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*** UPDATED x2 - Biss, Pawar respond *** Pritzker outlines Medicaid buy-in idea

Tuesday, Aug 1, 2017

* I stripped out the political rhetoric at the beginning and end, but you can click here to read the entire JB Pritzker press release if you want

I propose a public health insurance option that would allow every Illinois resident the chance to buy low-cost health insurance. I will work with legislators and the health care community to design this public option to provide another choice in the health insurance marketplace, to lower the cost of premiums and mitigate market uncertainty – at no cost to taxpayers.

If the Affordable Care Act (ACA) remains the law of the land, my plan would provide an important avenue to expand access to affordable healthcare in Illinois. But if Republicans in Washington are successful in repealing ACA, IllinoisCares would become even more necessary and could give Illinois a path to expanded innovative healthcare coverage at the state level.

IllinoisCares would allow Illinois residents to buy into the state’s Medicaid system:

    * Because Medicaid is individually administered by states, the program offers a unique opportunity for states to function as laboratories and lead in the creation of progressive healthcare policy.

    * With the creation of IllinoisCares, Illinois would be the first state in the nation to expand Medicaid in this manner.

    * Medicaid is a lower-cost option than private insurance, giving Illinoisans another choice when faced with rising premiums. It can be offered in every county, as opposed to the dwindling number of plans on the Affordable Care Act exchanges in many counties.

    * Illinois currently spends about $3,350 per year per adult and $2,108 per child for Medicaid coverage.[1]While an actuarial analysis will have to be completed to set premiums and cost-sharing rates for the program, it is clear that IllinoisCares offers a lower cost option for families compared to those being offered in the private insurance market.

    * As a Medicaid buy-in option, IllinoisCares would require Illinoisans who do not receive federal healthcare subsidies to pay premiums to cover the full cost of Medicaid coverage. As a result, there should be no additional cost to taxpayers for this program.

    * Participants who qualify for ACA tax credits could use those to help pay for their premiums.

    * IllinoisCares would be designed to encourage healthy young adults as well as older Americans who are not yet eligible for Medicare to participate and would help ensure a robust patient mix.

    * IllinoisCares could allow for affordable deductibles and copays as well as open enrollment and special enrollment periods, which are all standard features that keep plans affordable and stable in the private insurance market.

In the event of full repeal of the ACA, I will work to make sure IllinoisCares gives all Illinoisans affordable health insurance, and will enact patient protections so that Illinoisans with pre-existing conditions will not be discriminated against in healthcare coverage.

*** UPDATE 1 ***  Pawar campaign…

Ameya Pawar, 47th Ward alderman and Democratic candidate for Illinois governor, released the following statement after J.B. Pritzker suggested a policy proposal that would limit Illinoisans to a public option healthcare model:

“A public healthcare option for Illinois doesn’t go far enough to provide quality healthcare for everyone while lessening the burdens put on working families and small businesses. Illinois needs a single-payer healthcare system, and as Governor, I will take the steps to get us there.

“For far too long, government has perpetuated a culture of ‘deserving’ and ‘undeserving.’ Healthcare is a human right and single payer healthcare will deliver quality affordable care to every Illinoisan. Single-payer is about making our society a better place. It’s about putting people over profits. Single-payer is about doing the right thing.

“We need to elect more leaders who will advocate for a system that guarantees health care for all people, helps working families get the care they need while saving small businesses money that otherwise would be paid to big insurance companies.”

A single-payer system would allow healthcare providers to operate with far greater efficiency, meaning that more money is being spent on actual care than our current system allows. Medicare has a 2 percent overhead rate - that’s a remarkably efficient program, allowing significant savings that private insurance companies would be making in profit instead of passing along to the people. The total cost savings for Illinois under a single-payer system would amount to $17 billion annually, nearly two-thirds of our health care spending as a state, by eliminating private insurance providers and their administrative costs.

This issue has driven activism from a wide array of organizations, including social justice advocates, unions, physicians, health associations and religious institutions. But despite these efforts, the bills that lawmakers introduced in Springfield never made it out of committee.

Pawar’s campaign website has been mostly silent on this issue, however. Click here.

*** UPDATE 2 *** Sen. Daniel Biss…

“Health care is a human right, and I’m disappointed that J.B. considers it an option. We need a single-payer health care system in Illinois that covers everyone. I call on J.B. to put aside half-measures like optional care and embrace health care for everyone.”

