House approves Medicaid expansion

By Jamey Dunn

National politics played out on the Illinois House floor as lawmakers voted to approve a massive Medicaid expansion, which is a key component to federal health care reform.

Senate Bill 26 would allow people who have a household income of 133 percent of the poverty level to qualify for Medicaid. The federal government will pick up the cost of the expansion until 2017, when the funding drops to 95 percent. In 2020, federal support will drop to 90 percent. The U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act, sometimes dubbed “Obamacare” after President Barack Obama by its opponents, allowed states the option not to participate in the Medicaid expansion. (For more on the ruling and the expansion, see Illinois Issues September 2012.)The Department of Health and Family Services estimates that an additional 342,000 residents would be eligible for Medicaid under the bill. About 140,000 more who are Medicaid-eligible but not enrolled will also likely sign up for Medicaid once the federal mandate that requires Americans to have health insurance kicks in 2014.

The expansion comes after lawmakers approved more than $1 billion in cuts to the Medicaid program last year and put a moratorium on future expansion. However, Rep. Sara Feigenholtz, sponsor of SB 26, said that when the moratorium passed, lawmakers assumed the expansion under the Affordable Care Act would happen because the Supreme Court had not given states the ability to opt out yet. The Medicaid changes made last year are known as the SMART Act. The Illinois House debated the expansion for more than two hours today. “These things don’t come easy. These are big, big measures. This is probably the biggest bill on health care that the Illinois General Assembly will have ever passed,” Feigenholtz said.

Republicans called for lawmakers to skip the expansion because they say they are concerned that the federal funding may not come as promised. “A year ago, we voted to scrub individuals from the Medicaid rolls who no longer qualify because it was the only way to save the program,” said Rep. Jim Durkin, a Western Springs Republican. “Now the majority party wants to add another 500,000 people to Medicaid when we cannot afford those who are currently on Medicaid.” No Republicans voted in favor of the bill. Some urged delaying the vote until the budget picture on the federal level is clearer. “I ask you to defer this decision. We do not have to make this decision now. We can make this decision in veto session or we can make it in next spring session after the [federal deficit reduction] talks have taken place and we have more certainty as to what the figures are going to be and how they will affect the state of Illinois,” said Hinsdale Republican Patricia Bellock, who was a key player along with Feigenholtz in crafting the SMART Act.

Feigenholtz said that she thought that a lot of the reactions from Republicans are driven by the national partisan fight over the president’s signature health care law. The Republican-controlled U.S. House has voted 37 times to repeal the law, but the Democrat-controlled Senate just ignores the repeal bills when they are sent to that chamber. “I think that there has been for a long, long time a drum beat against Obamacare. I think it was a very political drumbeat,” Feigenholtz said. The Illinois Senate has already approved the expansion, but the House tacked on some changes to the SMART Act, so the bill will now go back to the Senate. “There are very minor tweaks in SB 26 when it comes to the SMART Act, the two most notable ones we were sued in court on, and these are ultimately where we feel the settlement will end up,” Feigenholtz said.

She said many lawmakers wanted to see further rollbacks to the SMART Act’s cuts but that she wanted to keep as much of the savings in place as possible. She said some legislators “whose communities were disproportionately affected by the SMART Act were still a little concerned about how it has affected their communities, but at the end of the day, I really believe that this bill, this measure, is really going to be the game changer” for health care in Illinois.

Quinn approves key piece of federal health care plan

By Jamey Dunn

Illinois took a major step today toward implementing federal health care reform law when Gov. Pat Quinn signed a substantial Medicaid expansion.

Senate Bill 26 will expand Medicaid coverage to individuals who earn up to 138 percent of the federal poverty line, which is $15,860 for adults and $21,408 for couples. This expansion of Medicaid benefits to childless adults, who were previously ineligible in Illinois, is a key piece of the Patient Protection and Affordable Care Act. Quinn said he wanted to be sure to sign the bill before President Barack Obama makes a visit to Illinois on Wednesday.

“So we can tell him we got the job done,” Quinn said in Chicago today. “This is essentially implementing the Affordable Care Act. Some call it Obamacare. I call it ‘I do care.’ And this is the way that we, the people of Illinois, are going to get more health insurance coverage for at least 342,000 of our neighbors. I think that’s really an important objective, that all of us have decent health care for everybody.” Quinn's administration estimates that 342,000 people will be covered under the expansion by 2017.

The new Illinois Medicaid population will be able to enroll in October, and their coverage will kick in on January 1, 2014.

The Affordable Care Act, as originally written, would have required all states to make the expansion or risk losing their federal reimbursements for Medicaid. But the United States Supreme Court viewed that as an overreach and ruled that states had the option to forgo the expansion without the penalty. Illinois is one of 24 states, including the District of Columbia, that moving is ahead with the expansion. Six states are still debating the issue, and 21 states have no immediate plans to expand. (For more on the Supreme Court ruling and the Medicaid expansion, see Illinois Issues September 2012.)

The federal government will cover the cost of the expansion for the first three years. Then the federal match is scheduled to taper down to 90 percent by 2020. Illinois officials estimate that the state will receive $12 billion in federal funds under the expansion by 2020. Chicago Democratic state Sen. Heather Steans, who sponsored SB 26 and serves on the Senate’s budgeting committees, said the federal money will cover some medical costs currently being covered by the state. “It replaces what the state is paying for now, what local governments are paying for right now and really all the uncompensated care that hospitals are having to do. So this is going to help every single hospital throughout the state of Illinois.” She said that more than $200 million in spending from the state’s general revenue fund would be replaced by the federal match. “This is in my view very strongly both fiscally and morally the right thing to be doing.”

Steans said that most of the people who will be able to get Medicaid coverage are employed. She said the expansion will make health care accessible for people all over Illinois. “Sixty percent of these folks have jobs ... but low-income jobs that don’t provide affordable health care,” Steans said. “It’s every single part of the state where we have people who are going to be newly eligible here. It’s critical for downstaters, for our suburbanites, for the city of Chicago. It’s everywhere.”

Chicago Democratic Rep. Sara Feigenholtz, said the expansion will bring coverage to traditional underserved residents, such as those living with mental health issues. “From the perspective of a legislator trying to meet a need, trying find a medical home for our constituents, this legislation today is the game changer.” (For more on how the expansion could affect mental health care in the state, see Illinois Issues March 2013.)

Julie Hamos, director of the Illinois Department of Healthcare and Family Services, said the expansion is not just about getting more people coverage, it’s about making sure they have efficient and effective care that will make them healthier overall. “The Affordable Care Act and the promise of the Affordable Care Act is not just about putting a health insurance card in everybody’s pocket. It’s about redesigning the health care delivery system, and we are very hard at work doing that to create coordinated integrated delivery systems that will really serve the clients,” she said. “The promise of the Affordable Care Act is to get better health outcomes for all the people in Illinois and the country, that’s the most exciting part. That’s the work still ahead of us.”

But opponents of the expansion are concerned that it would further damage an already troubled system. Ted Dabrowski, vice president of policy for the Illinois Policy Institute, said such a large expansion would redefine the nature of the program. “Medicaid was supposed to be a safety net for the poor, but when you add 25 percent of the population onto Medicaid, then it is no longer a safety net. It’s become so bloated and so expensive to run that the poorest of the poor can’t get access.” Stagnant reimbursement rates have led to some health care providers opting to not serve Medicaid patients.

Dabrowski said there could be access problems after the expansion. He said that the problems with health care in the state should be solved through the insurance market instead of through a “top down” federal plan that grows state programs. “There are legitimate problems that need to be handled,” he said. “We should fix those problems and attack those problems directly but not totally turn upside down the private market in order to reach those problems.” He said that by deciding to implement the expansion, the state is taking on future responsibility for residents who could instead buy insurance in the online marketplace that also comes along with the Affordable Care Act. SB 26 would roll back the expansion if the federal matching rates decline. But Dabrowski said that once the benefits have been given out, it is unlikely that lawmakers would support reducing them. “Most state governments have a hard time taking away any benefits they have given.”

Supporters say that the state should not pass on a golden opportunity to offer health care to a group that currently has few options and often seeks costly treatment in emergency rooms. “One would wonder why we wouldn’t want $12 billion of health care that is 100 percent match[ed by federal funds],” Feigenholtz said.

 “That’s an important fundamental right that everyone has. It’s not a privilege to have decent health care, it’s a fundamental right,” Quinn said.

Governor to sign Medicaid expansion

By Jamey Dunn

Gov. Pat Quinn is expected to sign a massive Medicaid expansion, which is a key piece of federal health care changes, approved by the Senate today.

