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When spending less costs more

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* From the Illinois Alcoholism Drug Dependence Association…

[Gov. Bruce Rauner] is aiming to slice $27.6 million out of the $127 million budget of the Illinois Department of Human Service’s Division of Alcohol Substance Abuse for alcohol and drug treatment, a 22% cut.

A cut of that magnitude would eliminate addiction healthcare treatment for 7,871 individuals next year out of the 47,000 currently receiving care this year or a 17% overall decrease, according to Illinois Alcoholism and Drug Dependence Association Vice President for Substance Abuse Policy Eric Foster, who noted that funding for addiction health care has been cut 24% since fiscal year 2009.

“Tossing 7,871 people out of treatment means tossing them out of any meaningful opportunity to get a job,” said Foster. “Any good, modern businessman, especially a small businessman, knows that healthy employees are productive employees. It’s economics 101.”

According to 2014 data from the Illinois Department of Human Services’ Division of Alcohol and Substance Abuse, 35% of individuals entering treatment outpatient services are employed at admission, and that number grows to 42.6% employed at discharge. For those who receive treatment at Halfway House Recovery Homes 13.3% employed at admission and a whopping 38.7% employed at discharge. […]

“Since 2009, the state has slashed $39.7 million from treatment, denying care to 8,941 individuals in order to solve annual, chronic budget problems,” said Foster. “The cutting of addiction health care by Governor Rauner is just Springfield business as usual. There’s no ’shaking up Springfield. Simple-minded cutting is what Rod Blagojevich and Pat Quinn did each year.” […]

“A 2005 study by Bloomington-based Chestnut Health Systems of more than 800 Illinois adults reported that treatment produced a 58% decrease in drug and alcohol use and a 69% increase in employment engagement,” said Foster. “Cutting programs that deliver results and that help low-income workers, minorities, and women is not “thinkin’ anew”, it’s just the same old Springfield playbook.” […]

“A 2006 study of prisoners completing the Illinois Sheridan reentry prison treatment program revealed that 21% were less likely to be re-arrested for a new crime and 44% were less likely to return to prison,” said Foster. “The creation of the Sheridan program was a symbol of innovation, and the Rauner Administration needs to expand treatment for offenders if it is serious about reducing Illinois’ prisoner population.”

Discuss.

posted by Rich Miller
Wednesday, Feb 25, 15 @ 9:57 am

Comments

Seriously — what’s the worst thing that could happen if Rauner recklessly slashes addiction healthcare treatment?

Someone drunk and addicted to pills might try to to rob a Walgreen’s drive-through by giving the pharmacist “a note threatening to blow his head off unless he handed over prescription painkillers”?

Seems unlikely, right?

– MrJM

http://www.chicagomag.com/Chicago-Magazine/October-2014/Bruce-Rauner/

Comment by MrJM Wednesday, Feb 25, 15 @ 10:11 am
It would be good if the Rauner admin explained why these cuts, and why these amounts. Presumably there is a rationale, but if they don’t lay it out, all that taxpayers hear is angry opposition.

One question I would have is whether the expansion of health insurance under the ACA affects the need for state governments to fund care directly. If patients can get their care funded under their individual insurance policies, Medicaid or subsidized private insurance, why would anybody with (now) federally mandated health insurance be denied care.

Not sure about prisoners, they could be a special case, but presumably at least some inmates have health insurance from when they were outside. Are we billing those policies or just switching them all to free taxpayer-funded care automatically.

Comment by Cassandra Wednesday, Feb 25, 15 @ 10:13 am
==Not sure about prisoners, they could be a special case, but presumably at least some inmates have health insurance from when they were outside. Are we billing those policies or just switching them all to free taxpayer-funded care automatically.==

Could be something to look at, although if they’re in prison how are they paying their premiums and keeping those policies?

Comment by Anonymoiis Wednesday, Feb 25, 15 @ 10:18 am
Donna dont care donna sez get a job

Comment by foster brooks Wednesday, Feb 25, 15 @ 10:20 am
Well, I imagine some of them have spouses and family policies.