Except, Pritzker does support a single-payer health care system. From part of Pritzker’s press release that I didn’t post

I hope there continues to be conversation about how we can expand healthcare coverage across our country, including the consideration of a federal single payer system, which I support. But with Donald Trump in the White House and Republicans in control of the House and Senate, it’s now up to the states to innovate. That’s why I’m proposing a public option for Illinois, which would be the first in the nation leading in this way. [Emphasis added.]

…Adding… From the Biss campaign…

In the language you cite, JB states he supports a “federal” single-payer system. The criticism Daniel made of his plan, is that he doesn’t support a state level single payer system. Indeed, the fact that Trump and Republicans control Congress is all the more reason a single-payer system at the state level, as we’ve seen with efforts in CA, is needed. The larger point is, while it’s nice he supports a federal level system, he’s not running to be governor of Congress. He’s running to be governor of Illinois, and his position on single-payer for the state is what Democratic primary voters want to know.

That’s a critical distinction among Dem primary voters and among the candidates in this race. I’d hate for people to get the impression that he supports single-payer, writ large, as your piece implies. Because he doesn’t.

- Posted by Rich Miller        

47 Comments
  1. - Deft Wing - Tuesday, Aug 1, 17 @ 11:56 am:

    An awesome timing of the roll out this plan. /s


  2. - Blue dog dem - Tuesday, Aug 1, 17 @ 11:57 am:

    I am either amazed,confused or stupid. Are states not on the hook for 10% expansion pick up in subsequent years? Does more participants equal greater state contributions? If i am stupid or confused help an old codger. If i am amazed, were does JB get the extra money?


  3. - perrier - Tuesday, Aug 1, 17 @ 11:58 am:

    If I’m not mistaken, the same proposal was vetoed in Nevada.

    http://www.latimes.com/nation/la-na-nevada-medicaid-2017-story.html


  4. - Discouraged in DuPage - Tuesday, Aug 1, 17 @ 12:03 pm:

    An intriguing idea, but the current Medicaid delivery system is seriously inadequate to take on all these additional members. We’d need many more participating doctors, particularly specialists, and hospitals. The rates for Illinois Medicaid are too low to entice providers to take large numbers of patients. If we had adequate networks, the per person cost would go up because people would actually be able to get care. All that being said, it might be worth exploring.


  5. - Grandson of Man - Tuesday, Aug 1, 17 @ 12:03 pm:

    Good for JB, for proposing ideas to expand health insurance. There’s a bipartisan group of around 40 U.S. reps, called the Problem Solvers caucus, who wants to strengthen Obamacare instead of repealing/replacing it. I wish them success. It’s probably what most people want.

    That’s what I support, bipartisan cooperation to strengthen the ACA or come up with something better.

    Bruce the Chickenhearted is choosing to not take a strong stand on ACA repeal/replace, one way or another. He’s awaiting the final legislation, or some other excuse, and then will supposedly take a stand.

    But there is no final repeal/replace legislation. Republicans are in such a frenzy to get rid of Obamacare that they’re throwing anything up against the wall to see if it will stick. Thankfully for over a million Illinoisans, there are three brave and compassionate Republicans who’ve stood in their party’s and president’s way.


  6. - Expletivedeleted - Tuesday, Aug 1, 17 @ 12:04 pm:

    Medicaid reimbursement rates are low enough and delays long enough to bankrupt most providers if even a moderate percentage of people enrolled in such a program. Or, alternatively, premiums would necessarily skyrocket after the initial period of losses. Didn’t we already go through this?


  7. - Epic - Tuesday, Aug 1, 17 @ 12:04 pm:

    As a supporter of single payer I like any idea that moves us closer to it. I hope it actually works, with the ACA I have family members who own a small business and can only afford this horrible health plan that’s still expensive.


  8. - Blue dog dem - Tuesday, Aug 1, 17 @ 12:08 pm:

    Just a friendly reminder. The all knowing CBO assessment required the Cadillac tax for the ACA to even be remotely (not really) solvent.


  9. - Arsenal - Tuesday, Aug 1, 17 @ 12:09 pm:

    I don’t disagree with Pawar that single payer is best (and neither does Pritzker, according to the Medium post), but IL’s fiscal problems put us in a lousy place to implement it on our own right now. A public option/medicaid buy-in seems like a good way to move the ball forward.


  10. - Sue - Tuesday, Aug 1, 17 @ 12:12 pm:

    This is simply Dems trying to out prosgressing one another. Vermont looked at single payer and determined it was too expensive. California is looking at if and they determined they would need an additional 14 percent payroll tax. Why can’t you folks figure out that providing more simply costs more and if you haven’t figured out Illinois is already broke you shouldn’t be running


  11. - JohnnyPyleDriver - Tuesday, Aug 1, 17 @ 12:12 pm:

    When your opponent is flailing like Rauner is, why would you run in and suck up the oxygen in teh room with a wonky policy proposal that would have had more relevance last week?


