Capitol Fax.com - Your Illinois News Radar

Medicaid stuff

Posted in:

Illinois
YouTube

* Republicans so far are saying three things about reforming the Medicaid program…

2) A cigarette tax hike is a non-starter

3) More efficiencies need to be found in Medicaid itself and more benefits need to be cut from more people

* But surprisingly enough, the Chicago Tribune is mostly on board with Gov. Pat Quinn’s plan…

The bottom line here is that Quinn has given lawmakers a template to do what he repeatedly has told them needs to be done. He’s given them plenty of time to debate this, to adjust, to add their own proposals before this legislative session’s scheduled conclusion May 31. All good.

The rendezvous with reality starts now. The Legislature is notorious for pushing off tough decisions to another day, another year, another decade. That can’t happen this time. “If we don’t make those changes, we won’t have a system at all,” Quinn said Thursday. He’s right.

So let’s get to it. Lawmakers, if you don’t like the governor’s solutions, let’s hear yours. Only one thing can’t change: The number is $2.7 billion.

And so is the Civic Federation…

“We commend Gov. Quinn for stepping forward in a timely fashion with a plan to save the Medicaid program — a plan that is reasonable, given the magnitude of the crisis,” says federation President Laurence Msall in an email. “We call on the General Assembly to adopt this plan or identify other comparable combinations of program cuts that are reasonable.”

* Quinn has said that anything short of that $2.7 billion goal will have to come out of other state programs. And since legislators have already cut Quinn’s proposed budget spending by $700 million, that means they’ll have to find more than $1.1 billion in cuts to Quinn’s introduced budget if they abandon the cigarette tax idea and don’t make up for the lost cash, for instance (the cig tax would raise about $336 million, which is doubled by the federal Medicaid match, so state spending would have to be cut by a like amount to make up for that approximately $700 million from the cig tax hike). No provider cuts means either $700 million in additional Medicaid service cuts or another $350 million in state budget cuts. The Republicans, however, are calling Quinn’s bluff…

But leading Republicans on the issue — Rep. Patti Bellock, R-Hinsdale, and Sen. Dale Righter, R-Mattoon — said they don’t believe Quinn will follow through on his threat of massive cuts.

* Polls consistently show that tax hikes on cigarettes are popular with a strong majority of Illinoisans. But the Republicans say they want Medicaid expenditure cuts instead…

The top Republicans in the Illinois Legislature say they won’t go along with Gov. Pat Quinn’s call for higher cigarette taxes to help the state’s struggling Medicaid program.

House Minority Leader Tom Cross and Senate Minority Leader Christine Radogno oppose “any tax increase to solve our Medicaid crisis.”

They noted that the Democratic governor said in his budget address that the state needs to reduce Medicaid expenditures and didn’t mention a tax increase. Cross and Radogno said they’ll hold Quinn to his word.

The Repubs don’t want cuts to providers, so they want the greatest pain to fall mainly on current recipients. That’s a political non-starter because there’s no way that Democratic lawmakers can agree to it. And the House Democrats clearly want a bipartisan proposal, so the cig tax hike might very well be dead if the Republican remain opposed…

House Speaker Michael Madigan, D-Chicago, will keep working with the governor, but finding a solution will require a “bipartisan coalition to get it all done,” said Steve Brown, the speaker’s spokesman.

Asked about the cigarette tax increase, Brown said, “I think anybody would say that you’re going to need a lot of other pieces of the puzzle to come together before you find a coalition to pass a revenue increase.”

* But Rep. Bellock is optimistic that a tax-free solution can be found…

Republicans on the working group said more cuts should be made.

Rep. Patricia Bellock, R-Hinsdale, said a number of cost-savings reforms passed by lawmakers last year still haven’t been implemented.

“We feel if we can get all of these reforms done and continue on a few major ones, we can get to $2.7 billion without increasing a tax on anybody,” Bellock said. “If we have a couple of more weeks to work on this, we think we can get to the $2.7 billion.”