Don’t get me started on why mass incarceration is such terrible social policy. Many probably do have to lapse their policies along with losing their jobs, their families, their chance for a decent life. But anyway, one wonders if anybody in the correctional health system checks. They probably don’t get cut off immediately.

Comment by Cassandra Wednesday, Feb 25, 15 @ 10:22 am
I think it’s pretty clear the Rauner peeps finished their term paper on the bus to school after pulling an all-nighter.

“…..and, um, half the local income tax, um, let’s say, $700 million in health benefits, and, what more do we need? Okay, $2.2 billion in pension savings. Done.”

Why they didn’t ask for an extension, I don’t know. It would have been a reasonable request from a new administration.

Comment by Wordslinger Wednesday, Feb 25, 15 @ 10:27 am
Cassandra

When I was an Officer Inmates were on the Medicaid roles.

Comment by Mason born Wednesday, Feb 25, 15 @ 10:27 am
if you are a compassionate individual, concerned about human lives and suffering, then this analysis makes sense. but rauner doesnt look at people. he looks at costs. gotta cut costs. get on board, so he doesnt have to come after you with his $20 mil hospitality fund. it will only hurt for a little while. then illinois will be boomin’ again.

Comment by langhorne Wednesday, Feb 25, 15 @ 10:28 am
@ Cassandra: “presumably at least some inmates have health insurance from when they were outside.”

The number is probably statistically insignificant.

Comment by JoanP Wednesday, Feb 25, 15 @ 10:31 am
Ms/Mr Mason Born
Which century was that? Wing nuts put a brick on that a long time ago.
This is simple one part of team BVR wants to unload the prisons while other are makin’ moves to fill up
Perhaps they were able to reconcile those approaches durin’ the big Cabinet Confab

Comment by Anonin' Wednesday, Feb 25, 15 @ 10:32 am
Senator Cullerton said the same thing about cutting dental care for Medicaid participants. Doing that will cost the state more in the long run.

Comment by Joe M Wednesday, Feb 25, 15 @ 10:33 am
Is there any reliable data on how successful that program is? Or do we just pay for it because it sounds nice? I would like to see the advocates on both sides put forth hard justifications for their positions, even tho that is something we rarely do in Illinois.

Comment by Harry Wednesday, Feb 25, 15 @ 10:34 am
===”Presumably there is a rationale.”===

Cassandra: that’s a reasonable observation and question.

But it’s quite a presumption. More likely they had a whole bucket of human services programs, and more money just needed to be cut from the whole category.

It’s curious that many Republican governors are touting cover from ACA when cutting state programs, while their Congressional colleagues just voted (for the 53d time?) to repeal the act.

The most difficult thing to deal with when deciding on these human services cuts, is that dozens of organizations can and do make the “pay now or pay more later” claim, many with pretty good data to back it up. That’s in addition to any moral arguments they make. Some claims are stronger than others.

The best cases are where we already tried it both ways, like dental coverage in Medicaid, and we actually did spend more elsewhere when it was cut.

Comment by walker Wednesday, Feb 25, 15 @ 10:38 am
I agree with Mr. Foster. Given proper treatment one of those addicts could grow up to be the king of the whole world and start 35 million new industries each employing billions of people and bringing in untold kabillions in economic activity. This real world budget is having a serious impact on fantasyland numbers.

Comment by Thunder Fred Wednesday, Feb 25, 15 @ 10:44 am
===There’s no ’shaking up Springfield. Simple-minded cutting is what Rod Blagojevich and Pat Quinn did each year.”===

Great line, which I think sums up the entire situation pretty well.

Comment by Dean Keaton Wednesday, Feb 25, 15 @ 10:44 am
I am the CEO of a treatment facility in the Chicago south suburbs. Our referrals are from hospitals, courts, jails, state mental health facilities, etc. Any assumption that cutting treatment saves money has no basis in fact. Without treatment costs are shifted to more expensive levels of care.

Comment by Allen Sandusky Wednesday, Feb 25, 15 @ 10:44 am
Anonin’

That was my understanding at the time. If I am incorrect I apologize. It was a decade or so not a century.

Comment by Mason born Wednesday, Feb 25, 15 @ 10:47 am
MrJM does it again!

