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In The News

Commentary: Health care in Delaware can be improved

From: Bay to Bay News

For multiple decades, the people of Delaware have had limited access to health care at an expensive cost, with quality outcomes below the national average. According to a 2019 Health Affairs article published by former secretary of health and social services for the state of Delaware, Dr. Kara Odom Walker, “Delaware may continue to be an expensive place for health care due to its market size and limited competition, and additional tools to reduce unnecessary costs and focus on waste may be critical.”

How can this be? Delaware is one of the most sophisticated regions of medicine in the world. Delaware is not a remote outpost in Siberia, although many of our problems mimic those of the sparsely populated state of Alaska.

How can Delaware begin to fix this?

Let’s start by:

  • Allowing Delaware citizens and businesses to buy health insurance from our neighboring states (Pennsylvania, New Jersey, Maryland and Virginia).
  • Allowing the reciprocity of medical and nursing licenses from our neighboring states.
  • Decommissioning the Health Resources Board (HRB) and its oversight Delaware Health Care Commission (DHCC) and eliminating the Certificate of Public Review (CPR) program once and for all.

According to its own 2020 internal and public polling, the HRB and its CPR program are dysfunctional. By any measure, both the DHCC and the HRB have failed their purpose.

The necessary outcome of these simple measures would be to introduce competition in health care for quality, cost and access to the existing monolithic hospital systems and Highmark, the only insurance carrier in Delaware.

To decline to make these restorative market measures will simply further guarantee the consolidation of our health care financing and delivery into a monopoly of Highmark, ChristianaCare and Bayhealth, with the expectation of the predictable rise in everyone’s cost, limitation of access to both rural and underserved inner-city Medicaid populations, and no incentive to have better outcomes.

In short, a failure to act now virtually ensures a deterioration of Delaware’s public health.


In June 1990, Delaware established the Delaware Health Care Commission to oversee the growth of health care services and to solidify the “Triple Aim” goals in health care for higher-quality outcomes, lower cost and better access. DHCC had also established the Health Resources Board Certificate of Public Review program “to regulate the number of beds in hospitals and nursing homes and essentially prevent excessive purchasing of expensive equipment.” However, this has not achieved the Triple Aim goals initially set forth. Instead, anti-competitive, monopolistic practices have continued in the health insurance industry and the hospital health care delivery system.

The predictable result has been no overall improvement in the quality of outcomes with a generalized deterioration of the metrics of Delaware public health, a consistent increase in cost over the national increase and no improvement in access to care through the consolidation of hospital services.

When the DHCC was formed, Delaware had multiple health insurers, with a directive to the insurance commissioner that there always should be at least three choices in the state for both employers and individuals. The other major insurance carriers left the state, leaving only Blue Cross Blue Shield of Delaware (BCBSDE), which was chartered here and could not leave, and Delaware’s Medicaid partnership with the federal government, which serves only as a broker to companies to manage the state’s Medicaid. Self-insured entities were mainly unaffected.

Having violated a semi-sacred principle of a choice of three major carriers, Delaware promptly declared that we only needed two choices and that the state itself counted as one of the choices. BCBSDE gave itself to Highmark Blue Cross Blue Shield as the last man standing, preserving its charter and improving purchasing power through consolidation.

Why did everyone else leave the Delaware marketplace? Because it was too expensive, and the liability of insuring Delaware’s not-so-healthy population was not likely to be profitable. To include in their network of providers ChristianaCare and Bayhealth systems and their fees schedules was too expensive. And they could not sell their insurance product without including those hospitals.

The HRB, through its duplicative licensing process, the CPR program, served to intimidate out-of-state hospital provider systems from entering the marketplace, which was just fine with the DHCC, whose makeup resembles a health care industry lobbying group. Meanwhile, the insurance commissioner was incapable of attracting other health insurers to the Delaware market, often remarking that there is nothing they can do to make insurers come to Delaware, which is, of course, the identical response from our legislators.

Dr. C.D. Casscells is the director of the Center for Health Policy at the Caesar Rodney Institute.

Delaware Ranks 44th in the Nation in Highway Performance and Cost-Effectiveness

From: Reason Foundation

Delaware’s highway system ranks 44th in the nation in overall

cost-effectiveness and condition, according to the Annual Highway

Report by Reason Foundation. This is a four-spot improvement from 48th in the previous report.