* Courtesy of BlueRoomStream.com, here’s Gov. Pat Quinn’s full press conference on Medicaid…

* And here’s the Republican press conference on Medicaid…

posted by Rich Miller
Friday, Apr 20, 12 @ 11:47 am

Comments

In the budget address the Governor proposed 2.7 billion in Medicaid cuts, “we must reduce expenditures in the program by $2.7 billion in the coming year.” I am confused on how the cigarette tax is considered a cut to Medicaid. One can argue that it allows one to avoid some of the cuts, but it is not a cut itself. He should say what it really is, a package of cuts that is less than 2.7 billion in the budget address and new revenue to avoid the cuts he initially requested.

Comment by muon Friday, Apr 20, 12 @ 12:17 pm
Okay. We tax cigarettes at a buck a pack to close the Medicaid budget gap. Medicaid will continue to grow in cost in the future. Plus, higher costs of smokes cause some people to quit smoking, lowering revenue. SO, as a percentage, this new tax will become less and less of the revenue needed to fund Medicaid, causing future budget problems. Cigarette (or other “sin” taxes) are not a solution to the Medicaid problem.

Comment by Cincinnatus Friday, Apr 20, 12 @ 12:33 pm
===Medicaid will continue to grow in cost in the future. Plus, higher costs of smokes cause some people to quit smoking, lowering revenue. SO, as a percentage, this new tax will become less and less of the revenue needed ===

You’re forgetting one hugely important thing. The fewer people who smoke, the less stress on Medicaid.

Just sayin…

Comment by Rich Miller Friday, Apr 20, 12 @ 12:36 pm
Right. Someone needs to run those numbers and see where they cross.

The real point is that what I call one-off tax is a bad choice to fund a recurring expense because the revenue stream is inflexibly rigid. If the proposed tax were indexed to a percentage of the total operating stream required to fund a given level of benefits, then you at least have a stream that doesn’t require constant tinkering. Quinn builds a proposal around $1 per pack, and tomorrow, we need $1.25 because of changed behavior (statistics show each buck reduces smoking by about 10%) to fund the benefit at the same level. Raise it?

Additionally, with the reduced provider care, more and more people will skip, or be unable to receive, preventive care and end up in hospitals where care is much more expensive.

Quinn’s reliance on the cigarette tax to close the funding gap is really just more of what we have now, and doesn’t really address the underlying systemic issues, it just moves their resolution down the road a bit.

Comment by Cincinnatus Friday, Apr 20, 12 @ 1:04 pm
Before the attacks on Medicaid begin here on this post, I hope people remember that most of Medicaid goes to pay for someone’s parent, Grandma and Grandpa in the nursing home, and further consider that depriving people of this sort of financial and caregiving relief will change everyone’s life, not just poor folks. Maybe we should change society to be more collective so seniors can get the care they need in the community, but I suspect those seeking to drown Medicaid in the bathtub won’t be all that happy with that solution. So, what is the solution? Do we allow infirm seniors to live on their own? Do we make it difficult or nearly impossible for children who need to work to actually work because they have to stay at home to care for their elders? Do we teach cargiving in high school so everyone is prepared to care for the seniors in their family? How do you feel about making sure that no one who has ever made a property transfer ever (and not just within the 5 year lookback period) is allowed on Medicaid? There goes the inheritance, unless of course, your family is in the nursing home business. Or, maybe those “death panels” Republicans were so upset about back in 2009 don’t seem so bad to them now.

Comment by Ellen Beth Gill Friday, Apr 20, 12 @ 1:24 pm
===doesn’t really address the underlying systemic issues===

From what I can see, the underlying systemic issue is that Illinois has too many poor people.

Comment by 47th Ward Friday, Apr 20, 12 @ 1:25 pm
One painless way to reduce Medicaid spending? Follow 8 other states and allow midwives to become Medicaid-reimbursable providers. For those Medicad moms who want to avoid (very expensive) hospitals for their births, let them use a midwife. We figure we can avoid $5M annually.

