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Question of the day

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* Yesterday, I asked you to vote on which optional Medicaid services you would eliminate. Just one of those optional services received more than 50 percent “support”: Group Psychotherapy for Nursing Home Residents. But eliminating that program saves only $13 million out of a total of $1.8 billion in cuts I presented to you.

Not so easy, is it? That won’t even make a dent in Gov. Pat Quinn’s demand for $2.7 billion in Medicaid reductions.

* Today, let’s look at possible cuts to Medicaid eligibility. Rep. Greg Harris posted the Department of Healthcare and Family Services’ 14 ways to cut eligibility which totaled about $196 million. I can only put 10 at a time on my polling app, so I took most of the top ten.

What we have here is the program name, followed by the number of human beings that will be cut off the rolls and then the total savings. “FPL” means federal poverty level. You can vote for as many cuts as you can stomach. Have at it, but make sure to explain your cuts in comments, please…

Online Surveys & Market Research

posted by Rich Miller
Thursday, Mar 8, 12 @ 11:58 am

Comments

Someone else vote, please….

Comment by OneMan Thursday, Mar 8, 12 @ 12:00 pm
I cut everything that applied to children or to the elderly — and it added up to jack squat.

– MrJM

Comment by MrJM Thursday, Mar 8, 12 @ 12:03 pm
I voted for the Hemophilia program. $19 mil to serve 250 people. That’s roughly $76,000 per patient. Tough to justify.

Comment by Kummerspeck Thursday, Mar 8, 12 @ 12:08 pm
I voted to cut them all. We are broke and just can not afford it

Comment by Informer Thursday, Mar 8, 12 @ 12:08 pm
Cut them all. The proposed levels here for All Kids and Family Care do not go deep enough.

Comment by Anonymous Thursday, Mar 8, 12 @ 12:13 pm
I’m really horrified by the two comments in a row about cutting all the programs. Did you even read all the options? I can think of no justification of cutting money for rape victims’ treatment.

Comment by Miss Marie Thursday, Mar 8, 12 @ 12:19 pm
Miss Marie, i can think of only one justification for cutting most of these: we don’t have enough money to pay for them.

Comment by steve schnorf Thursday, Mar 8, 12 @ 12:21 pm
Yes, we can afford it, Informer. We can raise income taxes again, for example. But not this year. 2013. I’m not in favor. But I believe this is on a lot of legislators’ minds, although I don’t believe most have the courage to say it out loud. Even those in safe seats. One of the many ways we are treated like children by Illinois state legislators, and the governor, of course.He’s still saying the temporary tax increase is temporary. Please.

I’m still wondering how these expenditures would be affected by ACA. In more generous states like Illinois, would those above the federal cutoff move off Medicaid to a federally supported private health insurance program, or would we have to continue to pay for them on Medicaid. Either way, they’ll have to have coverage and cutting them off for 18 months or less seems kind of dumb.

Comment by cassandra Thursday, Mar 8, 12 @ 12:26 pm
===But I believe this is on a lot of legislators’ minds, although I don’t believe most have the courage to say it out loud===

Maybe one or two of them. The rest? No way.

Comment by Rich Miller Thursday, Mar 8, 12 @ 12:30 pm
An increase in the 5% rate and corresponding corp rate would not be necessary to raise revenue. Extending the sales tax to services, closing loopholes, taxing retirement income, eliminating or reducing the 1.75% sales tax rebate along with substantial cuts to all of the areas above would go along way toward closing the fiscal gap until a graduated income tax is approved through referendum and passed by the GA. Until then, obviously, the 5% “temproary” rate has to be extended indefinitely. Pick your poisons, folks.

Comment by Bill Thursday, Mar 8, 12 @ 12:37 pm
Mathematically, we can raise taxes enough to pay for all the things we currently do. Politically, I’m not so sure we can. Responsibly, I’m not so sure we should. But we have to either or both raise more or spend less, because it’s hard to imagine anything more irresponsible than just spending more than we take in, year after year, with nothing done to correct it.

Comment by steve schnorf Thursday, Mar 8, 12 @ 12:44 pm
Tough choices, every one. This is the way it will be over the next few years. If we are to have a balanced budget we must cut programs, expenses, i.e. benefits and perks, or raise taxes.

It will take courage and fortitude and few, very few legislators have either, as near as I can tell.

