Health Care

Finding A Way To Pay

Adam Doster — Fri, 20 Nov 2009 14:16:57 -0800

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). The bill frees up $120 million from the state's Hospital Assessment Program to make payments to hospitals treating a high level of Medicaid patients, as well as pharmacists and smaller medical providers previously shafted by the stop-gap state budget. Making good on those payments could trigger additional matching funds from Washington, totaling an estimated $1.1 billion over the next two years. Here's Schoenberg's statement:

“Hospitals and other health care providers are key economic engines in communities all over the state, with hospitals employing nearly a quarter of a million Illinoisans and supporting many other businesses, including suppliers and vendors,” said Sen. Schoenberg. “At a time when unemployment continues to climb, this legislation will also create an immediate economic stimulus to preserve jobs and provide the residents of our state continued access to quality health care.”

Accessing all of the available resources is smart policy. And hopefully, Congress will ante up more state aid shortly to counteract the boom/bust budgetary pressures here in Illinois.

But let's be clear: These are short-term fixes to a problem that's dogged Illinois since well before the economy collapsed. Contrary to the talking points you'll hear from the Illinois Republican Party, the state is making solid progress at controlling rising Medicaid costs. We just need sustainable revenue to ensure we can pay the bills going forward.

Image used under a Creative Commons license by Flickr user Big Grey Mare.

Quigley Leads Charge On Domestic Partner Benefits Fight

Adam Doster — Thu, 19 Nov 2009 09:08:39 -0800

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.

In a fascinating volley between the two parties, Rep. Jason Chaffetz (R-UT) offered an amendment calling for the Government Accountability Office to study, two years after the bill's implementation, how the extension of domestic partnership benefits impacts health care premiums for other employees. Quigley quickly countered, filing an amendment requesting a similar report on whether the bill increased federal recruiting and retention -- an often-overlooked factor in such cost-benefit analyses. Both measures passed.

Here's Quigley's statement on the vote:

“The fact that the federal government, which should be setting an example for the rest of the nation’s employers, is currently discriminating against individuals based on their sexual orientation is frankly, embarrassing,” said Quigley. “Not only are we denying people thousands of dollars in benefits and violating our equal pay for equal work laws, but we’re making the government less competitive for top talent than private sector employers, 10,000 of which offer benefits to people no matter who they choose to love.”

According to The Advocate, the full House could vote on the measure before the end of the year.

Quinn-Hynes Health Care Debate Turns Towards Tax Reform

Adam Doster — Thu, 19 Nov 2009 07:33:23 -0800

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.

Also of note in the video above: Towards the end, you'll hear Quinn name-drop an October study from the Institute on Taxation and Economic Policy (ITEP) which determined that the amount of revenue the Hynes campaign projects their tax package will generate ($5.5 billion annually) is dramatically overstated. We highlighted this finding when the study was released, noting that the discrepancy stems from the amount of taxable income reported by the highest earners in the state, who would be subject to the highest income tax rate if Hynes' progressive income tax amendment was adopted. The Hynes campaign's numbers appear to assume that all of that wealth will be taxed, ignoring the ways in which rich Illinoisans shelter their income. That said, the campaign has not disclosed their methodologyand we've had trouble getting the underlying data from the Illinois Department of Revenue, so it's still unclear how Hynes (or ITEP, for that matter) reached their conclusion. But it's a big, nagging question that the local media has categorically ignored.

Of course, tax reform was only one component of the debate. Unlike their GOP counterparts, three of whom turned down CBHC's invitation to appear yesterday, Quinn and Hynes both called health care reform a fundamental human right and promised not to opt out of any ofthe provisions in the federal health care bill should it be approved. Instead, they both agreed in principle to implement the federal regulations and coverage mechanisms thoroughly and then extend state-based coverage (depending on cost) to anyone still unable to receive affordable care.

