27 Comments - Bill - Monday, Nov 26, 07 @ 9:39 am: One of the nice things about being governor is that you can do things like that. Thousands of Illinois citizens will now have access to moderately priced health insurance. We are fortunate that we have a Governor willing to act while the ineffective Legislature procrastinates and fights among themselves. - Anonymous - Monday, Nov 26, 07 @ 9:50 am: “Thousands of Illinois citizens will now have access to moderately priced health insurance.” Not if there’s no money to pay for it and no doctors willing to take it! - anonymouse - Monday, Nov 26, 07 @ 9:53 am: I think Bill is right, as usual. We can watch Vladimir Putin doing the same thing in Russia, and listen to the Russians say Putin is providing “stability.” Constitution? I don’t need no stinking constitution! - Lula May - Monday, Nov 26, 07 @ 9:58 am: Question Rich ? The $463 million that Blago line item vetoed. Did that pass ? Wasn’t there a question about the constitutionality of that move ? Did the legislature just roll over for that ? Isn’t anyone questioning this with a lawsuit ? Or were they just blowing hot air ? - Hickory - Monday, Nov 26, 07 @ 10:03 am: Ask your local hospital what an expanded Medicare program will cost them. The State doesn’t pay them enough to cover their costs. If a person making $80,000 a year does not purchase health insurance they should suffer the results. - Captain America - Monday, Nov 26, 07 @ 10:12 am: The affordable health insurance pool is a really good idea - too bad the Governor’s confronational, in-your-face style will probably doom the proposal. Ignoring JCAR after signing a bill that strengthtend its veto powers is hypocritical, but expedient. Given the likelihood of reduced State revenues associated with an impending recession and the multi-billion Medicaid funding shortfall, there is no money to pay for all the Governor’s health care initiatives - Illinois can’t even meet its current obligations to pay service providers reasonable payments promptly. A fiscal train wreck appears inevitable. Even a C student in Constitutional Law understands that legislatures must authorize programa and appropriate funds for health care programs before they are implemented by the executive branch. As a practical matter, I believe the only short term means to minimize the consequnces of the leadership impasse is to dump the primary enabler of Blago’ s extraconstitutional actions, Senate President Emil Jones. - Southern Right - Monday, Nov 26, 07 @ 10:14 am: Once the Vice President nomination is announced next year, expect the Governor to drop his hard line on Free health care for all and no funding. Second, the government has never been a more cost effective source, when and where competition exists. - Ghost - Monday, Nov 26, 07 @ 10:23 am: I sitll find it fascinating that he cut health care benefits from the budget, so he could find money to pay for health care. It would be interesting for an investigative reoirter/blogger to get and add up all the attorney fee bills the State has had to pay for challenegs to laws/rules and actions of the Gov’s since he took office, such as the challenge to the anti-computer game law etc. Plus the costs of Special Assitant Attorney Generals paid for by the State etc. The Gov has cost us at least 100mil in such expenses from other ill fated actions. His activity with ignoring JCAR will only add to the total of wasted funds. - Cassandra - Monday, Nov 26, 07 @ 10:27 am: There’s a lot we don’t know about the new proposal, chiefly, will it be available to those with pre-existing conditions at the same or close to the same cost as for those without. How high will the deductible be. How comprehensive will the policy be. My twentysomething nephew, who is healthy, is covered by an individual policy for a little over $100 amonth. But it has a high deductible and a lot of outpatient care and tests aren’t covered so his parents end up shelling out hundreds a year anyway for routine stuff. The catastrophic coverage is worth it, because my brother-in-law would pay it anyway, but for those without affluent relatives, the additional costs would be a deterrent. We need to be clear about what we are paying for here and Blago should be doing much more than he is to use the leverage of government’s huge outlays for health care to bargain down health care costs. Let’s not forget that many “nonprofit” hospitals pay their managers salaries in the upper six figures. It’s questionable if many of them meet their charity care requirements to maintain their nonprofit status. There’s plenty of room to bargain here. - GoBearsss - Monday, Nov 26, 07 @ 10:40 am: Rich, didn’t you say the thing you hated most was when people talked about a bill/issue when they obviously haven’t read about what it is? The plan this articles references is the “Illinois Covered Choice” part of the Governor’s plan. This wouldn’t be an expanded medicaid, or an expanded medicare, like people are harping about above. The whole idea is to require private insurers to carry this “affordable”/”moderately priced” plan. Which means every doctor in their