Senate Bill 26 would allow people who have a household income of 133 percent of the poverty level to qualify for Medicaid. The federal government will pick up the cost of the expansion until 2017, when the funding drops to 95 percent. In 2020, federal support will drop to 90 percent. The U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act, sometimes dubbed “Obamacare” after President Barack Obama by its opponents, allowed states the option not to participate in the Medicaid expansion. (For more on the ruling and the expansion, see Illinois Issues September 2012.) The Department of Healthcare and Family Services estimates that an additional 342,000 residents would be eligible for Medicaid under the bill. About 140,000 more who are Medicaid-eligible but not enrolled will also likely sign up for Medicaid when the federal mandate that requires Americans to have health insurance kicks in 2014.

Republicans spoke out firmly against the bill, saying that it makes no sense to add more Medicaid patients after cutting the program by more than $1 billion last year. “Only in Springfield would we take a program that has been mismanaged and is unaffordable” and add more people to it, said Sen. Dale Righter, a Mattoon Republican. “We cannot afford this. Other states have rejected it. We should reject it, too,” said Hinsdale Republican Sen. Kirk Dillard

Chicago Democratic Sen. Heather Steans, sponsor of SB 26, acknowledged the state’s budget problems, but she said the expansion is an opportunity to offer health care to people who truly need it and have the federal government help pick up the tab for services that governments and hospitals are paying for now. She noted that several business groups in the state, including the Chamber of Commerce, support the measure.

Some Democrats spoke out against the bill, but not because of the Medicaid expansion. The House tacked changes to last year’s Medicaid reforms that will roll back some of the limits for various populations. However, some members of minority caucuses argued that the cuts should have been reduced even further. “We’re talking about the sickest here in this state and many who were born that way,” said Chicago Democratic Sen. Donne Trotter. “My opposition is because it doesn’t go far enough to protect them.” He said recent reductions to state programs for the mentally ill and those battling addiction have left many of Illinois’ poor with no options. Opponents also said that they wanted Medicaid dental care restored. The changes last year cut dental care to emergency services only.

Steans, who sponsored the legislation cutting Medicaid last year, said she did not celebrate the passage of that bill after months of negotiation. “I went into my office, closed the door and sobbed for a very long time.” She said that cutting Medicaid last year was difficult but necessary. She added that she is open to restoring more of those cuts in the future if the state’s budget situation improves. But Steans said that “today is a much happier day” because more people will get access to health care under the Affordable Care Act. Quinn supports the measure and issued a statement today saying he intends to sign it.

U.S. Supreme Court ruling on health care law lets states opt out of Medicaid expansion

By Jamey Dunn

The U.S. Supreme Court upheld most of the key pieces of the federal Patient Protection and Affordable Care Act but left the door open for states to opt out of the law's massive expansion of the Medicaid program.

 The court upheld the provision known as the personal mandate — geared at getting everyone in the country who can afford health insurance to buy it. The ruling said the mandate is constitutionally protected because the penalty for not complying with the law is actually a tax. In its main argument for the law, the Obama administration had put forth that the law is protected under the Commerce Clause of the U.S. Constitution, but the court rejected that contention.


The court ruled that the government does not have the power to force citizens to buy health insurance under the Commerce Clause. President Barack Obama’s administration had argued that the mandate fell under the federal government’s power to regulate interstate commerce. The court found that giving Congress the power to regulate inactivity — in this case not purchasing insurance — was a step too far. “The individual mandate, however, does not regulate existing commercial activity. It instead compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce. Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. Every day, individuals do not do an infinite number of things. In some cases they decide not to do something; in others they simply fail to do it. Allowing Congress to justify federal regulation by pointing to the effect of inaction on commerce would bring countless decisions an individual could potentially make within the scope of federal regulation, and — under the government’s theory — empower Congress to make those decisions for him,” wrote U.S. Supreme Court Chief Justice Roberts in the majority opinion.

Roberts wrote that just because the administration argued that buying insurance would have a positive outcome on commerce by potentially decreasing costs for everyone in the marketplace doesn’t give Congress the power to compel people to do it. “People, for reasons of their own, often fail to do things that would be good for them or good for society. Those failures — joined with the similar failures of others — can readily have a substantial effect on interstate commerce. Under the government’s logic, that authorizes Congress to use its commerce power to compel citizens to act as the government would have them act.”

However, the ruling said that the law presents uninsured American a choice: Get health insurance or pay a tax. “Under that theory, the mandate is not a legal command to buy insurance. Rather, it makes going without insurance just another thing the government taxes, like buying gasoline or earning income. And if the mandate is in effect just a tax hike on certain taxpayers who do not have health insurance, it may be within Congress’ constitutional power to tax.” Roberts conceded that the tax is intended to compel action from consumers, but he wrote that such a move has been a component of taxation throughout the nation’s history. “None of this is to say that the payment is not intended to affect individual conduct. Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage. But taxes that seek to influence conduct are nothing new. Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry.”

The ruling limited the federal government’s power to push states to accept the large Medicaid expansion that is part of the law. Under the Affordable Care Act, states are required to expand Medicaid coverage to all people under age 65 with incomes below 133 percent of the federal poverty line in 2014. Currently, states are only required to cover certain populations, such as children, parents, the elderly and the disabled. The federal government would cover 100 percent of expansion costs for two years and then gradually step down some of its support.

As written, the law required that states take on this expansion or lose all federal matching funds. The court struck down that provision, saying it offered states a false choice. “As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. Congress has no authority to order the states to regulate according to its instructions. Congress may offer the states grants and require the states to comply with accompanying conditions, but the states must have a genuine choice whether to accept the offer. The states are given no such choice in this case: They must either accept a basic change in the nature of Medicaid or risk losing all Medicaid funding.” Roberts wrote that now states have the option to decline the expansion. “States may now choose to reject the expansion; that is the whole point. But that does not mean all or even any will. Some states may indeed decline to participate, either because they are unsure they will be able to afford their share of the new funding obligations, or because they are unwilling to commit the administrative resources necessary to support the expansion. Other states, however, may voluntarily sign up, finding the idea of expanding Medicaid coverage attractive, particularly given the level of federal funding the act offers at the outset.”

Robert Rich, director of the University of Illinois' Institute of Government and Public Affairs, said he is not surprised the court curtailed the federal government’s reach on this issue. “This ruling says carrots are OK; sticks are not,” he said. “I think it’s consistent with where the Supreme Court has come down on federalism in the past.”

Rep. Sara Feigenholtz, a Chicago Democrat, is optimistic that many states, including Illinois, will agree to the expansion. “I think that it’s going to be a rare case when a state says no,” she said. Feigenholtz, who spearheaded recent efforts to cut the state’s Medicaid liability by $2.7 billion, acknowledged that the law has become a political hot potato on both the state and federal level. “Yes, it is a states' rights issue, but I would hope that at the end of the day cooler heads prevail.”

Roberts distanced opinion from any commentary on the merits of the law. “We do not consider whether the act embodies sound policies. That judgment is entrusted to the nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.” But the political fight over the federal health care reform law seems far from over.

Squabbling between the two parties has led to Illinois putting the creation of its online insurance marketplace, also part of the affordable care act, on hold until after today’s decision. Rep. Frank Mautino, a Spring Valley Democrat, told the Associated Press this week that the state will likely not meet the deadline to create its own insurance exchange and would instead have to partner with the feds on an exchange. Mautino chairs the committee that was established to create the state’s exchange.

Republicans on the state and federal level stepped up after today's ruling to blast the law, dubbed “Obamacare,” and call for its repeal. “While I respect the court’s decision, the health care law threatens our economic recovery by raising taxes, imposing new regulations and creating a drag on the economy,” Illinois Republican Sen. Mark Kirk, said in a written statement. “Congress should repeal the health care law and replace it with common sense, centrist reforms that give Americans the right to buy insurance across state lines and expand coverage without raising taxes, while blocking the government from coming between patients and their doctors.”

Illinois House Minority Leader Tom Cross, who pushed back against efforts to implement the law on the state level, said in a written statement: “We have made tremendous efforts this year in Illinois to reduce our state-run health care program because we could no longer afford to provide the services that were once promised. Today’s Supreme Court decision affirms a federal law that has the potential to pile billions of dollars of additional expenses into our state budget that we cannot afford. We are encouraging Congress to repeal Obamacare at the federal level as soon as possible, and provide Illinois the ability to administer an efficient Medicaid program."

Comptroller Judy Baar Topinka warned that the ruling will cost Illinois when residents who are eligible for Medicaid but never signed up rush to the program to avoid paying the penalty for not being insured. “There is no doubt that this will cost the state; the only question is how much?” Topinka said. “We have thousands of residents around the state that are eligible for Medicaid but have never enrolled for one reason or another. We expect they will increasingly come forward, and I urge lawmakers to start saving now for those added costs.”

