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*** UPDATED x1 *** It’s just a bill

Thursday, Dec 10, 2020

* Press release…

In response to decreased use of health care services through Medicaid managed care organizations throughout the COVID-19 pandemic, state Senate Assistant Majority Leader Dave Koehler, D-Peoria, and state House Assistant Majority Leader Fred Crespo, D-Hoffman Estates, filed legislation today to require companies to return excess profits and reallocate funding to critical health care services.

“While insurance companies and managed care organizations see record-setting profits at the height of a global pandemic, rural communities across the state are experiencing unsustainable strain in their health care systems due to lack of resources,” Koehler said. “The money recouped through this legislation would provide immediate relief for Downstate hospitals that have been devastated by COVID-19.”

Hospitals across the state are facing an unprecedented decline in outpatient procedures and elective surgeries as a result of the pandemic, contributing to severe financial strain on health care facilities that serve Illinois’ most vulnerable populations. Conversely, MCOs in Illinois have benefitted from these declines, as enrollment-based payments have continued despite decreased use of non-emergency health care services.

In response, Koehler and Crespo introduced Senate Bill 4207 and House Bill 5867, respectively, which seeks to reallocate a portion of enrollment-based payments made to Medicaid MCOs throughout the pandemic. From an estimated monthly payment of $1.7 billion, a 20% return would yield $340 million per month that can provide needed relief to hospitals and other health care facilities that have been hit hardest by the COVID-19 crisis. In addition, recouping these funds can provide relief to health care service providers that may be impacted by state budget deficits.

“While safety net and critical care providers are struggling to remain open and serve their communities, MCO’s are continuing to receive over a billion dollars in state and federal funding each month,” said Crespo. “Residents across Illinois are making significant sacrifices in order to protect themselves and their communities, and we’ve even seen the auto insurance and cable television industries return unused money to consumers. It is unacceptable that MCO’s are profiting off of taxpayer dollars that aren’t being used. Clawing back some of the funding that MCO’s have received throughout the pandemic and reallocating those dollars to health care providers in low-income and rural communities could help hospitals remain open amid ongoing financial instability that has been exacerbated by the pandemic.”

* This is how Rep. Crespo explained the bill to WTTW

“We know that hospitals have not been doing services they normally do, elective surgery,” Crespo said. “So costs have gone down. So the plan here is to say, we should take back 20% of (the managed care organizations’) profits and redirect it to other Medicaid expenses the state has.”

Except he’s not talking about clawing back profits, necessarily. But, yeah, if they’re profiting off of a shift in the types of care provided, they should definitely lose that money.

*** UPDATE *** From Samantha Olds Frey, CEO, Illinois Association of Medicaid Health Plans…

The State of Illinois already has an existing mechanism to protect taxpayers and state from overpaying for underutilization and for 2020 requires that approximately 90% of the capitation received is spent on direct medical care.

While we have seen a shift in utilization we have not seen a 20% decrease in total medical costs for the Medicaid program.

It is important to note that MCOs don’t just pay for hospitals but a comprehensive healthcare benefit; such as: pharmaceuticals, long term care, and behavioral health. The proposed legislation would reduce the necessary resources to the Medicaid program and negatively impact providers and actually harm our most vulnerable residents. IAMHP is opposed to cutting a healthcare program for over 2 million people by 20% especially in the middle of a pandemic.

* Press release…

Illinois legislators and renewable energy businesses are calling for urgent action to save the state’s solar and wind energy jobs, and a new economic analysis shows that the proposed Path to 100 Act would not only save current jobs but would create more than 50,000 new jobs and $8.7 billion in increased economic output by 2033.

On December 4th, the Illinois Power Agency announced the close of state renewable energy incentives for residents in central and southern Illinois. With funding expected to disappear in northern Illinois in coming days, Illinois’ renewable energy program will abruptly end before the end of this year. The end of incentives will immediately impact the ability of homeowners and businesses to go solar and will force thousands of layoffs at solar businesses across the state in the coming months.

Senator Bill Cunningham and Representative Will Davis introduced the Path to 100 Act in early 2019 to address Illinois’ looming renewable energy crisis. The Path to 100 Act would improve and expand Illinois’ existing renewable energy program to allow the state to reach 40% renewable energy by 2030.

