* The Tribune editorial board may be finally starting to catch on to the Springfield game…

Gov. Pat Quinn’splan to scale back the state’s ailing Medicaid program is running into Republican resistance, primarily because Quinn’s mix includes a $1-a-pack cigarette tax hike.

“We’re looking for money rather than looking at the spending side, and it’s that default position that has gotten us exactly into the mess we’re in,” Republican Senate Minority Leader Christine Radogno told a City Club of Chicago audience Monday.

Fair enough. We’ve pushed as hard as anyone for Illinois to curb its vicious spending habit, which has left the state billions of dollars in debt and incapable of paying its bills.

But we strongly encourage Republicans to be flexible here, lest we lose the momentum for Medicaid reform (as well as pension reform). If these changes are going to happen, they’re going to be done in a bipartisan fashion. They’re going to need Republican votes. Quinn has proposed substantial cuts in spending on Medicaid, and he’s going to run into some Democratic resistance on that. […]

Illinois has a crisis: an expected $1.9 billion in unpaid Medicaid bills on hand by June 30, the end of fiscal 2012. Without a fix, that backlog will surge to $21 billion in five years. Providers wait about four months now to get paid; that delay could stretch to a full year. That puts a huge financial burden on the providers. Longer delays and steeper reimbursement rates could push more of them to stop treating Medicaid patients.

We credit Quinn for stepping up here, taking the political risk of proposing Medicaid and pension reform. His plan isn’t the last word, but it does set a solid framework.

This reform can’t wait. If Republicans have better ideas, bring ‘em on soon. And negotiate in good faith.

* But Gov. Pat Quinn is using the very same sort of argument on gaming that the Senate Republicans have used on Medicaid…

Quinn said gambling expansion, including slot machines at horse racing tracks, should not become a political distraction in the remaining six weeks of session for the General Assembly, because Medicaid and pension stabilization are “the highest priorities we can possibly focus on.”

The Chicago Democrat criticized lawmakers on both sides of the aisle pushing gambling expansion as “some … who frankly don’t want to deal with the hard things. They say the solution would be expanded gambling and we don’t have to make hard choices.”

Using revenues from the cigarette tax hike to avoid “hard choices” on Medicaid is pretty much exactly what the SGOPs are saying.

* And, like the cigarette tax hike, gaming expansion is no big deal to the public…

More than 60 percent of Illinois residents support a gaming solution that includes more casinos and the addition of slot machines at racetracks as a solution to create more than 20,000 jobs and generate nearly $200 million annually for the state, a newly released poll reveals.

Most Illinoisans support the gambling expansion bill Gov. Pat Quinn vetoed this year — at least according to a poll taken on behalf of the people who would most benefit from more gambling in Illinois.

The poll was conducted for the Illinois Revenue & Jobs Alliance, which describes itself as “a growing statewide consortium of labor organizations, business groups, farming and agribusiness interests, racetracks and horsemen associations, and local municipalities committed to the passage of SB 1849 which calls for the expansion of gaming in Illinois, including slot machines at racetracks.”

* And then there’s the whole idea of not allowing a few decades-old gambling establishments (racetracks) to offer more gambling…

“This is the same governor who has approved buying lottery tickets at home on your computer. So 10-13 million Illinoisians apparently can gamble on their computer at home, but a few people can’t go to a race track and gamble where they’re already gambling? I think that’s a very difficult stretch,” Lang said.

* But unlike gaming expansion, Quinn says he is open to some changes to his Medicaid plan…

Gov. Pat Quinn laid out his plan to cover a $2.7 billion Medicaid hole last week, proposing a cigarette tax hike, cuts in rates paid to Medicaid providers and reductions in services to Medicaid recipients.

However, administration officials acknowledged that components could change as lawmakers debate the plan in the coming weeks.

That comes as a working group of state lawmakers still wants to develop its own plan for closing the gap, a plan Republicans hope will avoid the tax increase and the rate reductions.

Quinn’s vision for closing the $2.7 billion gap is not etched in stone, according to his top aides.

* In other Medicaid news, Crain’s has a new story entitled “Medicaid plan would shift $250 million tab to private insurers”…

The Quinn administration’s proposal to force health insurance companies to shoulder a greater share of the cost for treating severely sick children might save the state $250 million a year, but it likely will drive up premiums on policyholders.

Reducing Medicaid spending on children with “special health care needs” — ranging from cystic fibrosis and sickle cell disease to chronic pain and depression — is a key part of Gov. Pat Quinn’s plan to cut spending by $2 billion a year for the federal-state health insurance program for the poor… The idea of shifting Medicaid costs onto private insurers is novel

* But here’s the actual explanation…

Under a quirk in Illinois eligibility requirements, children and their families whose income is low enough to qualify for Medicaid can participate in the program, even if they have private insurance. […]

Those nearly 35,000 children cost the state on average about $12,700 in 2009, according to an analysis by [Children’s Memorial Hospital] that Ms. Hamos provided to Crain’s.

The department projects it can save about $250 million a year if private carriers cover the first $36,000 in costs for only an estimated 7,000 children, with Medicaid picking up the rest of the tab. That’s the starting point for the state.

So, couldn’t that $250 million a year also be looked at as a state government subsidy of the health insurance industry?

* Meanwhile…

A national liberal advocacy group is criticizing Illinois’ Democratic governor’s proposed solution to the state’s Medicaid crisis.

Families USA is issuing a new report Wednesday that estimates job losses of more than 25,000 if Illinois cuts Medicaid spending by $2.7 billion.

So far, Quinn hasn’t really proposed cutting Medicaid spending by $2.7 billion because about $700 million of that amount would be from a cigarette tax hike combined with a federal match. The full report is here.

* And the Belleville News-Democrat has demanded deep state budget cuts in the past, but it doesn’t much care for a proposed local facility closure…

State officials say Gov. Pat Quinn’s plan to close the Murray Center in Centralia is a policy decision, but come on. Everybody knows the center is on the chopping block now because the state is billions of dollars in debt.

Understandably, people who have family and friends who live or work there don’t want the facility to close. But that can’t be the governor’s basis for the decision. As someone at a recent hearing on the proposed closure correctly pointed out, if that were the criteria, no state facility would ever be closed.

The state has to cut from somewhere, but is this a good place? There are many more straightforward savings to be had than Murray Center.

For example, the state could save about $13.5 million annually by eliminating the legislative scholarship program — about what would be saved annually by closing the Murray Center.

They had other budget ideas as well, but that $13.5 million is fantasy cash. The scholarships aren’t actually funded with any state money. They’re really just tuition waivers.

* Related and a roundup…

* Quinn defends proposal to raise cigarette taxes for health care

* Rep. Brady: Cigarette tax ‘not realistic’

* Illinois Residents Say They Want A Casino

* More on hospitals’ Medicaid ideas: A commenter on the Capitol Fax blog noted, correctly, that if the state kicks a lot more people off the Medicaid rolls, it ultimately would cost the hospitals, which provide 40 percent of Medicaid-reimbursed services. This is a point the Illinois Hospital Association made to the SJ-R editorial board last week. Space limits prevented me from more fully explaining this in the editorial itself, so I thought a little explanation here is in order.

* Added bus costs concern local schools

* Lawmaker: College Illinois! audit reveals no surprises

* Legislation would ban ‘tax zappers’

* New attorneys to fight unemployment benefits fraud

* IL moves to boot 2 school boards from office

* Historic schools, farmstead, city hall on IL endangered list

* Illinois Sets Funds to Alleviate No. 1 Trucking Bottleneck

* ComEd ready to install 4 million smart meters in IL