Politicians across the nation are still debating what the health care reform bill will and won't do. But good or bad, it could have major consequences right here in Cook County.
The Health and Hospitals System, already faced with a reduced budget since the lowering of the county's sales tax, must now also contend with the uncertainty of broader health care reform.
Health board chairman Warren Batts says he is still trying to sort out what the bill means for Cook County. But Batts and others expressed fears that the county health system might become a victim of a health care program that may encourage people to look elsewhere for care.
“We think there are some good things in it, but overall it’s pretty problematic,” says Margie Schaps, executive director of the Health & Medicine Research Policy Group.
Schaps complains that it doesn’t extend benefits to illegal immigrants and could leave as many as 400,000 people in the Chicago area without coverage.
“The concern is the people who get insurance, Medicaid or another private insurance are going to be drawn away,” she says.
With insurance options being extended to more people, patients who have relied on the county health system may migrate to other facilities, she says, weakening the county’s ability to serve residents and pay for services, creating what Schaps calls “a perfect storm.”
She says the health board is doing a good job of preparing for changes, but it must work to change the negative perceptions people have of the health system.
“They are working very hard to make the county health system a place where people want to go,” Schaps says. “They’re trying to reduce those waiting times. They’re really doing a lot of work to make that system responsive to their patients.”
Another problem is language that would reduce money, known as disproportionate share hospital funds, given to safety net hospitals like the county’s. The Senate bill would cut those funds by $4 billion beginning over 10 years. Last year, the county took in about $200 million in disproportionate share funds.
Health system CEO William Foley said in a statement that the independent board governing the health system is preparing to adapt in the face of big changes.
“We are looking at ways to better our healthcare system — making changes from everything from how we can better serve our growing ethnic population to how we make the healthcare system more accessible to people throughout the community,” he said.
The health care bill is yet another challenge Foley and the health system’s board has to deal with, but it’s one they’ve been pondering for months.
Despite the uncertainty the reform bill brings, the National Association of Public Hospitals, of which the county is a member, supports it. In a statement, it called the leadership of U.S. House Speaker Nancy Pelosi “extraordinary,” but advised its members to begin preparing for changes.
Larry Gage, the organization's president, says similar fears existed when Medicare and Medicaid passed, but that safety-net hospitals survived.
"Yes, of course, (patients) will be able to vote with their feet," he says. But, "we have several years to work on this. Extending coverage is the best thing for the country, the best thing for our patients, and the best thing for safety-net hospitals."
As the county health system grapples with health care reform – much of which doesn’t take hold for several years – it is also battling a $76 million reduction in county subdsidies in 2011, from the sales tax rollback.
Just how the new legislation will affect its strategic plan, an outline of how the county can reshape health care delivery due in June, remains to be seen.