Delaware ranks in the bottom 10 of all states in five of the report’s 12 metrics. (Delaware has no rural Interstate mileage). The state manages to have high overall costs, poor Interstate pavement conditions, and poor traffic congestion. Delaware’s administrative spending is the biggest problem. Delaware spends 1.5 times as much per lane-mile as the next worst state, New Jersey, and 3.5 times per lane-mile what peer state Connecticut spends, and 2.5 times per lane-mile what peer state New Hampshire spends. Urbanized area congestion is also a significant problem. Delaware commuters spend 75.29 hours stuck in congestion, five times the amount spent by Connecticut commuters, and nine times the amount spent by New Hampshire commuters.

In safety and performance categories, Delaware ranks 34th in overall fatality rate, 8th in structurally deficient bridges, 49th in traffic congestion, and 48th in urban Interstate pavement condition.

On spending, Delaware spends $148,736 per state-controlled mile of highway. It ranks 40th in total spending per mile and 32nd in capital and bridge costs per mile.

Delaware’s best rankings are in rural arterial pavement condition (1st) and structurally deficient bridges (8th).

Delaware’s worst rankings are in administrative disbursements per mile (50th) and urbanized area congestion (49th).

Delaware’s drivers waste 75.29 hours a year in traffic congestion, ranking 49th in the nation.

Delaware’s state-controlled highway mileage makes it the 42nd largest highway system in the country.

“To improve in the report’s overall rankings, Delaware needs to become more efficient, reduce its traffic congestion, and improve its urban Interstate pavement condition,” said Baruch Feigenbaum, lead author of the Annual Highway Report and senior managing director of transportation policy at Reason Foundation. “The state is not getting much bang for the buck as it ranks in the bottom three in urban Interstate condition and traffic congestion.” For additional analysis read more here.


Move to create Delaware inspector general post gains momentum

From: Delaware Live As calls mount for the creation of a statewide inspector general’s office in Delaware, one Newark lawmaker is drafting legislation to do just that.

Rep. John Kowalko, D-Newark, will introduce legislation in early 2022 to set the framework for the establishment of the new office, which would be tasked with investigating instances of waste, fraud, abuse and mismanagement within the state government.

The office would also seek to root out inefficiencies within government and streamline processes and practices to save taxpayers money.

The bill, if passed, will authorize the creation of the office and allocate funding for salaries, office space and other start-up expenses.

Kowalko said he expects that the office would require an annual budget of around $2 million to meet its goals.

Opponents say that cost is too much to ask of taxpayers, especially when the state already has an auditor of accounts to investigate financial mismanagement and abuse.

But with the indictment of State Auditor Kathy McGuiness on corruption charges and multiple instances of shady dealings and perceived cover-ups within the state government, Kowalko and others believe now is the time to act in the interest of transparency.

Some would like to see what exactly ends up in the bill.

“The concept of an office of inspector general, when we’ve seen so much bad behavior on the part of Democrats recently, would be a good thing potentially,” said Delaware Republican Party chairwoman Jane Brady. “But I would have to see the language of the bill and how they intend for it to work before I could indicate whether I would support it or not.”

This wouldn’t be the legislature’s first attempt to create an inspector general’s office.


Kowalko co-sponsored similar legislation in 2007 brought forth by then-Rep. Bill Oberle, R-Newark. That bill overwhelmingly passed in the House of Representatives but when it arrived in the Senate, it was tabled, never receiving a vote.

“I’ve noticed situations recently, like the situation with the auditor, the situation with Connections, even questions raised about asbestos removal at that Fisker site,” Kowalko said in an interview with Delaware LIVE News. “There seems to be no government oversight.” Read more.


Delaware hospitals ratings trending downward

From: The Center Square

 Delaware dropped from 29th to 49th in the fall 2021 Leapfrog Safety Grades report as two of the state’s major hospitals went from an “A” to a “C.”

The Leapfrog Group assesses how well hospitals in the 50 states and the District of Columbia prevent medical errors, falls, infections and accidents, according to a news release from the nonprofit organization. The hospitals are given a letter grade and the states are ranked according to the grade. The safety reports are released in the fall and spring of each year.

Only one other state, North Dakota, and the District of Columbia had no hospitals with an “A” score.

The Christiana Care Health System’s two hospitals received “A” grades in the spring but they were dropped to “Cs” in the latest report. The health care system’s hospital in Christiana received low marks for problems with surgery and harmful events afterward.

The Christiana hospital received high grades in a new safety measure evaluated by Leapfrog, “sepsis infection after surgery.” Sepsis is responsible for the deaths of 270,000 people a year with 160,000 of them attributed to postoperative sepsis, according to Leapfrog.

The Christiana Care Health System’s Wilmington location also received low marks for problems with surgery and complications after the surgery including kidney injuries. The hospital received high marks for infection control with the exception of surgical site infections that occur after colon surgeries.

