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29 lame ducks (or 31, or 30)

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Illinois

Lame-duck lawmakers could provide the extra push needed to get public pension changes and Medicaid reforms through the General Assembly this year. […]

Twenty-two incumbents — a mix of Republicans and Democrats — said they won’t seek re-election this fall. Another seven incumbents, mostly Republicans, lost their primary race Tuesday.

“It depends why someone is a lame duck. Sometimes people believe that being a lame duck is temporary. But by and large, these are good opportunities to move things” through the legislative process, said Kent Redfield, a political science professor at the University of Illinois at Springfield.

The issues sure to dominate the conversations in the halls of the Capitol are public pension and Medicaid reforms. The costs associated with Illinois’ Medicaid system and public pensions have ballooned in recent years, eating up more and more of the state’s budget.

…Adding… Commenter “train111″ says it’s 31 lame ducks, not 29…

How do they only get 29 lame ducks?? I get 31.

In the Senate: Bomke, A. Collins, Crotty, Cutra, Garrett, C Johnson, T Johnson, J Jones, Lauzen, Maloney, Meeks, Millner, Schmidt, and Schoenberg for 14.

In the House: Carli, Coladipietro, duBucklet, Dugan, Eddy, Evans, Gaffney, Howard, Krezwick, Lyons, May, J Mitchell, Mulligan, Nybo, Penny, Ramey, and Yarbrough for 17

Rep. Eddy resigned early this morning. It’s not clear yet who will replace him. If it’s a placeholder, then the number is 31. If it’s the guy who won the Republican primary, it’s 30.

* In a related story, Senate President John Cullerton is convening a Committee of the Whole today to discuss Medicaid…

An expert from the National Conference of State Legislatures will address the senators.

State strategies to hold down Medicaid spending vary. Tennessee limits adults to two brand-name and three generic drug prescriptions per month. New York set a Medicaid spending cap and gave the state health commissioner “superpowers” to make benefit changes or cut rates to providers without legislative approval if the cap is exceeded. Washington state is trying to limit coverage of emergency room visits for non-emergency care to three visits annually.

Democratic Gov. Pat Quinn has recommended cutting $2.7 billion from Medicaid. Sen. Heather Steans, also a Democrat, said Wednesday that cutting that much in one year “is going to be a real stretch.”

Cullerton agreed, saying the governor’s goal may not be achieved. “It might be other parts of the budget that are cut,” he said.

* Related…

* Illinois Senate President Cullerton Proposes Pension Changes: The state’s five pension systems are drastically under funded and it’s making it difficult for lawmakers to balance the budget. Senate President John Cullerton says part of the problem is there’s a big difference in the way the state funds pensions for teachers in Chicago versus Southern Illinois. “The State is paying virtually nothing into the Chicago Pension System, and $2.5 billion into theirs. I don’t think that anyone can say that’s fair. It’s time to ask local school districts outside Chicago to have some skin in the game”, said Cullerton.

* Taxes, tension up in Illinois: “Other states can look at Illinois and see that merely raising revenue without structural changes is not enough to fix the problem,” said Laurence Msall, president of the Civic Federation, a tax watchdog group in Chicago.

* Rockford seniors voice concerns on proposed health care budget cuts

* Will County Officials: Closing Mental Health Facility Would Be Devastating

* Will officials oppose Tinley center closing

* Public hearing set for Dwight Correctional Center

* Illinois turns to coordinated care in Medicaid program

posted by Rich Miller
Thursday, Mar 22, 12 @ 9:27 am

Comments

I love how Statehouse News (funded by the Koch brothers, by the way) sees the lame ducks as now able to vote for slashing pensions and medicaid. Rather than, say, increasing revenue?

Comment by dave Thursday, Mar 22, 12 @ 9:37 am
The 29 should form the “Duck Soup” Caucus … probably the only Caucus that can go against MJM and Cross. They could, maybe, be relevent, or at least relevent Mushrooms(?)

It can also be social; Duck Soup screening while serving Duck Orange’ and Turtle Sundaes?

They should wear Groucho Marx “glasses” on the Floors of each chamber on the last day … mix it up a bit.

Comment by Oswego Willy Thursday, Mar 22, 12 @ 9:41 am
Here it is for all you Senators that want to pay attention to save money on Medicaid

1) Audit your plan!!!! I would bet that 20%+ of your recipients that are on Medicaid are NOT supposed to be there. Recently DHS found that 6% of the recipients don’t live in Illinois! You supposedly have the money to cover these people then you should have the money to ensure eligibility.