Because he knows the consequences of bad budgeting, the comptroller emphasized "his obsession withfinancial responsibility." As governor, he said he would push to makethe higher reimbursement rate for Medicaid, which was established under the stimulus, permanent and continue to push for stem cell research at the state level (as he did in Illinois when President Bush eliminated federal funding). Quinn repeatedly reminded the audience of his 2001 walk across the state with Dr. Quentin Young, an ardent public health advocate. Quinn also suggested that voters look at his record fighting for the All Kids and Veterans Care programs as well as his veto this summer of a budget that would have eviscerated social service programs throughout the state.

Full Disclosure: The SEIU Illinois State Council, which sponsors this website, has endorsed Pat Quinn in the Democratic primary for governor.

Small Business Owners Stand Up To Giant Insurance Lobby

Adam Doster — Tue, 17 Nov 2009 13:32:48 -0800

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.

The crowd heard from Tom Balanoff of the SEIU Illinois State Council (which sponsors this website), Henry Tamarin of UNITE-HERE Local 1, Roberta Lynch of AFSCME Council 31, as well as former Cigna executive Wendell Potter, who characterized the current health care system as "a Wall Street Health Care takeover," (a similar sentiment to the one he expressed before a House subcommittee hearing this June).

This isn't the only reform-related event on the schedule this week in Illinois. Tomorrow, the Campaign for Better Health Care kicks off its annual conference with a debate between Gov. Pat Quinn and Democratic challenger Dan Hynes. Check back Thursday morning for our coverage.

Durbin "Struggling" To Find 60 Votes On Health Care

Adam Doster — Tue, 17 Nov 2009 09:13:22 -0800

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.

Health Care Round-Up: A Silent Stimulus, The Greater Good, Hare Blasts GOP's "Alternative"

Adam Doster — Mon, 16 Nov 2009 14:31:02 -0800

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.

SJ-R: Consider The Greater Good

Some news outlets in Illinois have been very critical of the health care reform packages being pushed through Congress. Just a few weeks ago, the Tribune editorial board all but endorsed the House GOP alternative bill, which would cover 12 times fewer uninsured Americans than the Democrats' proposal while saving less money. But the State Journal-Register has a different view. Pivoting off their recent profile of Verta Wells -- a Springfield resident who died because her lack of insurance prevented her from detecting her early signs of breast cancer -- the editorial board calls on lawmakers to "consider the greater good" and extend access to all Americans:

If terrorists killed 18,000 Americans annually – 15,000 more than died on 9/11 – it would be an outrage that would spur Americans to quickly come up with a solution and take swift action.

But when lack of health care is the cause of so much unnecessary death, too many of us furrow our brow, wag our finger and make assumptions and moral judgments about the uninsured that have little basis in fact. [...]

It is a national character flaw that shocks the conscience. While we treasure our country's unique individualism, when it comes to health care, there needs to be a willingness to consider the greater good. Verta Wells's story reminds us of that.

Read the whole piece here.

Unions Drop New Ads

As the final details of the health reform bills in Washington are ironed out, two major labor unions are hitting the airwaves in Illinois, targeting suburban legislators over their votes on health care. AFSCME is running identical ads supporting two Democratic congressmen -- Reps. Bill Foster and Debbie Halvorson -- who voted for the House measure last week. You can view the Foster spot here:

Meanwhile, the Foundation for Patients' Rights -- a new health reform advocacy group founded by the Service Employees International Union (whose Illinois state council sponsors this website) -- is running an ad against GOP Rep. Mark Kirk for his opposition to the proposal. Watch it:

(H/T Joseph Ryan)

Hare: GOP's Plan "Woefully Inadequate"

Rep. Phil Hare also took some cracks at the Republican's alternative bill during a Springfield press conference last Friday. Calling it "woefully inadequate," the Quad City Democrat blasted his GOP colleagues for failing to craft a proposal that extended coverage to all Americans. Watch it:

AHIP Rally Tomorrow

Tomorrow, don't forget to stop by the Renaissance Hotel in Chicago where eight small businesses owners from across the country will meet outside the annual conference of America's Health Insurance Plans -- the nation's top health insurance lobby -- to deliver a letter demanding to speak with CEO Karen Ignagni about her organization's position on health care reform. The action begins at 12 pm. Check out the specifics at their website.