Topinka estimated that the growth in Medicaid costs could total $2.4 billion over the next six years. “Illinois is a textbook example of what can happen if financial challenges are not proactively addressed,” Topinka said. “The state needs to learn from experience and take steps today to address the increased Medicaid costs that will occur in coming months and years.”

Health care advocates heralded the ruling as a victory and pushed for Illinois to implement the law. “Today’s Supreme Court decision helps to strengthen our nation’s tattered social fabric and provides hope that constitutional law and democracy matters,” Jim Duffett, executive director of the Campaign for Better Health Care, said in a written statement. “It is time for the obstructionists in the Republican Party in Congress and in Springfield, and a handful of insurance-industry backed Democrats in Springfield, to stop their crusade against Obamacare. It is time to put America and Illinois first, act like adults, and do something positive for a change that will help small businesses and hard-working Americans by implementing Obamacare. Meanwhile, we are urging Gov. [Pat] Quinn to immediately sign an executive order and begin implementing the new insurance marketplace so Illinois' hard-working families and small businesses will continue to enjoy the benefits of access to affordable, quality health care.”

Quinn today continued to call on state lawmakers to approve legislation to begin the creation of an exchange. However, he said that Illinois would likely partner with the federal government to create its exchange instead of doing it independently. “What we learned today is, the legal cloud has been eliminated. The U.S. Supreme Court, the highest court in our land, has said the Affordable Care Act is the law of the land, and we in Illinois plan to carry it out and make sure that people who need health care coverage, health insurance, are covered. That’s our goal.”

Quinn said he wants the state to adopt the Medicaid expansion in the law. “The state of Illinois is going forward with the president of our country, President Barack Obama, to expand using Medicaid [to offer health care to] those who would be covered under the Affordable Care Act. That is the law. We’re not backing down. We want to go forward. This is fully funded by the federal government beginning in 2014 and ultimately 90 percent funded." He said he hopes the state will "insure as many people as we can in Illinois who have fallen through the cracks.”  

Despite the heated rhetoric, Feigenholtz said she thinks the state can successfully implement the law, which she says will make life better for many. “I think millions of people across the state and people across this country will have greater access to affordable high quality health care.” She added: “I am frankly a little disappointed that we haven’t moved forward on this. But I think that today brings new hope. ... I think we can work through this. Hopefully tomorrow is designed to be better than yesterday.”

Senate approves federal Medicaid expansion

By Meredith Colias 

The Illinois Senate approved a measure to expand Medicaid coverage beyond mothers and children to low-income single adults as part of the federal health care reform law.

Senate Bill 26 would expand Medicaid eligibility to an estimated 350,000 adults who do not currently qualify for Medicaid. Adults from 19 to 64 earning up to 138 percent of the federal poverty level would now qualify. The Patient Protection and Affordable Care Act calls for coverage to be extended for those making 133 percent of the federal poverty level. However, the feds are allowing states some wiggle room, so in practice, the coverage will be extended to those making 138 percent, which was $31,809 for a family of four and $15,415 for a single person in 2012.

The bill’s sponsor, Sen. Heather Steans, a Chicago Democrat, said the expansion would be better for providers such as hospitals, local townships and health care clinics that currently are not reimbursed for providing health care services for uninsured adults. She said it would shift individuals now without health insurance away from using hospital emergency rooms as a costlier last resort for injury and illness. “We can get them up front into care coordinated programs…make sure they are getting the preventative health care they need to stay healthier, which is a much better system when you actually get people care they need,” she said.

Sen. Jacqueline Collins, a Chicago Democrat, said the expansion is important for vulnerable citizens of the state, such as those who “were asked to bear the brunt” of the Medicaid cuts last year. The federal government will pay 100 percent of the costs of the Affordable Care Act for the first three years. Afterward, the state will be responsible for 10 percent of the total cost per year. The bill has specific language allowing Illinois to opt out of the expansion if the share of the federal government's payment falls below 90 percent, and the state has to pick up more than 10 percent of the total cost.

No Republican voted in favor of the legislation. They said they were concerned it was a commitment the state could not afford, and would force newly eligible participants to choose Medicaid over other options, such as buying insurance in the online marketplace that is another component of the Affordable Care Act. "At some time, we have to understand that we have to take responsibility" for its cost when the federal government stops footing the full bill, said Sen. Bill Brady, a Bloomington Republican.

Minority Leader Christine Radogno said that Illinois should do more to negotiate the terms of the expansions with federal officials before agreeing to sign on. Arkansas recently struck a deal with the United States Department of Health and Human Services that will allow that state to spend some of its Medicaid dollars to buy Medicaid-eligible residents insurance in the online exchange. “What I think we lose by getting on more quickly than we need to is any leverage to work with the federal government to make the program fit better for Illinois,” Radogno said.

Steans said she was confident that proper safeguards were built into the law to avoid a risk to the state budget. “We are going to have control over this program as we want,” she said. She said it is more important to change how the current costs are paid and said governors throughout the country are also embracing the expansion. “We pick it up in [the budget now], it doesn’t get any federal matching dollars … Folks are coming in and getting this care [anyway],” Steans said.

 She added, “It just makes total economic sense, as well as it’s the right thing to get people more health care coverage.” The measure now heads to the House.

For more on the implementation of the Affordable Care Act, see Illinois Issues September 2012.

Medicaid plan not quite ready

By Ashley Griffin 

Gov. Pat Quinn says he wants lawmakers to address Medicaid reforms by the end of the week. But today, the sponsor of legislation that surfaced yesterday says the bill needs more work.

 In a House committee hearing, Rep. Sara Feigenholtz, a Democrat from Chicago, informed members that Senate Bill 2840, which contains various eliminations, service reductions and other changes to Illinois’ Medicaid system, was not ready for a hearing. “I think we’re moving forward, and we’re doing it well. I’m very optimistic that we’re going to have an agreement very shortly, but as you know, the devil is in the details. There’s a lot of moving parts in Medicaid reform. We just want to make sure that we’ve dotted all of our Is and crossed the Ts,” said Feigenholtz, the bill’s chief sponsor. She said House leadership is also working behind the scenes to make sure the proposal can get the votes needed to pass. “There are a lot of moving parts, I think the leaders continue to meet about making decisions about who's voting for what and putting together roll calls and making sure we’re ready to move forward.” Feigenholtz said they are also considering what parts of the overall proposal, which also includes a cigarette tax increase, to run first. Such an increase is not in SB 2840 and would likely be presented in a separate bill.

She added that she is weighing whether some components of her more-than-400-page bill should remain part of the measure. For example, Feigenholtz said a portion of the legislation that would clear the way for Cook County to take on more Medicaid patients might be removed. The provision would roll back a state mandate against Medicaid growth to allow Cook County to add to the Medicaid rolls 100,000 people who would become eligible in 2014 under the Affordable Care Act. The move to add more enrollees would let Cook County receive federal matching funds for patients who are currently getting free treatment at county hospitals. The measure would not be paid for with tax dollars from outside of the county.

 Cook County Board President Toni Preckwinkle appeared before a Senate committee yesterday to make her case. She testified in support of House Bill 5007, another piece of legislation that would lift the moratorium on Medicaid expansion for Cook County. “It would allow our system…to receive federal reimbursement for a population that we currently serve but who are not covered by any public or private health care coverage plan today,” Preckwinkle said. The federal government would also have to sign off on Cook County taking on additional Medicaid patients.

While Feigenholtz said she did not present her bill today because of “technical” issues, some Republicans have problems with the fundamentals of the overall plan. Sen. Dale Righter, who was a part of a legislative working group tasked with addressing Medicaid, said that Democrats jumped at the idea of using revenue to try to avoid cuts, but Republicans may not back that idea. “I can see where there’s an issue over there. … And it may be time for the Medicaid advisory committee to sit back down again and look for more reductions," he said. “Perhaps if they weren’t so quick to rely on new revenue, we’d be seeing a little more progress now." Righter, a Mattoon Republican, said he does not think there is any support in his caucus for a cigarette tax increase. Feigenholtz said again today that the plan, of which SB2840 would be a part, relies on a cigarette tax increase.

Quinn is pushing lawmakers to approve a solution this week, and take on pension reform, as well. “This is not a time for delay or denial or doing nothing,” Quinn said.

He said he wants lawmakers to deal with pension and Medicaid reform this week, so they have time to work out budget details next week. “We want two things this week — real focus on them. That’s pension reform and Medicaid restructuring.” The budget must be approved by May 31 to pass on a simple majority vote. If lawmakers fail to do that, there is the potential for a long and volatile summer session as Republicans try to wrangle more cuts out of Democrats. “It really comes down to, are we going to make things better for our kids than we found them? If we fail to act this week on Medicaid restructuring and pension reform, we’re letting our kids and their kids down. We have to rise to the occasion,” Quinn said.