2) Lower your income levels back to Federal minimums. A family insurance plan on the private marketplace costs about $1000/month. Currently a family making up to $80,000/year can get family coverage for about $100/month. That gap has to be picked up somewhere. We CAN NO LONGER afford to pick up that difference. Raise the premiums or get rid of the program.

3) You cannot keep doing the same thing and expect different results. Look to Minnesota and what they are doing. Engage Primary Physicians and Pharmacists. Yes you will have to pay them a little more but the savings will be tremendous on the back end in terms of ER visits and hospitilizations.

Free advice from someone on the front lines.

Comment by BIG R. Ph Thursday, Mar 22, 12 @ 9:50 am
Plenty will be cutting deals with Quinn to get back on the public payroll next year. I’m sure some are qualified to work in the mail room at Madigans or cullertons law offices.

Comment by Fed up Thursday, Mar 22, 12 @ 9:52 am
All we need for the 29 (Duck Soup Caucus) to do is to say the secret woid and win 5 dollars. That’ll solve the debt problem once and for all.

Comment by dupage dan Thursday, Mar 22, 12 @ 9:58 am
- dupage dan -

Well Played!

I know the Senate “Duck Soupers” will have more free reign than the House, just because of the make-up of those 4 party caucuses, but 29 … that will be something to follow.

Comment by Oswego Willy Thursday, Mar 22, 12 @ 10:07 am
===Lower your income levels back to Federal minimums.===

Feds aren’t allowing this.

Comment by Rich Miller Thursday, Mar 22, 12 @ 10:10 am
I’m trying to understand this issue better - I believe that fewer and fewer doctors are accepting Medicaid patients and therefore that is why so many go to the emergency room - even for routine care - because the ER HAS to treat them. Is this correct?

If so, then Medicaid is going broke paying for the ER treatment. My husband was recently in the ER - sent there by our doctor based on his symptoms - and the bill was over $13,000! Of course this included tests, x-rays, etc but the room itself was almost $800. Plus, the ER was packed and we were there for 7 hours - we waited 2 hours before a technician was available to do a specific test.

It seems to me that one possibility is to require doctors licensed in Illinois to accept Medicaid/Medicare patients (if this is not already being done). This would be step one. The next step would be to follow Washington state’s lead and limit ER care to what it was meant for - EMERGENCIES & medical care needed outside of regular doctor hours (will need to limit the later; otherwise those on Medicaid will just wait & go to the ER at night).

Doing these two things will:
- reduce the cost of Medicaid to the State because they will be paying fewer ER bills.
- reduce the burden in the hospitals for treatment of Medicaid patients in ER, which will in turn reduce the hospital’s costs.
- less financial burden on the state SHOULD equate to faster turnaround time to apy the doctors (who are now seeing patients in their offices) faster.

Makes sense to me, or am I not seeing one of those hidden requirements like the Feds not allowing the states to reduce benefits?

Comment by Both Sides Now Thursday, Mar 22, 12 @ 10:30 am
SORRY, should clarify - meant Feds not allowing the states to lower income levels to Federal minimums; rather than “Feds not allowing the states to reduce benefits”

Comment by Both Sides Now Thursday, Mar 22, 12 @ 10:32 am
How do they only get 29 lame ducks?? I get 31.

In the Senate: Bomke, A. Collins, Crotty, Cutra, Garrett, C Johnson, T Johnson, J Jones, Lauzen, Maloney, Meeks, Millner, Schmidt, and Schoenberg for 14.

In the House: Carli, Coladipietro, duBucklet, Dugan, Eddy, Evans, Gaffney, Howard, Krezwick, Lyons, May, J Mitchell, Mulligan, Nybo, Penny, Ramey, and Yarbrough for 17

That makes 31. Perhaps they didn’t count Nybo and Ramey who lost their bids to jump from the House to the Senate.

train111

Comment by train111 Thursday, Mar 22, 12 @ 10:50 am
Eddy resigned, so that’s 30. It’ll depend on who replaces him, though.

Comment by Rich Miller Thursday, Mar 22, 12 @ 10:52 am
Maybe they didn’t count Mulligan yet (?)

Comment by Oswego Willy Thursday, Mar 22, 12 @ 10:54 am
UNKNOWN NUMBER OF LAME DUCKS BECOMES “LAME” - CAPFAX TO INVESTIGATE

Comment by Oswego Willy Thursday, Mar 22, 12 @ 11:02 am
**Eddy resigned, so that’s 30. It’ll depend on who replaces him, though. **

Wouldn’t Eddy have already been included as a lame duck?

