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January 28, 2018

The (Champaign) News-Gazette

Mismanaged managed care

Those who are skeptical about the ability of government to effectively manage huge programs got some additional ammunition last week.

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The state auditor general’s office released the results of an audit it performed on the state agency overseeing the multibillion-dollar Medicaid program and came up with some disturbing news.

It concluded that the state’s Department of Healthcare and Family Services failed to properly oversee the spending of more than $7 billion in payments to managed-care organizations that contract with the state to administer benefits for Medicaid recipients.

Just to give readers an idea how big the state’s Medicaid program is, here’s a mind-numbing statistic to consider. One in four Illinois residents is a beneficiary of this staggeringly expensive social welfare program.

Medicaid and public pension costs are the two most expensive programs the state oversees.

Indeed, the rising costs of Medicaid and public pensions consumes so much money that it’s becoming increasingly difficult to fund core state programs, including K-12 and higher education, public infrastructure, law enforcement and mental health.

At Gov. Bruce Rauner’s direction, the state is moving toward managed health care as a cost-saving measure.

To start with, the program covered roughly two-thirds of Medicaid recipients in 30 counties. It’s being expanded to cover most Medicaid recipients in each of the state’s 102 counties.

But the audit, the results of which are not being disputed, revealed that the department simply wasn’t up to the job. Either that or it didn’t even try. Who knows what’s really going on inside mindless, cumbersome bureaucracies that operate with prehistoric technology tools and a stunning lack of accountability.

At any rate, the audit revealed that the department couldn’t produce data it was contractually required to collect. But that shortcoming barely scratched the surface in terms of the bureaucratic failure.

The department couldn’t provide reliable data on claims it paid to managed-care organizations, on claims that the organizations denied, on administrative and care costs the organizations incurred and what the organizations spent on legitimate health care costs as opposed to business costs.

Indeed, there is so much information that the department couldn’t produce, it’s hard to imagine what important information it did produce.

Frankly, the findings come across as borderline total system failure. One wonders, of course, if there was any fallout within the department over this management disaster.

The idea behind the managed-care program is that it will reduce costs and improve care. But crucial to that claim is the skill with which it is managed, and a major component of management is acquiring information that reveals the benefits, or shortcomings, of moving from one plan to another.

State officials have estimated the expanded managed-care program will save the state $1 billion once it’s in place. That would be good, although it’s a pittance compared with the estimated four-year cost of $63 billion.

Department officials tried to downplay the audit’s findings, stating that recommended fixes already were being put it place or will be put in place.

Since policy affects politics, Democrats were quick to heap the blame for this management failure on Gov. Rauner and his advocacy of the managed-care model.

But he’s hardly the first to suggest that managed care is a better, less costly way to deliver health care to those in financial distress.

Then again, he comes from the private sector, where the price of total failure is bankruptcy. There’s no similar kind of accountability in the public sphere, where bureaucracies set their own rules.

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January 27, 2018

Belleville News-Democrat

Lose two U.S. House seats, gain a fairer map?

Illinois has been losing population, and most projections show the state losing a U.S. representative after the 2020 U.S. census.

But a new projection shows that we are “dangerously close” to losing two seats in the U.S. House.

“(Illinois is) within that magic five points of potentially being on the odd side of the line,” said Kimball Brace, president of Election Data Services. “Illinois is between 100,000 to 192,000 people away from losing that second seat.”

Election Data Services ran three projections using different methodologies. The one showing two seats vanishing assumes Illinois loses about the same number of people lost in a census estimate released last month. That count showed a loss of 33,700, putting us at about 12.77 million residents.

There are 435 House seats, and those census counts every decade are intended to ensure our populace is evenly represented. If Colorado gains population and Illinois loses population, representation shifts to the growth.

Illinois had 25 representatives in 1950. It could have 16 by the 2022 election.

Losing two seats would obviously be a loss of clout, but the impacts in Southern Illinois could be more pronounced. Losing districts would mean a new congressional district map with bigger areas per representative — 12 of our 18 congressional districts are now clustered around Chicago. Illinois had 16 Republican and nine Democratic representatives in 1950, but now there are seven GOP and 11 Dems.

Zoom in on the Chicago area maps to see the perfect illustration of gerrymandering, especially the Pac-Man-shaped Fourth Congressional District held by U.S. Rep. Luis Gutiérrez. State lawmakers draw those maps, so who do you think wins and loses in Illinois House Speaker Mike Madigan’s world?

Right.

