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Wednesday, March 14, 2007 05:19 pm

A pound of cure

Governor prescribes remedy for health-care woes — but how bad are the side effects?

Untitled Document On a pleasant Saturday morning, James “Rock” Haley would rather be building a deck or demolishing a vacant home, something he says he learned to do as a teenager using little more than his bare hands. With broad, sturdy shoulders and muscular forearms, Haley looks every bit deserving of the nickname that’s he had since childhood, not someone who just celebrated his 70th birthday. Now that the weather’s warming up, Haley wants to buy a beat-up old pickup truck so that he can take on more landscaping jobs or hire a small crew to help him knock down a few houses to earn some extra cash. Even though he’s retired, Rock can’t afford
to rest.
His wife, Edna, has a rare muscle disease known as polymyositis, and doctors have said that her condition prevents her from working. During an hour-long interview at their home, the 53-year-old woman quickly grows restless, wincing from what she describes as an unusually high level of pain. Edna Haley doesn’t have health insurance, which means that the couple must pay for her medicine — she takes nine pills every day at a cost of $300 per month — out of pocket. The problem is that after paying for rent, utilities, and other household expenses, there isn’t much left of Rock Haley’s monthly $725 Social Security check — and anything invested in a business would mean less money for Edna’s health care. The couple may soon get some relief in the form of a massive new health plan rolled out last week by Gov. Rod Blagojevich. Coming on the heels of All Kids and Preschool for All proposals, put in place last year, Illinois Covered would extend access to health care for millions of uninsured adults in the state. About 500,000 Illinoisans who lack health insurance could be covered. To finance the plan, the governor has proposed a gross-receipts tax on businesses earning revenues of more than $1 million, which he labels a “tax-fairness plan,” as well as a payroll tax of 3 percent on companies that don’t offer medical insurance. Business groups and Republican lawmakers fired their first salvos before the governor started his annual budget address last week by pointing out that the proposal, which would raise $6.1 billion a year, would be the largest tax increase in the state’s history. Meanwhile, health-care advocacy groups lauded the governor for taking steps to fix a broken health system. Rock Haley just want to be able to get his wife, who is also diabetic, the prednisone and other drugs she needs to soothe inflammation in her muscles and test strips with which to monitor her blood-sugar level. The day before Thanksgiving, Edna’s blood sugar plummeted, and she had to be rushed to the hospital for the third time in 18 months. Even though he doesn’t have a car, the ambulance crew wouldn’t let Rock ride with his wife to the hospital. “I’ve been fighting this for a year and a half — and I know I’m not the only person,” he says. “I’m sure there are other people with spouses who are sick going through the same thing.”

Each of the four times the Haleys have tried to get help from the federal government by applying for Supplemental Security Income, they say, Edna has been denied. When they turned to the Illinois Department of Human Services for state assistance, the agency sent them a letter stating that “based on information provided you are not eligible for any programs the department offers.”
With $8,700 per year in income and no other assets, they can’t understand why Edna wouldn’t qualify for any government programs. Local charities have been able to help out some. The Haleys also contacted the offices of U.S. Sen. Dick Durbin, D-Ill., and state Sen. Larry Bomke, R-50th. Edna was twice issued a temporary medical card, good for 60 days. But the specialist whom Edna needs to see is typically booked months in advance, and she can’t get a prescription without seeing the doctor. But, as Rock Haley says, they’re not alone. About 1.7 million people in Illinois go without medical coverage, according to the Kaiser Family Foundation. Nationwide, the number of uninsured is 46.5 million. With Illinois Covered, the governor is trying to remedy the problem for the Haleys and people like them. On Sunday, March 4, speaking at the Fourth Presbyterian Church, in downtown Chicago, Blagojevich took the wraps off his plan for universal health care in Illinois. To make his case, the governor cited studies showing that lack of insurance reduces workplace productivity, causes families to go bankrupt, and is a leading cause of death in our nation.
He spoke of the effect of spiraling health-care costs on small businesses and noted that other large states, such as California, Massachusetts, Pennsylvania, and have already taken steps to provide health care for all. Maine, Maryland, Massachusetts, Hawaii, Vermont, and Tennessee also have adopted universal healthcare programs, while Oregon, New Mexico, and Arizona, are currently considering the idea. Under Illinois Covered, any adult who doesn’t have employer-sponsored medical insurance would qualify for comprehensive coverage, which includes prescriptions, regardless of health status. As explained on the state’s Web site, the Blagojevich plan consists of three tiers: Illinois Covered Choice, Illinois Covered Rebate, and Illinois Covered Assist. Under Covered Choice, small businesses with fewer than 25 workers that agree to pay 70 percent of the premium would be able to buy group coverage for less than they could now on the open market. Families of four earning $45,000 annually could get coverage for $2,250.
 Under Covered Rebate, premiums would be capped on the basis of family income, and for workers who receive insurance through their jobs the state would work with the insurance company to cover the difference between the state-offered discounted premium and the amount the insurance company actually charges. Finally, Covered Assist aims to help people such as the Haleys who live below the federal poverty level — $13,690 in annual income for a family of two — and who either don’t have access to employer-funded insurance or don’t qualify for Medicaid. In this instance, the state would pick up the tab for their health care. Blagojevich’s proposal won’t be an easy sell, however. Critics point out that the state already has a backlog of $2 billion in unpaid Medicaid bills. In addition, Illinois is already at the bottom among states in meeting its pension obligations — $38.6 billion in total unfunded liabilities. His health-care plan aside, the governor is also proposing $10 billion more for Illinois schools. Leasing the state lottery system should help pay for pensions, Blagojevich says. However, he wants corporations to help pay for the bulk of his new initiatives. During his budget address, the governor said while middle-class families have shouldered more and more of the state’s tax burden, the wealthiest corporations walk. A gross-receipts tax, which the governor says has worked successfully in other states, at a rate of 1.8 percent on service industries would close loopholes that preclude some corporations from paying corporate income tax. Other industries — construction, manufacturing, retail, and wholesale companies — will be taxed at 0.5 percent.
Exports, food, and medicines would be exempt from the tax.
Bomke, the state senator, says that even though he considers the governor’s proposal “pretty close” to socialized medicine and thinks that funding Illinois Covered might be difficult, given the state’s horrible fiscal shape, he’s not opposed to the idea in principle. “We have an obligation to provide insurance for people who otherwise can’t get it,” he says, “so I’m certainly in favor of trying to find some mechanism to help those people, like Edna.”
State Rep. Raymond Poe, too, feels that “expanding health-care coverage is a worthy goal we should strive toward” — but the Springfield Republican says he can’t vote for its funding mechanism in the current form. “Being fairly conservative, I’m always concerned about how we pay for things,” Poe says. “The health part, people are pretty receptive to. They like that it’s going through the insurance companies.”
However, he calls the gross-receipts tax a covert tax increase on working families. “People understand that it will cost the consumer in the end when they buy coffee, or a car, or a new refrigerator,” he says. When asked whether he believes that a lack of health-care coverage is also a hidden tax on poor people, some of whom are Poe’s constituents, he replies: “Absolutely.”