I would gladly give up a good percentage of both my medicare and social security if it meant helping truly needy children. I’m not talking about just feel good programs, but those programs that mean life.

I suggest a survey of the folks wiling to give up some of their, the good life, perks for the benefit of others. How about we start with our legislators.

Comment by Sunshine Thursday, Mar 8, 12 @ 12:45 pm
I voted for the options which removed non-citizens, and that reduced the level of eligibility for family care and all kids. Eliminating these programs is not possible, but lowering the cut off is.

Comment by SO IL M Thursday, Mar 8, 12 @ 12:50 pm
I selected IL Care RX and Undocumented kids since both are only State dollars and not federal matched.

All Kids, FamilyCare are relatively healthy populations at higher income levels. We can’t help everyone.

BCC is higher income populations and few women. Get hospitals to agree to do this as part of deal on charity care/tax exemption.

Leave the rest but see if something can be done on cost sharing. Earlier comment on Hemo group on expense per person. That is a very expensive condition. Medicaid should be for those with the greatest need. Any cuts should be targeted at people with lower needs or higher incomes.

Comment by Hoping for Rational Thought Thursday, Mar 8, 12 @ 12:52 pm
“I voted for the Hemophilia program. $19 mil to serve 250 people. That’s roughly $76,000 per patient. Tough to justify.”

Unless, the hemophiliac is your son, and government is your only source for care.

Somewhere, the purpose of government in a civilized democracy is being lost in this debate. Before we force the indigent to go to the emergency room, which will cost us more, several other areas of inordinate expense must be addressed, such as: Government employee benefits, means testing public education, outsourcing all government functions which can be provided competently and economically by the private sector, eliminating Illinois’ nation leading number of government units, decriminalizing personal cannabis consumption and instituting a progressive income tax.

But the sacred, never-to-be touched state constitution and campaign contributions from vested interests stand in the way.

So, the poor must suffer or die. There’s got to be a better way.

Comment by Cook County Commoner Thursday, Mar 8, 12 @ 1:04 pm
Voted to cut IL Care RX support because there seem to be other programs that provide some sort of assistance there. Hemophilia assistance and non-citizen renal support too. Tough, but the first program is $76,728 per a relatively small population. And non-citizen renal care is $20,321 per (very controversial) participant.

Family care eligibility reductions too, with a hope and prayer that federal insurance changes will pick some of that up.

Blue Cross Illinois reported a billion in profits recently, would be fascinated by their cost per customer for similar services.

Comment by Uptown Ed Thursday, Mar 8, 12 @ 1:14 pm
Why not give them a voucher for private health insurance premiums. Then you wouldn’t have to eliminate anything. PPO also have the advantage that they actually pay their bills. I’m offering a direction here, not a program.

Comment by Greg Blankenship Thursday, Mar 8, 12 @ 1:17 pm
The two biggest things that were off the chopping block (in my mind) were the people with hemophilia treatment (no one can afford over $76,000) and sexual assault victims. No one should be cutting programs for victims of sexual assault, in fact that is a program that should see a funding increase.

Comment by Ahoy Thursday, Mar 8, 12 @ 1:25 pm
I said to drop the services for non-citizens–including illegal immigrants. Family Care and ALL Kids should be reduced. The thing about services to retirees to consider is that the elderly (maybe medicaid is diff from medicare in this…) see that they’ve paid taxes for many decades and this is one of the thing they’ve paid for ahead of time. So, they think it’s appropriate to get it..even conservative-minded folks see it this way. I find myself understanding where they’re coming from…A bit torn on elderly svcs, thus.

But, as Schnorf says, there is no money. Perhaps we need to be tending to our own parents as well as our own children.

There may be some things that can’t be gotten in families or in the market, eg, sex crime victim care and perhaps hemophiliac needs, and disabled homes…so, maybe govt can step in to help to some extent.

Comment by Peggy R/Southern Thursday, Mar 8, 12 @ 1:36 pm
These programs should be for the really poor. For most of them, the eligibility levels were too high, so I voted for cutting all but the last. Other than the last, the one I questioned was the hemophiliac, so I don’t know if those people have any other way to pay for the treatment.

Comment by Skeeter Thursday, Mar 8, 12 @ 1:50 pm
Non Citizen programs need to go. I also think All kids needs to go it was up in illegally by Blago.