If you assume the state legislature remains Democratic, then a Republican governor means each party will likely take a loss, said Ken Moffett, an associate professor of political science at Southern Illinois University Edwardsville. But if there’s a Democrat in the governor’s mansion, then he said central and Southern Illinois will take a much greater hit.

There is hope on the horizon.

First, Illinois residents are upset by the practice, with 72 percent supporting an independent map commission in a Paul Simon Public Policy Institute poll.

Also, the issue is on our state’s political radar, with most of our eight gubernatorial candidates responding to a Change Illinois survey on the issue. Disappointingly, neither our Republican incumbent nor his challenger responded.

And judges have been losing patience with the party in power drawing maps that let politicians pick voters rather than the other way around, as former President Obama lamented. The U.S. Supreme Court as far back as 1986 saw Illinois’ partisan political maps as unconstitutional, but failed to come up with the right yardstick to measure a fair map.

State high courts, most recently Pennsylvania, have been ruling against overtly partisan congressional district maps. And the U.S. Supreme Court again is taking up the issue, with a Wisconsin case already before them and a Maryland case expected to be heard.

So maybe, just maybe, by 2022 we lose two congressmen but gain a fairer mapping system if the adults in black robes put the capitol’s children in check. Holding breath … starting … now.

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January 25, 2018

Chicago Sun-Times

Kids playing tackle football? Your call, parents, not government’s

Children under the age of 12 should not play tackle football. It is too dangerous.

We say that as an editorial board, and also as parents. We don’t say it as a matter of potential law. We believe this is a decision best left to parents, not dictated by the Illinois Legislature.

If ever there was a problem that seems to be taking care of itself, this is it. Participation in youth tackle football is plummeting, even without legal bans, as the risks become more widely understood. Since 2009, participation among boys ages 6 to 12 has fallen nearly 20 percent, according to the Sports and Fitness Industry Association, and you can bet participation will fall further as more parents wise up.

On Thursday, state Rep. Carol Sente, a Democrat from Vernon Hills, introduced legislation to ban tackle football for kids under 12 in Illinois. Her bill, supported by a group of former NFL players and physicians, is called the Dave Duerson Act, named for the former Bears player who committed suicide in 2011.

Duerson suffered from chronic traumatic encephalopathy, or CTE, a deterioration of the brain thought to be caused by repeated blows to the head.

“The bill honors my family’s hopes and my father’s legacy to protect future athletes and the future of football,” Tregg Duerson, David’s son, said.

We can’t support this bill, believing it intrudes without sufficient justification on the rights of parents, but it’s sure nice to see that 80 percent of American adults already have come around to the view that tackle football is not appropriate for children under age 14. Anybody who loves or profits from the game would be smart to agree.

If the NFL, for one, does not go the extra mile to make football safer at every age — by, among other measures, taking a complete and firm stand against younger kids playing tackling football — the game will go the way of boxing, which also was once wildly popular and profitable.

We respect the intentions of Sente and the others pushing this bill, so we’ll devote the remainder of this editorial to the evidence that tackle football really does do a number on a child’s developing brain.

CTE is a progressive disease that spreads slowly through the brain, killing cells. Researchers have found that the more tackle football played, the greater the risk of CTE. And the kind of milder hits to the head that coaches used to tell kids to “shake off” — those constant hits that go virtually unnoticed — can be just as devastating over time.

As the physicians supporting the Dave Duerson Act point out, children may be smaller and slower on a football field, but they suffer head hits every bit as dangerous as those sustained by college football players because their heads are larger relative to their bodies and their necks are small and weak.

In 2016, doctors at the Wake Forest School of Medicine using magnetic resonance imaging found that boys between the ages of 8 and 13 who played just one season of tackle football had diminished function in parts of their brains.

Last year, researchers at Boston University found that 110 out of 111 brains of deceased former NFL players had CTE.

Pop Warner, the nation’s largest youth football organization, opposes the proposed ban in Illinois on tackle football for children. On Thursday, the group made the same argument we’re making: It’s a decision best left to parents.

But what Pop Warner spokesman Brian Heffron said next was just plain foolish. “Literally millions of young people have played Pop Warner football for nearly 90 years and have grown up to be healthy, successful adults contributing to society in so many ways,” he said.

Yes, that is true. Most kids survive the hammering, at least in the short-run. Millions of Americans who grew up in a world of pealing lead paint, leaded gasoline, belching factory smoke and a haze of cigarette smoke also grew up to be “healthy, successful adults.”

But millions did not.

What parent would knowingly submit their children to such dangers?