IL-14 Residents Make The Case For Swift Health Care Reform

Angela Caputo — Fri, 13 Nov 2009 15:15:03 -0800

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:

Gutierrez Won't Vote For Health Care Reform That Excludes Immigrants

Adam Doster — Thu, 12 Nov 2009 08:48:56 -0800

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. From the Washington Post:

"I am not going to vote for a health-care bill that includes provisions that exclude people using their own money to go to the exchange regardless of their immigration status," said Rep. Luis Gutierrez (D-Ill.). "It is silly and stupid. If we do not allow them to purchase it, their communities will suffer. Their children will suffer."

This is a tricky position for Gutierrez. On the one hand, he has a lot to lose by voting against health care reform. A massive 32.2 percent of residents in the 4th district lack insurance, the 15th highest rate for non-elderly people of congressional district in the nation. But that number is high in large part because the vast majority of his constituents are working class immigrants (both legal and undocumented).

On the merits, Gutierrez is most certainly in the right. The cost of providing free emergency and charitable care to the nation's uninsured, many of whom are immigrants, is roughly $1,000 per individual with insurance per year. It's a hidden tax on all of us. Allowing this population to purchase public insurance would relieve local and state government hospitals who administer the care. Undocumented workers are on average younger and healthier than the U.S. average, so including them in the risk pool would likely help lower premiums across the board. And from a public health standpoint, it's undoubtedly a good idea to protect people who routinely work in the service sector, particularly the food preparation industry.

But in Washington, petty cultural politics can easily railroad common-sense policy. It's good to see Gutierrez pushing back.

Health Care Round-Up: Moderate Dems Voice Conerns, Hamos On Stupak, More Actions

Adam Doster — Wed, 11 Nov 2009 14:13:39 -0800

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:

Hamos: Stupak Amendment Is Unacceptable

While State Rep. Julie Hamos is just a candidate for Congress at the moment, the 10th District Democratic contender hinted yesterday that if she were on Capitol Hill last weekend, she would have voted against any bill that included language similar to the Stupak amendment. Here's her statement:

The Affordable Health Care Act is an important victory in the fight for quality, affordable health care. However, I am adamantly opposed to the last-minute addition of the anti-choice Stupak Amendment. I am disappointed that some Members of Congress would try to force a choice between health care reform for all with no reproductive health care for some.

I reached out to Rep. Jan Schakowsky and she told me that key members of the House pro-choice caucus met on Monday with House Speaker Nancy Pelosi and all of them agreed that the anti-choice language is unacceptable. I agree. They are hopeful that they can make the needed changes in the Senate or in the subsequent Conference Committee.

I have fought for women's reproductive freedom for decades -- from serving on the Board of Directors of Planned Parenthood to being involved in every legislative initiative affecting choice or reproductive health care. The Stupak Amendment is another clear reminder of how important it is to have a Representative in Congress who understands what is at stake and will stand up for what matters.

Actions Coming Up

Health care activists are still working hard to pressure recalcitrant lawmakers and insurance industry officials to support reform. Tomorrow, MoveOn's Rockford branch will protest outside of Republican Rep. Don Manzullo’s office at 12:00 pm "to criticize him for siding with the insurance industry instead of Illinois families by voting against health care reform with a public option during a recent House vote."

Next Tuesday, folks affiliated with Health Care for American Now are meeting at the headquarters of Blue Cross/Blue Shield in Chicago and marching to the Renaissance Hotel, where the industry group American Health Insurance Plans is holding their national conference. You can find more information, as well as a related video, at their website.

Quigley On The Stupak Amendment: "If Choice Is Out, So Am I"

Adam Doster — Tue, 10 Nov 2009 14:15:45 -0800

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.