Treatment for me (and mine!), but not for thee.

Comment by Jocko Wednesday, Feb 25, 15 @ 10:52 am
Your dog has access to better heath care than inmates.

Comment by Tobor Wednesday, Feb 25, 15 @ 10:53 am
The Sheridan program was a sham. Talk to anyone who works in parole. The were not allowed to violate inmates parole if they were a part of that program.

Comment by Me Wednesday, Feb 25, 15 @ 10:57 am
Cassy, why would you think inmates had private health insurance? Even if they did, how would the maintain it in prison?

Comment by Wordslinger Wednesday, Feb 25, 15 @ 11:05 am
He is workin’ hard, thinkin’ of ways of keepin’ the boat afloat. Today’s idea, linin’ up more of those in need of a helpin’ kick from the toe of his huntin’ boots, sendin’ them flyin’ overboard.

Comment by DuPage Wednesday, Feb 25, 15 @ 11:09 am
Numerous studies have proven the cost-effectiveness of substance use disorders (SUD) treatment. To cite one based in Illinois, Dennis and Scott (NIDA Grant No. R37 DA011323) found that 4,930 clients produced $20.6 million in health care utilization costs in the 90 days before they entered SUD treatment. They found that cost of treatment was offset in 18 months and generated net savings to Illinois tax payers of $14,589 per person over 4 years. The proposed cuts are a clear case of cuts that will produce significantly more costs to Illinois over the long run.

Comment by JCollord Wednesday, Feb 25, 15 @ 11:31 am
As I said above, everybody is supposed to have health insurance now, by law, and the policies of people going into the correctional system must be in efffect,for a while. Not everybody who goes to jail is a derelict who has been living on the streets for eons. Some arrestees have jobs. So is anybody checking, before the correctional system hands out unreimbursed, taxpayer-funded care. Ditto other govt health systems, including those providing addiction services. More importantly, why is anyone being denied care with the ACA now fully in effect in Illinois.

Alas, I remember those Cook County Hospital stories, whereby clerks refused to even accept health insurance info because it was easier to just bill the taxpayer and not the insurance co, or even Medicaid.

Comment by Cassandra Wednesday, Feb 25, 15 @ 11:36 am
==- MrJM - Wednesday, Feb 25, 15 @ 10:11 am:

Seriously — what’s the worst thing that could happen if Rauner recklessly slashes addiction healthcare treatment?

Someone drunk and addicted to pills might try to to rob a Walgreen’s drive-through by giving the pharmacist “a note threatening to blow his head off unless he handed over prescription painkillers”?==

Real classy. When the right attacks a Dem through their children, they have no shame. When a left winger does it, it somehow makes a legitimate point. Thought Mr. JM was better than that.

Comment by Western Ave. Doug Wednesday, Feb 25, 15 @ 11:44 am
Cassandra - Everybody is supposed to have health insurance, but coverage of substance use disorders has significant gaps. For one thing, insurance companies don’t have a lot of experience covering the more serious addictions that require residential or intensive outpatient, so coverage often falls far short. These are the same insurance companies that are managing care for the new Medicaid patients as well. For another thing, Medicaid doesn’t cover all services, such as case management.

Another issue is that every state gets federal money for substance use disorders treatment, but the formula for those grants requires a maintenance of effort which amounts to a match. Ultimately, the federal government will reduce Illinois’ grant by a similar amount of cuts, resulting in $2 cut for every $1 cut by Illinois.

Comment by JCollord Wednesday, Feb 25, 15 @ 11:47 am
Theres no need to fear….. Thenprison syst will pick up a good chunk of these folks. It is after all cheaper to imprison people then to treat them…. Right?…..

Comment by Ghost Wednesday, Feb 25, 15 @ 12:21 pm
At a time when we have record numbers of people lingering in prisons all over the country, many of them addicted or emotionally un-prepared for life, we’re going to continue to cut the budget for rehab? We lead the world in number of people living to prisons. This is exactly where more money needs to be assigned.

It was one of the many things that annoyed me about Quinn.
Who has the contract to build more prisons?

