Rauner's Budget is Bad Medicine for State's Health Services

The following post originally appeared on Crain's Chicago Business.

The much-anticipated “turnaround budget” from Illinois Gov. Bruce Rauner feels more like a “look back,” parading out failed ideas from past years. Rauner says this budget "preserves services to the state's most vulnerable residents”—but a quick review suggests this is far from true. Instead, we see a budget that:

• Further decimates a fragile community mental health system
• Reduces access to lifesaving drugs for people living with HIV and prevention services for those at risk of HIV
• De-funds critical substance-abuse treatments
• Drastically reduces cost-effective breast and cervical cancer screening services
• Makes it harder, and in some cases impossible, for people with disabilities and seniors to get support to live at home
• Reduces funding for evidence-based tobacco prevention and cessation services
• Eliminates Medicaid benefits for preventive health services, including adult dental care
• Eliminates health insurance for workers with disabilities, coverage unavailable in the private marketplace
• Slashes funding for hospitals serving Medicaid populations
• Eliminates funding for care coordination, originally designed to contain costs
• Secures Illinois' position near the bottom of states for per-enrollee Medicaid funding

It's ironic the governor calls these cuts “tough medicine,” when the proposed budget would deny any medicine and critical health care services to so many. We've been down this road before, and here's what we learned:

• Cuts of $113 million to mental health and addiction treatment services in fiscal years 2009-11 increased state costs by more than $18 million due to increased emergency room visits, hospitalizations and nursing home placements.
• Elimination of Medicaid coverage for adult dental services in 2012 caused spikes in emergency department visits for dental problems. In-patient ER treatment for dental problems averaged $6,498, nearly 10 times the cost of preventive care delivered in a dentist's office.
• Disinvesting in HIV prevention will lead to new infections, for which the Centers for Disease Control estimates lifetime treatment costs of $379,668 per case.
• For every dollar Illinois spends on providing tobacco cessation treatments, it has on average saved $1.29. Cutting funding for smoking cessation services will increase costs by up to $32.3 million annually in health care expenditures and workplace productivity losses.

As proposed, the Rauner budget is not only bad for our health, but it's bad for businesses, too, likely resulting in decreased productivity, loss of jobs and economic activity, and greater health care costs for employers. Some examples:

• The proposed child care “intake freeze” and increase in parent co-pays will lead to increased absenteeism as employees will take time off to care for children. Such absenteeism already is costing American businesses nearly $3 billion annually.
• Planned cuts to Illinois hospitals are expected to result not only in the loss of more than 12,500 jobs but $1.7 billion in economic activity.
• Cuts in funding for health care services, such as cancer screening, most certainly will increase the health care costs of Illinois businesses. One study of major employers found that patients with cancer cost five times as much to insure as patients without cancer ($16,000 versus $3,000 annually).

We urge the governor to listen to the critics of this budget and learn from Illinois' past experiences. We stand prepared to support him on this learning curve.

Barbara A. Otto
CEO
Health & Disability Advocates

Ages 55-64 and Uninsured...Where Can We Go for Help?

The number of people without health insurance in the United States has increased steadily over the last several years, from 43 million in 2007 to 49 million in 2010. Individuals between the ages of 55 and 64 make up 11% of this uninsured population. This age group is particularly vulnerable when uninsured: people age 55-64 are more likely than younger people to be in fair or poor health, and people age 55-64 who are uninsured are twice as likely to be in fair or poor health than their counterparts with health insurance coverage.

Regardless of health status, individuals in this group do not qualify for coverage through Medicare or Medicaid unless they have a serious disability (i.e., one that meets Social Security’s definition of disability for purposes of awarding Social Security Disability Insurance). Therefore, most people age 55-64 who do not have employer coverage are forced to seek coverage in the individual insurance market, where they may currently be denied a plan or charged exorbitantly high premiums for having pre-existing conditions.

