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There. Fixed it.

Monday, Mar 31, 2014

* Bruce Rauner and US Sen. Mark Kirk were interviewed yesterday on Rick Pearson’s increasingly important WGN radio talk show. One topic was Medicaid…

Rauner suggested the federal government wouldn’t pay for the bulk of the Medicaid expansion “for many more years.”

“When the federal government steps back to its traditional role of a being a 50-50 (payment) partner with states, Illinois will be facing a massive budget problem, a massive hole,” Rauner said.

That “when” should’ve been “if.” The feds currently pick up the entire cost, but the match isn’t ever scheduled to revert to a 50-50 split

Under the health-care law, the federal government will pay 100 percent of the cost of expansion in 2014, 2015 and 2016. Then the federal match is pared back to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and then 90 percent in 2020 and beyond. It would stay at the 90 percent level unless the lawmakers change or repeal the legislation.

So it would take congressional action and a presidential signature to slash those reimbursement rates by that much.

* Sen. Kirk

“The basic political trick of Obamacare is to claim that Medicaid is a health insurance and we all know many, I would say most, doctors don’t take Medicaid,” Kirk said at a news conference in Greektown.

“The question is, is their family actually going to be covered? And the answer is no — that when you show up and find out the doctor says, ‘No I don’t take Medicaid because the…payments are too slow and the state of Illinois is too incompetent to run this,” Kirk said.

“Payments are too slow” probably should be “too low.” I asked the comptroller’s office for the current Medicaid payment cycle…

We have $635 million in Medicaid bills at the Comptroller’s Office, dating back to Jan. 21, 2014.

That does not include what is still at DHFS, which we estimate to be an additional $800 million (the agency should be able to give insight on how far back those go).

The governor’s office says all bills are submitted for payment within 30 days.

So, the bill backlog isn’t nearly as bad as it once was.

Also, Illinois has one of the least costly cost-per-patient ratios for all of Medicaid. Why? Our provider reimbursements are very low. So low, that docs are reluctant to participate.

* Back to Rauner

But when asked if the state should roll back the expanded eligibility rules, Rauner said more investigation of fraud needs to be conducted and that the state should move Medicaid further into a managed care system.

Translation: I’m trying to run as a neo-liberal. Quit asking questions like that, Rick.

- Posted by Rich Miller        


24 Comments
  1. - Obamas Puppy - Monday, Mar 31, 14 @ 10:30 am:

    Has he answered one policy question? The only policy I have heard is that I hate teacher unions and they should be exterminated (so I can exploit the profession and make money off of my charter schools). Did I say that?


  2. - circularfiringsquad - Monday, Mar 31, 14 @ 10:31 am:

    Good to see Mitt “I AM a whimp” Rauner back in IL and demonstrating how little he knows about any part of government. Even Billboards Cross will tell you over $5 billion has been cut…Fed pays 100% of expansion before it goes back to 90%…
    Still waiting for anyone to ask WHAT WOULD DO MITT? Anyone ask how fishing in FL was?


  3. - Downstater - Monday, Mar 31, 14 @ 10:33 am:

    =Under the health-care law, the federal government will pay 100 percent of the cost of expansion in 2014, 2015 and 2016. Then the federal match is pared back to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and then 90 percent in 2020 and beyond. It would stay at the 90 percent level unless the lawmakers change or repeal the legislation.

    So it would take congressional action and a presidential signature to slash those reimbursement rates by that much. =
    So what happens if the Feds just stop paying at the higher levels? Do the state’s sue? We have already seen the Obama administration has change key components of the law, without legislative approval.


  4. - Jorge - Monday, Mar 31, 14 @ 10:35 am:

    Downstater….what if pigs fly tomorrow?


  5. - Ducky LaMoore - Monday, Mar 31, 14 @ 10:36 am:

    So, Rauner knows there are problem in the state government. He is wrong about what the problems are, and isn’t sure how to fix them. But, darn it, we have just got to do something.

    What I hear is, “We need to destroy Obamacare the same way it was created, with reckless abandon and no foresight for consequences.”