Dick Kay, the governor’s special advocate for health care, says that Illinois Covered was designed with people such as Edna Haley in mind.
A former Chicago TV newsman, Kay signed on to help Blagojevich sell his idea because Kay’s son, a freelance artist, has struggled to find health insurance. He describes the plan as a version of the Medicaid program — just one that lacks reimbursement from the federal government. His son would qualify, and without knowing all the specifics of her situation, Kay says, so would Edna Haley. Critics such as Bomke worry that a program that forces insurance companies to take on people they would otherwise not cover, even if taxpayers are helping pay for that additional cost, could push premiums up for everyone. Bomke says he wants to avoid putting Illinois into a situation similar to the one it was in the several years ago when a number of doctors left Illinois in the face of the rising cost of medical-malpractice insurance. This led to legislation, passed in 2005, capping the amount in non-economic damages that Illinois juries can award in malpractice cases. Kay doesn’t agree with the parallel: “The insurance companies will get more business, frankly. If the state is willing to assist with the premiums, more people are going to get coverage.”
Health insurers companies don’t want high-risk patients but have record profits, Kay says. “The insurance companies cherry-pick, and they would prefer to have persons who are covered by their employers. They don’t want people with risk; they don’t want the people with prior conditions —but I think like the governor thinks: It’s a moral imperative; the state has a responsibility to help people like that. “Yeah, the insurance companies might not like the plan to cover everyone, regardless of their health risk, but they will be paid for.”
Responding to the governor’s budget address, Illinois State Chamber of Commerce president Doug Whitley called the Blagojevich proposals reckless and irresponsible. If approved, businesses will be forced to slow expansion, trim jobs, or flee to more business-friendly states, Whitely says. He also takes issue with the governor’s assertion than businesses aren’t paying their fair share of taxes. Over the last four years, corporate income-tax revenues have grown by 87 percent and overall business taxes have gone up 34 percent, the chamber asserts.
“Businesses are paying their fair share,” Whitley says. “Focusing on corporate income-tax receipts to assess the tax burden borne by business is misleading.”
Surprisingly, many health-care providers, who continually bemoan the state’s slow Medicaid-reimbursement cycle, are on board with the proposal. The Illinois Hospital Association, Illinois Primary Health Care Association, and Illinois Academy of Family Physicians have joined with dozens of health advocacy groups and nonprofit associations to form the Illinois Health Care Justice Campaign in supporting Illinois Covered.
IAFP executive vice president Vince Keenan says that members of his organization are encouraged by Illinois Covered’s focus on preventative care and providing individuals with a “health-care home” as opposed to the current structure, which serves mainly as system for paying bills.
It’s a large but incremental step, Keenan says. “Family physicians, in general, are scientists — so we’d like to have more details, but we’re excited about what we hear. We’re also businesspeople, so the funding mechanism has received a lot of attention, but that’s really not our bailiwick.”

The day before Blagojevich gave his speech, Maryam Moustoufi was at the Capitol, representing the Islamic community pushing for health-care reform from a faith-based perspective.
“All of the great world religions believe in justice for all individuals, and health care is a justice issue,” she says. “Within Islam there’s a saying that says we should not sit down to dinner until we have checked to see if our neighbor has food to eat.”
Moustoufi’s husband has leukemia and must take medication that costs $100 per pill, but he has health insurance through his employer, the state of Illinois. Otherwise, it would be hard to find $3,000 every month for the rest of their lives, she says. “People talk about the United States’ moving towards a two-class system, but quite frankly I think we’re already there, because people’s lives are being determined by whether they have health-care insurance,” Moustoufi says. Whether the governor can actually get his budget package passed remains unclear. Although he has the support of Senate President Emil Jones, many lawmakers, including Democrats, listening to Blagojevich’s budget address didn’t seem thrilled when they heard about the tax increase. In the meantime, people such as Edna Haley will just have to wait it out. Her weight is down to 120 pounds from 167 last year. Some days she’s too weak to even hold a glass of water. Rock Haley isn’t sure whether it’s the federal or state government at fault; he just knows that the system doesn’t make any sense. With an appeal pending, the couple hopes that DHS will overturn its decision.  “You can only do so much with $725,” Rock says. “She’s not going to get any better. When she doesn’t have her medication, she just has to sit here and suffer. The hardest part has been watching her deteriorate.”

Contact R.L. Nave at rnave@illinoistimes.com.
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