House and Senate Republicans claimed during budget-related
floor debate last week that the super-majority Democrats had masked the true
size of their plan by delaying the start of some spending until the second half
of the upcoming fiscal year.
Yes and no.
Republicans pointed to the $317 million cost of
increasing Medicaid provider reimbursement rates, including for hospitals. But
that new spending doesn’t begin until Jan. 1, the halfway point in the 2024
fiscal year, which begins July 1.
And, so, basic arithmetic means that the rate
increase in Fiscal Year 2025 will be double FY24’s cost because that 2025
spending will cover all 12 months, instead of just six. That means the state
will start the following fiscal year with at least a $317 million hole.
Sometimes, it takes time to stand up new
programs, so state spending can’t justifiably begin for a while. That’s the
case here as well, according to the governor’s office, which says the higher
reimbursement rates can’t start until the state applies for and receives
permission from the federal government. And that can take a while.
Also, $317 million is only 0.6 percent of the
$56.6 billion state spending plan. Not much in the grand scheme of things.
While that $317 million is small in context,
just think about how much scrambling the Democrats had to do during the past
couple of weeks of spring session to collect enough crumbs under the couch
cushions to pull its appropriations bill together.
First, they blew well past their self-imposed
May 19 adjournment deadline because they couldn’t agree on a spending package.
And even then, it took 24 hours after the state’s top Democrats announced a
budget agreement that an actual budget bill surfaced because of even more
scrambling. And the budget agreement announcement itself was delayed by about
an hour because of even more scrambling over relatively small amounts of money.
The Democrats also only built a $100 million
cash cushion into this plan, or about 0.2 percent of total spending. That
doesn’t leave them any room if their revenue projections are too low by a tiny
fraction, or if spending is higher than anticipated.
Some Republicans pointed to the $550 million in
increased spending to cover the exploding health care costs for undocumented
residents as the reason why Democrats had to get so creative elsewhere.
Medicaid providers, they said, could’ve received more money if not for that.
That’s true, but only in the abstract. Yes,
proponents (including legislators) and the Pritzker administration vastly
underestimated what the health care program would cost and how many folks would
enroll. And, yes, the governor waited until this spring to turn to the
legislature for either statutory relief or the full, guaranteed legal authority
via authorized emergency rules to rein in costs in a way that can survive a
barrage of lawsuits. Mistakes, as they say, were made.
In the real world, you can’t just wish away
problems. “If only,” is a fine game for pundits and politicians. But it doesn’t
do you much good when building an actual state budget, which, unlike federal
spending plans, can’t rely on simply printing more dollars.
No matter how much some Democrats may have
privately grumbled about those massively increased costs, they would not
publicly trumpet any sort of solution which kicked thousands of people off
health care coverage (“Health care is a right” is a longtime Democratic Party
talking point, after all) and forced hospitals and other medical providers to
go back to treating them without any reimbursements.
And even though there was definitely some
resistance and bitterness about those unexpected costs, Black legislators have
wisely not had an appetite to publicly inflame the current tensions in Chicago,
where some local Black leaders and conservative whites are grabbing headlines
by echoing angry Fox News talking points about the costs of caring for the
influx of mostly Latino asylum seekers.
While some Democrats clung to the notion that
Pritzker had the authority to rein in costs without their assistance, they also
saw the almost daily and widespread court battles throughout the pandemic over
the governor’s use of emergency rules and executive authority.
Determined lawyers on the other side tied the
attorney general’s office up in knots throughout the pandemic and have so far
succeeded at stymying the implementation of both the SAFE-T Act and the assault
weapons ban.
Lawsuits over limiting enrollment, and putting
undocumented immigrants into managed care programs might still be filed, but
the state will be on much firmer legal ground by specifically allowing the
governor to file emergency rules.