State of the State: The Governor Will Renew His Push for Health Care Only to be Rechallenged

Feb 1, 2008


Bethany Jaeger
Credit WUIS/Illinois Issues

  To his credit, the governor also is a big thinker with a team of creative policy advisers.

But charm and ingenuity don't bode well with Illinois legislators cast aside as obstructionists. There's no better example than Blagojevich's marquee effort to expand state-sponsored health care, first to all children and now to adults.

Blagojevich has pushed for health care from Day 1 of his first term five years ago. He'll make health care a priority again this year, according to his office. But he'll have to try a different tactic after the legislature snubbed a few versions of his health care ideas last year. Blagojevich forged ahead anyway, using his executive power. He now faces a legal challenge because of it.

The governor's use of alternative routes to get what he wants is a symptom of a larger problem, the strained relationships within the Capitol. Distrust plagues negotiations between the governor and House Speaker Michael Madigan. Senate President Emil Jones Jr. tends to side with Blagojevich, pitting two powerful Democrats against one. Major pieces of legislation, including the governor's health care plans, have fallen victim to political infighting and have either stalled or been held hostage in other political disagreements.

Multiple challenges haven't stopped the governor from pushing his health care agenda. When Blagojevich couldn't advance his proposals through the legislature, he exercised his administrative powers. In addition to being contested by a bipartisan rulemaking committee, the governor's use of that power is subject to a constitutional challenge.

Attorney Richard Caro of Riverside filed a lawsuit in Cook County alleging the governor violated the Constitution by trying to expand health care to 147,000 more adults without legislative approval despite its $42 million price tag in the first year, according to the administration's estimates. The case later included similar arguments by Republican businessman Ron Gidwitz, a 2006 candidate for governor, and Greg Baise, president and CEO of the Illinois Manufacturers' Association. They filed suit on behalf of the Illinois Coalition for Jobs, Growth and Prosperity in Oak Brook.

Executive orders must be reviewed by the bipartisan panel of lawmakers called the Joint Committee on Administrative Rules. The panel of six Democrats and six Republicans rejected the governor's rule in November because it was filed as an emergency.

"It was sprung on us at the last minute, and it was no emergency," says state Sen. Ira Silverstein, a Chicago Democrat and member of the panel.

The committee will review the same plan for expansion this month, as the administration also filed the proposal as a regular rule that goes through a more public review process.

Sen. Brad Burzynski, a Republican panel member from Clare, says cost is the primary concern. "There's not any money in the budget for the expansion. There's no statutory authority for the expansion."

He says the cost estimates are crucial if a program will create a new class of Medicaid patients at a time when the Illinois comptroller's records show the state had $1.7 billion in unpaid bills at the end of December. (That $1.7 billion includes more than Medicaid bills.)

The administration says it's trying to get approval to get a federal match that would help pay for at least some of the expansion under Medicaid, but the feds have discouraged states from expanding income limitations of existing health care programs.

The Joint Committee on Administrative Rules' concerns took another hit when the governor publicly stated the panel serves only an advisory role.

That invited Illinois Attorney General Lisa Madigan to step into the Cook County lawsuit to defend the state's laws and the process of enacting those laws.

"Obviously, this case has broader implications of how the administrative process of Illinois goes forward," says Ann Spillane, the attorney general's chief of staff. "We believe it is part of our job to make sure the court hears an argument that the administrative process as it exists in Illinois is appropriate and constitutional."

The governor's office previously told news reporters that the attorney general's actions "jeopardize access to health care for hundreds of thousands of people."

Lisa Madigan's office disagrees. Spillane says Madigan "strongly supports the expansion of health care." 

"I think he's trying to turn this into a political argument, and it's not," Spillane says. "It's a substantive lawsuit about JCAR. It just so happens that it deals with health care."

The numerous machinations distract from the health care issue. Lawmakers of both parties say if the governor would go about expanding health care in a different way, he'd likely gain more support. 

Rep. Lou Lang, a Skokie Democrat and member of the committee, said after the November ruling that the governor can't keep trying to spend millions of taxpayer dollars on new health care programs without legislative oversight. 

"While we all support a better health care system, we have something under our Constitution called the Illinois General Assembly. If the governor wants to continue to try to bypass the legislative process in his effort to create a new health care system for Illinois, I think he's got some real problems ahead of him."

The Joint Committee on Administrative Rules could have another Blagojevich health plan in its lap soon. The administration plans to stretch the governor's first-term program, All Kids, to certain young adults.

All Kids already offers health insurance to children regardless of income and citizenship status. Families pay monthly premiums and co-payments based on income. The All Kids Bridge, as it's called, would cover those up to age 21 who have chronic illnesses and who, therefore, are unlikely to be able to afford private health insurance policies. The self-funded program would allow people to get insurance at a group price rather than an individual price through a private insurance company.

The administration estimates the extension would cost $15 million in fiscal year 2008, which ends June 30.

Sen. Randy Hultgren, a Winfield Republican and another JCAR member, adds that he and fellow lawmakers are open to helping more people access preventive care as intended under All Kids, but they're distrustful of the administration's claims that the expansion will be "cost-neutral."

"They're setting themselves up not to be able to meet the requirements and the expectations that we've already set," Hultgren says.

Committee members of both parties say they'd prefer the governor go through the legislative process to vet the details of the proposals, but Silverstein says he and other panel members still will have to deal with it when he does go through JCAR.

"I think we have an inherent problem here because no one gets along in Springfield, and the governor's trying to do whatever he can to get some of his public policy issues passed and implemented," he says. "It's very unfortunate."

Silverstein adds that the rules could be written in an acceptable way, but members first need adequate notice and thorough answers.

The lawmakers' conviction to challenge the governor underscores the problem of this entire General Assembly: distrust of Blagojevich and disapproval of unchecked authority.

"There is a definite breakdown in trust here, and it's going to take a long time," Silverstein says. "Maybe this session or some divine intervention, but I don't see it happening for a while."

The governor is expected to announce his new initiatives soon. If health care tops the list again, he'll also need to announce a funding source.

Last year's funding idea went down in flames. He introduced the so-called gross receipts tax on businesses, which was supposed to generate billions of dollars to pay for an expansion of health care to adults. Lawmakers soundly rejected the idea of a business tax soon after, and the plan stalled.

Another big idea is expected. If there's one thing predictable about this governor, it's that he's a big thinker, reminds Rep. Gary Hannig, a Litchfield Democrat and budget negotiator for his chamber.

"I don't foresee this governor coming in, saying, 'Well, this is all the revenue we've got, so it's going to be kind of meager, so we're going to have a meager year.' He's a big thinker and a big doer, and I think he has grandiose plans for this year, just like he did last year. He'll tell his budget people, 'Find me a way to get some money.'"

While some lawmakers could find it politically difficult to vote against health care during an election year, they're also unlikely to find new trust in this governor if he continues to try to bypass their branch of government and stretch his executive powers to the limit.

Even if Blagojevich succeeds in expanding some existing health care programs, they still lack a guaranteed place in the state budget without approval from the General Assembly.

The legislature already is expected to have a full plate this session as it tries to balance a state budget despite decreasing revenue estimates and compounding debt, pension payments and health care benefits for retired state employees.

The governor's push for new health care programs could face more tough challenges, particularly if lawmakers don't approve or fund them. 

Charm and ingenuity don't bode well with Illinois legislators cast aside as obstructionists.

Bethany Jaeger can be reached at

Illinois Issues, February 2008