    Good plan


  6. - VanillaMan - Monday, Mar 31, 14 @ 10:36 am:

    We will be screwed. There is no “ifs” about it. Believing that the Federal government will not be forced to cut back sooner than planned, should be the plan.

    We will be on our own. Maybe not today, but it will happen regarding this unsupportable federal government program.

    There are no magical unicorns pooping gold to pay for this - at any government level.


  7. - shore - Monday, Mar 31, 14 @ 10:37 am:

    To his credit Rauner’s come a long long way in dealing with the press and interviews since a few years ago when he went on chicago tonight and anders lindall ran circles around him. If Democrats want to get him tied up in a Braley/farmer, macaca or 47 percent comment moment they better move fast because he’s really come on and I thought dealing with the press/public speaking would be one of Quinn’s advantages.

    There are a bunch of good chicago journalists like Pearson getting into the podcast/radio game this spring-natasha korecki does a decent job with that thing the sun-times is experimenting with too. It’s a refreshing change from the national garbage spewed on cable news.


  8. - langhorne - Monday, Mar 31, 14 @ 10:38 am:

    rauner said previously he was going to “overhaul medicaid”……..waiting………waiting……


  9. - wordslinger - Monday, Mar 31, 14 @ 10:39 am:

    I would hope Sen. Kirk would have a little more empathy for those on Medicaid.

    Lord knows the taxpayers have provided him with the best health care money can buy. And it has cost, and continues to cost, a bundle.

    Regarding Medicaid, two-thirds of all spending covers seniors and people with disabilities. Thirty percent of Medicaid spending is for nursing home and long–term-care services.

    I’d be interested in where the “fraud” is, as enrollees never see a dime. The money goes directly to providers. What are talking about, Dr. Feelgoods’ writing Oxy prescriptions?

    http://www.cbpp.org/cms/index.cfm?fa=view&id=2223


  10. - Timmeh - Monday, Mar 31, 14 @ 10:41 am:

    == We have already seen the Obama administration has change key components of the law, without legislative approval. ==

    I’m doubting that it will come from Obama. More likely, a Republican administration would cut some of the overall costs of ACA and shift more of the costs onto the states. Slightly less likely (at least over the short term) is that a different Democratic president/congress would see this as a way to easily trim budgets by shifting more of the costs to the states. Either way, I doubt it will come to 50-50 any time soon.


  11. - illinifan - Monday, Mar 31, 14 @ 10:41 am:

    Love Rauner’s plan for Medicaid to move to managed care….he is a little late to the show. Over the next 2 years 50% of persons on Medicaid are being moved to managed care. Due to the Affordable Care Act there are additional initiatives for health groups to form Accountable Care Entities and we as a state were approved for Medicare Medicaid Alignment Initiative to see if health costs can be lowered for persons who are dual enrolled if they get more comprehensive case management services.

    Rauner needs to get a better research team so they can come up with a new idea.


  12. - Rolling Meadows - Monday, Mar 31, 14 @ 10:47 am:

    “Also, Illinois has one of the least costly cost-per-patient ratios for all of Medicaid. Why? Our provider reimbursements are very low. So low, that docs are reluctant to participate.”

    It really sucks to be on this.


  13. - VanillaMan - Monday, Mar 31, 14 @ 10:48 am:

    The guy elected in November probably won’t have the Obamacare catastrophe costs falling on Illinois during the next four years. So Rauner should have gone with the Democrat’s game plan on it by pretending that the magic unicorns will be able to poop gold to pay for it all - and punted on this question.

    Rauner won’t be able to prepare Illinois financially to face the Obamacare meltdown if he is elected. We won’t even be high on the list of states to bail out on it. So Rauner should probably focus more on other issues than this one.

    Same with Quinn. I don’t know how Illinois is going to be able to avoid the fiscal destruction that the ACA is going to heap upon it as it fails. It is probably going to need a special bailout on a federal level anyway.