The implementation of the Affordable Care Act makes a big difference for this population. Right now, the ACA is providing incentives to small business owners to keep providing employer coverage for people between the ages of 55 and 64. In 2014, insurance companies will no longer be able to deny people coverage due to a pre-existing condition, and premiums and cost-sharing subsidies from the government will help to ensure that people can afford to pay for coverage.

But what can people in this age group do until 2014? With support from the Chicago Community Trust, AgeOptions has put together a toolkit, “No Insurance? Health Care Options for Individuals Age 55-64 Without Insurance”:

This toolkit contains information about health care resources for individuals without insurance coverage, including:

• “Safety net” organizations and programs that provide access to health care
• Affordable Care Act provisions that will assist these individuals in obtaining coverage
• Where to go for information and assistance in finding health care options

AgeOptions hopes that this toolkit will be a valuable resource for people who are 55-64 and who are uninsured or underinsured. For more information and materials created by the Make Medicare Work Coalition (MMW), visit the AgeOptions website here: http://www.ageoptions.org/whatwedo/MMW.cfm

Erin Weir
Manager of Health Care Access
AgeOptions

The Affordable Care Act: Dollars Flowing into Illinois

There’s no debating that Illinois could use some healthcare help. The state is ranked the 29th healthiest state—not the absolute bottom, but nowhere near the top. A recent poll also listed Illinois as the 31st most obese state and 25th for diabetes—not exactly stellar statistics. The same source noted that ,while Illinoisans benefit from high usage of early prenatal care and a comparative availability of primary care doctors, the state faces severe challenges, including prevalent binge drinking, high pollution levels, and a high rate of preventable hospitalizations.

These problems are not insurmountable. However, we all know the state is in a budget crisis. Governor Quinn has announced a plan to drastically reduce spending and raise revenues for Medicaid. We understand the state budget crisis, but obviously, people in Illinois need medical services, and the state is currently struggling to provide them.

Luckily, the Affordable Care Act is there to throw a lifeline out to health service providers and state agencies and especially to the real people who need healthcare. Thanks to the ACA, the states will spend about $90 billion less on healthcare with the implementation of the law than they would have spent without it. Thousands of people will still be getting the increased services mandated by the Act, but much of the funding will be federal rather than state.

It’s important to note that these benefits are not in the distant future; Illinoisans from birth to retirement are already benefiting from the Affordable Care Act.

Assistance from the ACA starts when kids are young; the ACA has already provided:

• $10.3 million for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals into individual homes to connect families to the services they need to raise happy and healthy kids. These services include prenatal care, pediatric care, education, and parenting skills. 
• $191,000 for Family-to-Family Health Information Centers, organizations run by and for families with children with special health care needs.
• $4.9 million for expanding and improving school-based health centers. Illinois funds 38 school-based clinics that provide screenings, physicals, exams, and more to students.
• $555,000 to support the Personal Responsibility Education Program, which educates youth on abstinence and contraception to prevent teen pregnancy and sexually transmitted infections, including HIV/AIDS.

The ACA is also spending money putting people to work at improving healthcare! Illinois has received:

• $400,000 to support the National Health Service Corps, by assisting Illinois in repaying educational loans of health care professionals in return for their practice in health professional shortage areas. This program is designed to help medical, dental, and mental health providers who choose to work in needy communities to repay their student loans. This is a particularly critical program because these professionals provide medical and dental care that individuals desperately need; the program allows professionals to provide care to needy individuals without worrying about their reimbursement rates or their ability to pay back debt.
• $5.1 million for health professions workforce demonstration projects. This program is designed to supplement the workforce in areas that are either already short-staffed or expected to be in the future. The Illinois Workforce Investment Board’s report noted shortages of both registered nurses and licensed practical nurses in Illinois. 

And the ACA helps elderly Illinoisans, too!

• $457,000 to support Aging and Disability Resource Centers (ADRCs). ADRCs help seniors and people with disabilities understand long-term care options including community care. 