Washington State (about half our population) saves about $2M annually from moms who want to use midwives. They are a lot cheaper than Ob-gyns and there are no hospital fees.

Here’s the report:

http://www.illinoismidwifery.org/blog/wp-content/uploads/2012/04/Reducing-Medicaid-Maternity-Care-Expenditures-Through-Utilization-of-Certified-Professional-Midwives.pdf

(Currently, midwives are not Medicaid-reimbursable providers in Illinois, and they are outlawed, so we should license them and make them reimbursable in order to save the $5M annually).

Small step, but better than the alternatives.

Comment by Dan Johnson Friday, Apr 20, 12 @ 2:21 pm
=== The Repubs don’t want cuts to providers, so they want the greatest pain to fall mainly on current recipients. That’s a political non-starter because there’s no way that Democratic lawmakers can agree to it. ===

Its also a political nonstarter because the majority of Illinoisans oppose cuts in health care services.

According to a poll by the Pew Center on the States just prior to the 2011 tax increase, majorities of Illinoisans were willing to PERSONALLY pay higher taxes to prevent cuts in education, health care and human services.

Raise taxes and then cut the services the people want most, and you’re gonna need more than an umbrella for the ensuing storm.

Comment by Yellow Dog Democrat Friday, Apr 20, 12 @ 2:27 pm
Of all the solutions I have seen to the Medicaid crisis I think forcing Hoosier children off Illinois rolls is without doubt the best. I have no doubt every night these interlopers are crossing the Wabash river or possibly even using Lake Michigan as a route into the Land of Lincoln. I honestly could not believe given the level of cuts being discussed that a question was raised relating to these children yesterday.

Why the press at the Governor’s media event let Quinn go on and on about cigarettes was beyond me when thousands of poor people will be denied coverage. I think it called spining a story.

Comment by Rod Friday, Apr 20, 12 @ 3:12 pm
The problem with that, YDD, is most people have a difficult time believing their taxes are used for these things. And you can see why when, after the tax hike, the GA is still forced to cut education, health care and human services, just not as badly as they would have had to without the tax hike.

Righter sure has a weak memory. Can’t remember if he voted for the last cigarette tax increases or if he was even around for them. Kinda hard to forget, one would think, since one was done to boost money for schools as an alternative to Edgar’s tax swap and the other to plug the budget hole when the bottom first fell out. Pretty sure he got whacked for that vote during his first campaign in 1998 after he got appointed. The tax hikes were in 1997 and 2002, Dale. Not sure how you voted in 2002, but you voted for the 1997 increase.

But never mind those votes. They were before Dale became an ultra partisan hack and pandered to tea partiers.

Comment by Anon 1 Friday, Apr 20, 12 @ 3:28 pm
One important proposal that this article doesn’t mention is a proposal that actually ADDS a service to Medicaid and by doing so is poised to save the state 5 million dollars per year simply by making a service avaiable that Illinois women are asking for. The proposal - license Certified Professional Midwives (CPM) and make them Medicaid providers. The estimate of 5 million per year is based on only 2% of babies born to Medicaid moms taking place at home with 2% being the number seen when access to CPM occurs in other states. Other states are already taking advantage of this group of providers - the ONLY birth providers who are specifically trained to attend home births - and seeing the financial benefits of simply giving women another choice where to birth.

Including CPM in the Medicaid system is a win across the board. The state saves money by actually adding a service. The midwives are held to the highest national standard of education and training that exists for home birth providers via a certification process already in place! More importantly they will be integrated into the community and no longer be commiting a crime by attending births. Illinois families will benefit by knowing their midwives are certified by a national agency. We will be able to find quality midwives and be given another choice where to have our babies. Those who do not prefer home birth will not be harmed by this addition - it will simply be a service they can chose not to utilize.