network would accept this plan, and get the same rates they get from the private insurers. And its affordable not because it pools the risk (this is where Ms. Nix is wrong), but because it eliminates the risk. The State would pick up the tab for all claims over a certain amount in a year. If this sounds familiar, you may be right - It is the exact same idea Barack Obama has proposed. A lot of the healthcare folks have been wanting to go this direction for a while. It is really the only sure way to make private insurance affordable for people who aren’t in large companies. - steve schnorf - Monday, Nov 26, 07 @ 10:46 am: A couple of thoughts: First, could we help ourselves by separating the two issues; what to do about access to health care, and how to pay for it? If we can first make the decision that we actually want to do something about access to health care, and what that something is, then we have a strong incentive and justification to find the funding. As to what, I think the Governor is on a good track here. There are several specifics to be worked out, but generally the idea of private insurance, with a state subsidy to help defray the cost for people with lower incomes, is probably much more sellable in Illinois than single-payer (socialized medicine, to the opponents). I don’t like the idea of no premium, but a sliding scale one based on income, much as we do with subsidized day care for working parents. The idea of the state acting as re-insurer of high outlier costs also make sense to me. If we pay the outlier costs directly to providers at medicaid rates, it will help control costs to the state. The debate on what the maximum income eligibility should be appears endless, but again, a sliding scale premium could help work thru that issue. I don’t think the premise that hospitals are greatly harmed by a proposal such as this is 100% correct. First, many of the people who would be served under such a plan are currently uncompensated or severely discounted accounts anyway. Also, if we could work out an agreement to give hospitals credit against their charitable contribution requirements for their below cost medicaid reimbursements, then we will have begun to address the issue AG Madigan has been raising, something that would be very beneficial to hospitals. The issue of having an adequate number of non-hospital providers is very difficult, but surely it is going to require rate increases for the providers. However, since the state is probably the second largest buyer of non-medicaid health care services in Illinois, perhaps there are other things that could help. What if the state required any provider who wanted to be a participant in the state employees health program to accept recipients of the state’s other healthcare plans? It would be difficult, but perhaps the state could get help on that issue from two of its largest unions, AFSCME and SEIU. Both unions have a strong record of progressivism on social issues, and that might make them allies in such an approach. Well, I’ve rambled on, but as a last comment, the idea of a small payroll tax on employers (except the very smallest) who don’t provide health care coverage for their employees doesn’t seem such an outrageous idea to me. It will never fly, though, unless we can first reach agreement on what we are going to use it to pay for. - Cassandra - Monday, Nov 26, 07 @ 10:51 am: The fact that every doctor in the network would be required to accept the plan doesn’t go to the issue of community rating. If the insurance company can peg its rates to your health history and keep raising its rates if you have serious health problems, that still makes the plan unaffordable for many who need it–now. And allowing the insurance company to bill the state for what the it considers extra isn’t an answer either. The taxpayers will get fleeced by the insurance companies. For this to work, there has to be a medical cost containment component. I agree with the general direction the guv is taking but, especially given the problems Massachusetts is having, if it all seems too easy there are some problems lurking that haven’t been adequately addressed. - GoBearsss - Monday, Nov 26, 07 @ 10:59 am: The Massachusetts model was so different it can’t even be compared in the same ballpark. They relied on bringing in all these low-premium, high-deductible, barebones insurance policies. They didn’t do anything to regulate or address the private insurance industry. This is 100% in the opposite direction. Under the bill, you wouldn’t be able to be denied, and it had mandated co-pay and deductible levels. And the community rating issue, I believe, is in front of JCAR now. That was one of Blago’s healthcare announcements from this summer - that private insurers would not be able to take health status into consideration - i.e. jack up your rates just because you or someone in your small business got sick. - Mr. Wizard - Monday, Nov 26, 07 @ 11:13 am: Steve, Some very sound ideas on what might sell this idea to legislators and voters; and, I think that something like it is probably inevitable, in the absence of federal action, as