Comment by dave Thursday, Mar 22, 12 @ 11:03 am
You’re right, Dave.

Comment by Rich Miller Thursday, Mar 22, 12 @ 11:15 am
== It seems to me that one possibility is to require doctors licensed in Illinois to accept Medicaid/Medicare patients (if this is not already being done). This would be step one. ==

It many ways this would ironically make the problem worse. Because you would be putting an additional burden on the doctors who could least afford it. It isn’t so much the doctor in Naperville who would end up with a host of these patients, it would be the providers in those neighborhoods. So you would increase the load of lower reimbursement clients for those providers, producing additional financial strain on those folks who could do very little to reduce their fixed costs (malpractice insurance, rent, staff salaries) to compensate for the lower reimbursement rates.

Comment by OneMan Thursday, Mar 22, 12 @ 11:34 am
Providers in “those” neighborhoods already have Medicaid Patients. I think Both Sides Now has an excellent idea. If you want to practice medicine in Illinois, you need to accept a certain percentage of Medicaid patients. Those providers who already serve Medicaid patients as part of their practice would not be affected.

Comment by PublicServant Thursday, Mar 22, 12 @ 11:50 am
===If you want to practice medicine in Illinois, you need to accept a certain percentage of Medicaid patients.===

Another reason the Doctors will leave IL.

Not saying its right or wrong … just stating doctors may consider not practicing here or leaving IL if they are a mandatied a measureable requirement for services they may or may not do already, or required to do in other states …

Comment by Oswego Willy Thursday, Mar 22, 12 @ 12:21 pm
Yeah, lets force doctors to take specific patients, brilliant!

Where do I even start with this…

a) Transportation
How is someone going to get to a GP in Hindsdale? Is the sate going to pay the cab fare? What about in Southern Illinois, going to pay the cab fare down there as well?

b) The cost structures… please don’t take this wrong, but it is really, really obvious you don’t work in a medical practice. There are fixed costs, in large part based off of location. Labor costs, rent costs, equipment costs. Most of what goes into a medical practice is fixed cost If you FORCE a doctor to take someone on in their practice who has a lower reimbursement rate they have three basic options (see a reduction in income, see more people in the same amount of time to try and maximize revenues or charge more to those without insurance which is the only place they can really set prices). Is any of those good for the quality of care? On top of that you have to take on someone with a 5 month or longer payment cycle, bet your employer would be thrilled if the state said they had to take on x% of customers who would take 5 months to pay.

c) Really? So using your logic the person in front of me using the link card should get their groceries for less than I do since they are on a government program and Jewel should have to wait 5 months to get paid for that jug of milk. Why not apply this to every licensed profession, attorneys, locksmiths, hair dressers? You must take on at least x% of clients who are going to pay you less and pay you 5 months after service is rendered.

d) It is medically bad… Why? Well in part if you force a % of clients to be anything you are reducing the ability for a practice to fire a patient. Fire a patient? Yep from time to time practices fire patients if they miss too many appointments, are really rude to staff, consistently fail to follow medical advice and for other reasons.

At the end of the day these are private businesses. Is there another business that you would like to legislate take at least x% of their customers who have a specific method of payment?

looking forward to hearing it.

Also spare me the myth of the rich health care provider… They exist, but it isn’t the norm anymore.

Comment by OneMan Thursday, Mar 22, 12 @ 12:30 pm
You know you could look at making the program such that doctors would want to participate but it is so much easier just to blame them, isn’t it?

Comment by OneMan Thursday, Mar 22, 12 @ 12:32 pm
The lame duck count also assumes Berrios won — she well may have, but I think there will be a recount. Given how the ward totals break down, there is a statistically good chance of some voting irregularities in the 30th and 31st Wards, and that would benefit Guzzardi. Again, not saying that’s what happened, or that a recount will be successful; just that I would leave the Berrios race in the too close to call column for now.

Comment by the Other Anonymous Thursday, Mar 22, 12 @ 12:36 pm
Oh good. A whole new class of “lame ducks” for people to complain about.

Comment by mark walker Thursday, Mar 22, 12 @ 12:38 pm
===I would leave the Berrios race in the too close to call column for now. ===

Only if you believe in divine intervention.

Comment by Rich Miller Thursday, Mar 22, 12 @ 12:39 pm
The Berrios race … She will have enough votes to win … you can try to justify in your head the math “to the path” but save the time, she will have enough.