  12. - Generation X - Tuesday, Aug 1, 17 @ 12:13 pm:

    States should be in charge of their own healthcare systems and not the Federal Government. If Illinois wants single payer than that should be law of the land no matter how terrible of an idea it is.

    Didn’t work in Vermont, California knew it wouldn’t work there. There is just no way to pay for it


  13. - Quiet Sage - Tuesday, Aug 1, 17 @ 12:14 pm:

    Which policy group or think tank came up with Pritker’s very interesting idea of expanding Medicaid to create a public option? I don’t believe the idea came solely from Pritzker himself. I agree with Pawar that Medicare for All is the goal, but expanding Medicaid to become a universal public option is an innovative way to begin getting there.


  14. - John Doe - Tuesday, Aug 1, 17 @ 12:16 pm:

    ==Didn’t work in Vermont, California knew it wouldn’t work there==
    Didn’t work in Colorado either.


  15. - Anon0091 - Tuesday, Aug 1, 17 @ 12:19 pm:

    So it’s great for Ameya to call for single-payer. Does he mean a state or federal system? If it’s Federal, good luck. If it’s state, that was just tried in VT, but failed. So what exactly is he proposing and how will we pay for it?


  16. - Lucky Pierre - Tuesday, Aug 1, 17 @ 12:19 pm:

    Which Democrat running for Governor will win the prize for promising the most “free stuff” to the base?

    Will any Democrat running for Governor acknowledge how much taxes on middle class families will have to go up just to pay what we owe for unfunded pensions much less expand spending?


  17. - Southwestsider - Tuesday, Aug 1, 17 @ 12:23 pm:

    Waste of energy to have to read about Pawar. He will come in last place. He should stick being an Alderman.


  18. - Nick Name - Tuesday, Aug 1, 17 @ 12:23 pm:

    I’d like RNUG’s take on this.


  19. - Norseman - Tuesday, Aug 1, 17 @ 12:24 pm:

    A little early in the campaign to come out with a major plan. This will give opponents plenty of time to find the inevitable flaws that come with campaign designed initiatives.


  20. - Red Ranger - Tuesday, Aug 1, 17 @ 12:26 pm:

    When Vermont and California cant pass single payer in their states because its too expensive, how do you think that will go over here? The Pawar campaign continues to act like its running for student body president of a local high school and not Gov of one the nations key states. Hes just not ready for anything close to prime time.

    Medicaid buy in is interesting, I guess, but its likely not much cheaper than a catastrophic health plan sold in the private market Its already extremely tough to find practitioners to take Medicaid because the really poor reimbursement rates and this will only make the problem worse. It will have the same problems the ACA has, you give people insurance, but if no one takes it, what do they really have? It would be better if JB just expanded the dollar threshold for ACA subsidies to help people buy whatever plans are left on the Exchanges.


  21. - Just Observing - Tuesday, Aug 1, 17 @ 12:26 pm:

    While I lean toward a federal single-payer system, I would worry that people, particularly those most in need of healthcare, would move to Illinois just for the health care and drain the system.


  22. - Sideline Watcher - Tuesday, Aug 1, 17 @ 12:42 pm:

    Someone help! If this is something that people pay for it themselves, why are folks saying there is no way to pay for this. Also, if people are paying their own premiums, wouldn’t that be an infusion of cash into the system maybe allowing up to increase the reimbursement rates? Wouldn’t that then convince more doctors to take medicaid patients that won’t now because of rates too low and the ridiculously long time it takes for the state to pay providers?

    Am I way off? Seriously asking for someone who knows more about insurance than me.


  23. - Sideline Watcher - Tuesday, Aug 1, 17 @ 12:55 pm:

    Sorry for the typos. “maybe allowing US to increase the reimbursement rates”.


  24. - Sue - Tuesday, Aug 1, 17 @ 12:59 pm:

    Sideline- so your fix is to throw more money at the ACA? You should be in the Congress. The ACA needs cost constraints not more money. The Dem answer to every problem is to just spend more money


  25. - Perrid - Tuesday, Aug 1, 17 @ 1:00 pm:

    I wonder what the feds would have to say about the Medicaid buy in option open to all. Changes to the State Plan have to be approved by them after all, and traditionally the the feds pay for more than have the Medicaid costs. Unless Republicans succeed in capping Medicaid, in which case IL will be on the hook for new programs, no matter how good or efficient they are.


