal Immigrants?

By: Hon. William L. Witham, Jr., Advisory Board Member, A Better Delaware

Veteran benefits, including health care, are not just a nice perk for veterans. They are something earned through the service, and often sacrifice, of our armed forces, dedicated to defending our country.

Recently, there has been a lot of debate about access to appointments and health care provided to veterans, here in Delaware and around the country. There is a great deal of concern that the Department of Veteran Affairs (VA) is diverting resources from veterans to provide health care for illegal immigrants in the custody of Immigration and Custom Enforcement (ICE)

There has been a long-standing arrangement between the VA and ICE to process claims for illegal immigrant medical care. It is an interagency agreement with the VA and ICE Heath Services Corps (IHSC) to provide health care claim processing and referral services for illegal immigrant patients. The cost of the care is to come from the ICE budget. Although it has been in place since 2002, members of Congress, prior senior level VA administrators, border control agents were recently surprised to learn of this arrangement. When they became aware, they held hearings, and proposed legislation to be sure no resources are diverted to prevent or delay health care for our veterans.

Darin Selnick, who served as Veterans Affairs Adviser on the Domestic Policy Council during the Trump administration and also as a senior adviser to the VA Secretary, said the arrangement was a surprise to him and others he knew that served during the administration. He believes it would have been stopped if it were more widely known among officials. He further points out, “In my position, we would have stopped this, because if the VA had the extra ability to do this, then they should have been doing it for the veterans and not for another agency.”

It has been difficult to know exactly what the costs are, how they are adjusted, and whether VA health resources are diverted from veterans. The administration claims that the VA does not provide any funding for health care to ICE detainees. It claims that only 10 employees are funded by ICE – the same number that was funded in 2002. But the increase in numbers is staggering. In fiscal year 2021, ICE budgeted more than $74 million for payment to the VA for referral and medical claims processing. And, in fiscal year 2022, the VA staff processed 161,538 immigrant health care claims. These numbers call into question the claim that there are only 10 people at the VA handling these matters. At the same time, the VA reports that, in 2023, there was a backlog of 378,000 claims by veterans, and that they took an average of over 125 days to process. The VA expects the backlog to grow in 2024. It strains credibility to suggest that there has not been an adverse impact on veterans and their access to timely health care as immigrant claims seem to have been prioritized.

Further, the VA allows illegal immigrants to access the Community Care Network Providers, a system that allows veterans to receive care, covered by the VA, at non-VA facilities. The use of these centers is intended to provide more timely medical care to veterans. Adding additional demand on those resources necessarily affects access to care for our veterans.

All these circumstances lead to ever increasing pressure on federal resources, particularly the VA, to provide assistance to the unlimited inflow of immigrants. We cannot and should not divert the limited resources we have to provide health care to our veterans. They should be our first priority.

Witham is a retired Kent County Resident Judge who has served over 40 years in Delaware’s justice system. He is also a former leader in the US Army Reserve and National Guard with 34 years of service.


Delaware’s Labor Drought: Challenges and Solutions

By: Jane Brady, Chair, A Better Delaware 

We are all aware of the ridiculous amounts of money that the federal government was offering states during the pandemic. Many of those states, including Delaware, used the money to increase unemployment benefits, far exceeding any amounts paid in the past, and to continue those payments far longer. After the pandemic was declared to be over, our workforce was significantly smaller than before the pandemic. There are several reasons for that. Many workers enjoyed working from home and did not want to return to the office. More remarkably, in some instances, the worker would have had to take a pay cut to return to work. And, of course, expanded workers’ compensation payments were a big reason for that.

As time has gone on people are still leaving the workforce. According to WalletHub, in February 2024, Delaware has the highest rate of job resignations in the country. Last year, we were number 6 among all the states for job resignation rates.

Each year, the US government calculates the labor participation rate, which is the number of people over 16 years of age who are employed or actively seeking employment, divided by the total number of people in that population who are available or eligible to work or actively seek work. Students, retirees, disabled individuals or people who are voluntarily not interested in working are not included in that calculation. In Delaware, approximately 60% of all eligible and available workers are not seeking work, according to the Federal Reserve Economic Date (FRED).

So, against these facts, what has the government done to try and create incentives for people to go back to work? Well, actually, the government has acted counter to that objective. First, Delaware has continued increased unemployment payments, making it more feasible to not go back to work.

Are we administering those payments accurately and with good integrity to be sure those claiming unemployment meet the requirements to receive it? Were we careful with the literally, more than a billion dollars that passed through the unemployment office’s system? Well, we don’t know.

Delaware’s State Auditor, Lydia York, recently issued a report criticizing the financial management, or rather, the lack thereof, in Delaware’s unemployment insurance office. York identified a lack of oversight, outdated systems, and limited training of the staff, so severe that independent auditors could not even determine where all the money in the system came from. Employers pay into the unemployment insurance fund for the benefit of those employees who leave their workplace and are determined to be eligible to receive unemployment compensation. A great deal of money passed through the unemployment insurance fund as a result of the Covid pandemic and federal monies. In fact, $1.4 billion, according to the Delaware’s unemployment insurance office, was paid to over 100,000 people in the first two years of the pandemic. Poor training, the influx of significantly more money, expanded eligibility and an increase in claimants all served to overwhelm the capacity of the computer management systems and staff alike. It is not known how many people are receiving payments who should not be, and how much money those payments represent. Steps need to be taken to improve the hardware and better manage the monies paid into the fund by Delaware’s businesses.

Abut at least as significantly, Delaware’s occupational licensing requirements, which is a form of government regulation, affects workforce participation. Delaware has among the strictest licensing requirements for certain occupations in the country. These types of regulations have been found to deprive millions of Americans of opportunities and career advancement, and as a result, drive up the cost of goods and services. A recent report by the Institute for Justice found that the effects of licensing regulations impact particularly low-income Americans, who already struggle to find work and open small businesses. The training or classes to comply are expensive and take time to complete.

These regulations also limit employment mobility, especially across state lines. Delaware’s current shortages of teachers, doctors, nurses and other professional service workers has been attributed to outdated licensure requirements which are too restrictive. We all want capable and competent professionals in those jobs, but our requirements keep entirely capable and competent workers from locating here or advancing in their careers. One of the most recent examples is Naaman Center, which has been working for nearly a year with Delaware’s Health and Social Services Department to secure the certificates and licensure the agency requires to provide substance abuse treatment. This is an organization that has other facilities in Pennsylvania and has been in the business of providing treatment for over 2 decades.

Delaware needs to make a commitment to improve opportunities for workers in order for businesses to attract and retain quality employees, and for businesses to locate here and thrive. We have written about the shrinking economy in Delaware, many have written about the fact that our kids leave the state for better employment opportunities and there is much documentation about the shortages of professionals in our schools and hospitals. It is time for leadership in Delaware’s government to recognize we need to improve our schools, reduce regulation and red tape, and provide the kind of work and business climate that attracts and retains the best and brightest for the benefit of our citizens.

 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.