Cuts to Medicaid program headed to the governor

By Ashley Griffin and Jamey Dunn

Gov. Pat Quinn is close to his wish of having comprehensive Medicaid reform done by the end of this week.

A bill that would make massive changes to Illinois’ Medicaid system is on its way to his desk. On Thursday, Senate Bill 2840, which aims to cut $1.4 billion to $1.6 billion from the state’s Medicaid liability, passed the House with 94 “yes” votes and 22 “no” votes. It was approved in the Senate, 44-13.

The proposed plan includes tighter eligibility checkups, which would be conducted by an independent vendor, rate cuts to some providers and reduction and elimination of some services. The proposed plan emphasizes changes to utilization controls, which would limit how many times a patient could use a certain service or cap the cost of treatment he or she could receive. The cuts to services include:

• Eliminating coverage for group therapy for nursing home residents, chiropractic care for adults and in-patient detoxification programs. 
• Eliminating adult dental care other than emergency treatment. In emergency situations, such as infections, the program would cover patients getting teeth pulled. 
• Eliminating the Illinois Cares Rx program, which helps seniors pay for prescription drugs. 
• Requiring a $2 copay for prescription drugs.
• Capping hearing, speech, occupational and physical therapy at 20 sessions. 
• Limiting patients to four prescriptions per month. Three of the prescriptions could be brand name drugs. 
• Limiting patients to one pair of eyeglasses every two years. 
• Requiring prior approval for the repair or replacement of equipment, such as prostheses and wheelchairs 

“It is not without pain. The intent really is to minimize the hurt,” Chicago Democratic Sen. Heather Steans, who sponsored the bill in the Senate, said about the legislation.

The bill also contains rate cuts to some health care providers. Larger, for-profit hospitals would see a 3.5 percent reduction in the rates they are paid for providing Medicaid services, but safety net hospitals and rural “critical access” hospitals would be safe from the rate cut. Other providers would see a 2.7 percent rate reduction, but some, such as physicians and dentists, would be exempt from that cut.

Most provider organizations signed off on the rate cuts, but Department of Healthcare and Family Services Director Julie Hamos said the reductions were the result of difficult negotiations. “Nobody’s OK with this proposal, truthfully. Every single provider group, I think, would like to step before you and tell you that they’re not exactly OK with any of this,” she said. “We did do a lot of work with them. We really tried to understand how we could create a tighter system.” And Hamos said the state would come out with a “better” Medicaid system.

The General Assembly also approved today another key component of  Medicaid reform, House Bill 5007. The measure would allow Cook County to add to the Medicaid rolls an estimated 250,000 people who would become eligible in 2014 under the Affordable Care Act. The move to add more enrollees would let Cook County receive federal matching funds for an estimated 100,000 of those patients who are currently getting free treatment at county hospitals. Those pushing SB2840 noted that some patients who would lose services under the bill would be covered by such a Cook County expansion. The federal government would have to sign off on the plan, and no tax money from outside of the county would go toward the expansion.

The push to reduce Medicaid costs comes in the wake of Quinn’s “rendezvous with reality” budget address in February, when he told lawmakers they could not go home for the summer until they pass comprehensive Medicaid reform and called on a Medicaid working group to help solve a $2.7 billion crisis — an amount Quinn says would carry over into 2014 if lawmakers do not act now. “I assure you that if we do nothing, it will collapse,” said Rep. Sara Feigenholtz, a Chicago Democrat and sponsor of the bill.

Some of the most controversial cuts in the plan are the eliminations of maintenance dental care for adults and Illinois Care Rx, which is a prescription drug program that helps low-income seniors pay for their medicine. Approximately 180,000 seniors would be affected by the loss of the Illinois Care Rx program. The cut to adult dental care would affect 172,000 Illinoisans. “We believe that these cuts in human terms are very damaging. People will not get less sick because we made these cuts,” said William McNary,
 co-director of Citizen Action/Illinois. According to McNary, the cut to the Illinois Rx program is the biggest reduction in the plan, and it will cost the state more in the long run if seniors are not able to get the prescription drugs they need and end up in nursing homes.

Under the reductions, adults who have oral infections could get a tooth pulled. But Dave March, director of government relations for the Illinois State Dental Society, said most oral surgeons, who would perform an extraction in an emergency situation, do not take Medicaid. He said patients with oral infections often end up in emergency rooms, which have little to offer them. “All they can do is give them antibiotics and send them away.” He said that such infections left untreated can turn into life-threatening abscesses.

Those who opposed SB 2840 argued there are other options legislators could have considered, such as fund sweeps, applying sales tax to services and closing some of the corporate loopholes to help the state bring in more revenue instead of cutting Medicaid. “There’s lots of things, ladies and gentlemen, we can do rather than putting senior citizens and disabled people out on the street without having access to their health care,” Chicago Democratic Rep. Mary Flowers said during floor debate.

Members of the Black Caucus and the Latino Caucus came out strongly against the bill in both legislative chambers. “Once we push that green light, are we pushing people into the grave? That’s the question that we really need to ask ourselves,” said Sen. James Meeks, a Democrat from Chicago.

Proponents acknowledged the pain that the plan would cause but said the changes are needed to keep the system from collapsing because the state cannot afford to reimburse providers. “There are going to be people who get benefits today under the Illinois Medicaid program … who will no longer receive them. Or they’re not going to receive them in as convenient of manner as they do today, and that’s going to be tough on some people,” said Sen. Dale Righter, who served on the legislative working group that negotiated Medicaid reform.

“This is not immoral,” said Sen. Matt Murphy, a Palatine Republican. “What would be immoral in my mind would be to sit back, pretend there’s no problem” and let the system fall apart.

The measure that passed today would rely on other proposals that the General Assembly has not yet approved, such as a cigarette tax that could possibly generate $331 million with a federal match. Quinn is urging lawmakers to pass the tax. This is the first step toward saving Medicaid for those who rely upon it. “The status quo would have led to Medicaid’s collapse, and I am pleased to see the General Assembly take strong action to put our Medicaid system and our state on the path to sound fiscal footing,” Quinn said in a prepared statement. “And there is more work to do. The General Assembly must move quickly to pass legislation to add a dollar a pack to the cost of cigarettes, which — combined with today’s legislation — will achieve the necessary $2.7 billion in savings to rescue Medicaid.”

Righter, a Republican from Mattoon, warned that some of the reforms would need federal approval and that DHFS would have the last word on whether many of the changes are made in practice. “No one should walk away from this chamber tonight … and say, ‘We did our part, didn’t we?’ That would not be true,” he said. “We are going to have to work with and push and provoke the administration to move forward on all of the things that are in this bill.” Righter and other Republicans accused Hamos and Quinn of stalling previous Medicaid reforms by not being aggressive enough when seeking federal waivers.

Hamos said DHFS is committed to making the changes that are in the bill. She noted that the agency moved ahead with previous reforms without permission from federal officials. “You know that last year, I ran into some problems with the federal government. I expect to again. We challenged them. We did, in a very public way, take them on. They were unhappy then. They’re still unhappy with us. I expect that to happen again. I expect that there might be some lawsuits. But I’m the one who's responsible,” Hamos said.

 She added: “My agency is taking this very, very seriously. We have been fully engaged. We really believe in this. We really believe that it’s hugely important. …We have just a gigantic task ahead of us. I know that. I believe it. I don’t sleep well at night. But we are fully engaged and will do everything possible.”

What's been done? What's yet to come?

By Jamey Dunn

The Illinois General Assembly approved historic changes to the state’s Medicaid system this week. But with six days left until the spring legislative session is scheduled to adjourn, lawmakers still have plenty to do.

Medicaid 
Both chambers approved Senate Bill 2840 on Thursday. The measure contains reductions to Medicaid services. While lawmakers said they tried to avoid ending programs altogether, the plan would eliminate the Illinois Cares Rx program, which helps low-income seniors pay for medicine, and dental care for adults, except for in emergency situations. The legislation also includes cuts to the rates some hospitals and health care professionals are paid for providing Medicaid services.

Both chambers signed off on House Bill 5007, which will allow Cook County to put more people on its Medicaid rolls. The expansion would come at no cost to downstate taxpayers and would allow the county to recoup federal matching dollars for thousands of patients who are currently being treated at county hospitals.

The House today approved a cigarette tax that is a key piece of the overall Medicaid reform plan. The Senate has yet to take up the bill.

Neither chamber has taken a vote on SB 3397, which would prevent the state from pushing Medicaid bills off into future fiscal years.