  14. - yo - Monday, Mar 31, 14 @ 10:52 am:

    can’t wait ’til the ACA fails, as V-Man prognosticates. Single payer here we come, baby!!


  15. - Wensicia - Monday, Mar 31, 14 @ 10:53 am:

    Rauner continues to display his ignorance on state matters. Who on earth could trust this guy to do the job and vote for him?


  16. - Walker - Monday, Mar 31, 14 @ 10:59 am:

    VMan: You’ve got your crap-colored goggles on again. Your scenarios just don’t wash.

    Your own Medicaid solution? And no “cut fraud and waste” nonsense. That’s blaming the victims, when those who commit such fraud, like the current Governor of Florida, make millions by cheating the taxpayers.


  17. - Cassandra - Monday, Mar 31, 14 @ 11:05 am:

    Yes, Rauner continues to make stupid factual mistakes (federal reimbursement for Medicaid)
    which are particularly annoying given his ability to pay good salaries to researchers. Or, he could just use the Google himself.

    Mistakes like this lead to wondering about whether he understands anything about state government–sure, it can be shaken up, but you have to understand what you are shaking. Or is this just arrogance-I won’t bother looking it up, I know everything, I don’t have to study. Typical CEO behavior.

    No way am I going to vote for Quinn after the $54 million non-violence grant boondoggle. He has no respect for taxpayers, whatever he says. It’s all about him.

    But Rauner is looking iffy too, to this undecided voter.

    Is there a Green candidate?


  18. - The Doc - Monday, Mar 31, 14 @ 11:16 am:

    ==We will be screwed. There is no “ifs” about it==

    You have been warned by master prognosticator/healthcare expert/foremost economics authority.

    Any attempt to refute this measured and pragmatic response from VanMan, particularly if based on data and facts, will not be tolerated.


  19. - Demoralized - Monday, Mar 31, 14 @ 11:18 am:

    ==wondering about whether he understands anything about state government==

    I’m quite certain he doesn’t understand it. Unfortunately, those that back him think that is a good quality.


  20. - dave - Monday, Mar 31, 14 @ 11:24 am:

    Do Rauner and Kirk know that IL’s law that expanded Medicaid expansion also includes language that sunsets the expansion if the reimbursement below 90%?

    Also… is Mark Kirk saying that he would vote to reduce the reimbursement rate? I’d like to see Kirk’s plan to get to 60 votes in the Senate to reduce the reimbursement rate.

    There is absolutely no path, any time soon, for a Congress and President to approve a lower reimbursement percentage.


  21. - 47th Ward - Monday, Mar 31, 14 @ 11:57 am:

    ===That “when” should’ve been “if.”===

    I think Kirk meant when the GOP retakes the Senate this year and the White House in 2016. As in, that’s when the federal government will reduce the Medicaid reimbursement rates.

    More unintentional honesty from Senator Kirk, who thankfully didn’t have to rely on the federal government when he got sick.


  22. - too obvious - Monday, Mar 31, 14 @ 12:11 pm:

    Does anyone realize Rauner companies have had all kinds of Medicare/Medicaid related problems?

    I do hope someone eventually decides to vet Rauner. Preferably before he becomes governor. At least that would be my preference.


  23. - LBJ - Monday, Mar 31, 14 @ 1:32 pm:

    Its interesting that a guy who ran a very aggressive primary campaign would make such a glaring mistake. Has he re-tooled his staff for the general election?

    If he can’t understand elemental fiscal issues…


  24. - DuPage Dave - Monday, Mar 31, 14 @ 5:55 pm:

    The SMART Act for Medicaid reform was passed two years ago in the spring session. Millions have been spent on consultants as well as hiring new state workers to ferret out fraud. The effectiveness of these efforts is in dispute, but it has been a legitimate, serious effort to remove ineligible people from the list.

    Rauner is showing once again how uninformed he is about how the state operates, and what efforts are being carried out to do exactly what he says he will do if elected.

    He should say what’s wrong with the fraud finding efforts of the last two years, and how he would change those to be more effective.


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