Health care key governor race issue

Controlling costs to be a challenge By Judith Graham

On the issue of health care, the governor's race pits an incumbent with a strong record of expanding medical coverage against one challenger focused on controlling costs and another advocating universal health insurance.

The stakes are enormous: For the first time, health care overtook education as the largest spending item in this year's Illinois budget.

Meanwhile, there is a growing sense of crisis as private companies stop offering health insurance, safety-net institutions grapple with escalating demand for care and 1.8 million residents remain uninsured.

Whoever wins the election will have to decide if the state is willing to take on further expansion in medical coverage and how to stem rising health-care costs.

Democratic Gov. Rod Blagojevich's signature accomplishment is the extension of insurance coverage to as many as 475,000 previously uninsured children and adults. The move was engineered by expanding public programs such as FamilyCare and creating the nation's first universal insurance plan for children, All Kids.

"Blagojevich has made good on his promise to expand publicly financed health insurance at a time when many other states have cut back benefits," said Robert Kaestner, a professor at the University of Illinois at Chicago's Institute of Government and Public Affairs.

Praise of All Kids

All Kids generally wins high praise for offering comprehensive insurance to as many as 250,000 children. "It's a great idea because kids are often the ones left behind" in a changing insurance market, said Dr. Joel Shalowitz, professor of health-industry management at Northwestern University's Kellogg School of Management.

But some critics contend that despite a massive public relations push for the program, many of the children signed up would have qualified previously for state aid. And even supporters worry Blagojevich may have oversold the state's ability to afford the expanded coverage.

"I believe his administration has been more willing to spend and less willing to manage," said Doug Whitley, president of the Illinois Chamber of Commerce.

"We think all parents want to keep their children healthy and the governor was right in recognizing this, but we're deeply concerned because it's unclear what the future holds in terms of balancing the state budget," said Jerry Stermer, president of Voices for Illinois Children.

Blagojevich's staff says it has worked hard to rein in Medicaid expenses while preserving benefits, largely by imposing new controls on prescription drugs, adjusting payment rates to medical providers and introducing a "light" form of managed care. But the estimated savings, $450 million, is only a fraction of the $12 billion Medicaid budget.

Providers have been angry at Blagojevich for allowing medical bills to go unpaid for months. Blagojevich's staff responds that Illinois' backlog of unpaid medical bills has been cut to $1 billion and that the governor recently promised to pay all providers within 60 days.

"Every time, the payment cycle magically decreases right before election time and then, after the votes are counted, the spigot gets turned off," said Todd Evers, secretary of the Illinois Pharmacists Association.

Still, Evers gives Blagojevich credit for standing by Illinois seniors when Medicare's vast new prescription drug program began this year. Instead of discontinuing programs that help seniors pay for drugs, as other states did, the governor made sure Illinois programs plugged gaps in the Medicare plan.

Not living up to billing

Another drug program, I-SaveRx, has not lived up to its billing, however. Last month, the state auditor general called the program "illegal" and found only 3,700 residents had signed up to buy discounted drugs from Canada and other nations.

Health care has been an on-off priority issue for Republican challenger Judy Baar Topinka. On her Web site, her proposals are contained under a section titled "state finances/common sense budget cuts."

Topinka's two main goals are to cut $2.9 billion from the projected Medicaid budget over four years and to rein in costs by asking the federal government to pay its share of the program in the form of a block grant.

Topinka's staff said her plan revolves around bringing rigorous managed care to the Medicaid program and doing a better job of verifying the incomes of applicants. She also would enforce strict limits on assets for future Medicaid applicants and place a family income limit on All Kids eligibility.

Dr. Arthur Kohrman, a professor emeritus of pediatrics at Northwestern University and the former head of Illinois' Medicaid advisory commission, thinks more managed care for Medicaid might be a good idea--if it's done right. But, he notes, the state's earlier experiments with managed care were "extremely disappointing," largely because Illinois low-balled payments to plans. That's a recipe for ensuring that poor people get second-class care, he contended.

Others think the block-grant idea is terrible. "It's like saying to your employer, I seem to be spending too much on my household budget so why don't you freeze my salary for the next four years," Stermer said. "Once you say that, it's hard to go back and ask for a raise if you need one."

Green Party candidate Rich Whitney supports a single-payer, universal health-care system. Government would pay most of the bills; private doctors and hospitals would provide the care. While some experts say it could be the best way to cover everyone at a reasonable cost, it flies in the face of the tradition of employer-based insurance.

Whitney would finance his proposal through a combination of payroll and income taxes as well as administrative savings from eliminating private insurance, a spokesman said. Consumers and businesses would probably end up spending less on health care because they would stop paying premiums, the spokesman suggested.

But a state task force on health-care reform in Illinois recently voted against the universal health-care option and there's little appetite in the state for what is perceived as a radical solution to the ongoing health-care crisis.

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