Budget 
The Senate Democrats approved a budget plan without Republican support in their chamber. But some predict that it will likely be ignored by the House, much like the Democrats budget was last year. “It’s … a chamber squabble for you folks. It’s to beat the House of Representatives. And here’s what’s going to happen: You’re going to go through all this turmoil over here and all this grief,” Sen. Dale Righter, a Republican from Mattoon, said during floor debate of the bills. “And what’s going to happen is, these budget bills are going to zoom over to the House of Representatives, and they will meet exactly the same demise as your budget did last year.”

The Senate Democrats’ bills are all currently scheduled for a hearing in the House Executive committee on May 31, the last day of the scheduled session.

Some pieces of the House’s budget have emerged, and they contain cuts that are sure to be unpopular. Senate Bill 2413, which was discussed in a House budgeting committee this morning, would cut $25 million from early education programs and reduce funding for children’s mental health programs from $1.6 million  to $300,000.

Ireta Gasner, senior policy associate for the Ounce Of Prevention Fund, estimated that the proposed early childhood cut would mean that more than 25, 000 children would lose the chance to go to preschool. She said that under the cut, early childhood programs would have been cut by a total of $80 million over the last four years. She said cuts to early childhood programs lead to greater spending elsewhere in future budgets because children who do not receive preschool are more likely to need other state services down the road. “We have to be clear that any savings we think we’re realizing from this $80 million in cuts is only going to come back in real costs to children and to our taxpayers in the near future and in the long term.”

Senate Democrats say their plan would not cut spending or K-12 education. Chicago Democratic Rep. Deborah Mell, who serves on the House’s K-12 budgeting committee, said that she hopes the House will consider some aspects of the Senate Democrats’ proposal.

SB 2443, which a House budgeting committee approved Friday evening, would cut higher education by just over 6 percent. The Senate plan would cut higher education by between 3 percent and 4 percent.

Gov. Pat Quinn's budget proposal called for no cuts to higher education or K-12. In fact, he pitched a $20 million increase for early childhood education and a $50 million increase for Monetary Award Program (MAP) grants for college students.

Pensions
A proposal to reduce retirement benefits for state workers may emerge in the coming days. House Speaker Michael Madigan has hinted on what that plan could look like. He told the Illinois Channel yesterday that the bill would likely eliminate compounding interest cost-of-living adjustments and replace them with an adjustment of 3 percent or half the rate of inflation, whichever is less. Madigan said the plan would not require workers to pay more for their retirement or wait longer to be eligible for full benefits. Quinn's proposal included both an increase in employee contributions and the retirement age.

“We’ve made good progress. We’re concerned with the fiscal security of the pension systems, and we’ve determined that the biggest cost driver that leads to fiscal instability in the pension systems is the automatic compounded [cost-of-living adjustment],” Madigan said. “So our view is that should be adjusted. … There are other elements to the program. But we’re not going to call on employees to make additional contributions. We’re not going to change the retirement age. But we do feel that local school districts and community colleges and universities ought to assume the responsibility to make the pension payments for their employees.” Madigan said the cost shift would be done gradually. He said that he thinks lawmakers can send a plan to Quinn before adjournment.

“I don’t know. He may have an agreement with the unions by the end of the day,” House Minority Leader Tom Cross said this afternoon. Cross said that he has not been in on negotiations with unions. He said he plans to meet with Madigan on Saturday to discuss the issue. “This thing, I think, is still evolving. …We certainly will have a little better approach to it after tomorrow, a little better feel for it.”

Republicans have voiced opposition to the idea of shifting costs to school districts, universities and community colleges. “I’ve never been a big fan of the cost shift,” Cross said. But he would not say if he would oppose such a shift, saying that he wanted to see the whole proposal before ruling out any one idea.

Cross said that the current compounded cost-of-living increases are “not sustainable” and that they are a good place to look for cutting costs. “The key is, how do you find the most significant savings that’s constitutional. Whatever you do in this exercise, you’re going to make somebody very, very mad. But [when] we go back to the bottom line, we’ve got an $85 billion unfunded liability,” Cross said.


Gaming
The House approved a gaming expansion bill, and the Senate will probably take a floor vote on it before adjournment. Sponsors say they think it would pass in the Senate. However, Quinn is opposed to the bill, so supporters would likely be seeking support to override a veto sometime down the road.

The House is scheduled for session Saturday morning, but not Sunday. The Senate is taking the weekend off. Both chambers are scheduled to be back in session on Monday.

House passes gaming bill it previously rejected

By Ashley Griffin and Jamey Dunn

The final weeks of legislative session rarely pass by without rumors of a gambling expansion passing. But sponsors of a bill that failed in the House last fall are betting that this is their year.

Earlier this week Gov. Pat Quinn urged legislators to address Medicaid reforms by the end of the week and not to get distracted by “shiny things,” such as gambling, but today a gaming bill passed on the House floor with 69 “yes” votes and 47 “no” votes.

Senate Bill 1849 was described by sponsor Rep. Lou Lang as an attempt to strike compromise with Gov. Pat Quinn late in May of 2011. A gaming bill, SB 744, had passed in both chambers, but Quinn had vowed a veto. Senate President John Cullerton used a procedural move to keep the measure from ever landing on the governor’s desk. Quinn put out some suggestions — which included not allowing horse racing tracks to have slot machines, a pivotal part of the bill that had passed — for a new bill. Lang came out with a new version, SB 1849, that he said scaled back the plan that had passed, and addressed some of Quinn’s concerns. The bill failed in the House during the legislature's 2011 fall veto session. 

But it would seem some attitudes have changed in the last year.

“When we have almost 8 percent of our people out of work, when we can’t cobble a state budget because we don’t have enough revenue, when the 30,000 or 40,000 jobs in the horse racing industry are disappearing, when our convention and trade shows are down — when they should be up — when thousands of our people every day get in their cars and drive through Chicago and the south suburbs of Cook County and spend their money in Indiana, I think this is much more than a bright shiny object. I think this is a imperative for state government to move this forward,” Lang, a Skokie Democrat, said during floor debate of his bill today.

The measure aims to open five casinos statewide, in Chicago, Park City, Danville, Rockford and in the south suburbs of Chicago. The exact location of the fifth casino would be up to the Illinois Gaming Board to decide. The bill includes slots at horse racing tracks but does not allow for slots at the Illinois State Fairgrounds or Chicago airports, which Quinn previously bashed publicly. The bill also aims to reduce the number of gaming positions available from 2,000 in the original bill to 1,600. Casinos currently are allowed 1,200 positions. The Chicago-owned casino proposed in the plan would be allowed 4,000 positions. Lang said the bill clarifies language about the oversight of the Chicago casino, something Quinn had cited previously as a concern.

According to Lang, the bill would direct all up-front licensing fees to pay down unpaid bills. Lang said the plan could pay off $1.2 billion to $2 billion in overdue bills. The legislation would provide a new inspector general for the Illinois Gaming Board and additional funding for that board. The plan also calls for $31 million to go to agriculture programs annually, $10 million to fix up the state fairgrounds and $10 million to go to gambling addiction services annually. Lang said the expansion could generate anywhere from $300 million to $1 billion for the state. He said the volatile economy makes estimating the total revenue difficult.

Supporters argued that gambling expansion could help bring in much needed revenue. “In the next week, we’re going to make some very, very, very difficult choices. This is the last place that we can go at this point to try and address some of the needs of our communities. So when you’re thinking about these appropriations committees and what we’re going to cut, remember that today … you’re going to have a choice. Do you want to raise money to help fill some of the problems and relieve some of the cuts?” Rep. Ed Sullivan, a Mundelein Republican, said during floor debate of the bill.

But some said lawmakers should not look to a gambling expansion to solve immediate budget woes. ‘If we’re talking about getting money to prevent the cuts that we’re going to have to make this year, it’s not going to happen,” said Rep. David Harris, a Republican from Arlington Heights. “It is not a windfall, so don’t go spending the money because it’s not coming in. Clearly there will be dollars coming into the state, but it’s not anywhere near what you think it’s going to be.”

Opponents called the promise of billions in revenue “fools’ gold.” “The amount of revenue generated is inflated, and they will not get that money for several years,” said Anita Bedell, executive director of the Illinois Church Action on Alcohol & Addiction problems. Bedell — who advocates on behalf of gambling addicts, the people she says are the collateral damage in such an expansion of gaming — said she was very disappointed in today’s vote. She noted that Quinn is unlikely to sign the legislation.

Earlier this week, Quinn warned against lawmakers losing focus on passing Medicaid and pension reforms by taking up gambling. “I’m not going to get distracted by that subject. Sometimes down here, shiny objects can distract people. We don’t want any of that this week.” Shortly after the House passed SB 1849, Quinn released a statement trashing the bill. “This new bill falls well short of the ethics standards I proposed in my framework last October. Most importantly, it does not include a ban on campaign contributions as lawmakers in other states have done to keep corruption out of the gambling industry and out of Illinois. Massachusetts, New Jersey, Pennsylvania, Louisiana and bordering states like Iowa, Michigan and Indiana have all approved such bans,” Quinn said in prepared statement. “It does not provide the Illinois Gaming Board with sufficient time to make critical licensing and regulatory decisions. This bill also does not provide adequate oversight of the procurement process. It does not ensure clear oversight of the proposed Chicago casino.

