Managed care reforms will be irrelevant to uninsured Illinoisans
by Charles N. Wheeler III
In recent years, the Illinois General
Assembly has labored in vain to
enact managed care reform that would
balance legitimate concerns about
quality of care with equally valid
worries about health care costs. Now,
that elusive goal might be within
lawmakers' grasp as they head into the
final weeks of the spring session with
high hopes for a plan that would
provide many of the safeguards
reformers want without undermining
the cost-savings so attractive to the
business community.
An agreement would be great news
for the millions of Illinoisans enrolled
in health maintenance organizations
or other state-regulated managed care
plans.
For another 1.5 million residents,
though, whatever reforms might
emerge would be irrelevant because
they are not covered by any type of
health insurance. Their ranks include
the working poor — folks who
typically labor at minimum-wage jobs
with limited benefits, or who can't
afford the cost of employer-offered
health insurance — as well as people
whose existing physical problems make
them poor risks for insurance plans
eager to limit exposure to future costs.
Moreover, their numbers are rising, at
the rate of more than 100,000 a month
nationally, according to U.S. Census
Bureau data.
But voters in separate
referendums across Illinois
have endorsed the idea that
access to decent health care
is a fundamental right.
While lawmakers have concentrated
on protecting consumers against the
worst abuses of managed care, public
sentiment has been growing to do
something about the plight of those
without coverage.
Most notably, last month voters in
separate referendums across Illinois
overwhelmingly endorsed the idea that
access to decent health care is a fundamental right. They did so by asking
lawmakers to propose an amendment
adding universal health care coverage
to the Illinois Constitution's Bill of
Rights.
Dubbed the Bernardin Amendment,
the proposal takes its name from the
late Cardinal Joseph Bernardin of
Chicago, who wrote in a 1995 pastoral
letter that health care is an essential
safeguard of human life and dignity,
which society is obligated to ensure for
all.
Besides adding to the Bill of Rights,
the amendment would direct the
legislature to enact by May 31, 2002, a
plan for universal health care coverage
that permits everyone in Illinois to
obtain decent health care on a regular
basis.
The victory margin in the nonbinding referendums in several counties
and dozens of cities, villages and townships ranged from a low of about 64
percent to a high of almost 84 percent.
The plan garnered almost 65 percent
of the vote in suburban Kane County,
where a petition drive got the question
on the ballot. The April results
followed an 83 percent favorable vote
in Cook County last November.
Although the proposal stalled in the
House a year ago, proponents believe
the referendum results will encourage a
closer look at the issue by lawmakers.
"There's definitely momentum," says
East Moline Democratic Rep. Mike
Boland, the amendment's sponsor.
"It's really in the air, particularly since
the election."
Jim Duffett, also a supporter, likens
the Bernardin plan to a barometer to
gauge popular support for universal
coverage. The vote "will help push the
debate another step or two," says
Duffett, executive director of the
Campaign for Better Health Care,
a statewide coalition promoting
universal coverage.
A final vote on the Bernardin
Amendment might not come until
next year, allowing supporters to
underscore public support for the plan
through another round of referendums
in the March primary.
The help likely will be needed, as
proposed amendments need three-fifths approval in both legislative
chambers to go on the general election
ballot, and universal health care coverage is a controversial notion.
Still, some of the criticism now
being directed at the Bernardin
Amendment is off the mark. Despite
opponents' claims, the proposal does
not require a government-run system;
instead, its wording gives great
flexibility to the legislature. The charge
is simply to design a plan "that
permits everyone in Illinois to obtain
42 / May 1999 Illinois Issues
decent health care on a regular basis."
"It leaves it up to the legislature to
come up with some type of plan to
make sure everybody has access,"
Boland notes.
The plan could involve tax credits
for employers or individuals to help
cover premium costs, or expansion of
Medicaid to cover more working poor
(for example the families of KidCare
children), or contracts with private
insurers for coverage, or a combination of elements, including co-payments and deductibles, Boland says.
"I have full confidence that we have
enough brainpower out there that we
can all sit down and come up with
something," he says.
In fact, legislation promoted by the
Campaign for Better Health Care
would set up a bipartisan commission
to study the issue over several years.
Through a series of public hearings,
the panel would develop detailed,
side-by-side comparisons of a variety
of options for citizens to evaluate.
Final recommendations would be due
to the legislature by 2004.
The traditional safety net
has been shredded, though,
by today's market-driven
managed care. The Bernardin
Amendment reminds us we
have a duty to replace it.
"All sorts of ideas should be on the
table and argued pro and con,"
Duffett believes. "There should be a
very healthy debate."
Nor do supporters concede as a
given that higher taxes would be needed to pay for expanded coverage.
Costs would depend on the final plan,
and the money could come from the
state's share of the tobacco lawsuit
settlement, estimated at some $360
million a year for the next 25 years.
Not too many years ago, people
without insurance relied on what
some economists called a "Robin
Hood" mechanism to cover health
care costs: Everybody else was willing
to pay a little more to subsidize their
care.
The traditional safety net has been
shredded, though, by today's market-driven managed care. The Bernardin
Amendment reminds us that we have
a duty to fashion a replacement.
Charles N. Wheeler III is director of the
Public Affairs Reporting program at the
University of Illinois at Springfield.
Illinois Issues May 1999 / 43