Gov. Rod Blagojevich wants the state to embark on an ambitious new program to offer health insurance to all Illinois children, regardless of income. He would pay for the expansion by transforming most of the state’s Medicaid program into a form of managed care.
The initiative lays out laudable goals. The problem of the uninsured is significant–millions of workers and their families fall through the cracks because they earn too much to qualify for Medicaid but can’t get coverage through employers. A move to managed care is essential to curb the skyrocketing costs of Medicaid.
Under the managed-care component, 1.7 million Medicaid recipients would pick gatekeeper physicians, who would be charged with keeping a closer eye on patients, coordinating care with specialists and preventing unnecessary tests and treatment that run up costs.
As with any new and complicated government program, the devil is in the details. And, so far, we know too few.
Medicaid is already the largest program in Illinois government. At $8 billion a year, it consumes $1 out of every $3 in the state’s operating fund. Blagojevich says the switch to managed care would save $57 million next year, of which $45 million would be used to subsidize coverage for 50,000 more children in the first year under his proposed All Kids program.
There would be the potential for tens of thousands more to sign up in the future. Just how many is unclear. The Census Bureau estimates there are 253,000 children in Illinois who lack health insurance, but Blagojevich aides are unsure whether that number is accurate.
They hired a consultant for $50,000 to check the math. That work isn’t done, but the administration announced its initiative anyway.
Managed care in the private sector has helped slow increases in health care costs, but it has hardly stopped them. Blagojevich’s program counts on lots of initial savings, but it also creates a new entitlement. It is not clear the savings will still be there five or 10 years from now.
Many other questions need study: Will there be enough doctors willing to manage care for all these Medicaid patients? Will the doctors have adequate time and resources? Will they have enough financial incentive?
Just months ago, Blagojevich aides were indignantly rebuffing Republican complaints that they were dragging their feet on bringing managed-care disciplines to Medicaid. Managed care had promise, the administration said, but the record in other states was so spotty that it was important to proceed with caution.
But now Blagojevich wants to jump in headlong and get an OK from lawmakers in their brief fall session, which starts Oct. 25. Quick action is important, he says, to get the program ramped up by next summer. That timetable neatly coincides with his re-election campaign.
The reforms are intriguing. But the long-term implications–for the health of patients and the state treasury–cry out for a thoughtful and detailed analysis. So far Blagojevich is having none of that, orchestrating a series of campaign-style media events and rallies to apply pressure to approve this quickly.
Blagojevich says this is an important and groundbreaking reform. If he believes that, he should take the time to dazzle us with facts and arguments, not pyrotechnics.