Comment by Belle Wednesday, Feb 25, 15 @ 12:29 pm
When Blagojevich attempted to slash funding for addiction treatment, Flannery dubbed them “the dumbest budget cuts ever.”

There is broad bipartisan support for treatment, and intentional or not, he is building the case for a tax hike brick-by-brick.

Comment by Juvenal Wednesday, Feb 25, 15 @ 12:31 pm
According to a 2000 study done by University of Missouri, St. Louis of former Illinois prisoners who had drug or alcohol addition. Treatment completers had a recidivism rate of 37%
after four years, those who failed out of treatment had a recidivism rate of 67% after four years. Drug users without any treatment had a 53% recidivism rate after four years.

But this same study did not quantify the percentage of former Illinois prisoners who failed out of post prison treatment programs. From national data I have seen 50 to 60% of those entering treatment fail out their first attempt.

So looking at the data I suspect that extreme conservatives like Governor Rauner who look at the cost reward ratios of programs unfortunately view these programs which are successful for a significant minority of drug and alcohol abusers as not being cost efficient. I doubt they will admit that, because after all they are compassionate conservatives.

Comment by Rod Wednesday, Feb 25, 15 @ 12:34 pm
Ghost - You are right that the Illinois prison system will pick up a good chunk. But this will increase costs instead of decrease them. It costs over $30,000 to put a drug offender in the Illinois prison system for year compared to less than $10,000 to put them into treatment. This proposed cut will signficantly increase costs for the Illinois prison system.

Comment by JMann Wednesday, Feb 25, 15 @ 12:35 pm
I didn’t attack Bruce Rauner or his (adult) child.

Bruce Rauner’s budget will eliminate addiction healthcare treatment for thousands. And as much as some of us would like to pretend otherwise, drug and alcohol addiction can strike any family. Even “good families” from “nice communities”.

Bruce Rauner’s actions will have terrible, terrible consequences for thousands of individuals and families across Illinois. Lives will be ruined and families will be destroyed.

And the shame of it isn’t that Bruce Rauner SHOULD know better — the shame is that Bruce Rauner DOES know better.

– MrJM

Comment by MrJM Wednesday, Feb 25, 15 @ 12:40 pm
@Belle12:29 =Who has the contract to build more prisons?=

I think the state just sold a brand new prison to the federal government. I hear another new one downstate is under utilized. Meanwhile the remaining prisons are overcrowded.

Comment by DuPage Wednesday, Feb 25, 15 @ 12:45 pm
Cassandra 11:36

== So is anybody checking,… ==
I believe that ‘assumes’ staff to do the checking. Each additional ‘new check’ requires someone or some system to do the work.

== Alas, I remember those Cook County Hospital stories,… ==
I dare say that every public and private organization has some ’stories’ of excesses, screw ups, and one-eaches that someone can point out as waste or lack of follow-thru. GM has them; IDOT has them; legislators have them.

Comment by sal-says Wednesday, Feb 25, 15 @ 12:45 pm
Not a very smart move by Gov. Rauner.

Comment by Jack Stephens Wednesday, Feb 25, 15 @ 12:56 pm
Every group says, “Cut everybody else, but not me. I’m too important”! Gets tiresome. Every program needs cuts - they’ve been living on fake borrowed money for too long.

Comment by Formerpol Wednesday, Feb 25, 15 @ 1:06 pm
States can now apply to have Medicaid cover prison inmates. In many cases, that would mean the feds would cover 100 percent of the costs until 2017, as they would be new enrollees. Not sure Illinois has signed up, though. At least the inmates would be eligible for the basic ACA package the rest of us get under ACA laws. That would include some addiction services.

Comment by Cassandra Wednesday, Feb 25, 15 @ 1:40 pm
Cassandra@1:40p
So, you’re suggesting addicts commit felonies to receive health care? Seems costly to me.

I wonder if Donna Arduin is advising Rauner to have the elderly and chronically ill do likewise.

Comment by Jocko Wednesday, Feb 25, 15 @ 1:54 pm
Addiction is a disease and has been defined as such by the American Medical Association once the late 1950s. It kills more people than diabetes or Alzheimers, yet lags behind those diseases in terms of funding, especially when comparisons are made in terms of dollars per patient. Many politicians are saying that we need to act in order to stem the current opioid and heroin epidemic, yet no action is complete without funding. If the Governor wants to address a public health emergency, he needs a serious budget to do so.