Comment by He Makes Ryan Look Like a Saint Thursday, Mar 8, 12 @ 2:07 pm
I voted to cut most and raise income limits. Undocumented have to go. I believe, People are going to die because of this.

Comment by Palatine Thursday, Mar 8, 12 @ 2:13 pm
If we’re out of money and in the hole - we have to cut down to what we have coming in.

Comment by titan Thursday, Mar 8, 12 @ 2:24 pm
@Schnorf -

I humbly suggest a third option: spending the money we do have more efficiently to achieve the same outcome.

And a fourth: Stop doing things that are low priorities. I look forward to the commission’s report on mandatory tax and budget expeditures and mandatory transfers.

Comment by Yellow Dog Democrat Thursday, Mar 8, 12 @ 2:24 pm
I guess I am in a very, very minuscule minority that will stand up for legislators. Even on this thread of politically astute and educated readers, legislators are derided as having no courage or fortitude to do the “right” thing. Look at the choices that have to be made! There are 177 people who we elect to made decisions for us that have to choose between hemophiliacs, kids, or senior citizens. This ain’t like picking out socks, folks. These are life and death decisions that nobody should have to make. Yes, I know they sought the job; and yes, I know they get paid to do it. But that doesn’t mean that they aren’t human beings who will likely agonize over these decisions.

Comment by Old Shepherd Thursday, Mar 8, 12 @ 2:27 pm
And I would humbly suggest that part of the reason we, the body politic, and the general public find it difficult to identify specific cuts in health care, human services and education is because poll after poll shows those are the services most valued by the public.

Cutting those areas makes as much sense as trying to lose weight by eating fewer fruits and veggies because thats what you have been eating the most of.

A sustainable budget, like a sustainable diet, requires cutting out the things you dont need and getting enough of the things you do need

Comment by Yellow Dog Democrat Thursday, Mar 8, 12 @ 2:30 pm
How much do hemophilia programs cost in other states? Who pays for them?
Losing your hemophilia meds is a death sentence. But is there any way to reduce the per-patient cost?

Comment by soccermom Thursday, Mar 8, 12 @ 2:40 pm
My elderly mother used to be on Circuit breaker and received assistance with her meds. She stopped being eligible last year when eligibility was raised. The local senior center helped her to find a Medicare part D provider and got her the best deal they could find. When I went to pick up her January meds, I had to make out a check for over $300. If I hadn’t been able to help her out, my mother would have been making decisions between food or meds that month.

I talked to person who runs the senior center and she told me about a couple who lost their eligibility the same time my mother did. The husband has serious health issues and is on a lot of medications. Even with Medicare part D, between premiums and copays, his meds will cost them over $5000 this year. They will be deciding between food and medication every month.

My mother has friends who now take prescription meds every other day in order to make them last. That’s never a good idea with blood pressure or diabetes meds.

These are people who lost eligibility in the first round. If the benefit is cut completely, the ones who are in real poverty will be next.

This is way beyond questioning whose ox gets gored. There are very real human costs every one of these cuts.

Comment by Aldyth Thursday, Mar 8, 12 @ 2:43 pm
@Schnorf -

I agree with you that it is politically difficult.

A big part of the political difficulty is that 1 in 4 voters think the corporate income tax is our number one source of revenue and 1 in 4 voters thinks that higher ed and transportation are our number one spending priorities.

They are dead wrong on both counts.

But it goes a long way to explaining why there’s opposition to closing corporate loopholes and the sentiment that further cuts can be made without real human consequences.

I think the voters are alot smarter than we give them credit, but they can’t make an informed decision without all the facts.

Our friends in the mainstream media are partly to blame. Go reread the coverage of the governor’s budget address and see how much of it focused on insider politics and omitted basic context about the budget debate and the human impact of proposed cuts.

Comment by Yellow Dog Democrat Thursday, Mar 8, 12 @ 2:58 pm
I voted to remove the benefit for undocumented kids and the lower eligibilty for Family Care and All Kids for $124 million in savings. Some of the savings should be diverted to preventitive care to cut down on future health care costs. There also needs to be more innovative ideas to help. For example, rural Illinois has many volunteer Firefighters and EMTs. Perhaps a program could be started to have well-being checks by the FDs to check on vital signs, eating and living habits etc. It would be good community service, good training and would cut down on the 3:00 AM emergency calls.