So far, Illinois has received $170.7 million in grants due to the Affordable Care Act. These grants are creating tangible improvements to the physical and fiscal health of our state. Thanks, Affordable Care Act!

This article, written by Caitlin Padula, was originally posted on The Sargent Shriver National Center on Poverty Law's blog, The Shriver Brief. 

The Affordable Care Act & Nursing Home Abuse

A Look at Nursing Home Abuse  

Elder abuse in nursing homes is largely due to the inadequate staff levels. According to a 2001 Health and Human Services (HHS) study, 90 percent of nursing homes are understaffed. Lack of adequate staffing is known to lead to:

• An over-worked staff.
• An under-trained staff.
• High staff turnover.
• Mistakes in patient care.
• Inadequate time with patients. (Most nursing homes do not meet the federal government’s recommendation for 4 hours of patients care with every patient, daily.)
• Staff exhaustion, burn-out and stress
• Inadequate staff-to-patient ratios
• Inadequate staff background checks.

Before the Affordable Care Act, the federal government did not require nursing homes to complete staff background checks. According to an HHS report:

• 90 percent of nursing homes employ at least one staff member with a criminal background.
• Almost 50 percent employ 5 or more staff members with at least one conviction.
• 5 percent of nursing home staff members have at least one criminal conviction.

Ultimately, all of these are potential causes of abuse, and intentional and negligent neglect.

A Look at The Patient Protection and Affordable Care Act and Nursing Home Abuse

The Affordable Care Act (ACA) will affect nursing homes in a positive way and, if successful, curb the rate of abuse in these facilities. According to Families USA, the ACA will establish important programs, committees, and grants that will increase the effectiveness of the long-term care workforce and care. These numerous establishments aim to:

Improve the long-term facility workforce through:

• Increasing the size of the long-term care workforce to meet the needs of long-term care residents.
• Understanding and analyzing workforce supply and demand.
• Encouraging people to enter the long-term care workforce.
• Curbing the long-term care workforce’s staff turnover rate through retention efforts.
• Improve the quality of staff training by educating staff about demanding resident conditions, such as dementia; proper ethics; the importance of reporting staff abuses of residentsm identifying signs of elder abuse and identifying administrative abuse.

Improve elder care by:

• Increasing the at-home care and decreasing long-term care facility usage; at-home care is less expensive to state and federal governments
• Increasing the knowledge of caregivers by providing resources concerning finances, care, etc.
• Increasing consumer knowledge of nursing home facility deficiencies and staffing levels.
• Improving long-term facility environments.

Decrease elder abuse through:

• Increasing resources to increase how quickly elder abuse cases are investigated.
• Establishing quality staffs through mandatory nationwide staff background checks and education.

Amber Paley, Blogger/Writer
Nursing Home Abuse.net

What lies ahead for the Patient Protection and Affordable Care Act in 2012?

2011, the first full year for the Patient Protection and Affordable Care Act (ACA), is coming to a close. As we’ve written about in the past blog posts, Facebook posts, tweets or on our home page, the year saw many ACA developments, from the announcement of the definition of “essential health benefits” that are guaranteed under the law, to the initial stages of Illinois’ health insurance exchange legislation, to the rescission of the CLASS Act. This year also saw the early effects of the law’s impact – from the young adults who can now stay on their parents’ health insurance plan, to the seniors whose prescription drug costs in the Medicare “doughnut hole” are shrinking, to the people with chronic conditions who are no longer uninsured due to the availability of the state’s federally funded pre-existing condition insurance plan. 

Of course, many provisions of the ACA will not take effect until 2014, but several provisions of the law are slated to start in 2012, including:

• A series of demonstration projects designed to strengthen Medicare by eliminating fraud, waste, and abuse;
• The Medicare Independence at Home demonstration, which will test out coordinated care medical teams providing care to certain high-need Medicare patients in their own homes;
• A Medicaid demonstration, which will allow bundled payments for medical care that include hospitalizations, as well as extending the Medicaid Accountable Care Organizations savings to pediatric providers within those organizations; 
• A new annual tax on pharmaceutical companies; and
• On October 2012, Medicare payments for hospital readmissions will be reduced, to offset excessive readmissions to hospitals, such as early discharges from a hospital, which could result in a return visit.
   