“As long as I’m governor, I will not support a gambling bill that falls well short of protecting the people of Illinois. It is clear that this gaming bill still needs significant improvement.” Quinn urged lawmakers to turn their focus back to the subjects of Medicaid and Pensions.

“This is a governor who has said that it's perfectly OK with him and his administration promoting online sales of lottery tickets, so 12 million Illinoisans are gambling at home online. So to say a few hundred people can’t put a nickel in a slot machine at a race track where they are already gambling just does not make any sense to me,” said Lang. He said he is confident that the measure will pass in the Senate and head to Quinn’s desk.

If Quinn fulfills his promise of a veto, backers may be spending time this summer lobbying for votes to override Quinn in the fall veto session, when they will have plenty of lame duck lawmakers to call on for support.

New Medicaid enrollments coming faster than expected

By Jamey Dunn

Illinoisans have signed up for Obamacare more quickly than the Illinois Department of Healthcare and Family Services expected, Director Julie Hamos says.

Hamos told a House budgeting committee today that her agency had predicted about 509,000 people would enroll in Medicaid under the Patient Protection and Affordable Care Act. She said today that about 430,000 of them could be enrolled by the end of the calendar year. “We are actually seeing stronger numbers, larger numbers, earlier than we ever really expected.” Based on the applications that the department has on hand, Hamos said an estimated 315,000 Illinoisans who are newly eligible for Medicaid have applied so far. “We thought that we were going to be at 200,000 this year.”

Under Obamacare, the federal government will pay for 100 percent of the cost of patients who are eligible under the expansion of the law for the first three years. But HFS has predicted that some residents who are already eligible for Medicaid but have not applied will apply now because of the outreach efforts associated with the launch of the Affordable Care Act. The state would only get the standard 50-50 federal match for those enrollees. Illinois has received 82,000 applications from the federal online insurance marketplace and is sifting through them. Hamos said that until that job is done, there is no way to know how many of the applicants would fall under the lower funding match level.

Hamos also told the committee that the savings targets established under the 2012 Medicaid reforms (also known as the SMART Act) will not be reached. The original savings estimate was $1.6 billion, but Hamos said today it has been revised to $1.1 billion, which she called “still very significant for a program like this.” Hamos said several factors led to the savings being less than expected, including procurement timelines, pending litigation and delays in federal approval of same changes. The federal government also denied some of the proposals in the law. Hamos said the savings estimates tied to the state’s efforts to purge Medicaid of the ineligible enrollees was too high.

While Republicans have accused Gov. Pat Quinn’s administration of not being aggressive enough in implementing the Medicaid changes geared toward cutting costs, some said today they were glad to hear that the savings are still significant. “To be able to look at the savings from the SMART Act, [it] shows us that we did do something in government,” said Hinsdale Republican Rep. Patricia Bellock.

Speaker: Gaming is dead

House Speaker Michael Madigan deflated all momentum behind a capital bill this afternoon with one statement: “Given the conditions that exist here in Springfield, I think that the proposed expansion of gaming is a dead issue.” And the state’s operating budget remains unbalanced, as the House continues to reject ideas that would plug what the governor describes as a $2 billion hole. While the House is expected to vote next week to restore some of the governor’s $1.4 billion in cuts, they’re unlikely to support revenue ideas to pay for them.

Madigan spoke in a Statehouse news conference shortly after the full chamber rejected the Senate’s gaming proposal, which would have allowed a new land-based casino in Chicago, a state-owned casino and a new riverboat somewhere in the state. It also would have allowed slot machines at horse race tracks.

The multibillion dollar revenue source was the crux of a $34 billion capital construction plan. Without it, Illinois enters its ninth year without a major capital plan and without federal matching funds earmarked for transportation projects.

“This is another example of the speaker’s shenanigans to thwart the capital bill, which would put hundreds of thousands of people to work, and to impose an income tax on the people of Illinois next year,” the governor’s office wrote in an e-mail. The governor is not giving up on capital, said his spokesman Brian Williamsen in a phone conversation.

In a characteristically methodical way, the speaker led his caucus in rejecting most of the funding source of the capital plan. Yet Madigan added that he would not declare a capital plan dead, just gaming.

Without gaming, he said he’d consider previous revenue ideas, including one proposed by House Minority Leader Tom Cross last year that would offer a limited expansion of gaming at existing casinos or riverboats. The speaker also has his own version of a gaming plan that would reform the Illinois Gaming Board. And he cited a previous measure he supported: a constitutional amendment that would increase the Illinois income tax to fund education and construction needs.

Madigan denied, however, that he would propose an income tax increase after the November elections, as the governor and some Republicans repeatedly have charged. “I am not going to support an increase in the income tax during a lame duck session of the legislature,” Madigan said. He did not, however, rule out next spring. “Next spring is next spring. That’s a long time away.”

Senate Minority Leader Frank Watson said it’s unfortunate the speaker took gaming off the table to fund capital. “Revenue has to be generated to fund a capital bill, and gaming seemed to be the best alternative.” He added that although he’s not happy about it, Madigan’s statement could have a positive side. “I think we’ve been strung along for a long period of time … If this is going to bring closure to at least the revenue source, then, I guess, so be it.”

Watson said his caucus would be willing to consider alternative revenue sources for a capital plan, and he charged the speaker with the responsibility to propose such alternatives.

Capital bill summary: All parties say they’re not going to give up on capital, but none seem to offer alternatives that would serve as a compromise. Gaming was thought to be the compromise between most of the parties, but the House didn’t like the Senate’s procedural method that prevented the House from being able to make any changes to the gaming plan. So the General Assembly went from having what looked like a compromise to what turned out to be another dramatized clash between two chambers, leaving us where we started.

The operating budget is just as anti-climactic at this point. To be clear, the state does have an operating budget in place with most of the $59 billion spending plan activated. Yet the governor’s $1.4 billion in cuts announced Wednesday still leave an unbalanced budget, according to the House and Senate GOP. According to the House speaker, “The word 'balanced' is one of these things that’s in the eye of the beholder.”

State Medicaid spending often is one area that can be delayed to balance the current year’s budget. Sen. Dale Righter, a Mattoon Republican, explained last night that regardless of the governor’s budget cuts that affect state Medicaid programs, the state still has to reimburse medical providers who care for Medicaid patients. “We still owe those bills. So the governor’s not cutting growth in government when he cuts Medicaid. He’s just pushing bills off into the future,” Righter said.

The rest of the governor’s spending cuts, particularly to human services, could be considered by the House next week. It’s scheduled to return Tuesday through Thursday. The Senate is not, meaning no cuts will be restored unless the Senate also agrees. That could be a while, considering Senate President Emil Jones Jr. said his chamber isn’t scheduled to come back to Springfield until the annual fall session in November. His spokeswoman said they would wait to see what the House did next week before deciding whether to override some of the governor’s vetoes before then.

But, there’s always the chance that the state budget could end up where it started, with relatively flat funding levels for most state services and some decreases for operations. “I could see nothing happening,” Cross said after the House rejected gaming.

The one option remaining on the table in the House is so-called fund sweeps. The Senate and the governor want to allow the governor to transfer about $530 million from dedicated funds to the state’s general fund. It’s been done for years under multiple administrations. Although fund sweeps appears to be the one common ground between all parties, Cross said it’s a) not enough and b) not guaranteed. “If you’re going to end up using fund sweeps, where does it go? Does it go back to pay bills? Does it go to [developmental disabilities]? Does it go to higher ed? To nursing? There’s not enough to take care of all these. So I don’t know. It’s possible at the end of the day nothing happens.”

Madigan said last night that his Democratic members want to define which funds could be swept and where the money would go. They also may want to reduce the amount transferred.

Sen. Donne Trotter, a budget negotiator for his chamber, said there’s actually about $1.9 billion available in the dedicated funds that otherwise is considered “surplus” at the end of each year. He said he’d be willing to consider changing the amount transferred, whether it’s more or less than $530 million. Madigan, however, said fund sweeps historically topped off at $300 million.

Either way, Trotter and many others agree that fund sweeps won’t solve the budget deficit, whether the state operates at $1 billion or $2 billion in the red.

Operating budget summary: There’s a lot of work to do. If the House overrides some of the governor’s budget cuts without approving ways to pay for them, the budget will tilt further out of balance. The level of funding for state services during the second half of the fiscal year could come down to how well the state economy performs and whether legislators agree on ways to plug remaining holes when they reconvene this fall.