Two other state hospitals, Bayhealth Kent Campus in Dover and Wilmington’s Saint Francis Hospital, also received “C” grades. Beebe Healthcare in Lewes and Tidal Health Nanticoke in Dover received “B” grades.

The fall 2021 safety survey is Leapfrog’s largest, with 2,901 hospitals receiving grades, according to the organization. The grades are compiled by leading safety experts with guidance from the Johns Hopkins Armstrong Institute for Patient Safety and Quality.

“As the pandemic continues, we all have heightened awareness of the importance of hospitals in our communities and in our lives,” said Leah Binder, president & CEO of The Leapfrog Group. “It is critical that all hospitals put patient safety first. Now we have more information on more hospitals than ever before, so people can protect themselves and their families.”

Less than 1% of the hospitals received an “F” and 32% received an “A,” according to Leapfrog. Virginia, North Carolina, Idaho, Massachusetts and Colorado have the highest number of hospitals with “A” grades.

Federal unemployment insurance benefit slowed employment growth

From: Badger Institute 

“Unemployment rate fell faster in 22 states that eliminated supplemental benefits early.”

   Shortly after the advent of the COVID-19 pandemic, Congress passed the CARES Act, a $2.2 trillion bill designed to alleviate the negative economic consequences of government-mandated shutdowns. Included in the bill was a $600 weekly federal unemployment bonus payment on top of the state benefits that unemployed workers already could receive.

Since the combined federal/state unemployment insurance benefit was greater than the weekly wages of many employees, some economists worried that it might depress employment growth. We decided to examine whether the federal bonus payments served as a disincentive to workers returning to jobs once the economy rebounded.

During the throes of the crisis, when many restaurants, retail establishments and other businesses were closed, the boost helped people weather job losses. But to prevent the supplemental benefits from discouraging a return to the workforce, lawmakers set them to expire after six months.

That changed in August 2020 when the Trump administration, via executive order, extended the benefit at half of the original $600 rate. The American Rescue Plan, which passed in March 2021, extended this $300 weekly benefit until Sept. 6, 2021 — although states had the discretion to end it earlier, and many did.

Wisconsin, under Gov. Tony Evers, continued paying the federal benefit as long as possible, right up through early September.

The fact that the U.S. economy has been plagued with unfilled jobs in the past six months as the shutdowns were lifted Read more.

The Significance of Workforce Development: How States are Helping Businesses and Individuals Succeed

From: Expansion Solutions Magazine. Communities, states and regions work with economic development agencies along with businesses as well as universities, tech schools, and companies to support their workforce needs with appropriate education and training, incentives and grants available to businesses and/or hired workers. 

It is crucial for companies, states and communities to identify high-demand occupations, the process used to identify the occupations, and if a state publicly displays required training or credentials. Business and economic development leaders identify high-demand occupations and the required training to enter the skilled occupations. High-demand professions are defined as those acknowledged in the state as being in need within the state economy or where employee shortages exist. 

In compliance with the Workforce Innovation and Opportunity Act (WIOA), all states have a statewide workforce development board or council, and these groups of community leaders appointed by local elected officials and charged with planning and oversight responsibilities for workforce programs and services in their area. However, some states have gone beyond the requirements in federal policy to expand the board’s membership to include additional members within the education system, such as state superintendents of education and chancellors of postsecondary institutions. 

Additionally, some states have developed policies that expand the responsibilities or charges of the board to include explicit connections to education in both K-12 and postsecondary settings. Let’s look at some outstanding state programs outlined. Read more.

States Must Use Caution When Spending ARPA Funds to Avoid Waste

From: Citizens Against Government Waste

The American Recovery Plan Act (ARPA) included $350 billion in the State and Local Fiscal Recovery Fund, $195.3 billion of which was given to the states, with the remaining $154.7 billion divided among local governments, tribal governments, and territories.  Because states are not required to obligate their share of the funds until December 31, 2024, or spend them until December 31, 2026, several states have elected to take a patient approach to distribution.  The National Council of State Legislatures reported that 13 states have yet to allocate any funds sent to them by the Department of the Treasury, while the most of the others have allocated only a fraction of the funds given to them.

