IHA Daily Briefing: Feb. 8

State Faces $3.2 Billion Budget Gap
Guv Releases Transition Committee Reports
IHA Legislative Reception Feb. 19 in Springfield
Survey Shows Growing Underinsured
Briefly Noted

State Faces $3.2 Billion Budget Gap
The Pritzker administration today released a new report indicating that the state faces a budget gap of $3.2 billion in the upcoming fiscal year (2020), $400 million higher than previous estimates.

According to a press release, “Digging Out: The Rauner Wreckage Report” builds on and extends the work of the Illinois Comptroller’s Office, identifying even worse damage than previously known – particularly the true magnitude of the budget deficit and the backlog of bills. Late payment interest penalties related to the state budget impasse (July 2015-August 2017) have exceeded $1.25 billion, and interest on the refinancing of the bill backlog will surpass $2 billion.

“Illinois will need years to dig out of the fiscal mess this administration inherited, and the road to recovery will begin with Governor Pritzker,” said report author Deputy Gov. Dan Hynes, who oversees budget and economic issues for the administration. “The Pritzker administration will be honest and transparent about the challenges we face and put forward long-term plans and investments that will get our state on firm financial footing. Despite these challenges, we will propose a balanced budget that invests in education and human services that were decimated under the previous administration.”

The report notes that the state’s debt associated with unpaid bills is nearly $15 billion: $7.9 billion in unpaid bills, $5.5 billion in backlog borrowing, $650 million in interfund borrowing and $500 million in estimated backpay for state workers.

Gov. Pritzker will deliver his first State of the State and budget address on Feb. 20.

Guv Releases Transition Committee Reports
Gov. J.B. Pritzker and Lt. Gov. Juliana Stratton this afternoon released a series of eleven transition committee reports, including a report on healthcare and social services from the Healthy Children and Families Committee. The committees met several times during December.

In issuing the reports, Gov. Pritzker and Lt. Gov. Juliana Stratton said they are “deeply grateful to the more than 400 Illinoisans from all over the state, representing both political parties, who served on 11 different committees to provide a diverse set of views about how to solve the myriad of challenges facing our state. As part of the new administration's commitment to ensuring that every person has equitable access to opportunity and well-being, the transition committees also viewed their work through a racial and economic equity lens across state agencies.”

The Healthy Children and Families Committee report noted numerous issues in the Medicaid program: “Inefficiencies and failures in the state’s Medicaid system haves led to an 8.1% drop in Medicaid enrollment since 2015, including a reduction in the number of children enrolled. Enrollment declines are the result, in part, of delays from increased hurdles enrollees face because of the added barriers of new verification procedures for application and redetermination processing. Failure to enroll and reenroll people in a timely manner has created a cycle of “churn” in enrollment, leaving thousands of people without insurance for months at a time. In addition, low reimbursement rates and confusion during the transition to managed care threaten the stability of provider organizations and reduce the number of medical professionals available to serve patients with Medicaid coverage. Underinvestment in community-based health providers has added to the lack of stability in care for individuals, including those with complex medical needs, including substance use, addictions, and mental health challenges.”

The report makes recommendations in three major areas:

  1. The new administration should break down racial and economic barriers to ensure every child, individual, family and community has the tools they need to build healthy lives, so all Illinoisans may reach their full potential;
  2. The new administration should eliminate health disparities by increasing access to affordable health care and preventive services, including mental health and substance use treatment, in every community across Illinois; and
  3. The new administration should stabilize and transform prevention and intervention services for children and families to better support families and care for children and youth.

Some of the recommendations focus on Medicaid managed care: “The state can improve Medicaid access, quality, and service delivery by increasing oversight, transparency, outcome reporting, and enforcement of Managed Care Organization (MCO) contracts. To allow for growth in access to care across specialties in all areas of the state and ensure a sustainable network, the state can increase Medicaid reimbursement rates across all services. Improved care coordination between providers and MCOs will improve patient outcomes and increase efficiencies. For Illinoisans who use Medicaid as their health insurance provider, the state can ensure continuity of care by improving determination and redetermination processes to prevent children and individuals from getting kicked out of coverage.”

See the Healthy Children and Families Committee report and list of committee members, which included IHA President and CEO A.J. Wilhelmi. See all the transition reports here.

IHA Legislative Reception Feb. 19 in Springfield
Sign up now to attend IHA's Legislative Reception at Maldaner's in Springfield on Tues., Feb. 19 from 5 to 8 p.m. (the evening prior to the Governor's State of the State/budget address). To RSVP, click here.

As the Illinois General Assembly begins their spring session, the hospital community faces many challenges, including continued state budget pressures and deep concerns with Medicaid managed care. IHA is poised and ready to serve as your trusted voice on these and other key healthcare issues in Springfield to support you in caring for your communities and transforming the healthcare delivery system. IHA's Legislative Reception will be a prime opportunity for you to meet your state legislators to discuss critical healthcare issues.

If you plan to attend, please let your legislators know that you will be at the reception.

Survey Shows Growing Underinsured
More U.S. adults are underinsured with the largest growth among people with job-based health plans. That’s according to results from the Commonwealth’s Fund’s latest Biennial Health Insurance Survey. Twenty-eight percent of U.S. adults who have health insurance through their employer were underinsured in 2018, up from 20 percent just four years earlier. At the same time, people who bought plans on their own through the individual market or the marketplaces were the most likely to be underinsured, with 42 percent reporting a lack of adequate coverage in 2018.

The survey showed that underinsured adults reported having trouble affording their care due to:

  • Problems getting care: 41 percent of underinsured adults said they delayed needed care because of cost, compared to 23 percent of people with adequate insurance coverage; and
  • Difficulty paying medical bills: Almost half (47 percent) of underinsured adults report medical bill and debt problems – nearly twice the rate as those who are not underinsured (25 percent).

Survey findings show that since the Affordable Care Act (ACA) became law, fewer adults lack insurance, but gains have stalled. Despite changes by the Trump administration and Congress that were expected to weaken the ACA, this survey finds no change in the adult uninsured rate between 2016 and the second half of 2018. By late fall of 2018, 12.4 percent of adults were uninsured, down from a high of 20 percent in the Commonwealth Fund’s 2010 survey, conducted the year the ACA became law.

Briefly Noted
The Centers for Disease Control and Prevention (CDC) recently launched an app to help vaccination providers quickly and easily determine which pneumococcal vaccines a patient needs and when. More details and links to download the app can be found on the CDC’s website.

The November 2018 Medicaid and Children’s Health Insurance Program (CHIP) enrollment figures showed more than 72.6 million individuals were enrolled in Medicaid and CHIP nationwide. More than 66 million were enrolled in Medicaid and more than 6.5 million were enrolled in CHIP. In Illinois, the total Medicaid and CHIP enrollment for the month was nearly 2.9 million. Illinois Medicaid enrollment was about 2.6 million while CHIP enrollment was nearly 245,000.