Despite court rulings, Obamacare subsidies to continue in Illinois

By Jamey Dunn

Dueling court rulings handed down today put the future of a key piece of Obamacare into question, but for now, nothing will change about the way the law is implemented in Illinois.

A three judge panel in Washington D.C. ruled this morning that under the Patient Protection and Affordable Care Act, federal subsidies to bring down the cost of insurance should only be available to residents of states that operate their own online insurance exchange. Under the decisions, Illinois and 35 other states would lose the subsidies. Illinois partnered with the feds on Getcoveredillinois.gov, but the website still relies on the federal exchange to sign patients up for coverage.

Just hours after the U.S. Court of Appeals for the D.C. Circuit weighed in, The Fourth Circuit Court of Appeals in Virginia issued a diverging opinion on a similar case. That panel of judges said that the wording of the law was unclear, but the majority agreed that the law allows for the subsidies to be dispersed through the federal exchange.

In Illinois, 217,000 people obtained insurance through the exchange. More than three quarters of those qualified for a subsidy. Health officials in Illinois say that those approximately 168,000 will not lose their subsides as an immediate result of the rulings. “We are monitoring today’s appeals court decisions in which two courts have rendered differing rulings. The bottom line for now is that nothing has changed, and the subsidies created under the law to help people cover the cost of their health care remain in effect. Get Covered Illinois is focused on preparing for the enrollment period for year two that will start this fall,” Jennifer Koehler, executive director of Get Covered Illinois, said in a written statement.

President Barack Obama’s administration says it plans to ask the full panel of judges at the D.C. appeals court to consider the issue. That group is made up of seven judges appointed by Democrats and four appointed by Republicans. Two other judges, one appointed by a Democrat and one by a Republican, could sit in on the case. It is possible that the issue may end up before the U.S. Supreme Court. The court previously upheld the law, but allowed states to opt out of a massive Medicaid expansion called for by the Affordable Care Act. Illinois lawmakers approved and Gov. Pat Quinn signed into law the expansion in Illinois.

State online insurance exchanges 

Source: The Henry J. Kaiser Family Foundation, KFF State Health

Enrollment grows as Obamacare sign-up deadline approaches

By Jamey Dunn

According to enrollment numbers released by the federal government today, more than 313,000 Illinoisans have obtained health care coverage under “Obamacare.”

As of the end of February, 113,733 got insurance coverage through either Illinois’ insurance marketplace or the federal website. That number is up by 25,131 from January’s total. In addition to those who have chosen insurance plans, about 200,000 people have received coverage under the Medicaid expansion, which is a key component of the Affordable Care Act. “February was a busy and productive month, and we are working hard to build on it in the next three weeks. We want everyone who is not yet covered to know that the six-month enrollment window will be closing as of March 31,” Jennifer Koehler, executive director of Get Covered Illinois, said in a prepared statement. “To everyone who has been waiting on the sidelines, we are saying: ‘Don’t delay: Enroll today.’ Go to our website, GetCoveredIllinois.gov and find out what your options are. We are working closely with hundreds of community partners across Illinois to ensure that everyone who needs assistance can get it, and that no one misses out on the opportunity to enroll in a quality, affordable health plan this month.” Those seeking insurance coverage that begins on April 1 must unroll by this Saturday. Anyone who does not have coverage by the March 31 deadline would be subject to a penalty fee when they file their tax returns for 2014. However, there are exemptions for those who opt out of coverage for religious reasons or those who can show that they are not eligible for Medicaid and cannot afford coverage. The next open enrollment period is scheduled for November with coverage beginning in January 2015.

Of the Illinoisans that have purchased insurance, 77 percent are eligible for federal subsidies to help cover the cost. More than half of those getting coverage are women and 25 percent are between the ages of 18 and 34. This group, dubbed the young invincibles, are important to the program because their relatively low need for health care would offset the costs of insurer the older and those with pre-existing conditions. The rate of young enrollees in Illinois tracks with the federal numbers, but is lower than the number of them that are eligible for coverage. The Henry J. Kaiser Family Foundation, a nonprofit that focuses on health policy, estimates that about 40 percent of those eligible to purchase insurance on the exchange nationwide fall into the young invincibles category. Health care officials on the state and federal level are courting young people to sign up before the March 31 open enrollment deadline. Illinois partnered with the satirical news website The Onion to advertise coverage. President Barack Obama made on online splash today by pitching Obamacare on Between Two Ferns—a talk show hosted by Zach Galifianakis that airs on a website called Funny or Die.

For more on the state's online insurance exchange, see the current Illinois Issues. 

Statehouse news coverage in Illinois follows national trends

By Jamey Dunn

A new report on statehouse press corps found that as the number of full-time reporters shrinks, new media outlets and political communication staffs seek to fill the gaps in coverage.

The Pew Research Journalism Project surveyed statehouse media outlets, political communications staff and experts on government in all 50 states. (Disclosure: I participated as a respondent in the survey.) The group found that nearly 1,600 reporters are based in state capitol buildings covering state governments across the country. The majority of those journalists, 851, are assigned to cover state government part time, while 741 are on the state government beat—covering legislatures, governors and state agencies— full time. State populations are generally predictive of the size of their statehouse press corps. Pew found that of the 10 most populous states only two, Georgia and North Carolina, were not among the 10 largest press corps. At the time of the survey, Illinois had 22 full-time statehouse reporters. Texas had the most at 53 and South Dakota had the fewest with two.

Less than a third of all newspapers in the country assign a reporter, either full or part-time, to the statehouse. The vast majority of television stations, 86 percent, do not assign a reporter to the state capitol. Still, the largest share, 38 percent, of reporters based in state capitol buildings work for newspapers, and newspaper reporters make up 43 percent of full-time statehouse journalists. Television comes in second at 19 percent of all reporters covering state government. Nontraditional outlets, such as digital-only sources, make up 16 percent. Wire services make up 9 percent of reporters assigned to state capitols across the country, and most of those journalists work for the Associated Press. Radio reporters make up 8 percent. University entities and “additional sectors” rounded out the totals with 7 percent and 6 percent, respectively. (Pews figures total more than 100 percent because of rounding.)

The study cites statistics from the American Journalism Review, which tallied up statehouse newspaper reporters five times between 1998 and 2009. Each time the number of reporters dropped, and the largest decrease came between 2003 and 2009, when the overall number of newspaper reporters saw a large decline. Statehouse bureaus shrank at a slightly larger margin, 35 percent, than newsrooms, 30 percent. “It does suggest, if nothing else, that statehouse jobs are certainly no more immune to the cutbacks then anything else,” said Mark Jurkowitz, associate director of the Pew Research Center’s Journalism Project. For more on the cutbacks in Illinois, see Illinois Issues October 2008.

The survey found that traditional news sources are turning to consolidation and collaboration. One-time rivals are now working together and sharing information. For example, the Miami Herald and the Tampa Bay Times now share a bureau in Tallahassee and coordinate their coverage of Florida state government. Students are also playing a big role in statehouse coverage. One of seven people reporting from a state capitol pressroom is a college student. This finding holds true in Illinois, with statehouse bureaus taking on Public Affairs Reporting interns during the spring legislative session since the programwas founded in the 1970s. Jurkowitz said that it is impossible to tell if interns are being used to make up for recent cuts in staff because there is no historical documentation on the number of statehouse interns nationwide.

Pew found that one in six statehouse reporters work for “nontraditional” outlets, such as nonprofit organizations, niche publications and digital-only news sources. According to the study, the largest statehouse bureau in the country, which has 15 reporters, is operated by the Texas Tribune, a nonprofit primarily digital operation. Most of these outlets are relatively new, such as The Illinois News Network, which is based out of the conservative-leaning think tank the Illinois Policy Institute. But some are longstanding news sources, such as Rich Miller’s Capitol Fax. Pew found that many such organizations have an ideological bent or market paid subscription content to “insiders” seeking information on state governments because it relates to their occupation.

Political communication staffs now provide information that more closely resembles news coverage. “The legislative offices themselves are getting much more into the business of directly communicating with the public and circumventing the media,” Jurkowitz said. In Illinois, the Senate Democrats and House Republicans are both good examples of this trend. A slideshow highlighting new laws created by Senate Democratic communication staff went viral earlier this year, receiving more than 1 million views. Both caucuses frequently capture video of their members and distribute it online, post information to websites that resemble news outlets and stay active on social media. Former journalists serve as high-level staffers for both caucuses. For more on they ways Illinois officials use social media, see Illinois Issues November 2013.

Citizens can also access live-streaming video and audio of legislative session and most hearings on the Illinois General Assembly’s website. Jurkowitz called all this direct communication from officials a “mixed blessing” because it provides the public with more information, but it often comes with a hefty dose of political spin.