What will undoubtedly become the biggest news of 2012 will be the Supreme Court case on the constitutionality of the ACA, beginning on March 26, 2011. Due to the number of different arguments against the ACA – ranging from the validity of the individual mandate to the constitutionality of the Medicaid expansion - the outcome of the case could take many different forms, from keeping the law in its entirely, striking down the whole law or portions of the law. The decision is expected in June 2012.

Also in 2012, it will be important to watch how the implementation of pieces of the ACA that are already in effect will continue, most notably, the establishment of a health benefits exchange in each state. Many states, have already begun the implementation, and are at various stages in the process, such as the 15 states (like Illinois) that have already enacted an exchange or intent of establishment legislature. Other states are working to pass such legislation, and others have not taken any steps towards establishing an exchange, either deferring to the federal government to run their exchanges, or riding on the assumption that the ACA will be struck down in the upcoming Supreme Court case. (See here for a recent news article about the status of the Illinois Exchange).

There are still many unknowns about the future of the ACA; however, what’s clear from our eight-part Neighborhood Stories series is that we have a lot of work to do to educate the communities in Illinois about the benefits of the law for small businesses, individuals/families and community organizations. Stay tuned to Illinois Health Matters for interactive features in early 2012, to help YOU understand how health care reform will impact you, your family and your community.

Happy, Healthy Holidays! 

Policy to the People - Illinois Policymakers Weigh In about ACA Implementation in Illinois

Health care reform in Illinois may originate from the federal law, the Affordable Care Act, but it is up to each state to implement many pieces of the law. For that reason, we made Illinois' implementation of health care reform the focus of our latest multimedia Neighborhood Stories series. The video, Policy to the People (by Jay Dunn) is the third in our series, and is accompanied by an article, Making Health the Best Policy (by Jeff Steele).

As health reform policies take shape in Illinois, it is important to make sure they benefit the citizens of the state. In the video, Senator Donne E. Trotter (IL -17th District) explains what he sees as necessary to keep policy geared towards the people, specifically those who are currently uninsured or underinsured. He advocates a “three pronged attack,” that involves policymakers, medical care providers and the citizens and health care consumers themselves, in the establishment of reform. “What we’re looking at,” Sen. Trotter explains, “is not as much what this law is going to do for people like myself, but for the future of America. We’re going to have a healthier society.”

The accompanying article, Making Health the Best Policy, explains the steps that Illinois policymakers have taken since 2010 to establish health care reforms right here in the Prairie State. Those who back the Affordable Care Act are attempting to impart positive messages, to counter the law's opponents working daily to ensure its provisions never go into effect.

We spoke to key policymakers in the Governor's Office, the Department of Health & Family Services (HFS) and the Illinois General Assembly about their vision of how reform will impact west and south siders' ability to gain insurance. Under the new health care law, HFS Director Julie Hamos says: “We believe there will be one million more people who will have access to private health insurance through the exchange, or public insurance through Medicaid...These are people who have not had a doctor, or a health checkup, in many years.” Michael Gelder, Governor Quinn's senior health policy advisor and Chair of the Illinois Health Care Reform Implementation Council says, “People on the west and south sides should see this as an opportunity to get health insurance. They should also see it as an opportunity to make their elected representatives, both federal and state, hear that they’re enthusiastic about [reform], and that they expect us to deliver on that.”

Check out these two great new pieces, as well as the other articles and videos in the Neighborhood Stories section of the Illinois Health Matters website, or on our new high quality Vimeo channel here. Stay tuned for the next installment where we look at how the Affordable Care Act is impacting local community organizations.