Paying for health care is one of the biggest pressures on state government finances, and the man who gets elected governor next November will face an array of complex questions about health care costs and availability. GateHouse News Service asked candidates for governor to respond to a series of questions about health care.

EDITOR'S NOTE: This is the latest in a series of stories that provide in-depth discussion of where the candidates for Illinois' next governor stand on the key issues facing state government. GateHouse News Service surveyed the campaigns and will provide their answers in stories that will run regularly through the end of the year.


Paying for health care is one of the biggest pressures on state government finances, and the man who gets elected governor next November will face an array of complex questions about health care costs and availability.


GateHouse News Service asked candidates for governor to respond to a series of questions about health care. The questions were sent to seven Republicans and two Democrats. The partisan primary elections will be Feb. 2, with nominees advancing to the fall general election.


Q. What would you, as Governor, do to lower/contain the state's health-care costs?


Several Republicans focused on Medicaid, the federal-state program that provides health care to the poor, saying it should be more cost-effective and accountable.


State Sen. Bill Brady, R-Bloomington, said the state could save more than $1 billion though improved management of the Medicaid program, ensuring that Illinoisans have greater access to care during the earliest stages of illness.


Commentator Dan Proft favors using "premium assistance programs" to help Medicaid recipients buy health insurance in the private marketplace and then manage their own health care decisions and associated costs.


Former Illinois attorney general Jim Ryan supports reducing long-term care services for Medicaid recipients and increasing home- and community-based services, a change that he said could save the state $70 million.


DuPage County Board Chairman Bob Schillerstrom and Andy McKenna, a businessman and former head of the state Republican party, want to move Medicaid recipients into a managed-care system. They say it would be cheaper and would offer better care.


McKenna and state Sen. Kirk Dillard, R-Hinsdale, called for reforming the state's tort system. Dillard said that would "reduce frivolous lawsuits which are driving up the cost of health care in Illinois."


Businessman Adam Andrzejewski said the quickest way to trim state costs would be to move all state workers to consumer-directed health care plans that grant employees more control while insuring them against catastrophic events.


On the Democratic side, Gov. Pat Quinn said he has worked to control health-care costs for current and retired state workers and needy Illinoisans. He cited an expanded Medicaid case-management program for the aged, blind and disabled, which he said would improve care and save money.


State Comptroller Dan Hynes favors expanding eligibility for the state's disease-management program to "drive down costs and achieve better outcomes." He also said better performance reporting is necessary to identify which programs work.


Q. How would you balance the need to control health-care costs vs. providing adequate health-care services?


Andrzejewski said consumer-directed health care plans and health savings accounts are effective ways for patients to gain more control over their health-care dollars.


Brady called for eliminating "lawsuit abuse," thereby reducing costs associated with workers compensation and medical malpractice cases.


McKenna said managed care should be utilized "to a much greater extent to increase patient options and reduce health-care costs through competition."


Proft, who favors rolling back Medicaid eligibility requirements, said the focus should be on low-income seniors, persons with disabilities, children from low-income households and pregnant women.


Ryan wants to conduct an inventory of spending, with "less than vital services" getting eliminated or pared down so more money is available for the highest-priority needs.


Schillerstrom cited the importance of "accountable local control," referring to a DuPage County program that coordinates preventive medical care for people who otherwise might not seek treatment until they're seriously ill.


Quinn said both priorities must be addressed. He supports President Barack Obama's proposals to improve efficiency and accountability in the health care system.


Hynes said both goals can be achieved by more aggressively managing higher-risk populations and by offering financial incentives to providers for preventive medicine techniques and effective disease management.


Q. Federal officials continue to discuss a health-care overhaul. If a public option (creating a government-run health insurance program) is included in the final federal plan, do you think Illinois should be able to “opt out”?


The Republicans all basically said yes, though some left a little wiggle room, pointing out they would have to examine the wording of any final federal measure.


Andrzejewski said as a matter of principle, any state should be permitted to opt out, but his decision would depend on the potential consequences to Illinois.


Ryan's view was similar, and he said he would "push for the course of action that best serves the people of Illinois."


Brady criticized the public option as too expensive and said the existing system should be fixed, not radically overhauled.


Dillard favors opting out "because of the potential for expensive unfunded mandates."


McKenna said he is rooting for Congress to defeat the plan, which "would create unprecedented government control over Illinoisans' health care decisions."


Proft echoed that sentiment, calling the U.S. House-passed bill "a horrific piece of legislation."


Schillerstrom said health care "is far too important to put in the hands of the federal government."


On the opposite side were Democrats Quinn and Hynes, who agreed that Illinois shouldn't opt out.


Q. With regard to state workers' health-care costs, do state employees need to shoulder more of the financial burden?


The Republican hopefuls generally said yes, though to varying degrees.


Andrzejewski said state employees' health benefit packages should be reduced, at least until state government can balance its budget.


Brady said current and retired state employees should have a choice between managed care and a more traditional preferred provider organization, but they should pay the difference in cost if they opt for the pricier PPO.


Dillard said he would "look at all ways to cut excessive costs, including balancing employee premiums with the state's share."


Schillerstrom and McKenna said current and retired state workers should pay more of their health care costs.


Proft said all state retirees should pay for a portion of their health care benefits.


Ryan said the state should shift away from its practice of guaranteeing a certain level of benefits to government retirees, relying instead on a health care trust fund to pay for retiree benefits. The fund would collect contributions from the state, along with current and retired state workers.


Quinn said the state must make sure its employees have access to quality health care, yet also close the budget deficit. He said that's why he ordered "a modest increase" in retirees' contributions for dental coverage and why his 2009 budget proposal would have boosted state employees' contributions for health insurance.


Hynes said the state has to live up to its existing responsibilities before "we can even begin a discussion about employees paying more in health care costs." Many employees presently have trouble accessing health care, or they're receiving collection notices because the state doesn't pay bills on time.


Q. Should Illinois make changes in the health-care benefits it provides – e.g., should benefits be expanded or reduced? Should more people or fewer people be covered?


Andrzejewski said he wants to make sure that health care providers are more "transparent" in disclosing costs of services.


Brady said Medicaid and medical malpractice lawsuit abuse are the main areas that need to be changed.


Dillard said he'd work to "find an equitable balance between state and employee costs and look for new ways to reduce the cost of care without reducing benefits."


McKenna and Proft want to reverse the expansion of Medicaid eligibility guidelines that occurred during Rod Blagojevich's tenure as governor.


Proft also favors tightening income-eligibility criteria for the All Kids program.


Ryan said the state shouldn't further expand eligibility for Medicaid.


Schillerstrom called for a greater emphasis on preventive care and for more resources to investigate Medicaid fraud.


Quinn said that while "we must find ways to make sure we provide health care more efficiently and affordably," he would oppose any move to reduce Medicaid eligibility or limit access to needed care.


Hynes said that before expanding health care benefits any further, "we need to shore up the foundation of our health care system." That includes increasing physician reimbursement rates and keeping providers on a manageable reimbursement cycle.


GateHouse News Service State Capitol Bureau