Progress Illinois

The backlog of payments to Medicaid providers is a serious problem in Illinois. When these notoriously low reimbursements to primary care physicians administering care to Medicaid patients don't arrive on time, it makes the doctors increasingly reluctant to treat that population. That diminishes health care access for some of the state's most vulnerable citizens, thus raising the potential for public health outbreaks and preventive disease and deaths. It's an unsound system, both economically and morally.

Since the recession hit, Illinois has been making payments to most providers by the skin of its teeth, thanks almost exclusively to President Obama's stimulus bill, which provided $2.9 billion in short-term federal aid. Congress could pass along a little more help if the Democrats' health care reform bill passes; the version that the House approved provides $23.5 billion for state legislatures to pay a higher share of all Medicaid costs -- 66 percent on average, up from 57 percent prior to the stimulus -- for an additional six months in 2010.

This morning, the state also took some independent action aimed at solving this problem, as Gov. Pat Quinn signed into law HB 542, sponsored by Rep. Dan Reitz (D-Sparta) and Sen. Jeffrey Schoenberg (D-Evanston).

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The federal government is one step closer to providing health care and retirement benefits to domestic partners of its gay and lesbian employees. Yesterday, the House Oversight and Government Reform Committee approved H.R. 2517 by a 23-12 vote. Illinois Democrats Mike Quigley, Danny Davis, and Bill Foster all supported the legislation. GOP Rep. Aaron Schock voted against it. From Alyssa Rosenberg's report on the contentious hearing:

Republican committee members argued that the 2009 Domestic Partnership Benefits and Obligations Act was an inappropriate extension of benefits to a small subset of federal employees at a time when unemployment was rising. They also said such a move would threaten the definition of marriage as a union between a man and a woman, and could open the door to fraud by people of the same sex who simply wanted access to benefits.

Democrats countered that extending access to health and survivor benefits to the same-sex partners of federal workers in exchange for an agreement that those employees would abide by rules governing nepotism and financial disclosure for their partners, was a matter of equality and of establishing the federal government as an inclusive, competitive employer.

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Yesterday afternoon, as part of the Campaign for a Better Health Care's annual conference, Gov. Pat Quinn and Democratic primary challenger Dan Hynes engaged in an hour-long debate on health care reform. Because it costs the state money to provide coverage to the poor and to protect public health, the debate routinely veered into discussion about the state deficit and the gubernatorial candidates' competing tax reform proposals. When it did, things got snippy. Watch this compilation:

Notice how neither candidate even broaches the most important aspect of this debate: how they plan to convince the legislature to go along with their respective proposals next year. In a sense, this debate is taking place solely in the abstract.

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America's Health Insurance Plans (AHIP) kicked off its annual conference in Chicago this morning and health care reform is sure to be a major topic of discussion. Just over two weeks ago, AHIP CEO Karen Ignagni said her organization -- the nation's top health insurance lobby -- was "concerned" that the recently-passed House bill will increase health care costs for families and employers across the country and "significantly disrupt" coverage for millions more. This came after Ignagni's months of lip service to Democratic leaders about her support for their broad proposal.  The group even commissioned a study to back up its conclusions about the bill, but the findings were largely dismissed for shoddy math and effectively refuted by the Congressional Budget Office's analysis.

Today, eight small business owners affiliated with the Main Street Alliance showed up at the conference with a simple question for Ignagni: Why is AHIP attempting to maintain the status quo? After sending a letter Friday requesting a meeting, the entrepreneurs were not surprisingly rebuffed.  Instead, they appeared outside the conference, where they explained, one-by-one, how the exploding cost of health care premiums was making it difficult to operate profitably. Watch some excerpts:

Following the press event, the business owners took to the streets, joining hundreds of their friends and allies -- including numerous labor leaders and reform advocates -- in a protest across the street from the conference.

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Today, Senate Majority Leader Harry Reid is expected to receive an analysis from the Congressional Budget Office (CBO) on his chamber's health care bill. Sources tell ABC's George Stephanopolous that the package will cost below $900 billion, will extend coverage to most Americans, and will reduce the deficit in both the short- and long-term. That report would clear the way for the leadership to bring the bill to the floor, perhaps by the end of the week.

One reason the legislation will score well is in the inclusion of a public option (with an opt-out clause for states), which the CBO predicts will hold down costs, even if the version eventually approved is weaker than liberals prefer. Last night, progressive senators met with Reid to reiterate the importance of the government-run plan, both as a check against insurance companies and as a testing ground for important insurance and delivery system reforms.

But both Reid and Sen. Dick Durbin aren't sure there's enough support in their chamber yet. With conservative Democrats and Connecticut Sen. Joe Lieberman already hinting they would join Republicans in a filibuster, Reid estimates they are currently three votes short of passing the procedural hump. On MSNBC last night, Durbin said he was "struggling" to whip his members. Watch it, courtesy of TPM:

Perhaps the CBO score will provide Durbin with some key ammunition. Only time will tell.

Here's the latest in health care news ...

A Silent Stimulus?

To weather the unrelenting economic recession without slashing services, state governments are going to need more assistance from Washington. Luckily, some help is on the way. And it's coming via an unlikely source.