Comment by Past the Rule of 85 Thursday, Mar 8, 12 @ 3:03 pm
===But is there any way to reduce the per-patient cost?===

Drug prices for hemophiliacs skyrocketed over the past several years because the military started using the drugs to save the lives of soldiers injured on the battlefield. As the wars come to a close, the drug prices might fall.

Comment by Rich Miller Thursday, Mar 8, 12 @ 3:17 pm
Roll All Kids back to cover those at 200% FPL and take the “All” out and get illegal immigrants out of the count and those covered. If you don’t think that people in other countries know the states that provide health care “free” for all children and use that as a guideline for places they can go and exploit then you would be wrong.

Comment by Don't Worry About the Government Thursday, Mar 8, 12 @ 3:28 pm
I think the easiest adjustment of all is changing the federal poverty level criteria for eligibility for some of the services. If you are 300 percent of FPL you are not in as tough a spot as someone at 200 percent of FPL.

I appreciate Rep. Harris’s very detailed list of services and possible savings. I don’t know if it’s possible, for example, to move a big number of skilled nursing facility residents to supported living. Yes, the difference in rates is large enough that potential savings are there.

But at the same time he’s suggesting raising the minimum score needed to get into a nursing facility, meaning that there will be fewer individuals at the low end of the need-for-care scale to move.

Also- per Aldyth’s comment above- last year’s cuts to prescription assistance for the elderly had a big negative impact. I don’t see the political will to stick it to Grandma again this year.

None of this will be easy. Lots of people will get hurt when it’s over.

Comment by DuPage Dave Thursday, Mar 8, 12 @ 3:45 pm
% of Population and % New Births in Illinois

White person not Hispanic 63.7% - 53%
Black persons 14.5% - 17.4%
Hispanic persons 15.8% - 23.5%

These are numbers to keep in mind when, expecially when half the births in Illinois are covered by Medicaid, when determining who we are insuring.

http://quickfacts.census.gov/qfd/states/17000.html
http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_01.pdf pg. 42

Comment by Don't Worry About the Government Thursday, Mar 8, 12 @ 3:46 pm
300% of Federal Poverty Level (FPL) for a family of 3: $57,270

200% of FPL for a family of 3: $38,180

133% of FPL for a family of 3: $25,390

Comment by Robert Thursday, Mar 8, 12 @ 3:51 pm
A family of 4, with a net income of $67k, pays $80/mo to insure their kids. I don’t know about Illinois specifically, but at those levels, a full 68% of the US households qualify for this program.

It needs to be scaled back A LOT. And if it doesn’t, I’m probably going to go enroll my kids in the program.

Comment by JN Thursday, Mar 8, 12 @ 3:54 pm
There is no good reality here. This attacks people who: a) don’t have billion-dollar-sugar-daddies to promote for them; & b) are in the lowest economic fabric of our society.

It seems to me that this can’t be dealt with in one year, as Q wants. And this didn’t happen overnight. We’ve also got 6-10 billion in unpaid bills & Q and the gang ain’t doing much about that.

So. I come up with 1) Undoc kids - let’s take care of IL citizens 1st; 2) Non-citizens dialysis - same reasoning; 3) All Kids to 200% - everybody’s got take a hit; 4) Family Care to 133% - same reasoning; 5) Reduce Care RX to 1/2 - old folks are gonna die, and I’m one of them, I understand the issue.

So, doing all that only reduces Q’s 2.7B by less than 200M, or about 6%.

Quinn needs a reality check. The folks he’s targeting here need and depend on the State’s help.

And, somewhere in the world, ’someone’ needs to start to deal with the imbalance between income and medical costs; the medical apparatus needs to come to grips with reality, too.

I see comments about ‘politically difficult’. Unfortunately, these aren’t about some favored contractor: these are IL human beings. Life or death in some cases.

Comment by sal-says Thursday, Mar 8, 12 @ 4:04 pm
Very difficult to do after I turned in my vote I feel like a rat. Hurting kids ,bleeders, and old folks. I sure some of these programs could be cut
but it needs lots of research.

Comment by mokenavince Thursday, Mar 8, 12 @ 4:17 pm
@Don’t Worry About the Government: What was the point of your posting that last factoid?

Comment by chitownHV Thursday, Mar 8, 12 @ 4:19 pm
I have a couple questions about the presidential primary I was hoping to crowd source.

Is the presidential primary not really a statewide primary, but eighteen separate Congressional district primaries?

