Fiscal uncertainty and election-year politics remain on a collision course as the Rhode Island General Assembly begins its 2026 session on Tuesday.
The state faces a projected deficit of about $100 million for the fiscal year beginning July 1, a relatively small amount compared with the past. But the Trump administration’s cuts could dramatically increase the state’s potential health care spending.
“Just on the Medicaid side, there will be people who lose coverage either from HealthSource (RI) or from Medicaid, from the federal actions,” said Michael DiBiase, president and CEO of the Rhode Island Public Expenditure Council, a business-backed watchdog group, and a former top state official. “We don’t know how many, but they will certainly be a large number. We’re going to have that issue to face with respect to uncompensated care.”
In related news, it remains unclear if the Atlanta-based Centurion Foundation will be able to complete its financing to acquire Roger Williams Medical Center in Providence and Our Lady of Fatima Hospital in North Providence, and if state money might be needed to keep the hospitals afloat.
Legislative leaders have resisted calls for years to raise the state income tax on affluent Rhode Islanders. But it’s possible that a paucity of state revenue amid various challenges could change the equation.
Adding to the intrigue, this is a statewide election year.
While RIPEC has pointed to soaring state spending in calling for slowing the rate of spending growth, DiBiase said special interest groups will press for more spending as candidates step up their campaigns.
Democratic Gov. Dan McKee, who faces a challenge from former CVS executive Helena Foulkes, has an incentive to use the budget proposal he plans to unveil on Jan. 15 to try to win more support among voters.
Meanwhile, House Speaker Joe Shekarchi, who has an outsized influence on how lawmakers revise the budget, is expected to decide in the coming weeks whether to join the Democratic primary for governor.
McKee, 73, inherited the office when Gina Raimondo left to become U.S. Commerce secretary in 2021. He won a four-year term in 2022, but has been dogged by low approval ratings in the aftermath of the Washington Bridge saga.
The 113-member General Assembly typically meets a few days a week from January through June while debating hundreds of bills and holding months of hearings on the budget.
The issues facing consideration at the legislature this year include a new education-funding formula proposal unveiled by a Rhode Island Foundation-backed commission after a year of work.
Shekarchi has championed efforts to confront Rhode Island’s housing crisis, while defending state spending growth as a way to meet the state’s needs.
In a recent op-ed distributed by the legislature, Senate President Val Lawson said her chamber will continue to focus on health care as a priority.
“In 2026, we will continue working to strengthen our health care workforce, especially primary care providers,” Lawson wrote. “That includes acting on the recommendations expected in January from a Senate commission’s review of creating a medical school at the University of Rhode Island, part of a long-term solution which would have many lasting benefits for our state.”
Lawmakers serve two-year terms and it’s likely most current legislators will seek re-election this year. The filing deadline for candidates is in June.
Republicans – who hold 10 seats in the 75-member House and four in the 38-member Senate – have struggled for years to increase their representation.
In a new twist, a conservative-leaning group, the League of Rhode Island Businesses, hopes to oust some progressive-leaning lawmakers with its own candidates.
