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County health struggle moves to Springfield

Sunday, May 20, 2012
Chicago Sun-Times
by NEIL STEINBERG

Springfield has its allure — it must, right? People live there. They can’t all be trapped by cruel circumstance. Among visitors, however, there are only two attitudes toward the state capital: to get out as soon as possible, if currently there, or to never return, for those who’ve escaped.

So when I learned that Cook County Board President Toni Preckwinkle is ducking away from the magnificent springtime bliss that is Chicago to journey to the brackish backwater of Springfield, I figured there must be a compelling reason. And there is.

Preckwinkle is lobbying the Illinois Legislature, the first time she has done so personally, over a bill that in times of less partisan insanity would be a no-brainer.

“A year ago in January, the legislature adopted a moratorium requiring no expansion of Medicaid until January of 2014,” Preckwinkle said Friday. “We’re applying for a waiver so we can enroll people now who will be eligible in 2014, and in order to do that, we have to get an exemption from the statute.”

The waiver would let 100,000 low-income people in Cook County join Medicaid in July.

The problem is, when the legislature was banning people from signing up for Medicaid, it neglected to also adopt a law banning them from being sick. So the last-resort county hospitals — Stroger and Provident, plus 16 ambulatory care clinics — are forced to treat more people for free than they already do: some 55 percent, 80 percent in the ERs. That is not a healthy business model.

“Most of the people we serve do not have private insurance,” said Preckwinkle. “We provide an extraordinary amount of charity care. Some world class institutions in town have less than 5 percent, some 1 or 2.”

Preckwinkle has hope the exemption will pass since it cost Downstaters, ever jealous of Chicago glittering like an unobtainable gem on their horizon, exactly nothing.

“Medicaid in Cook County is paid for entirely by our taxpayers and the federal government,” said Preckwinkle. “There is no state contribution.”

Even Republicans see a benefit. Gov. Rick Perry in Texas and Gov. Chris Christie in New Jersey supported similar waivers in their states, and here Tom Cross expressed his support, which of course sent off alarms among the national Republican mullahs.

“The Republican leader of the Illinois state house is on the verge of voting to speed up the implementation of Obamacare’s Medicaid expansion in the state nearly two years early,” the National Review gasped.

The Republicans have a point in that this is still taxpayer money, albeit federal, being spent. Where their point falls apart is when you ask, “So how do low-income people get health care?” The Republican answer — “they don’t” — is too often drowned out by the mouse shriek of malice passing for debate.

This is not just a funding issue. It’s also a question of giving 100,000 people access to better health care — now, because while those without insurance get care however they can, when someone is paying for someone’s health care, that health care naturally improves.

“This is very important. It will have a tremendous impact,” said Dr. Ram Raju, chief executive officer of the Cook County Health and Hospitals System. “Patients come first. This is an opportunity for us to give care the way care is supposed to be given. In this country, care is so fragmented, episodic. This will give us an opportunity to give coordinated care to patients.”

Providing adequate care is how overall health care costs are kept down. Dr. Raju used the example of an uninsured diabetic. After 18 months of haphazard neglect, that patient might need a kidney transplant at Stroger Hospital by the time Medicaid finally scoops him up in 2014.

Without the waiver, “these people are going to get sicker and sicker by 2014,” said Dr. Raju. “How does it make sense, when these people are going to get Medicaid anyway, to let them get sicker?”

Well, maybe they won’t be on Medicaid. Republicans, unwilling to wait for President Romney to ax Obama’s Affordable Health Care Act, assuming the Supreme Court doesn’t do it next month, might want to strike the first blow. The county doesn’t see that happening.

“We are very confident,” said Dr. Raju. “I hope the state will see how valuable and strong the proposal is. Every other state is taking advantage of this.”

Maybe so. But if this were such a done deal, then the president of the Cook County Board would not be spending the next two days in dusty Springfield, sweet-talking legislators, imploring them to make the practical, moral and economical choice. If the health of citizens were a priority all along, we wouldn’t be having this fight in the first place.



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