  26. - Perrid - Tuesday, Aug 1, 17 @ 1:00 pm:

    Pay for more than *half*


  27. - Anonymous - Tuesday, Aug 1, 17 @ 1:48 pm:

    I agree the ACA needs more cost restraints. How about a requirement to follow the prices set by Medicare? That’ll rein in the costs of that $300 bottle of Tylenol at the hospital.

    Vermont and Colorado proposals were incomplete, they lacked proper funding mechanisms and few details. It will be revisited when a more comprehensive proposal is crafted.

    I’d like to see that from Pritzker, but he is on the right track.

    Progessives like Pawar need to come to the realization that pragmatism and incrementalism works.


  28. - Mittuns - Tuesday, Aug 1, 17 @ 1:50 pm:

    Anonymous @ 1:48 pm was me.


  29. - Markus - Tuesday, Aug 1, 17 @ 2:11 pm:

    This was a real eye-opener for me. $3,350 annually per adult; that’s full cost state and federal contributions. I’m paying $9,000 annually per adult with a $7,000 deductible and a “free” $300 annual physical. Even taking low reimbursement rates into account, somebody’s getting rich and somebody’s getting screwed in the insurance marketplace. Group plans through an employer are not any cheaper, employers just pick up the cost.

    Theoretically, Pritzker could raise provider reimbursement rates by 50% for private-pay IllinoisCares participants and offer me a low deductible plan for about half of what I’m paying now. We are getting hosed by insurance & drug companies and opaque billing practices of medical providers in our current “not so free” market system.


  30. - Anon0091 - Tuesday, Aug 1, 17 @ 2:46 pm:

    LP wins the Evelyn Wood Reading Failure award for the day with this comment:

    “Which Democrat running for Governor will win the prize for promising the most “free stuff” to the base?”

    Read the release again LP. He’s not promising “free stuff.” He’s promising a way to “buy in” to Medicaid. Try to keep up.


  31. - Sideline Watcher - Tuesday, Aug 1, 17 @ 2:53 pm:

    Sue:
    Sideline- so your fix is to throw more money at the ACA? You should be in the Congress. The ACA needs cost constraints not more money. The Dem answer to every problem is to just spend more money.

    Not sure where you got that out of my questions. I was literally asking to help think thru what I don’t understand and that’s what you come up with?

    Let me try again. This plan is built off of people paying for it themselves. Using private insurance that is already being used to manage medicaid right now. So if people pay their own premiums, how is that throwing more money at the ACA? So if you are not super poor, or really old, or really sick, or disabled or a vet….cuz all those people have public insurance…you suggest what Sue?

    This is Illinois not Washington, so we can’t do anything about the single payer arguments. And our Governor won’t even weigh in on what to do if Trump Care kicks millions of folks off of medicaid. Please tell me why it would be a bad idea to give people the chance to buy for themselves from insurance companies they already know, what poor people get automatically now with no taxpayer dollars?

    Markus…couldn’t agree more.


  32. - Sideline Watcher - Tuesday, Aug 1, 17 @ 2:55 pm:

    I just scrolled up…Sue maybe I confused you because I capitalized “us”. I was trying to correct the mistake I made when I typed “up” in my first post. I didn’t mean to say US like the United states. I meant us like Illinois.


  33. - Blue dog dem - Tuesday, Aug 1, 17 @ 3:04 pm:

    We seriously have to be the laughing stock of the country. $160 billion in debt. Penai6on system at 34% funding levels and politicians promising singke payer. Yikes


  34. - Anonymous - Tuesday, Aug 1, 17 @ 3:15 pm:

    Wondering if that yearly cost is just the cost to administrate the program per participant, not pay actual fees. As a new Medicare participant given the cost of medication, lab work etc.


  35. - Markus - Tuesday, Aug 1, 17 @ 3:18 pm:

    Blue dog- Have you looked at the numbers? A public option has merit.

    Medicaid per capita cost- $3.3K for real care
    Medicare cost per capita- $11K for real care
    Bronze ACA or Employer Group Plan- $16K in premiums and deductibles before insurance picks up a dime of cost for care.

    There’s room for a public option. Medicaid and Medicare are not healthy cohorts yet they cost less than private/group insurance with a theoretically healthier cohort. If insurance companies/GOP want to charge me as an old guy 5X the premium of a younger person, give me the option to pay full-cost Medicare rates rather than get gouged by greedy insurance and drug companies.