Or will Illinois proportionately award the delegates based on the statewide outcome and then use the vote totals for delegates to pick which delegates go?

If the state is a series of primaries in individual districts, has there been any attempt to figure out (e.g. poll) which districts are in play?

Comment by Carl Nyberg Thursday, Mar 8, 12 @ 4:27 pm
I’m picking nits here, but no one is a citizen of IL. You are a citizen of the US (or not). You are a resident (or not) of IL.

Comment by Cheryl44 Thursday, Mar 8, 12 @ 4:28 pm
@chitownHV- It helps my argument that Illinois is indeed a place where illegal immigrant come to find work and start families especially and obtain “free” healthcare for their children through All Kids.

Comment by Don't Worry About the Government Thursday, Mar 8, 12 @ 4:39 pm
Greg Harris is my Rep, and my neighbor, in a way I was horrified when saw his list and choices he was givng us to choose from. But having read the comments on this thread I now realize Greg helped make these cuts far more real.

Its pretty clear that the cuts will not add up to 2.7 billion. It is also pretty clear the Governor will not get all of the cuts he wants. Sal in his post above had it right.

Comment by Rod Thursday, Mar 8, 12 @ 4:45 pm
I voted for none of these. If cutting off someone’s health care made them healthy, I could support it. But of course, it doesn’t. It just means they won’t receive health care. (Remember, emergency room care only covers emergencies. It doesn’t cover chemotherapy, medicines, etc.) Are we really prepared to say we would rather let people get sick and die than to raise taxes or find other programs to cut?

Comment by Anonymous Thursday, Mar 8, 12 @ 5:00 pm
Anonymous - The problem is that we need to cut billions in spending and nickel and diming state agencies and services aren’t going to make up that difference. We are going to have to get into the big three (healthcare, education and pension obligation).

Comment by Don't Worry About the Government Thursday, Mar 8, 12 @ 5:07 pm
“I’m picking nits here, but no one is a citizen of IL. You are a citizen of the US (or not). You are a resident (or not) of IL.”

Not to be cranky, but… I suspect this was from my comment. THIS is an –IL– budget proposal. And, actually, I view my self as an IL citizen. Sorry.

Comment by sal-says Thursday, Mar 8, 12 @ 5:14 pm
“Non Citizen programs need to go. I also think All kids needs to go it was up in illegally by Blago.”
AGREE
But I voted for most of the cuts.
However, the survey is too targeted about these particular cuts. There are many other priorities to balance. When we have a state government that awards connected and wasteful contracts like crazy, and is increasingly continuing “endemic hiring fraud”, it would pay to first look for cuts in the “corruption tax” category.

Comment by JustaJoe Thursday, Mar 8, 12 @ 5:36 pm
ALL of the ABOVE.

Comment by Chicago Repub Thursday, Mar 8, 12 @ 5:36 pm
I would like to see Illinois list the programs that existed 20 years ago. Those programs would continue to be funded at 2011 levels. Any that have come into being since then would have to be re-authorized by a 3/5 vote of the GA.

Comment by dr. reason a. goodwin Thursday, Mar 8, 12 @ 9:12 pm
This exercise just proves why across the board cuts of the percentage needed to meet the overall goal is the only way to go. No one is wise enough to know which programs should be zeroed out.

Comment by wishbone Thursday, Mar 8, 12 @ 9:38 pm
Don’t Worry:

If your post insinuated what I think it did then that was a very ignorant and racist comment. Are you suggesting that the Hispanic population is all made of illegals? Are you suggesting a certain populatino doesn’t deserve care? Please do explain.

Comment by Demoralized Friday, Mar 9, 12 @ 2:17 am
Undcoumented kids and Non-citizen renal so I guess I am a jerk about people coming to live here.
Family Care-I don’t have kids so I feel don’t have them if you know you can afford them.

Comment by BelleAire Friday, Mar 9, 12 @ 6:24 am
I have read 2 chapters of “Winner Take All” and this is one of the issues covered in Chapter 2. Our services have gone down the tubes compared to all European Nations and Canada.

Comment by BelleAire Friday, Mar 9, 12 @ 6:27 am
“I would like to see Illinois list the programs that existed 20 years ago.”

LIFO would be an interesting track to explore. Surprising to see 250-300% FPL families getting services. Start phasing all services out at 100%, curve TBD.

Comment by Sideliner Friday, Mar 9, 12 @ 8:11 am