Robert F. Rich is the director of the Institute of Government and Public Affairs at the University of Illinois and is a professor of law and of medicine. He is an expert on health-care policy and law and discusses his views of the “Illinois Covered” proposal put forth by Gov. Rod Blagojevich this spring.
Is “Illinois Covered” universal health insurance?
It depends on what you mean by universal health insurance. It provides access potentially to all those who want to be covered but it does not mandate health insurance for everyone. Universal health coverage would mean that there is near 0 percent of people uncovered. This plan would not necessarily result in near 0 percent of people uncovered.
Is it a proper role for government to be involved in providing health insurance coverage?
I think the answer to that is ‘yes’ if you look at it on a worldwide basis. We are the only country in the world – I should say the only advanced democracy in the world – that doesn’t have universal health coverage. Or to put it differently, in every other country health care is a legal right. And one of the things that distinguishes the United States from all other countries is that health insurance for health care is voluntary. It’s not a legal right and ‘Illinois Covered’ doesn’t change that.
Illinois Covered doesn’t require participation. Is that something that should be required, as automobile insurance is, for example?
My view is yes. My view is that I find it rather odd that Illinois as well as many other states require drivers to have automobile insurance and we don’t require that people should have health insurance. Again, in every other country in the world, health care is a legal right. It’s not something that is voluntary; it’s not something you choose or not choose. You have it; it’s a right of citizenship.
Independent of a program like this, would mandated health insurance cut back on the cost of health insurance?
It depends whether you have rate regulation. If you’re going to have universal coverage and you want to make it more affordable, you have to do one of two things: either you have to regulate the rates the insurance companies may provide, like Germany, for example, or you have to provide subsidies to businesses and to individuals to ‘afford’ health care insurance as Gov. Blagojevich is proposing. Now what’s interesting about Gov. Blagojevich’s proposal is that he is mandating that insurance companies provide low-cost premiums in Illinois; that’s a different kind of mandate.
So will Illinois Covered provide enough access to health care for those who need it at this point?
I think you have to answer that question saying, will Illinois health care in combination with Medicaid provide enough sufficient access? I think the key point there is (access) to those who need it or want it – and then it depends on how you define ‘need it’ or ‘want it.’ I think the key point is that even Gov. Blagojevich’s own figures say that he will be covering 515,000 adults who are uninsured of the current 1.4 million who are uninsured. That still leaves more than half a million who will be uninsured.
What will this mean for the employer who’s providing insurance to his employees?
What the Blagojevich plan says is that small businesses, meaning 25 employees or fewer, may purchase Illinois Covered if the business pays up to 70 percent of the premiums. That may be unaffordable for businesses. The second dimension, and I think this is a legitimate fear, is that some businesses will see this as an opportunity to stop providing coverage for employees. They will say ‘OK, the state is doing this, they’re subsidizing this, and they’re paying for it. I no longer need to do this.’ So instead of increasing access broadly, we may decrease access through our employer base system.
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