Comment by Oswego Willy Thursday, Mar 22, 12 @ 12:44 pm
So sorry …

I need to clarify …

No shenanigan, no snark, no hidden meaning … I am just of the belief Berrios will carry the day, period.

Comment by Oswego Willy Thursday, Mar 22, 12 @ 12:46 pm
Oneman, it seems to me that allowing the medical provider to maximize his revenue is costing everyone else a lot of money by having to treat medicaid patients in emergency rooms. As Both Sides Now states, hospitals cannot turn these patients away. They’re private businesses too.

Comment by PublicServant Thursday, Mar 22, 12 @ 1:14 pm
===hospitals cannot turn these patients away. They’re private businesses too. ===

Hospitals can’t physically pick up and move … but doctors and a doctor’s practice can …

Comment by Oswego Willy Thursday, Mar 22, 12 @ 1:28 pm
Actually, no an ER doesn’t have to see you for anything you walk in with. They have to screen you, they don’t have to treat you.

Look at EMTALA
http://www.enotes.com/healthcare-reference/treatment-without-insurance

They have to provide some basic treatment, basic treatment.

It isn’t small practices maximizing their revenue it’s about them staying in business.

It seems to me that grocery stores fail in poorer communities, so should Jewel have to charge me more in Aurora so they can run a store someplace else that loses money? That would reduce the amount of public food aid money spent at more expensive convenience stores. That’s basically what you are saying Should a grocery store chain be required to provide stores in areas they lose money in and make up for it by charging other shoppers more?

Again nothing about addressing what makes the program such that no one wants to participate, like paying in a reasonable amount of time or paying at a level that covers costs. So instead lets just force them all to participate that will solve the problem.

Do you have to pay multiple license fees to the state that far outweigh the regulatory costs for your profession to the state to do your job? My wife does,there are 4 different ones if I am not mistaken.

Comment by OneMan Thursday, Mar 22, 12 @ 1:45 pm
Winters also not running.

Comment by Coach Thursday, Mar 22, 12 @ 2:20 pm
So if we had term limits, we’d have a regular supply of lame ducks to make the tough decisions?

Comment by Rudy Thursday, Mar 22, 12 @ 2:32 pm
Oswego (and Rich),

If I had to bet on the ultimate outcome, I would bet on Berrios. But this race is definitely one where a recount could occur, and given the breakdown of votes — the 31st Ward looks very different from every other ward — I could not rule out the possibility of a different outcome. Not very likely, to be certain, but not impossible. If we were still using punch cards, a 111 vote margin would be problematic.

Comment by The Other Anonymous Thursday, Mar 22, 12 @ 2:49 pm
===…a 111 vote margin would be problematic.===

one hundred and eleven votes .. with the number of total votes cast in a House primary might as well be 1,000.

Get in the 30’s or so before you even start a recount, then you might get my attention.

You are chasing a vote, a vote and half, a precinct - every precinct. Lot of votes to be chasing.

Comment by Oswego Willy Thursday, Mar 22, 12 @ 3:00 pm
Sorry Oneman. Thanks for the info. I had no idea doctors were in such bad shape financially.

Comment by PublicServant Thursday, Mar 22, 12 @ 3:53 pm
Its true, Public Servant.

According to the Bureau of Labor Statistics, doctors have gone from being the highest paid profession to…

…oops. Sorry, I just checked. Doctors are still the highest paid profession.

But, for gods, their compensation is measily.

Comment by Yellow Dog Democrat Thursday, Mar 22, 12 @ 5:30 pm
P.S. Attorneys are required to do pro bono work.

Comment by Yellow Dog Democrat Thursday, Mar 22, 12 @ 5:32 pm
PPS. The number one cost driver for health care is insurance reimbursement processing, and I wouldnt be surprised if Medicaid could use some streamlining.

Most doctor’s offices have more clerical staff than nurses, just to deal with the paper trail.

Comment by Yellow Dog Democrat Thursday, Mar 22, 12 @ 5:35 pm
When did the requirement come in for attorneys to do pro bono work?

Comment by attorney Thursday, Mar 22, 12 @ 6:40 pm
Unless something has changed, here is a stubborn fact about the complaints about emergency room use by Medicaid. If the visit isn’t for an emergency (using for routine health care), the hospital gets paid a regular doctor’s office fee, not an emergency room fee. There are still a lot of problems created by the use of emergency rooms for routine health care, but creating great overpayment demands on Medicaid isn’t one of them.

Comment by steve schnorf Thursday, Mar 22, 12 @ 10:33 pm