Comment by b2manatees Tuesday, Apr 24, 12 @ 11:55 am
Comparing changes in coverage from 1997-1998 and 2008-2009, 11% of children in the lowest income quartile, who were uninsured, gained insurance; however, 13% of children in that quartile who had private insurance lost it, while Medicaid/CHIP expanded by 23% of children.

In the third-lowest and second-lowest quartiles, the proportion of those gaining Medicaid coverage and those losing private coverage were almost identical, suggesting that Medicaid was replacing private coverage in the majority of cases.
Those individuals who are subject to the replacement will have poorer access to health care, because Medicaid pays less than private insurance.

Put more simply, health insurance is not the same thing as health care (http://bit.ly/HdAr4B).

President Obama’s national health care law will cost $1.76 trillion over a decade, according to a new projection released today by the Congressional Budget Office (CBO), rather than the $940 billion forecast when it was signed into law.

Comment by Carly EngageAmerica Tuesday, Apr 24, 12 @ 12:38 pm
I agree with previous posters that making Certified Professional Midwives legal providers of home birth and paid for by Medicaid will help save a lot of money.

Also taking out coverage of circumcision would cut some costs. Most states in the US’s Medicaid programs do not cover circumcision. It is then up to the parents to pay a couple hundred dollars out of pocket if they really want this totally cosmetic and elective procedure done on their son. Medicaid does not pay for other cosmetic/ elective procedures, why would it cover this one?

Comment by Jennifer B Thursday, Apr 26, 12 @ 5:18 am
License Certified Professional Midwives (CPM) and make them Medicaid providers. The estimate of 5 million per year savings is based on only 2% of babies born to Medicaid moms taking place at home with 2% being the number seen when access to CPM occurs in other states. Other states are already taking advantage of this group of providers and they are seeing tremendous savings. This needs serious consideration.

Comment by KBKRN99 Thursday, Apr 26, 12 @ 7:21 am
The Coalition for Illinois Midwifery has put together a proposal for a pilot project of just 30 Certified Professional Midwives (CPMs). These midwives are experts in attending out-of-hospital births. In fact, they are the only childbirth professionals whose certification requires that they receive out of hospital training. Allowing families who use Medicaid to give birth at home with a CPM, if they want to, will save the state millions of dollars every year. Illinois legislators have been approached by Illinois citizens for the past 33 years asking them to license CPMs. For the past 12 years there has been a licensure bill filed and in play during every session. Illinois legislators have repeatedly declined to license CPMs due to the sole opposition (based upon unfounded claims) of the Illinois State Medical Society (ISMS). Twenty seven other states in the U.S. do not have a problem with the the CPM credential. Not one state has ever rescinded their CPM licensure law, once passed. The entire country of Canada does not have a problem with this credential either. Yet the ISMS continues to oppose licensure, quoting scientific studies, such as “the Wax Paper” (Dr. Joseph Wax et al.) that have been repeatedly repudiated for their multiple mathematical errors and flaws in design. The University of British Columbia has compiled an annotated bibliography of every recent study of home birth and ranked them according to their quality of design. It can be found here http://www.washingtonmidwives.org/assets/Home-Birth-Annotated-guide-to-the-literature-May2011.pdf
It shows that a) the ISMS is basing it’s argument on bad science and b) around the world, home birth with licensed direct entry-midwiives (CPMs in the case of the U.S.) is safe. If our legislators continue to heed the ISMS warnings based upon flawed studies, rather than heed a smart proposal based upon well designed studies, they will miss a wonderful opportunity to save millions in Medicaid dollars without taxing anyone’s vices or reducing anyone’s paycheck or taking away anyone’s healthcare. AND they will solve a problem that has long plagued the state - the problem of not having nearly enough midwives to attend all of the home births that occur annually in our state - approximately 800 per year and expected to rise. Licensing CPMs is a win-win-win situation.

Comment by Jiandra Monday, Apr 30, 12 @ 5:50 pm