Illinois General Assembly Puts Pressure on Hospitals to Provide Charity Care

31 05 2012

The Illinois General Assembly is considering legislation, known as SB3261, to require hospitals that receive property tax exemptions to provide more than stabilization care (already required by the federal Emergency Medical Treatment and Active Labor Act, or EMTALA) to people who earn 125% or less of the federal poverty level in rural areas, and 200% or less in urban areas. The amount of free and subsidized care provided by hospitals has been a hot button issue in Illinois, and across the country, at least since 2007, when the U.S. Senate began a series of hearings on charity care, and in Illinois since a high-profile case involving Provena health care put hospitals’ tax exemptions in limbo. The legislation is an interesting approach to solving the problem of health care provisioning for low-income residents, given the immense shortfalls in Medicaid funding states have been facing since the freefall in tax revenue brought on by the Great Recession.





Gas and Cigarettes and Addiction Funding

25 05 2012

So here’s an interesting problem for students of how cities operate.

Public health and public transportation are two of the marquee issues for planners, and they’re intertwined. Land use planners have recently turned towards policies that encourage walkability, bikeability, and “transit-oriented development.” Mayor Emanuel’s administration is currently undertaking an impressive, ambitious plan to introduce more than 100 miles of protected bike lanes, of the type found on Kinzie Avenue between Jefferson and Wells. Decreasing reliance on cars is a public health issue because it makes it easier for people to be active, and decreases vehicle emissions that pedestrians encounter as they move around the city. Similarly, the Affordable Care Act had provisions for public/private community health facilities with a focus on patient outcomes rather than fee-for-service models that merely encourage remedial care.

Two of the main sources of funding for public transportation and public health (particularly as the latter is undergirded by state Medicaid) are gasoline and cigarette taxes, respectively. You can see the immediate problem; the better transportation and health systems are designed, the more they must compromise the source of their funding. With transportation, this creates the most immediate problem: with increased volatility of gasoline taxes and a sharp increase in ridership, ill-equipped public transportation systems need more and more money to handle the increase (the fares are never enough to capitalize increased infrastructural capacity).

A brief by the American Public Transportation Association touches on this problem; as public transportation ridership increases, capacity needs increase even while revenues drop. Because fares will never be sufficient for real expansion of capacity, there’s a systemic knot that can’t be untied without a federal-state-local approach to overhauling the funding system.

Obviously, there’s a similar problem with the vice-and-obesity taxes on things like cigarettes, alcohol, and fast and junk food. Where these revenues are meant to fund necessities–community health care in particular–the fact that the tax exists as a “disincentive” to unhealthy decision making implies the outcomes we want–healthier city living–are not really priorities. The addiction persists.





Mayor Emanuel’s First Budget Passes Unanimously

16 11 2011

The City Council voted today to pass Mayor Emanuel’s budget unanimously, 50-0. Chicago News Coop reporters Hunter Clauss and Dan Mihalopoulos described Aldermen’s comments as “near worshipful” though not without acknowledging the necessary pain that will come with cuts to front-line workers, library and mental services, and elsewhere.

The budget affects deep cuts, particularly around staffing, to close the $600+ million budget deficit the city faced. The budget came in at $6.3 billion. Aldermen lauded the Mayor for being inclusive in the planning process. While under Mayor Daley unanimous budget votes were often used as evidence that the Council was a mere “rubber stamp” for the Mayor’s prerogative, a unanimity does not necessarily entail that. Aldermen seemed to feel like they got their words in during the preparation process, which is arguably much more important than voting against the final budget. Tracking how the budget has changed from its initial form to today would be more instructive; unfortunately that process is not particularly transparent, or at least self-evident.

AFSCME Council 31, which represents thousands of city workers, released a statement upon passage of the budget bemoaning the deep cuts to basic and needed social services:

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