A new economic impact analysis of the Path to 100 Act found that, by 2033, the legislation would result in:

    • 53,298 jobs created or supported during construction
    • 3,215 jobs created or supported annually during operations
    • $8.27 billion in increased economic output during construction
    • $571 million per year in increased economic output during operations

The analysis was conducted by Dr. David Loomis. Loomis is the co-founder of the Center for Renewable Energy at Illinois State University and the President of Strategic Economic Research and has over 20 years of experience in energy and economic development analysis.

“Fixing Illinois renewable energy program is low-hanging fruit for the General Assembly and should be a top priority – we have a proven way to create jobs, benefit consumers and reduce pollution as well as a backlog of projects that could provide a rapid economic stimulus across the state,” said Representative Will Davis, House Sponsor of the Path to 100 Act. “There is no reason to delay fixing this.”

The report is here.

- Posted by Rich Miller        

11 Comments
  1. - yeah... - Thursday, Dec 10, 20 @ 11:21 am:

    But isn’t the fundamental bargain of managed care that the state pays a flat amount per enrollee per month and the insurance company has to make it work?

    Seems like this is changing the deal after the fact.


  2. - Carol - Thursday, Dec 10, 20 @ 11:22 am:

    The Crespo/Koehler Bill seems like a great away to fund some of the items in the Black Caucus’ health care pillar. It may also help avoid some of the cuts the Gov has recently alluded to it. This seems like a win, win.


  3. - Rich Miller - Thursday, Dec 10, 20 @ 11:24 am:

    ===seems like a great away to fund===

    Only if it’s real money. I’m not sure it is yet.


  4. - MakePoliticsCoolAgain - Thursday, Dec 10, 20 @ 11:26 am:

    I’m all in on someone finally holding the MCOs accountable. They take billions from the state and don’t even do the basics like ensuring their clients’ nutritional needs are met. The MCOs are going to try and do so much spin on this, but they won’t be able to escape from their dividends doing so well during a pandemic.


  5. - Third Reading - Thursday, Dec 10, 20 @ 11:37 am:

    Always risky to predict the General Assembly, but I’m almost 100% certain Senate Bill 4207 and House Bill 5867 won’t pass and become law during the 101st GA.


  6. - Dotnonymous - Thursday, Dec 10, 20 @ 12:13 pm:

    MCO’s were always about the money…not care.

    They charge a monthly fee for every participant instead of fee for each service…for what?

    If it isn’t a hustle…it isn’t Illinois?


  7. - Downstate Illinois - Thursday, Dec 10, 20 @ 12:46 pm:

    Well the lack of green energy scams is one bit of good news. Illinois is currently the third largest energy exporting state. Let’s keep it that way rather than switch to inefficient, expensive and unreliable green energy. We need cheap reliable energy solar and wind are anything but.


  8. - DuPage - Thursday, Dec 10, 20 @ 12:57 pm:

    They should require the state retiree and Trail insurance to return their excess profits and then use that money to catch up on the states late payments on the state retiree dental plan. A lot of dentists now demand state retirees pay in full up front.


  9. - illinoyed - Thursday, Dec 10, 20 @ 2:49 pm:

    @downstate illinois - your info on the cost of renewable energy is completely incorrect, you can ask the CFO of an Illinois school district saving $270 k a year with solar, or the International Energy Agency
    https://www.dailyherald.com/news/20201111/huntleys-district-158s-new-solar-panel-system-could-generate-up-to-270000-a-year-in-savings

    https://www.popularmechanics.com/science/a34372005/solar-cheapest-energy-ever/


  10. - Perrid - Thursday, Dec 10, 20 @ 2:59 pm:

    Until someone can explain to me how this is different from the MLR, the Medical Loss Ratio, which basically means the MCOs have to spend 85% of the money paid to them on medical costs or they have to pay it back to the state, I’m going to assume this is just bluster.


  11. - Interested Party - Thursday, Dec 10, 20 @ 7:33 pm:

    Perrid is right - it’s all about the Medical Loss Ratio. While MCOs may not have been paying for elective procedures, they’re paying more for telehealth visits than pre-COVID, paying for thousands of COVID hospitalizations (higher cost care than most elective procedures), and covering testing costs. I’m betting their MLRs aren’t down much if at all. And if they are, there’s already a clawback. And in fairness, MCOs also are now paying an assessment to the state of over $600 million; unlike the hospital assessment, MCOs aren’t getting that money back in payment for services.


Sorry, comments for this post are now closed.


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