01:00 AM EDT on Friday, April 23, 2004

FOR YEARS NOW, elected officials at all levels of government have struggled to address the nation's health-care crisis, and meet the ever-increasing demand for affordable health care.

Thanks to programs such as RIte Care and RIte Share, along with private insurance, about 9 in 10 Rhode Islanders have insurance access to health care -- a remarkable coverage rate, second only to Vermont's.

But, sadly, while Rhode Island enjoys a relatively high level of care, there remains a significant part of the population that lacks the most basic coverage. Over 100,000 Rhode Islanders -- and 40 million people across America -- still have no health insurance. Closing this gap is one of the greatest domestic challenges our nation faces.

As health-insurance premiums rise each year, small businesses face a difficult decision. To maintain the same level of coverage, they must either cover these extra costs or pass them along to employees. Many business owners confront an even starker choice: Decrease benefits or drop coverage altogether.

Year after year, the costs to businesses and consumers have increased at a rate much higher than inflation, often in the upper double digits.

Unfortunately, Rhode Island's primary health-insurance provider has failed to shoulder its fair share of the burden. Recent media reports regarding the state-formed nonprofit Blue Cross & Blue Shield of Rhode Island paint a picture of corporate misgovernance. Clearly, there must be more regulation of the health-care industry in general, and of Blue Cross in particular.

Blue Cross appears to have acted in its own interest, rather than the interest of the community -- violating the very philosophy of a nonprofit organization. Simply put, it is inappropriate for any nonprofit to make loans to its executives -- especially loans that are not required to be repaid. I challenge Blue Cross to justify its decision to increase rates while forgiving $600,000 loans.

Despite its flaws, Blue Cross provides a critical service to the people of Rhode Island. We all understand that without health insurance, Rhode Islanders would be reluctant to seek medical attention, or unable to afford preventive care -- resulting in even higher costs in the long run. What we do not understand is how Blue Cross can raise rates to subsidize non-operating expenses in lieu of providing high-quality affordable medical care to its subscribers.

I eagerly await the findings of the General Assembly's Permanent Joint Committee on Health Care Oversight, and believe they will be an important tool as we work to improve health care in Rhode Island. I strongly support the committee's efforts and urge its members to act as aggressively as possible.

Meanwhile, I will continue my efforts in Congress to ensure that no family is forced to go without health coverage. As Rhode Island struggles with these great challenges on the local level, I am at work on my own health-care proposal in Washington.

At the crux of any meaningful health-care reform must be a commitment from the government to act in the best interest of its citizens. A national template for this type of coverage already exists: the Federal Employee Health Benefits Program (FEHBP). It manages health insurance for more than 8 million federal employees, retirees and dependents. This program, composed of private insurance carriers, is administered by the federal government, which assumes responsibility for approving or disapproving carriers, negotiating benefit and rate changes, and auditing carriers' operations under the law.

With administrative costs of less than 1 percent (compared with private-sector costs that can reach 30 percent), and a below-average annual premium increase, the government can offer a wide variety of choices and protections to its employees.

The system is funded by the taxpayers.

I think it is time we started offering every American the kind of coverage and oversight that members of Congress and federal workers have come to rely upon. Health care is much more than an issue that polls well with voters. Elected officials at every level of government must take the incremental steps needed to develop a universal health-care system that is affordable, high-quality and well managed.

I firmly believe that health care is a basic inalienable right of every American. If we work together to address this critical issue, I know we can realize this goal.

James Langevin represents Rhode Island's Second Congressional District.