states try to “muscle” down health care costs. However, I question the ultimate effectiveness of such programs for a simple reason: they rely on the gov. to make them work. Anybody who really understands the full history of government’s involvement in health care, knows that it IS the problem, not the solution. The last 50 years shows that gov. cannot drive down costs - only the marketplace can do that. - Little Egypt - Monday, Nov 26, 07 @ 11:59 am: Steve, you’re correct. You were rambling. The very first thing the State absolutely has to do is pay their bills on time before they will get medical providers on board for any further health care plans. PERIOD. - Budget Watcher - Monday, Nov 26, 07 @ 12:30 pm: Steve Scnorff, If the state paid outlier costs at medicaid rates, roughly 75-80% of costs for hospitals…less for for non-hospital medical providers, who do you suppose gets the bill for the the uncompensated care, the costs beyond what the state has presumably raised payroll taxes to pay for? It likely means higher premiums for you and I, which is simply a non-governmental tax. You also suggest leveraging Medicaid and state group health insurance programs, with the help of major employee unions, as a method of increasing provider participation and access to care. That would be a pretty heavy lift, and one that would almost certainly have to have some rate increases attached. Again, up goes the price. For the record, I believe government, if it’s going to support healthcare for the poor and aged, should commit to healthcare for all, and should entirely eliminate income from the healthcare eligibility equation. So, I guess I’m a universal healthcare supportor. I also believe that if the Governor wanted take on this crusade, he should have made that clear to voters a year ago. Then we could have made the last election a proxy referendum in Illinois on the importance of healthcare for all. But unfortunately, he lacked the TV for that. - steve schnorf - Monday, Nov 26, 07 @ 12:35 pm: LE, go ask the Hospital Assn about whether they would favor making more people eligible for medicaid-like services. Tell me how many hospitals have withdrawn from the medicaid program in the past 10 years. As to individual providers, you’re absolutely right. But, again, I think if you ask providers, a lot of them would prefer to see available dollars go to rate increases, not payment cycles, or at least a mix. Rate increases are forever, while the payment cycle fluctuates, and since the state is a sure, but slow payer, you can safely (and relatively cheaply), borrow against your receivables. It may be as simple as “would you rather be waiting 110 days for $100,000, or for $150,000″. - steve schnorf - Monday, Nov 26, 07 @ 12:57 pm: BW, but aren’t they currently getting zero percent of cost on many of these folks and highly discounted billings on many others, especially in emergency rooms, and to ask your question, who is paying for that now. BTW, I accept the fact that my taxes, whether direct or indirect, will have to go up to address this problem. I’ve reached the point of believing that this issue is one that the citizenry is going to demand be addressed, and therefore the intellectual debate needs to over how and how well, not whether. - Garp - Monday, Nov 26, 07 @ 1:18 pm: Any healthcare plan needs to be nationwide-not state by state. You cannot piece meal a program without causing more problems than you solve. I’ll wait for Hillary or Obama to figure it out and treat Blago’s proposals as electioneering. Quinn worked very hard and took lots of criticism to help get Blago re-elected. The Gov has not spoken to him since. I believe that Governor Blagojevich and his staff think they are better and smarter than everybody else. If you feel you don’t need to communicate with your Lt. Governor how do you really feel about every other elected official? - Little Egypt - Monday, Nov 26, 07 @ 1:33 pm: Well Steve, I worked for the Illinois State Medical Society for a number of years and had enough doctors come and go into my office that I know for sure their complaints of SLOW State payments are a very real concern, to the point of limiting the number of medicaid patients they will see. Slow payments have driven some doctors out of this state. New doctors that come here are largely foreign born. They will jump on board any state program to gain the patient numbers and will be happy with the payment cycle for a while until it starts really biting into their lifestyle. Then, they too will quit taking on new medicaid patients. I’m not surprised at all that the hospitals want more insurance programs because right now they are treating a whole lot of people with no insurance and are either passing on the charges to you and me or they are eating the costs. You can choose for yourself what the hospitals are doing to make up revenue but I choose to believe they aren’t eating much of the cost themselves. Only for a while, if at all, will providers be happy with waiting the same period of time for more money but that too will stop. In fact, I’m betting that there are not a whole lot of doctors who are willing to “borrow against their receivables (relatively cheaply, lol)” when they don’t have to. But I do agree with you on one thing, a lot of them would prefer to see a mix of available dollars go to rate increases AND an increase in payment cycles. - Rich Miller - Monday, Nov 26, 07 @ 1:41 pm: The biggest reason the guv needed such a large tax hike (GRT) was that the employer assessment didn’t provide enough money to boost reimbursement rates and speed up the payment cycle. That’s a very big reason why the Hospital Assn. endorsed the GRT. - Combining Two.... - Monday, Nov 26, 07 @ 4:05 pm: 1) Harold Washington memory - tax evasion charges; couldn’t be that lucky again, could we at the State level? 