Bill Brady thinks Illinois' Medicaid program is "one of the worst run systems" in the country. Public health experts disagree.
Bill Brady says he will fix the state's deficit budget if elected governor in November. Yet when asked to explain in detail how he plans to close the gap without any new revenue, the Bloomington Republican has been wildly inconsistent, modifying, ignoring, or backtracking from statements that have served as central components of his stump speeches thus far.
What's more, some of the ideas on which Brady stands firm are divorced from reality. Take, for example, his views on Medicaid. In an interview Monday evening with Fox Chicago, Brady characterized Illinois' public health plan as "one of the worst run Medicaid systems ... in the country." Watch it (the full interview is available here):
BRADY: We have one of the worst run Medicaid systems, health care systems in the country. We don't give access to people at the earliest stages and it costs us a lot more money, not to mention the quality of life.
In 2007, the Public Citizen Health Research Group published a report titled "Unsettling Scores" that attempted to rank state Medicaid programs using four metrics: eligibility, scope of services, quality of care, and provider reimbursements. Illinois scored markedly well on scope of services -- fifth nationally -- in part because the program adequately covers the medically needy, meaning those with inordinate medical costs.
It also scored above average (16th) for quality of care. Those enrolled, in other words, have access to high-quality services and doctors.
Overall, however, Public Citizen ranked Illinois' Medicaid system just 32nd nationally. Where do we go wrong? First, our reimbursement rate is very low, especially compared to the rate at which Illinois doctors who provide Medicare services are reimbursed.** That's part (but not all) of the reason why Illinois spend less per patient than 41 states. Secondly, while both Republican and Democratic administrations have rightly expanded coverage to include more working people left behind by the employer-based system, some services are restricted to those at the lowest poverty levels.
It should be noted, however, that this report was published before Illinois ramped up its public managed care programs (which are both different than the "capitated" managed care approach proposed by Republicans). The goal of this program is to connect Medicaid recipients with primary care doctors and more effectively manage chronic diseases. Now, doctors are meeting more frequently with patients to administer preventive care and are coordinating those treatments with other providers the patient might see. Granted, the programs still have plenty of kinks. But last year alone, the state saved $320 million as a result of them. And those savings are expected to rise over time.
What's the lesson here? Illinois' Medicaid program is not a perfect model by any means. Providers get stiffed and the system, like the rest of the health care industry, is subject to rising costs. That being said, Medicaid delivers real economic security to the millions of working class Illinoisans who rely on it. And the reforms in place are already holding down costs.
In short, we're far from "one of the worst run Medicaid systems" in the country. Brady might want the working poor off the Medicaid rolls, but it's going to be difficult to wring substantial savings out of a relatively well-functioning system.
** (5/13): The wording of this sentence has been updated for clarity.