Health care plan's best bet
Coverage for all has a chance in Illinois
By Judith Graham
Chicago Tribune staff reporter
February 26, 2006
With millions of Americans losing health insurance and crying for relief from soaring medical costs, Illinois is considering a bold and once-unthinkable proposal--extending medical coverage to all state residents.
It's a daunting, politically controversial and potentially expensive prospect, with 1.8 million uninsured people in the state. But experts say health reform may stand a better chance of passing in Illinois than almost anywhere in the nation.
"The odds are long, but they're much better in Illinois than most other states," said Alan Weil, executive director of the National Academy for State Health Policy.
An unprecedented public debate is under way, with public hearings on health-care issues being held in each Illinois legislative district. Meanwhile, a new 29-member task force has been meeting regularly and plans to deliver a report on various reform proposals to the legislature as early as August.
A wide range of options is likely to be considered, including expanding Medicaid to cover more low-income adults, providing health insurance subsidies or tax incentives to small businesses, and letting the uninsured buy coverage through new insurance pools, several task force members said.
"The process in Illinois is unique, and we're all closely following what is happening there," said Mark Blum, executive director of America's Agenda, a coalition of 20 national and international labor unions.
Illinois last year became the first state to promise medical coverage to all children. But some experts suggest the time is ripe for even more aggressive action.
"Medical providers are taking it on the chin. Consumers are taking it on the chin. Employers are taking it on the chin. And there's a real feeling out there that this could be the last great chance we have to do something," said Howard Lerner, who heads the new health-care task force and is president of the Rehabilitation Institute of Chicago.
"The sense of physicians at this point is if we don't find a solution for these problems, a solution will be imposed on us," echoed Dr. Craig Backs, another task force member and president of the Illinois State Medical Society. "That's not something we want to see happen."
Governor's signature issue
Illinois' political climate is especially favorable for health reform, with a governor who has made health care a signature issue and a legislature controlled by Democrats, who tend to make medical issues a priority. Still, here as across the country, there are deep ideological and partisan divides over how to fix a dysfunctional medical system and enormous concerns about potential costs.
"I think the business community would very much like to see government undertake initiatives to help the market work better. But unfortunately when something happens in this state, it almost always is an expansion of government-provided health care and we have great difficulty supporting that," said Todd Maisch, a vice president at the Illinois Chamber of Commerce.
The current debate was jump-started by the Health Care Justice Act, a little-known piece of legislation passed in 2004. For the first time, the act affirmed that "it is a policy goal of the state of Illinois to insure that all residents have access to quality health care at costs that are affordable."
The act went further by setting up a process for debating health reform throughout Illinois and a timetable for coming up with a "health-care access plan" for the state legislature to consider.
The key dates are approaching. More than half the legislative districts in the state have already held public hearings. The task force was due to present a report on reform proposals to the legislature next month, but that deadline has been pushed back to the end of summer because of funding delays. Meanwhile, the act strongly encourages lawmakers to vote on a proposed plan by the end of this year and start implementing reforms by July 2007.
"This is a process we have never formally engaged in before in Illinois, and a groundbreaking opportunity," said Dr. Lawrence Haspel, senior vice president of the Metropolitan Chicago Healthcare Council.
What's really new is the fact that consumer and business organizations, medical providers, health insurers, lawmakers and others are working together for the first time to consider reform options. In the past, the groups have held widely divergent views and made little effort to collaborate.
Consensus is by no means guaranteed. Virtually every other state that has attempted significant health reform has seen its efforts founder under the weight of competing special interests. And though some experts argue health care is a local concern that needs local solutions, others maintain problems are national in scope and beyond any individual state's ability to manage.
"Can you imagine every state having its own unique health-care system? That would be a disaster," said Kim Maisch, Illinois state director for the National Federation of Independent Business.
Clinton impact lingers
Also, public officials keenly remember the fallout from President Bill Clinton's attempt to reform health care a dozen years ago--leaving a sense that the issue is so divisive that any attempt to address it is bound to end disastrously. The question now is, are enough people upset enough over soaring medical costs and eroding insurance coverage to make it worthwhile, politically, to take on these issues?
Kenneth Robbins, a task force member and head of the Illinois Hospital Association, thinks the answer is maybe. "For a dozen years, health reform has been one of the third rails of American politics," he said. "Now, the issue is regaining respectability and people are willing to come up to the rail. Whether they're willing to touch it yet, I just don't know."
In any case, no one expects a one-size-fits-all answer to emerge in Illinois, including advocacy groups that in the past devoted their efforts to pushing a Canadian-style, government-run health-care system.
"That just doesn't have enough appeal here," said Jim Duffett, executive director of the Campaign for Better Health Care. Instead, he predicts, a "hodgepodge of public and private solutions" will be put forward, and "controlling costs" will be part of any discussion to expand access.
Rep. Elizabeth Coulson (R-Glenview), who supported the passage of the Health Care Justice Act, said Illinois has already done "pretty much the obvious things" in expanding coverage to low-income children and their families through KidCare, FamilyCare and now Gov. Rod Blagojevich's new plan, All Kids. That program will extend medical coverage to about 250,000 uninsured children, beginning July 1.
Going forward, Coulson envisions a series of incremental reforms targeting specific populations, such as poor, single adults without children (who currently don't qualify for Medicaid) and young adults (who often lose their medical coverage when they leave college and start working in entry-level jobs). Another target group might be people ages 55 to 64 who can't get insurance because of a pre-existing medical condition and are too young to qualify for Medicare.
"I think there's actually a will to expand coverage in Illinois, but it won't be one solution and it won't happen next year," Coulson said.
"Everybody is going to have to get something and everybody is going to have to give something for this to work," said Lerner, the chair of the state's health-care task force. Any expansion of coverage must be paired with measures to make health insurance more affordable and to encourage more preventive services that help keep people well, he said.
So far, public comments have overwhelmingly endorsed the need for the state to take aggressive action. At a recent hearing in Skokie, Beryl Clemens, 74, described what it was like to live without medical insurance for seven years after her husband died and before becoming eligible for Medicare.
Fearful of an accident, Clemens stopped driving and became isolated. Unable to afford care, she stopped seeing the doctor and filling prescriptions.
"I was unhappy, I was scared," she said, telling the task force: "I would be very pleased if you passed a comprehensive health-care bill in Illinois so no one else has to go through what I went through. ... It was a living nightmare."
Would you like to learn more about the Health Care Justice Act? Visit the Illinois Department of Public Health online at www.idph.state.il.us.
For information on the act, click on the "Health Care Justice Act" box on the department's home page. On the next page, you can access a schedule of meetings over the next couple of months by clicking on "Public Hearings."
Written comments also can be mailed to Tracy Morgan, Illinois Department of Public Health, Division of Health Policy, 525 W. Jefferson St., Springfield, IL 62761. Or e-mail comments to email@example.com.