Comment by Slingshot Wednesday, Feb 25, 15 @ 2:21 pm
Jman yep…. I was going for snarkcasm

Comment by Ghost Wednesday, Feb 25, 15 @ 2:26 pm
Speaking from personal experience within my family, cutting back on funding and services for people dealing with substance abuse problems will only cost more in the end (I’m guessing, but probably a lot more). It’s often difficult for folks to find services when they need them. It’s hard to be told that a program is full and a slot won’t open up for a while. And, when someone who wants to get help can’t get it, it’s difficult to impossible to break the cycle of abuse.

Comment by Phil Wednesday, Feb 25, 15 @ 2:27 pm
==Every program needs cuts==

Yeah. That’s the answer. Cut indiscriminately without thought of the consequences. Good idea. Not.

Comment by Demoralized Wednesday, Feb 25, 15 @ 3:06 pm
Study after Study demonstrates that treatment works and that it is FAR MORE cost effective than the longer term effects of untreated substance abuse! The citizens of Illinois cannot afford to have their access to treatment cut any further than it already has been!!

Comment by Merry Beth Wednesday, Feb 25, 15 @ 3:29 pm
Dear Cassandra,

You are right, some arrestees have jobs.

But arrestees are very different from jail detainees who are very different from IDOC inmates.

We don’t send employed and law-abiding (insurance mandate-following) substance abusers to prison where they might soak up unreimbursed, taxpayer-funded care for up to 60 allowable days* without making a monthly Obamacare payment.

* most prison-carrying felonies take well over 60 days to resolve, so the person is uninsured by the time they reach IDOC.

Nor is it in the state’s interest to invent an entire new layer of medical billing bureaucracy for the rare rich fish who slips through the net.

Lalaland.

Comment by crazybleedingheart Wednesday, Feb 25, 15 @ 4:00 pm
Nobody seems to be arguing that the cuts are good, folks. They are simply saying this is how much revenue we have, so something has to give. A very good businessman told me many years ago that expenses are easier to reduce than increasing income. It’s logical that we see the cuts first, and we get to tell our government what they should cut instead of treatment.

Comment by steve schnorf Wednesday, Feb 25, 15 @ 4:02 pm
“A very good businessman told me many years ago that expenses are easier to reduce than increasing income.”

Was that “good businessman” making drug and alcohol addiction treatment policies for a state?

– MrJM

Comment by MrJM Wednesday, Feb 25, 15 @ 5:21 pm
Man, Schnorf went into the tank for Bruce faster than expected. That LCC appointment must mean a lot to you, eh Steve?

Comment by Anonymous Wednesday, Feb 25, 15 @ 7:57 pm
If Steve’s in a tank, I’m jumping in with him. His usual comments are just about making the numbers work, which isn’t especially pro-Rauner.

All these cuts are tough to swallow, and destructive in some ways. Tax increases are hated by most voters to whom the legislators are supposed to answer. These are tough issues, but the numbers have to work, and the public has to buy in as well. We keep asking if not this cut, then what? Is there a level of spending that must be reached to gain neede support for higher taxes? How do we get to a balanced budget? No one is there yet. Most responsible commenters do have thoughtful positions on the tradeoffs.

Comment by walker Wednesday, Feb 25, 15 @ 11:14 pm
I’m looking at this as a budget issue, not as a late night dorm room philosophical debate by college sophomores. And, not on day 1, but at the end, the numbers need to work. We have no way of knowing yet what “at the end” will look like, but that’s when we should judging the totality of the budget. Believe me, right now we are supposed to looking at the cuts and decrying them. If I’m wrong, tell me how, and what is going on instead. If saying this out loud puts me in the tank, so be it, but I believe the budget he introduced for the main part does us a great favor. I tells us the truth Quinn tried to tell us in his last budget but couldn’t pull off. Maybe I’m in the tank for Quinn too.

Comment by steve schnorf Thursday, Feb 26, 15 @ 12:26 am