  36. - Markus - Tuesday, Aug 1, 17 @ 3:48 pm:

    Anonymous @ 3:15- It’s the whole bass, the entire cost of care.


  37. - Chicagonk - Tuesday, Aug 1, 17 @ 4:10 pm:

    Isn’t Biss a mathematician? I’d love to see him explain how he plans to make the math behind single-payer work.


  38. - Sue - Tuesday, Aug 1, 17 @ 4:13 pm:

    Markus reimbursement rates for Medicaid explain the difference and why it’s not very easy getting treated but for at a hospital. Most doctors refuse to,treat Medicaid patients because they can’t cover their costs. Other then that you have a great idea there


  39. - Watson - Tuesday, Aug 1, 17 @ 4:23 pm:

    Markus, medicaid costs less because reimbursement rates are low. Refusing to pay for something doesn’t make the cost of delivering it any less. Doctors will simply refuse to see medicaid patients, or move out of the state if they are forced to take them.


  40. - Markus - Tuesday, Aug 1, 17 @ 4:34 pm:

    Sue and Watson- If you read my comment, you’d see that Medicaid reimbursement rates for a buy-in insurance program could be raised by 50% and I could still get coverage for half the cost of my current premium with a low deductible.


  41. - Veil of Ignorance - Tuesday, Aug 1, 17 @ 4:47 pm:

    I do think Biss makes a valid point that his position and Pritzker’s are different. Pritzker is messaging that as Governor he’ll combat the Trump administration and possibly GOP Congress. If so, it’s more relevant what he supports on the state level rather than saying he supports federal single payer; that answer is more like Rauner saying he supports immigration reform, but is silent on state level measures that he could actually help make a reality.


  42. - Expletivedeleted - Tuesday, Aug 1, 17 @ 5:19 pm:

    @Markus
    Medicaid reimbursement rates would need to increase significantly more than just “double.” Private insurers are paying several times what Medicaid does… thus a big population shift to Medicaid results in providers receiving a small fraction of the payment for the same services. TANSTAAFL.


  43. - Ron - Tuesday, Aug 1, 17 @ 6:57 pm:

    I’m not opposed to a federal single payer system, but illinois should in no way attempt a state wide system. Our politicians can’t even pay our current bills.


  44. - Anonymous - Tuesday, Aug 1, 17 @ 7:01 pm:

    I remember fondly when senator Biss introduced his single payer health care legislation. It was inspiring to see his political courage. So much detail including on how he was going to pay for it.

    oh wait, he didn’t do that. Still hasn’t. Does he realize that he currently has a job that would allow him to do the things he says he will do if elected Governor?


  45. - revvedup - Tuesday, Aug 1, 17 @ 8:40 pm:

    As someone who has dealt with Illinois DHS/HFS bureaucracies as a patient, and with no disrespect to the overloaded, underpaid caseworkers, I would NEVER sign up for such a program. 3 out of 4 doctors I see refuse Medicaid-only patients; all told me the laughably low reimbursements and State bureaucratic nightmares make it impossible to tolerate the Medicaid nightmare.


  46. - Discouraged in DuPage - Wednesday, Aug 2, 17 @ 9:50 am:

    We all need to remember that Medicaid is an entirely different program from Medicare. Expanding Medicare to cover all is a great goal. But expanding Medicaid is different and far less effective, and it doesn’t get us to universal coverage.


  47. - Markus - Wednesday, Aug 2, 17 @ 10:48 am:

    Just for grins I went back through a few recent office visit EOB’s and compared them to current Medicaid provider reimbursement rates. Let’s just say at worst Medicaid is 50% of what an insurance company pays with their negotiated rate, but may be up to 75% depending on how it gets coded.

    That puts the Medicaid buy-in on the table for a State, particularly if you raised provider reimbursement rates for buy-in patients. Obviously the system needs to be efficient and actually pay claims which Illinois is not good at. My main point is that there is a huge gap between Bronze ACA/employer group plan premiums/deductibles and the actual health care costs spent on generally less healthy Medicaid/Medicare patients. Medicare is not an available option States to implement, but Medicaid could be. A Medicaid buy-in program that reimburses at about a Blue Cross negotiated rate is worth looking into.

    Why do most big companies self-insure as opposed to buying a traditional plan? Because the insurance company mark-up is so high on a risk adjusted basis for a large cohort. If small businesses could join the buy-in, they could save money just like the big corporations do compared to insurance market prices.


Sorry, comments for this post are now closed.


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