In 2010, Illinois spent $15.5 billion to provide medical care for the poor, according to a recent Associate Press article. (Up from $7.5 billion in 2000.)
The U.S. Census Bureau says that the 2010 Illinois population was 12,830,632. By simple division, the average cost to each resident of Illinois to pay for medical care for the poor is $1,200 per year.
The same said that under the budget passed by the Illinois Legislature, doctors and hospitals have been promised virtually the same fees for services rendered to those on Medicaid that they had received during the prior year. But the amount budgeted to pay for those fees is $1.2 billion short.
The shortfall, however, is only part of the problem. In addition, there are $6 billion of overdue and unpaid medical bills from prior years. Therefore, next year at this time, it appears that there will be $7.2 billion in unpaid medical bills.
Doctors and hospitals will have to wait longer to be paid. A spokesman for the governor suggests a 30-day payment wait might be expected to increase to 120 days.
But is that for "new" bills, or for the bills already six months overdue? In light of this, what can the doctors and the hospitals say other than, "It's better to be paid money eventually, than not to get it at all."
But if doctors and hospitals know they will get paid "eventually," and "eventually" gets 20 percent longer each year, how long will it be before the doctors and the hospitals can no longer wait for "eventually" to happen?
When you buy food from the grocery store and eat it within a few days, it's a little unfair to promise the grocer you will pay him in six months or so. If your grocer is required to pay within 30 days for the meat and potatoes he sells in his store, how is he going to pay his supplier and employees if you don't pay him?
When I was a boy, our family doctor was Dr. Cahill. I don't ever recall going to his office, but I recall him making a house call when I got the chicken pox. But medicine has changed.
Today the practice of medicine is more complex. The doctor is assisted by a clerk/receptionist, an office nurse, a scheduler, an insurance billing assistant, a Medicare billing assistant, etc.
These employees all have to be paid, and the doctor doesn't have the luxury of telling his staff he will pay them in six months or whenever he "eventually" gets paid by the State of Illinois.
When a doctor is forced to wait six months to be paid for seeing Medicaid patients, he had better have a sufficient number of privately insured patients to allow him to meet his employee payroll, to pay for his malpractice insurance, to pay the rent on his office, to pay himself a reasonable salary, etc.
If he doesn't, he won't be in business when "eventually" finally comes. I don't think Dr. Cahill faced these problems.
I think it is fair to say that the state's ability to pay doctors and hospitals isn't going to improve as long as the economy remains in the doldrums, and tax revenues remain low. But then, what happens when Obamacare kicks in?
What happens to those doctors and hospitals who, because of private insurance payments, are now able to wait six months to be paid for services rendered to Medicaid patients?
If doctors' revenues fall sharply, what does that do to their ability to see Medicaid patients, and wait months to be paid? If doctors has to see more non-Medicaid patients (because those patients no longer have private insurance) to keep their revenues at pre-Obamacare levels, does this mean that the doctors and the hospitals will have less time to see Medicaid patients?
I don't know. But if a doctor is used to a certain level of income, and what he can charge patients is reduced, he will need to see more patients to generate the same income. And I suspect, that means, he will be able to see fewer of the poorest patients.
Especially, if the state cuts fees paid, or turns "eventually" into something even longer.
Posted Online: July 6, 2011, 2:53 p. m. - Quad-Cities Online.com
By John Donald O'Shea
Copyright 2011
John Donald O'Shea
John Donald O'Shea of Moline is a retired circuit court judge.
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