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Cook County commissioners target big hospital budget for cuts

Tuesday, November 07, 2017
Chicago Tribune
by Hal Dardick

Cook County commissioners target big hospital budget for cuts

1 of
Antonio Perez / Chicago Tribune
Cook County commissioner Richard Boykin speaks out as the Cook County board meets to answer questions, Tuesday, July 18, 2017, raised by the Chicago Tribune investigation. (Antonio Perez/ Chicago Tribune)

Hal Dardick, Chicago Tribune

6:35 pm, November 7, 2017

One Cook County commissioner on Tuesday pointed to hundreds of millions of dollars in unpaid medical bills as a possible way to plug the county’s budget hole — but Health and Hospitals System officials warned that might be like trying to squeeze blood out of the proverbial turnip.

At a budget hearing, Commissioner Richard Boykin told Health and Hospitals System officials that more should be done to collect upward of $350 million in outstanding debt.

Boykin also accused Doug Elwell, the system’s deputy CEO for finance and strategy, of constantly lowballing the amount of unpaid bills at $90 million to $100 million.

Elwell and system board Chairman M. Hill Hammock later told the Tribune that the lower figure is the amount of money the county has a chance of actually collecting. Some of the debt is sent to collection agencies, but the bulk of those unpaid bills are for services provided to uninsured and underinsured patients without the wherewithal to pay.

“We could take that and try to sell it,” Elwell said, adding that the idea would be looked into. “My guess is we’re not going to get any takers, or we’re going to get a taker for very little money.” Hammock said collecting 10 percent of the debt “would be a big success.”

Boykin’s push is a sign of how commissioners are hunting for ways to cut from County Board President Toni Preckwinkle’s proposed 2018 budget after repealing the county’s controversial soda tax. They’re quickly approaching a self-imposed Nov. 21 deadline to approve a spending plan.

The Health and Hospitals System proposed budget reaches $2.4 billion if all pension and other indirect costs are included. That’s about 44 percent of county spending in Preckwinkle’s $5.4 billion plan.

But Dr. Jay Shannon, CEO of the system, explained that $1.2 billion comes via Medicaid funding through the Affordable Care Act. That money gets funneled directly into health care costs, including those paid to other hospitals that are part of the CountyCare managed health care network, he said

An additional $727 million comes through other federal and state funding that goes directly to health care payments, while hundreds of millions more dollars go to required pension and debt payments.

In the end, local taxpayers only foot about $110 million in costs for day-to-day county health system costs — compared with $389 million in 2010, under the last budget crafted by the administration of Preckwinkle’s predecessor.

Since then, the Affordable Care Act, commonly called Obamacare, has helped the county to dramatically reduce local costs. And the system has been doing a better job of collecting debts from people and insurance companies.

Shannon said about $90 million of the local subsidy is going for medical care at the Cook County Jail and Juvenile Temporary Detention Center, where law requires the county to provide care without charging. The rest, he said, is about evenly split between the Department of Public Health and a small portion of the hundreds of millions of dollars the county spends on caring for people who can’t pay each year.

Nevertheless, Commissioner Jeffrey Tobolski, a McCook Democrat who like Boykin helped lead the effort to repeal the soda tax, said he would like to see the Health and Hospitals System cut $27 million — the amount it was going to be allocated from the repealed tax.

Shannon has proposed cuts of about $12.4 million, which would include closing Oak Forest Health Center in the south suburbs, getting the unions to agree to allow job openings to be posted outside the system more quickly and farming tuberculosis care out to community health clinics, among other changes.

“Your proposed cuts are not enough,” Tobolski protested. “There’s going to need to be more.”

But in an interview with the Tribune prior to his Finance Committee appearance Tuesday, Shannon said further cuts could lead to a loss of patients who are insured or otherwise have the wherewithal to pay.

“We’re now down to a point if we’re asked to cut stuff, what we’re cutting is the service,” Shannon said. “We’re not cutting down on pencils or legal pads we’re buying. We’re cutting down on services, and that deteriorates our ability to provide those services to vulnerable communities, but also it cuts down our ability to collect revenue.”

Twitter @ReporterHal

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