Medicaid use skyrockets in the suburbs as potential cutbacks loom
SPRINGFIELD -- The number of suburban residents enrolled in Medicaid has skyrocketed in recent years, even as Gov. Pat Quinn takes aim at funding for the health care program for the poor.
Suburban enrollment in the Medicaid program has risen drastically since the state's 2006 fiscal year: 89 percent in DuPage County, 76 percent in Kane, 103 percent in McHenry, 73 percent in Lake, 84 percent in Will, and 19 percent in Cook County, including Chicago, according to data from the Illinois Department of Healthcare and Family Services. That's far higher growth than in the state as a whole, where the number of people enrolled in Medicaid has risen 30 percent in the same period -- forcing the state to pay more and sacrifice funding for schools and other programs.
In his budget address on Wednesday, Quinn is expected to call for large cuts to Medicaid spending to help deal with the state's dismal finances. Medicaid, which costs the state $15 billion, is one of Illinois' largest expenses.
Yet, the prospect of cuts comes at a time when more and more suburban residents are using the program and when finding doctors in the suburbs who participate in the program already can be a formidable challenge.
The reason for the sharp suburban increase is the combination of a tough recession and policies that expanded Medicaid programs when former Gov. Rod Blagojevich was in office, said Rep. Patti Bellock, a Hinsdale Republican and Medicaid expert.
But more suburban residents needing government medical aid hasn't necessarily translated to more doctors who provide it.
Doctors who treat Medicaid patients are reimbursed for the cost of the care provided, but often months late and at a rate so low they lose money. For that reason, many suburban doctors have stopped taking on poor patients.
Dr. Brad Epstein, an obstetrician and gynecologist at Suburban Women's Health Specialists in Elgin and Algonquin, said he sees Medicaid patients because many have just fallen on hard times and might eventually have private insurance.
"Believe me, no one wants to be poor if you don't have to be," Epstein said.
But as the number of Medicaid patients he sees is on the rise and as cuts proposed by Quinn might delay payments further or cut reimbursements, Epstein makes no guarantees for the future.
"I never promise I'll keep taking it," he said.
Finding a doctor can sometimes be easier for someone on Medicaid in Chicago, where there are more low-costs clinics, said Candace King, executive director of the DuPage Federation on Human Services Reform.
"I don't want to say there's nothing in the suburbs," Candace King said. "But there's not enough."
When people can't find doctors, they can get sicker. And when they eventually seek hospital care, it's typically more expensive than prevention would have been.
"They're going to come to our offices and emergency rooms sicker," said Dr. Wayne V. Polek, a St. Charles anesthesiologist and president of the Illinois State Medical Society.
The state's rising Medicaid cost is a complicated problem and even small tweaks to any part of the system could have big impacts for patients, doctors and hospitals. For that reason, lawmakers facing tough re-election battles might hesitate to agree to big changes before the November election.
The state already has begun trying to sift through records to kick fraudulent recipients off the rolls. And disabled and elderly Medicaid patients in the suburbs are part of a sometimes controversial managed care pilot program meant to reduce costs.
Still, Quinn is targeting health care spending for a simple reason: It's among the state's biggest expenses, and getting the state's finances under control would almost certainly require changes to the program in some form.
Suburban hospitals, which are already planning to fight back against Quinn's proposed cuts to Medicaid -- even before any details have been released -- stand to lose a lot through cuts.
But in a letter to the editor in the Daily Herald this week, Maryjane Wurth of Naperville, president of the Illinois Hospital Association, acknowledged the system had to be fixed -- somehow -- and offered to work with Quinn on the issues.
But she discouraged "rash decisions."
"There are no easy answers. But if state leaders make rash decisions like imposing drastic cuts or quickly moving large numbers of people into HMOs -- it could have far-reaching consequences that hurt patients, communities and the health care system," Wurth wrote. "IHA is deeply concerned about the governor's plan to cut $2 billion from Medicaid. When health care services are eliminated because of Medicaid cuts, those services are gone for everyone, not just Medicaid patients."
Whatever Quinn specifically proposes Wednesday, lawmakers are likely to change the plan -- perhaps drastically -- as they debate it over their annual spring session.
State Sen. Dan Kotowski, a Park Ridge Democrat and budget leader for his party, said it's clear that resolving the state budget in 2012 won't be a simple task.
"There's no question that we have a challenge before us, but it has to be done," he said.