2) Never thought I’d say it, but… Could we trade Gov. Gridlock for Gov. Studinator from Calif? At least Studinator gets things done for the Citizens of his State - like the mortgage fiasco. - Budget Watcher - Monday, Nov 26, 07 @ 4:32 pm: Steve, If the Governor truly believes he has a mandate to pursue universal access to healthcare, why didn’t he tell the voters this last year. Instead we got an unhealthy dose of “What was she thinking” ads over and over and over….no mention of a multi-billion dollar healthcare intiative to be paid by Illinois businesses and ultimately by consumers. If we’re beyond the intellectual debate regarding whether, wouldn’t the call for universal access to healthcare have been a slam dunk. The question is rhetorical, as the 107-0 vote speaks to why he didn’t propose this in the election cycle. Also, I was under the impression that disproportionate share payments, the myriad of critical hospital access payments, Medicaid uncompensated care payments, and the granddaddy of them all, hospital assessments (all federal dollars) helped to compensate for the uninsured and the under-insured. Of course, we have to throw in the subsidies that private payors pass on to policy holders as a hidden tax, although inner-city hospitals miss out on much of that. Since hospitals under the Gov’s plan would get reimbursed by the state for much of the above, would you and I see “peace dividends” on our premium payments? Would the federal government assume it didn’t need to fund the assessment program anymore? Ultimately, there’s a lot of questions that should be answered before we jump in, and frankly, I’m not convinced we’re past the time for an intellectual debate over whether we should do this as a stste, or rather as a national initiative. - steve schnorf - Monday, Nov 26, 07 @ 8:59 pm: Watcher, I agree that there are many questions to be answered, and no, I don’t expect us to see any drop in private health insurance premiums—-at best a decrease in the rate of increase. I don’t know the financials now on how the assessment program has affected rates, but I’m willing to guess that many hospitals, including some major ones, operate at best on the bubble in terms of breaking even on operations. I would be really surprised to find that many hospitals get any lower than 5% of revenues lost to uncompensated care/bad debt. I understand your point on his proposal for universal care not being a slam dunk. I personally believe that bad tactics resulted in the debate being focused almost entirely on the GRT plus payroll tax. Unfortunately, that resulted in too many elected officials being off the hook on having to explain what they think we should (or even shouldn’t) do about the uninsured. We shall see. - Disgusted - Monday, Nov 26, 07 @ 10:21 pm: To several previous points: I also think that universal health care should be a federal, not a state, responsibility because of portability problems state to state. If we think we have problems seeing a doctor now, try going across state lines to receive care or to see a specialist in another state. Regarding hospital costs, the day has come for some truth in advertising from hospitals and a plan to allow people to supply some of their incidentals while in hospital. Why pay $5.00 for an aspirin when you can buy a huge bottle for that amount, with the same ingredients. Let’s stop being manipulated by drug companies. I would be less suspicious of the governor’s initiatives and plans where he touts doing things for the good of the citizens of Illinois IF he did not plaster his name and face on everything, many times over. I just saw a two-sided, 8 1/2″ x 11″, 4 color piece, recently printed for the new push for affordable healthcare, and the gov’s name was on it in various sizes of type, 5 TIMES. In two pages! Talk about ego. - Just so we're clear... - Monday, Nov 26, 07 @ 11:58 pm: Steve, am I wrong in saying you now make your living mainly as an insurance advisor-lobbyist? - steve schnorf - Tuesday, Nov 27, 07 @ 12:39 pm: Clear, I have done no lobbying in 3 or 4 years. I have no insurance companies or HMOs as consulting clients. I spend the single greatest number of my retirement hours a a member of a non-profit board (non health related). I make most of my living from my pension. If you have a point, make it. If you have additional questions, ask them. 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