Health care: key initiatives

With an abundance of new money to spend, state lawmakers made a number of improvements in health care delivery in Illinois. Lawmakers found money to boost rates paid doctors and hospitals to care for the poor. They chose not to approve an agreement that would have given the University of Illinois Hospital to Cook County. And they repealed a controversial law that requires AIDS testing for a marriage license.

Much of the focus of the session was on providing healthcare for Illinois citizens. The Illinois Accessible Health Care Act, a measure that would have required businesses to provide health insurance for their workers, died due to business opposition. It was pushed by the Illinois Hospital Association, which estimates that its facilities provide $600 million annually in care for which they are not paid.

The act would have required firms with at least five employees to provide coverage for workers who have worked for three consecutive months and averaged at least 17.5 hours per week. For workers the plan included a $500 annual deductible and a 20 percent copayment; they would pay between 20 and 40 percent of the premiums.

Carrying the bill were Sen. Howard Carroll (D-1, Chicago) and Rep. John Cullerton (D-7, Chicago). The pair said the proposal was designed to address the needs of the working poor who enjoy no health insurance benefits from their employers. "A growing segment of our population is completely losing access to the health care system," Carroll charged. Cullerton urged that employers be made responsible and complained that employers and employees who pay for health insurance end up subsidizing the businesses that do not provide any coverage.

The mandatory insurance measure drew strong business opposition. The Illinois State Chamber of Commerce organized a coalition named Business Opposed to Mandated Benefits (BOMB) which complained the plan would cost business $800 million in the first year. Business prevailed as the measure failed in the House.

Hospitals fared well on legislation boosting reimbursement rates for hospitals that serve the poor. Senate President Philip J. Rock (D-8, Oak Park) championed a "Fair Share" initiative to increase payments to hospitals whose patient populations are 25 percent or more Medicaid clients. Rock argued that health care was becoming a luxury in the state: "Poor families on Chicago's west and south sides, as well as in rural parts of the state, are watching the doors of their community hospitals close."

Per diem reimbursements rates to 46 hospitals will go up between $40 and $230, in the bill that was signed into law by Gov. James R. Thompson on August 21. The increase will provide $60 million to hospitals. To qualify hospitals must have a high percentage of Medicaid clients or operate where there is a doctors' shortage or serve children exclusively.

One hospital issue that lawmakers could not resolve was the proposal to have Cook County take over the operation of the University of Illinois Hospital. The University of Illinois, which projected a five-year deficit of $70 million for its hospital, would, in turn, use Michael Reese Hospital as its teaching hospital.

The proposal set off a firestorm of protest from residents of Chicago's west and south sides who feared the loss of quality, accessible health care services. The Illinois Department of Public Health studied the question and concluded that 11 conditions must be met. Those conditions ranged from assuring that service to vulnerable populations not be disrupted to expanding outpatient services. Questions over accessibility lingered and questions over cost loomed, so lawmakers declined in the final days of the session to approve the measure.

Doctors who serve the poor fared better than proponents of the University of Illinois-Michael Reese-Cook County Hospital affiliation. Rates paid doctors under the Medicaid programs were increased effective July 1:

• From $12.65 to $18 for routine office visits.
• From $446 to $770 for comprehensive obstretical care.
• Overall 16.5 percent for other medical services.

When he signed the increases into law, Gov. James R. Thompson urged physicians to take Medicaid patients as clients. Susan S. Suter, director of the Department of Public Aid, said, "Our goal is to increase access to medical care for the needy in Illinois and to get children the medical care they need, especially preventive medical care."

Still awaiting the governor's decision in late August was a measure to repeal the 18-month-old law that requires a couple to take an AIDS test before obtaining a marriage license. The mandatory test, the only one like it in the nation, was a part of the original 1987 package that lawmakers passed in response to the growing epidemic. Thompson signed the original law, insiders say, in part because he feared its veto would have sparked overrides of other vetoes that he considered more important.

The law has caused an increase in weddings for bordering states. Its opponents — chief among them Dr. Bernard J. Turnock, director of the Illinois Department of Public Health — charge that the required tests have been expensive and unproductive. Turnock projected that in the first six months of the testing, 70,000 individuals spent more than $2 million for the test. Those tests turned up eight cases.

In the fight against drug and alcohol abuse, lawmakers passed several initiatives, including:

• A ban on smoking in school buildings.
• A program to promote drug abuse prevention education through teacher training and community planning.
• A requirement to post notices in liquor stores warning that consumption of alcohol when pregnant may result in birth defects.

For health care, it was a different kind of year. There was some money, and those problems that could be addressed with more cash were. Issues that languished, like mandating employee health insurance, would have meant a more fundamental realignment of public/private responsibilities. □

August & September 1989 | Illinois Issues | 55