“You missed your appointment. Please reschedule.” My friend sighed as the telehealth system disconnected. He’d recently switched to Illinois Medicaid, and seeing a doctor now seemed harder than getting Taylor Swift tickets. His rescheduled visit? With a physician assistant who couldn’t refill his pain medication. Technical issues, they said — but I knew better.
In Illinois, 1 in 4 residents get their health care through Medicaid. Illinois offers free health care to people with low or no income. This sounds fantastic — until you need a doctor or a prescription. Why? Not every doctor, hospital, nursing home or pharmacy accepts Illinois Medicaid. Many providers avoid Medicaid like the plague. It’s not personal; it’s math. Illinois Medicaid pays less than all of its neighboring states do, in some cases significantly less. Would you work for a noticeably smaller paycheck?
Doctors, pharmacies and hospitals aren’t charity organizations. If Medicaid pays pennies to the dollar, providers cover the difference out of their pockets. As a result, many simply opt out. Illinois Medicaid manages costs, sure — by making care inaccessible for the very people Medicaid is supposed to help.
The situation is dire. Illinois Medicaid insures more than 3 million low-income individuals, but the state’s financial strategy seems to be: “We’d love to help, but not too much.” Add this to the state’s declining population — taxpayers — and you see the domino effect.
Healthier, wealthier residents pack up and move to states with better health care benefits. Some just move over the border to Wisconsin, Michigan or Minnesota. Others set up in Arizona or Florida, where health care works better.
So, how do we turn “Ill-inois” into “Well-inois”?
First, let’s acknowledge the elephant in the room: Medicaid pools are expensive because they include only sick and low-income people. This burden is offloaded to the public. Illinois taxpayers pay for Medicaid through federal and state taxes: Illinois Medicaid receives half its funds from the federal government, and the other half must be funded by the state. If Illinois would allow people to pay premiums to enroll in the program, Medicaid would have some people in the group who are well.
Start small. Let health care workers enroll in Medicaid by paying premiums. These folks work long hours caring for us. Shouldn’t they at least have decent health insurance? Enter the “Well-inois” option. By adding healthy participants who pay premiums, we balance the Medicaid pool, reduce costs and generate new income. This is neither a public aid nor a marketplace product. It would be a new stream of income from premiums that could be invested in building a statewide health care option for Illinoisans to keep them well.
Imagine this: A certified nursing assistant signs up for Medicaid with affordable premiums and solid benefits. Suddenly, being a CNA is attractive — and not a job you take because you can’t find anything else. “Well-inois” would make health care jobs in Illinois competitive and, dare I say, cool.
Recently, I met a 54-year-old pain doctor who is practicing in Illinois and still repaying his student debt from medical school. That is not exactly a system that is attractive to young people to enter the medical profession. Neither are 80-hour workweeks because we do not have enough providers who accept Illinois Medicaid.
“Well-inois” could raise Medicaid reimbursement rates to match — or exceed — private insurance. Crazy idea, right? Not really. When reimbursements are fair, more providers accept Medicaid. Doctors stay in Illinois instead of hopping the border for better pay and lower malpractice premiums.
Medical students might even consider staying after graduation, instead of running off to Wisconsin in their new white coats.
And speaking of Wisconsin, have you noticed its malpractice premiums are lower? That’s because that state caps lawsuit payouts. Illinois? Not so much. Combine high malpractice costs with low Medicaid rates, and you’ve got a recipe for physician shortages.
If “Well-inois” were to take off, it could create real competition for private insurance. Workers wouldn’t feel shackled to jobs they hate just for health benefits. Suddenly, Illinoisans could prioritize their health — and happiness — over their employer’s open enrollment deadlines.
Massachusetts figured this out years ago. Its state-run program, MassHealth, doesn’t just provide care — it raises standards. With proper oversight, transparency and accountability, Illinois could do the same. Taxpayers would stay in control, and health care wouldn’t feel like navigating a hedge maze blindfolded.
Illinois legislators need to create a Medicaid buy-in pilot program for health care workers. Sure, it would take work — and money — to get started. Rather than having multiple advisory boards that meet a handful of times a year, the state might even need a dedicated agency, like Massachusetts’ Health Connector, to handle negotiations and investments.
But the payoff? Fewer people leaving Illinois, a healthier population and a health care workforce that’s actually excited to stay here.
The key is trust — and a solid plan. Would health care workers join? Would Illinoisans stop fleeing to greener pastures? If yes, “Well-inois” could be the blueprint for a healthier Illinois.
Maria Gross Pollock became a patient advocate and health care policy researcher as a disabled graduate student at Northeastern Illinois University. Pollock serves on the Illinois Rare Disease Commission, which focuses on health care access for people with rare conditions.
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