Illinois' dubious claim of first to cover all kids

State of Illinois
All Kids Illinois' Program to Provide Health Care for All Kids
Governor Rod R. Blagojevich ...more than a quarter of a million children right here in Illinois do not have health insurance. That means they can't see a doctor or get medicine when they need to. When they do get medical care, it's often in the emergency room, after a small problem has grown into a big problem. That's wrong. I believe every child should be able to get medical care when they need it, before it becomes an emergency. That's why I created the All Kids program: to make health care a reality for hundreds of thousands of families across the state. Illinois will be the first state in the nation to provide affordable, comprehensive health insurance for every child. Of the 250,000 children in Illinois without health insurance, more than half come from working and middle class families who earn too much to qualify for state programs like KidCare, but not enough to afford private health insurance. Through All Kids, comprehensive health insurance will be available to every uninsured child at rates their parents can afford...

Comment:
Gov. Blagojevich and the state of Illinois are to be commended for taking this initiative to become "the first state in the nation to provide affordable, comprehensive health insurance for every child." Although our one goal is to enact a single payer national health insurance program covering everyone, as individuals most of us support interim incremental measures that do expand access and coverage.

Dedicated advocates of universal health insurance, such as Sen. Ted Kennedy and Sen. Hillary Clinton, insist that adopting a single program of national health insurance is not politically feasible, so we should abandon that effort and direct our attention to incremental steps that will eventually result in universal coverage. One of the most radical steps that currently has some political traction is to provide universal coverage for all children.

Supporting health care for innocent little children is a political winner, not to mention that it is not much of a budget buster since most children are quite healthy and have only very modest health care needs. Although most incremental measures have been referred to as baby steps, covering all children would be a major giant step, even if incremental. So Illinois is the first state to enact universal coverage for children.

Let's look at some of the specifics.

* Current employer-sponsored and individually purchased insurance programs remain in place. Very low income families may qualify for a rebate if they follow a complex process. Adding administrative complexities to the current excessive administrative burden is flawed policy.

* In the future, individuals who wish to switch their children from private coverage to the All Kids program, primarily because of its premium structure, will have to wait one year without any coverage whatsoever before they can be enrolled (except for very low income families). Mandating a period of uninsurance is flawed policy.

* The program is means tested. Not only are premiums adjusted by income level, but also co-payments are tiered based on income, and even the total out-of-pocket maximum for cumulative co-payments is adjusted. This results in administrative complexities that are compounded by the fact that income levels change, creating instability in the benefit level for which the children qualify. Also, means tested programs are somewhat intrusive and demeaning and NEVER result in 100 percent participation. Means testing for a universal program is flawed policy.

* Failure to pay premiums results in cancellation of coverage. Reinstatement requires retroactive payment of all premiums plus a three month penalty of having no coverage. The majority of uninsured children are in families on tight budgets. Periodic problems paying bills are inevitable. Terminating coverage for personal financial difficulties is flawed policy.

* Under All Kids, physicians and pharmacies may refuse to provide services if co-payments are not paid. Including program requirements that obstruct access to care is flawed policy.

* The cost to the state is to be offset by the dubious savings theoretically attained by shifting state health insurance programs to a managed care system. Failure to establish a permanent, reliable source of funding is flawed policy.

* The application is eight pages and requires submission of various supporting documents. To improve enrollment rates, a large network of Application Agents has been established. Even with this costly administrative program, it is anticipated that only 50,000 of the 250,000 uninsured children will be enrolled this year. A true universal program should automatically enroll everyone. Even though all children uninsured for over a year are qualified for this program, administrative barriers will keep many out. Anything less than automatic enrollment is flawed policy.

* Physicians must contract with the state to provide services under this program. It is clear that many physicians are unwilling to do so, partly because of distrust due to a backlog of claims under the state's Medicaid program (which will be folded into All Kids). Parents may lose the option of taking their children to their current primary care physicians merely because of provider contracting considerations. Establishing restricted primary care provider lists is flawed policy.

* Primary care physicians will serve as the gatekeeper for specialized services. Although the specifics are not yet clear, presumably primary care providers will have to use restricted, in-network provider lists when referring children for specialty care, if such services are even covered. Such restrictions may not allow the primary care physician to use established, coordinated referral patterns, possibly resulting in fragmented, disruptive, and less accessible care. Not including all providers of health care services is flawed policy.

This is that giant incremental step of covering all children that everyone is talking about. It is a truly beneficial program. But it fails to provide universal coverage. It fails to reduce costly administrative excesses but rather adds more to our fragmented system of funding care.
It fails to remove financial barriers to access. It fails to provide free choice of health care providers. Simply stated, it costs more than a single payer system and it fails to establish single payer policies that would ensure accessible, comprehensive health care for everyone.
The next legislator that tells you that single payer should be rejected because it's not politically feasible, tell him or her that the election of obstructionists to health care justice is no longer politically feasible. Then share the word with others and follow through on election day.
DMc-QOTD