Today, the Washington Post reports that wedged into the House health care reform bill passed two weekends ago was $23.5 billion directed at states to cover short-term Medicaid costs. Here are the details:

Medicaid relief for states comprised one of the biggest pieces of February's $787 billion federal stimulus package, but that funding will run out next year, halfway through states' next round of spending plans.

Under the Affordable Health Care for America Act, the federal government would continue to pay a higher share of all Medicaid costs -- 66 percent on average, up from 57 percent before the stimulus -- for an additional six months, and erase in one fell swoop a major chunk of states' projected shortfalls for the coming year.

If enacted, this would be a huge boon to state lawmakers clawing to close projected 2011 budget gaps in the coming months. The provision is not included in the Senate version yet, but there is still plenty of time to insert it.

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Over the past year, Capitol Hill has been portrayed as ground zero in the health care debate. But the heart of the fight was never in D.C. Rather, it was in the millions of households across the country, where the uninsured and the underinsured live in fear, knowing that they can't afford to get sick or even find insurance companies willing to enroll them because of pre-existing conditions. Just a week after the House passed landmark legislation to finally change that, Democratic U.S. Rep. Bill Foster was back in the 14th District today. There some of his constituents made the case for why the nation can't afford to wait any longer to see those reforms through.

"My husband and I, we've done everything right," Amy Ruppert of Batavia said, "We don't have any outstanding debt. We've paid all of our bills." But with her COBRA plan set to expire within months and a pre-existing condition prohibiting her from buying into a new plan, "we will be one step away from catastrophic financial devastation," she said. Watch:

Over the past couple of day, we've highlighted statements of disgust from Illinois congressmen and candidates about the restrictive anti-choice amendment added to the House health care bill that passed last weekend. But abortion isn't the only hot-button issue that could complicate the Democrats' reform effort. Immigration is emerging as a potential sticking point, as well.

Lawmakers in both chambers have decided that insuring undocumented immigrants is not politically feasible. But as the final details are ironed out, Republicans and some Democrats are working to limit the assistance and consumer protections available to undocumented and legal immigrants alike. Legal immigrants who have been in the country for less than five years would not be eligible for Medicaid and Medicare, following current law, even though they are eligible for government subsidies on the exchange. And while the House bill allows those in the country illegally to purchase insurance on the health insurance exchange with their own money, the Senate is likely to bar them entirely.

Immigrant rights advocates aren't too pleased that protections for immigrants, who face mounting disparities in health care access and outcomes, are eroding. If the conference committee bill tracks more closely to the Senate version, Rep. Luis Gutierrez says the White House won't be able to count on his vote.

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Some more health care news...

Moderate Democrats Voice Concerns

In her Sun-Times column this morning, Carol Marin singles out Democratic Reps. Melissa Bean and Bill Foster for their yes votes in favor of health care legislation this past weekend:

We may disagree with one another on whether, in the end, this legislation is good for America. Or whether we as a nation can afford all of its provisions.

But what is harder to disagree with is that health care in this country, at the moment, is a ragged, patched quilt of different levels of coverage.

And for between 35 million and 45 million of us, there's no coverage at all.

That's why this vote, to my mind anyway, was historic. And why it took some moxie to say yes.

Foster told Marin that his vote was "easy," yet he's still publicly criticizing some key planks of the legislation including the design of the public option. Foster contends that if the government is allowed to borrow money for start-up costs at a lower interest rate than private companies, the insurance industry will be put at a disadvantage. Bean isn't totally sold yet, either. She tells the Pioneer Press that she's seeking "improved cost containment measures" like the creation of an Independent Medicare Advisory Council, which would have the authority to make recommendations to the president on annual Medicare payment rates and other reforms.

Meanwhile, Rep. Debbie Halvorson has released a slick video explaining why she supported the legislation. There aren't a lot of legislative details in the spot, but there are three testimonials from women in the 11th district who have faced medical and financial strains because of inadequate health insurance coverage. "I really believe this bill," Halvorson says to close the piece, "is going to move us into the direction of affordable, accessible, and quality health care." Watch it:

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Rep. Jan Schakowsky isn't the only Chicago Democrat taking a stand in favor of reproductive rights. In a statement released this afternoon, Rep. Mike Quigley said he too will vote against a final health care reform bill if it contains the Stupak-Pitts amendment language:

On Saturday, we entered the final stretch of a 100-year march toward extending health care coverage to the millions of Americans who currently live without.  I’m proud that we were able to move historically forward on health care reform, but was very disappointed with the inclusion of the anti-choice language in the bill. As we continue to refine the bill, we must make sure that this progress does not come at the expense of the more than 150 million women in America.

The goal of overhauling the heath care system is equality – to give every American access to comprehensive coverage and make it affordable.  The Stupak amendment disrupts that very equality and does exactly the opposite.  It says only women who can afford insurance deserve access to reproductive health care and marks an unprecedented restriction on people who pay for their own insurance. It directly and unfairly attacks the rights of lower and middle class women.

I will continue to fight to remove this discriminatory language before a final bill reaches the President’s desk and ensure that women do not become sacrificial lambs on the path to health care reform.   I will not vote in favor of a final bill that contains language to restrict a woman’s rights any further than current law.  If choice is out, so am I.

Both Quigley and Schakowsky spoke out against the amendment on the House floor this past Saturday.  Letters signed by them and other opponents of the measure will soon be sent to House Speaker Nancy Pelosi and President Obama.