Op-Ed Mon Oct 03 2011

The Battle Over the Cook County Health and Hospital System Budget

By Monica Reida

On Tuesday, the Cook County Board of Commissioners will vote on the upcoming budget for the Cook County Health and Hospitals System (CCHHS). Tensions have arisen In the weeks since the CCHHS Board of Directors released their budget and the Cook County Board President Toni Preckwinkle informed the CCHHS Board of Directors that they could not request the required county subsidy because of what is set in the planned County Budget.

As explained in a previous Gapers Block piece examining the Fantus Health Center, the CCHHS receives a county subsidy that helps with their funding. The rest of their funding comes from insurance, Medicaid, Medicare, and patients paying for their treatment.

The current budget that will go before the board would ask for a $283 million subsidy; Preckwinkle has said that the maximum subsidy the CCHHS can receive is $248 million.

In regards to the requested subsidy, Preckwinkle has been quoted as saying, "In the current financial climate, it is not feasible for the Cook County Health and Hosptial System to receive an additional subsidy from county taxpayers, and we feel that it's important for government bodies to take responsibility for their budget shortfalls."

The Tribune editorial board applauded this statement by Preckwinkle and took the stance of "Don't you mess with her, Board of Directors."

But in a wider context, the facilities in the CCHHS are where people will be treated for their conditions, regardless of their ability to pay. While Preckwinkle suggested it is inappropriate for them to want a larger subsidy in the current economic climate, the problem itself is the economic climate. It is precisely the economic downturn that calls for maintenance of the CCHHS subsidy.

Unemployment in Cook County stands at 11%. Many are underemployed at part-time jobs. These individuals often lack private insurance and if they need health care, charity care is the only option. Yes, hospitals in the United States are expected to provide charity care, especially for those who want to keep their non-profit status. But the CCHHS is supposed to treat those people; it's part of their mission statement.

Furthermore, the CCHHS is supposed to ensure that people are able to receive treatment for conditions such as HIV as well as make health care accessible to people in communities in Chicago and Cook County through their Ambulatory and Community Health Network (ACHN). Can this mission be served? Aren't we supposed to be making health care more accessible for people?

But the system still treats people who have no health insurance and no way to pay out-of-pocket. The Tribune's editorial board suggests that the solution would be to try to attract more Medicaid and private insurance patients who can cover their co-pays.

There's a problem with this suggestion.

First of all, there is currently a massive backlog of Medicaid payments from the State of Illinois. The CCHHS hospitals and clinics aren't getting paid and neither are the other hospitals in Illinois. What's more disturbing about this is that John H. Stroger Jr. Hospital of Cook County, the main facility in the CCHHS, is considered a disproportionate share hospital by the Illinois Department of Public Health. This designation means that because of the large number of Medicaid patients treated there, they should have expedited reimbursements. So a question to possibly be probed here is how that backlog is affecting the other hospitals in Illinois.

The other problem with the suggestion from the Tribune is that getting patients with private insurance to willingly use a CCHHS facility such as Stroger or Fantus is an unlikely proposition. People with private insurance who have a choice of health care facilities will probably go with a local facility or a facility that they think is the finest. There is a stigma surrounding the system that will keep people from ever wanting to be treated at a CCHHS facility.

The Tribune editorial adds an even more controversial suggestion. Let's only treat Cook County Residents in the CCHHS facilities; let's not treat undocumented immigrants!

Here's a problem with that suggestion: Stroger Hospital has a well-respected trauma center and burn unit. If a patient that is undocumented or lives outside of Cook County is burned, shot, stabbed or involved in a car accident, does that mean he or she shouldn't be treated because they cut into the funds from Cook County taxpayers?

The answer for this can be found on a statue of Louis Pasteur that sits across from the deserted, old Cook County Hospital. There, an inscription reads, "One doesn't ask one who suffers: What is your country and what is your religion? One merely says, You suffer, this is enough for me, you belong to me and I shall help you."

Discrimination against patients for the sake of saving money is contrary to the purpose of public health. After all, this is a system that has always treated the people who were discriminated against by other institutions.

The truly problematic aspect of the budget is that Stroger Hospital, Provident Hospital and the ACHN seems to be having a problem with billing. In fact, the Preliminary Budget Assumptions even has, "Implement Physician Billing" listed in the guide to the 2012 budget. (Link opens PDF file.)

Based on this, the CCHHS could be doing better financially if they had a good billing system in place and the State of Illinois was paying hospitals their Medicaid reimbursements.

While the Board of Directors didn't decrease the subsidy to the level Preckwinkle wanted there was still a decrease. Yet the cuts were still not as deep as Preckwinkle wanted them to be. When it comes to health, how deep can you cut? You can cut down on waste or negotiate a pay cut, but at what point does it begin to affect the care patients receive? On which side do you err? The CCHHS is still in a state of transition and modernization and the County probably still won't give them the money they need. The effect on public health could be devastating.