He's trying to score political points for next year's gubernatorial election. He's hoping to draw voters' attention away from ongoing federal investigations into possible ethical wrongdoing in his administration. He's looking to impress Beltway pundits to stoke his national aspirations.
Detractors found no end of ulterior motives in Gov. Rod Blagojevich's ambitious plan to provide health insurance for all Illinois children, unveiled last month and ticketed for legislative approval in the fall session now under way.
For his part, the governor urged the critics to be less angry and less cynical.
"Whatever happened to a sense of idealism and embracing an idea that will help people and, in this case, children?" he asked.
Perhaps the naysayers are correct; perhaps the governor's intentions are completely aboveboard. Either way —and the truth most likely lies somewhere in between — ensuring access to affordable, comprehensive health care for all youngsters is surely a worthwhile goal.
To achieve that objective, under the Blagojevich plan — dubbed All Kids — starting next July 1, the state would offer health insurance for more than 125,000 children whose families earn too much to qualify for existing state-subsidized coverage but too little to afford private insurance. Currently, families earning up to 200 percent of the federal poverty level — for example, about $38,700 annually for a family of four — are eligible for state insurance.
All Kids would cover children in families with earnings above that ceiling. Parents would have to pay monthly premiums based on income level, as well as co-payments for doctors' visits and other medical services, but the amounts should be less than under private insurance.
To pay for the program's projected $45 million first-year cost, Blagojevich would use most of the projected $56 million that would be saved by shifting the 1.6 million people who now have state-supported, fee-for-service health care — along with the new All Kids participants — into a mandatory managed care program.
Unveiling the plan, the governor noted that Senate President Emil Jones and House Speaker Michael Madigan had signed on as lead sponsors, about as gold-plated a guarantee of passage as a bill could get. To further All Kids' flight through the truncated fall session, its authors chose to leave some of the program's finer details to be worked out through rule-making by the agency overseeing the program, the Department of Healthcare and Family Services, the new name for Public Aid.
Done deal or no, implementing the program poses some significant challenges, especially given the state's previous difficulty making managed care work.
Either way? and the truth most likely lies somewhere in between - ensuring access to affordable, comprehensive health care for all youngsters is surely a worthwhile goal.
More than a decade ago, former Gov. Jim Edgar proposed shifting more than one million Medicaid clients into an HMO-type system as a way to provide better health care for poor people and save money for the state. Under his plan, the state would have paid HMOs and prepaid health plans a flat rate per person to provide medical care, instead of paying doctors and other providers directly.
But federal regulators took 22 months to approve the proposal, citing a host of concerns about its impact on the poor. Providers weren't interested in signing on at the rates the HMOs wanted to pay, and the HMOs couldn't enroll enough folks to make a decent profit. In the end, Edgar's managed care effort faded away, with only about a 10th of Medicaid clients — all volunteers — enrolled in HMO-type care.
The current administration sees basic differences, though, between All Kids and the Edgar plan. For starters, officials say they can implement the new program without first getting federal approval, under revamped policies in Washington designed to give states greater flexibility.
Moreover, rather than paying a flat fee to HMOs, which then would contract with medical providers for services, Blagojevich hopes to set up a case management network, in which primary care physicians would oversee children's care, for example, ensuring they receive preventive measures such as immunizations and avoiding unnecessary emergency room visits.
The network doctors would be paid for managing the care but would assume no financial risk because the state would continue to pay for the actual treatment, a feature designed to make the management role more attractive.
Even granting such differences, though, major concerns persist, perhaps none so important as ensuring that enough doctors, dentists, pharmacists and other providers are willing to participate in the program to guarantee that the additional children covered will have access to care in fact, and not just on paper.
Indeed, Republican lawmakers who long have pushed for managed care argue that any savings from the shift should be used to increase the rates the state now pays providers, rather than in expanding coverage to more children. They note, correctly, that the state's reimbursement rates for Medicaid and KidCare clients are often less than providers' costs, resulting in higher bills for other patients.
Moreover, the state is chronically behind in paying providers, to the tune of more than $1.5 billion as fall began. The state's low-pay, slow-pay reputation provides little incentive for doctors and other health care professionals to accept Medicaid patients.
A federal court ruling last year, however, may help improve provider recruitment for the state-paid health plans. In the decision, a judge in Chicago held that the state Medicaid program violated federal law by not affording poor children the same access to medical services as children with private insurance. A major reason, the judge concluded, was that state Medicaid reimbursements were too low to entice doctors, dentists and other providers to treat clients. As a result, higher rates are in the offing.
As the governor suggested, who can contest the premise that every child in Illinois should have access to health care? The task ahead for legislators and administration officials is to turn the lofty rhetoric into concrete results for the state's youngsters.
Charles N. Wheeler III is director of the Public Affairs Reporting program at the University of Illinois at Springfield.
Illinois Issues, November 2005