“I do think there’s been a loss in general across the country, and that’s very concerning to me,” Patrick Marley, who covers the Wisconsin Statehouse for the Milwaukee Journal Sentinel, told Pew “We have scads of reporters in Washington covering every bit of news that Congress makes. State legislators have more effect on people’s daily lives. We need to have eyes on them, lots of eyes.” Jurkowitz said Pew’s research indicates that state governments may be doing more heavy policy lifting than they have in the past. He said a separate Pew study found that almost half of state governments enacted more laws in 2012 than Congress did in 2011 and 2012 combined.

As Congress continues to be gripped by gridlock, states have been left to tackle high profile policy issues, such as immigration and health care. For example, states are playing a large role in the implementation of the Affordable Care Act and a ruling from the U.S. Supreme court allowed them to opt out of a massive Medicaid expansion—a key component of the law. In many cases, state lawmakers voted on whether to adopt the expansion. In some states, governors made that call. “Obviously, we know that not a lot of activity is going on here at the federal level,” he said. “I think we’ve seen a lot of the big national public policy debates actually play out at the state level.”

House plans additional session to finish business incentive plan

By Jamey Dunn


UPDATED ON NOVEMBER 10: Speaker Michael Madigan announced on the House floor today that members of the chamber will return for session on November 29. That is a change from last night's announcement of November 21. 

Lawmakers will likely be returning to Springfield later this month to wrap up a plan intended to keep businesses in the state.

As the legislative session was drawing to a close this evening, it was announced on the House floor that legislators should be prepared to return to the Statehouse for session on November 21. Veto session was originally scheduled to last through tomorrow. “It will be an opportunity for the House Revenue Committee to report a tax incentive bill,” House Speaker Michael Madigan said after the announcement. When asked whether the tax incentive package, which began as a plan to keep the CME Group from making good on threats to leave the state, would be addressed, Madigan said, “That’s the plan.”

A spokesperson for Senate President John Cullerton said Cullerton is “surveying his members” to see if they are available for more session days.

Cullerton introduced a bill that would cut taxes for the CME Group, which owns the Chicago Mercantile Exchange and the Chicago Board of Trade. CME representatives said the recent income tax increase would result in the company owing the state $158 million. Republicans demanded other business friendly provisions and said they would not support a bill that was geared to only one business. Sears is also looking for incentive to stay in the state. Since the introduction of the bill, wish lists from all sides have been piled on, and Madigan seems to be seeking more time to iron out a deal that can pass.

Additional session days would allow sponsors who have been unable to drum up support for their bills more time to try an find “yes” votes.

One such sponsor could be Skokie Democratic Rep. Lou Lang. Senate Bill 1849, a revamped version of a gaming expansion package, failed to pass today in the House. Lang said yesterday that he was seeking a veto-proof majority, but the bill failed to gain even the simple majority needed to move it over to the Senate.

Lang said the new bill was a better version of a gaming package that lawmakers approved last spring. “This bill provides less gaming and more oversight.” He said he took Gov. Pat Quinn’s complaints about SB 744, which Quinn vowed to veto, under consideration when drafting the new plan. But in the end, the sticking point is allowing horse racing tracks to have slot machines. Quinn is opposed and Lang and Waukegan Democratic Sen. Terry Link, who is the gaming point man in his chamber, say a gambling expansion cannot pass in the legislature without them. Quinn’s office did not respond to an inquiry about the governor’s position on SB 1849.

“The first thing that the governor said was, No help for our agribusiness people. No help for central and southern Illinois. 'No help for you. You’re on your own. You’re on your own. Oh, we’ll continue to cut jobs in your communities. We’ll close facilities in your communities,'” Lang said during floor debate. “It would make me angry if I lived in central Illinois.”

Lang attempted to tweak legislative frustration with the governor toward his favor, but in the end, it may have been Quinn’s opposition that pulled off of this new bill at least some of the original 65 “yes” votes for the larger gaming package approved in spring.

Madigan said Quinn’s opposition to slots at horse racing tracks and what most see as an inevitable veto for SB 1849, if it should pass, may have damped support. “That could dissuade people from voting yes.”

“Clearly several people who voted for this in May did not vote for it today. I had several members who voted no last time that told me that they were going to vote yes today,” Lang said. “We’ll get to the bottom of it and figure out if we can find the necessary votes to pass it by tomorrow.”

Lang said legislators should not allow Quinn’s veto threats to sway their votes. “That happens around here a lot. And that would be not a proper way to make legislation. We have a Constitution that provides for three coequal branches of government, and I would hope that legislators would not abdicate their responsibilities under the Constitution worrying about what [the governor] might do if we pass a bill.”

Other issues could bleed into extra session days. House Minority Leader Tom Cross has yet to call, SB 512, his plan to reduce pension benefits for workers hired before reduced benefits kicked in this year. The deadline has passed to override Quinn’s budget vetoes, which include a cut to Medicaid reimbursements for hospitals and an unpopular cut to funding for school transportation. Without a corresponding rate cut, the Medicaid reduction would essentially push bills into next fiscal year. The vetoes stand, so lawmakers may look to make budget tweaks in the near future.

Welcome to the house of cards

By Patrick O’Brien and Bethany Jaeger
There are 1.7 billion reasons the House and Senate have their work cut out for them as they try to negotiate a state budget by the end of the month.

That’s the difference between the chambers’ closest budget proposals, according to Sen. Donne Trotter, a Chicago Democrat and the Senate’s lead budget negotiator.

Trotter also said the “Christmas tree” budget advanced by the House earlier this week would not be considered by the Senate. “It’s a non-starter,” he said. “We’re not going to that level whatsoever.”

The Senate’s budget plan, which advanced along party lines today, increases spending in some state agencies and modestly increases funding for education. But it depends entirely on the approval of a $16 billion pension bond deal that would go toward pension liabilities. But it also would free up about $500 million that otherwise would have gone into the state’s annual contribution to the five public employee pension systems. See more about how that would work in last night’s blog post.

Sen. John Sullivan, a Rushville Democrat, said the pension deal is far from done. “It’s absolutely going to be troublesome, especially in the House,” he said. “It’s going to be troublesome here as well.” If the deal fails, Sullivan added, the state could have to cut $500 million from state agencies.

Senate Minority Leader Frank Waston said the pension bonds don’t even live up to the obligations Democrats set for themselves in a 2003 deal. “Every year, we go through this,” he said during floor debate. “At some point in time, somebody’s going to have to pay. And unfortunately, reality has not set in, especially on your side of the aisle.”

The GOP voted against the plan because they said it was out of balance, partially because they think Democrats are misjudging the amount of revenue the state’s flagging economy can produce.

Sen. Christine Radogno, a Lemont Republican and budget negotiator, questioned Democrats’ priorities. For instance, they would decrease funding for teachers who work with students in the Illinois Department of Juvenile Justice. “I don’t think the priorities are right at all,” she said. And if the pension deal fails, then the entire budget is out of whack.

Funding for the expansion of the LaSalle Veterans Home also was not part of the Senate’s plan. Sen. Gary Dahl, a Peru Republican, said it was an act of political retribution. “When you pick on my veterans, we’ve got a problem,” he said. “You’ve gone out of bounds on this one.”

The Democratic proposal would increase funding for veterans’ homes, including the one in LaSalle. But Dahl said that wouldn’t be enough to hire the number of nurses necessary to fill beds that are already available but unused. See the next print edition of Illinois Issues magazine, available in the first week of June, for more information about the funding crunch at all of the state’s veterans’ homes.

Trotter simply said the budget proposal lives within the state’s means. “This is the time to be responsible,” he said. “This is all we can afford.”

Here’s a few examples of the Senate’s version of a budget, which all agreed was a starting point:

• The Senate would spend $29 billion out of the state’s general revenue fund.

• The Senate budget relies on $1.73 billion in new revenues:
• $1.2 billion of that would come from such items as state tax revenues and the federal stimulus package.
• $530 million would come from fund sweeps of dedicated accounts. That would be split up: The Senate Democrats would use $260 million of that to collect federal matching funds to pay Medicaid bills, and then they’d spend $170 million on about two dozen school construction projects that were promised state funds about five years ago. It wasn’t specified how the remaining $100 million would be dispersed.
  

• It also relies on the $16 billion pension deal to free up $500 million that otherwise would have gone toward the state’s annual contribution.

• The Medicaid bills, however, continue to mount, although the Senate Dems’ budget proposal would not include new Medicaid programs. The payment cycle also would remain around 70 days on average, which is not an improvement.

• The Senate would increase education funding so that the minimum state aid per student reaches about $6,000. It also would increase money available for early childhood education programs and bilingual education.

• Neither chamber proposes closing any prisons.