In his February budget address, Gov J.B. Pritzker unveiled plans to hold accountable health insurance companies that put lower costs ahead of patient care. The system has evolved such that health insurers are making decisions about care — what to pay for, what to require of patients and what to deny — that put patients through major hardship when they’re sick and need the coverage they pay for. We all know this.
As president and CEO of a safety net hospital on Chicago’s Southwest Side, I applaud Pritzker’s initiative. With one caveat: The same standard of accountability should apply to the state of Illinois.
Prior to Pritzker being elected governor, the state began to shift the Medicaid reimbursement process to a managed care system — essentially, turning over to private firms what the state used to do. In a nutshell: It has allowed for-profit companies earning billions of dollars off taxpayers to make decisions about how and when to reimburse hospitals for Medicaid services. Naturally, the hospitals that rely most on Medicaid reimbursement are most affected.
That’s my hospital in the Little Village neighborhood. We care for all patients who need our help, regardless of ability to pay.
Between 2015 and 2019, we lost nearly all of our cash reserves due to a change in our Medicaid reimbursements. We still struggle to balance our books. We are at the mercy of a system run by profit-driven companies and bureaucrats, not health professionals. The system is unwieldy, opaque and unpredictable.
A 2021 investigation by the Better Government Association described the system as “largely bereft of government oversight in which the for-profit insurance companies boosted profits by routinely denying and reducing reimbursements to providers who treat low-income families, foster children, pregnant women and the elderly.”
This is no way to provide care to the underserved communities our governor and many other elected officials in the state and in Chicago purport to represent. Isn’t that what they remind us? That they speak for this population? That health care is a human right? That health equity is their top priority?
I believe in health equity too. I wouldn’t be here if I didn’t feel passionate and committed to the special, vulnerable population we serve. But if the state won’t require the for-profit insurers to pay hospitals in accord with federal law, the precise population our public officials claim to represent will be directly harmed. And it’s not just us. There are dozens of safety net hospitals suffering under the status quo.
Our hospital in 2020 sued the state of Illinois. It wasn’t an easy decision. No one wants to bite the hand that feeds them. But the managed care system is breaking us.
The state is fighting our lawsuit at every turn. Fortunately, the courts have stepped in to protect us. A federal appeals court recently ruled that our lawsuit has a right to proceed. The hospital “depends on full, timely Medicaid payments to keep its doors open and provide care to patients,” the ruling judges wrote.
We applaud Pritzker’s commitment to protect rank-and-file Illinoisans getting cheated by predatory insurance companies. We stand firm with his initiative to hold them accountable for the decisions they make to cut costs while harming patient care.
So what about hospitals like mine being harmed by state government? Will Pritzker and the Democrat-controlled House and Senate change the status quo?
If they don’t, they will be leaving the state’s most vulnerable populations in the dust.
Guy A. Medaglia is president and CEO of St. Anthony Hospital in Chicago.
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