Thus far, local governments have used their portion of the grants on a wide array of projects ranging from the expansion of broadband access and infrastructure repair to the promotion of green energy and the development of athletic fields.  In Alabama, the state’s only use of APRA funds has been the allocation of $400 million for the construction of two prisons.  Hawaii’s legislature designated $1 million for a Sea Urchin Hatchery in addition to $300,000 for an engineering assessment of Aloha Stadium.  Use of grant money designed to provide relief from the COVID-19 pandemic for these and similar projects takes a page from Sen. Kirsten Gillibrand’s (D-N.Y.) infrastructure playbook, when she claimed that paid leave, child care, and caregiving are all infrastructure.  Just as everything fits under infrastructure, so too can anything be sold as COVID relief, sea urchins included.

As state and local governments prepare to appropriate their remaining ARPA funds in their upcoming 2022 legislative sessions, governors and legislators must allocate the money with caution to avoid funding wasteful projects unrelated to COVID relief or creating unsustainable programs that will be unaffordable when the federal well runs dry. Read more.

Kent County approves $5 million in grants for small businesses, hotels

From: Delaware Live 

Kent County Levy Court has approved a $5 million grant program for small businesses and hospitality companies affected by the pandemic.

The measure, which passed unanimously during a Nov. 9 meeting, is Kent County’s first use of the $35.5 million it received in American Rescue Plan Act funds.

The grant program includes $3 million in grants for businesses with less than 100 employees to pay for employee wages and other business expenses and $2 million for hotels, event venues and other tourism hospitality industry companies.

Judy Diogo, president of the Central Delaware Chamber of Commerce, said it’s important to remember that many small businesses had to close during the pandemic by no choice of their own.

She doesn’t know exactly how many small businesses were forced to close permanently because not all of Kent County’s businesses are members of the chamber, but she is aware of 58 member businesses having closed because of COVID-related impacts.

“Small businesses are desperately trying to come back now,” Diogo said. “They’re desperately trying to get themselves back up and running, and they’re having a difficult time getting employees. For many of them, they have used all of their capital to keep themselves open through this time.”

Under the program, at least 633 small businesses would be able to qualify for aid, Diogo said.

County administrator Michael Petit de Mange said grants can be used for any type of business expense that would otherwise be paid for with the revenue that has been lost.

“It’s going to be spelled out in the grant application, but it could be paying bills, it could be covering payroll or business supplies or other expenses related to the business utility expenses,” he said.

Grant applications will be processed by Dover accounting firm Faw Casson to check for compliance and eligibility.

They will then be reviewed by the Central Delaware Chamber of Commerce and Kent County Tourism Corporation, who will send their final recommendations to the Levy Court for approval.

Once the applications are determined to be accurate and complete, they will be referred to the Levy Court, which will vote on their approval. Payment will be issued directly by the county. Read more.

State to invest $2 million in farmers, local food supply chain

From: Delaware Live

Delaware will spend $2 million in federal COVID-19 relief funds to establish a seed fund aimed at stabilizing and strengthening small and mid-sized farmers and local food supply chain operations.

The First State Integrated Food System Program, announced Thursday by Gov. John Carney, will be paid for using funds the state received from the American Rescue Plan Act.

Delaware received $925 million from the federal stimulus bill, which is designed to hasten the economic recovery from the pandemic.

In a press release announcing the investment, Gov. John Carney said the seed fund will provide a “coordinated approach” to improving local access to affordable and nutritious Delaware-produced foods while supporting Delaware farmers.

“We know the COVID-19 pandemic has impacted small-scale food businesses and Delaware families’ access to food,” Carney said. “That’s why the Council on Farm and Food Policy will work with partners to develop and administer a diverse portfolio of grants and loans to improve the availability and accessibility of local produce, animal protein, value-added products, and other foods, promoting overall economic growth here in Delaware.” Read more.

NEW STUDY: Pandemic Response Grew Government ‘Barriers to Opportunity’ for Entrepreneurs

From: Pacific Research Institute

Government actions to “help” small businesses in the wake of the COVID-19 pandemic have worsened pre-pandemic government-imposed burdens to entrepreneurship, finds the final paper in the Breaking Down Barriers to Opportunity series released today by the nonpartisan Pacific Research Institute, a California-based, free-market think tank.

“The federal government’s economic pandemic response was wasteful and ineffective, worsening the government-created obstacles to prosperity entrepreneurs faced before the pandemic – such as taxes, regulations and lack of access to credit,” said Dr. Wayne Winegarden, Pacific Research Institute senior fellow in business and economics.

“Promoting Economic Recovery Through Entrepreneurship Not Government” analyzes the impact of the federal government’s COVID-19 relief effort on small businesses.

Winegarden makes the case that the historic increase in the government’s burden on the private sector economy – including $5.9 trillion in newly-authorized federal spending – paves the way for higher future taxes that will diminish the after-tax returns and incentives to start or expand new businesses. Read more.