As  a direct result of Obamacare,  lots of people in Illinois have health insurance who never had it before. “I’m very grateful to President Obama for making healthcare part of his public legacy. Almost half a million people, 480,000 people in Cook County got healthcare coverage through the Affordable Care Act, half a million people, and across the country it’s 20-million people,” Cook County Board President Toni Preckwinkle tells us.

But the even better news is that “In our own health system before the ACA about 70% of our patients were uninsured… and now the reverse is true. About two-thirds of our patients are insured and one-third are uninsured. So, what we’ve seen is not only lots more people getting healthcare and the security that brings, but also public health institutions… have also seen real benefits to their bottom line as a result of the fact that more of their patients have insurance.”

“In 2010 when I was elected the taxpayers of Cook County were contributing $400-million a year to our healthcare system,” she continues. “And in this last budget it’s like $111½ or something like that, so there’s a $300-million difference. Some of it’s efficiencies over the last six years, but most of it is the substitution of federal dollars for local dollars. The federal government took on the obligation of trying to provide healthcare for the uninsured across the country in those states that were willing to become part of Medicaid expansion. And that has been a godsend for the individuals who got the care, who got healthcare coverage and a godsend for public institutions like ours as well as our hospitals and clinics across the county whether they are public or not.”

In  fact, the medicare expansion under Obamacare has not only put the Cook County Health and Hospital system in the black for the first time in its 180-year history, but it’s forced the institution to consider something unimaginable even a year ago – competition for this now-insured patients.

“In the past nobody wanted our patients,” she says. “They were poor people with complicated illnesses. Often multiple issues that were challenging them, diabetes and hypertension at the same time or struggles with cancer, and we were a provider of last resort, and we took anybody who came to our door. We still do regardless of their income, their insurance status, their citizenship status. We take anybody who comes in our door, and that’s been a blessing for Cook County for 180 years. But as a result of the Affordable Care Act and the fact that people have insurance now they can choose, and so we’re an environment which is competitive for the first time for us, and the real challenge for us is to up the quality of care that we deliver and peoples’ perceptions of us. You know I think if you ask people they know that our emergency room is a world-class institution. If you have trauma, if you’re shot, if you’re in an automobile accident…burned, that’s the place you want to go. But we have a world-class institution across a number of specialties, and what we’ve got to get out to people is it’s not just our emergency room that’s wonderful, it’s more broadly the care we deliver…That means that we have to both market ourselves and deliver services in a way that we haven’t been forced to do before.”

So what happens when the Trump administration finally gets its legislative act together and abolishes, or severely restricts, the ACA? What will be the effect on Cook County and its taxpayers?

“It’s not just that we will lose the federal support for the people that in our own Medicaid expansion plan, which is called County Care, about 145,000 people, but that people who are in other Medicaid expansion programs, and ours isn’t the only one, Blue Cross Blue Shield has one for example, some of the private insurance, people who are covered by those programs as well will come to us by default, as people without insurance in the past have always come to our public health system. So we estimate the impact is at the minimum 300-million, but it could be as much as 800-million. And we only have a budget of 4.2-billion, so that’s a pretty big hit,” Preckwinkle explains.

In fact, with White House leaks, an independent counsel and possible Russian influence over the administration, Preckwinkle says the only slight ray of optimism is that “all the things that are happening, it seems to have moved attention away from substantive issues like healthcare.”

It’s a wide-ranging, hour-long discussion, and you can read the full transcript of the show here: CN transcript May 18 2017

The following are some selected highlights from today’s discussion.

On Bruce Rauner’s inability to get a budget passed for two years:

I mean the first obligation of government at whatever level you are is to, if you’re the executive propose the budget and then get it passed. And the fact that when Rauner came in he said, “I’m only going to work with them on the budget if they do X, Y, Z,” term limits and workman’s comp and whatever else he was talking about. You know, when I came in there were things I wanted to do too around affordable housing, around consolidation in government, around immigration, but I never said to the Board of Commissioners I will only work with you on the budget if you work with me on these other things. Government operations is one thing, and then your substantive agenda on these other issues is another, and your first obligation is to get your budget passed, so we’ve passed balance budgets for the last seven years.

On how running a government differs from running a business:

You have to deal with people who got elected on their own, who have their own ideas, their own vision, their own constituencies. You’ve got to persuade people, make deals with people. You have to build a consensus for what needs to be done and then move ahead with it. You can’t just give people orders. You can’t say, “I want you to change workman’s comp laws. I want you to enact term limits. I want you to do whatever else it is,” and think that they’re just going to do it, they won’t. And I don’t know, particularly given the strong leadership in the President Cullerton and Speaker Madigan how he felt that he was going to just tell them what to do and they would do it. And then I think he got himself boxed. When he finally figured out that wasn’t going to work he had already said that these were the conditions on which he would work with them on the budget.

On the impact the budget mess is having on Cook County:

You know the state owes us as of this month $107-million.  $107-million, and they’ve owed us as much on a monthly basis as $183-million. The range has been $57-million to $183-million… But all of our local units of government are impacted by the fact that we don’t have a state budget. I think people don’t understand that. And in our county we’ve been able to manage it, but for units that don’t have reserves they are either borrowing money or cutting services, you know, or laying people off. I mean this is a nightmare.

On the national perception of Illinois:

Social service agencies are being devastated. Local units of government are really challenged because the state is not paying or paying nine to ten months late. Our higher education institutions are really struggling, and then we’re the only state in the country that hasn’t had a budget for two years. It makes us look like we are hopelessly inept and dysfunctional. It’s hard to argue that we’re not.

On whether Bruce Rauner is vulnerable in his re-election bid:

I hope and pray…I think he is. I think we have to get the word out about the devastating impact of his failed leadership on ordinary people in Illinois. And I think the poll numbers for him are below 50% that think he’s doing a good job, so if you’re an incumbent and theoretically you’ve been working hard for your constituents for the past three years, it’s hard to argue that’s a good thing…You know, I think his governorship has been devastating for the State Illinois, so needless to say I’ll be working hard to make sure that he’s not re-elected.

On prospects for significant police reform with the Sessions DOJ:

I think external pressure to perform better would have been helpful in the Chicago Police Department. It’s clearly absent now. Attorney General Sessions has said, “Whoa, we’re not going to look at local units of government and how they police their communities. We’re not going to engage in these kinds of audits of performance that we engaged in before.”

On a conversation with a CPD Commander about resources:

One of the commanders said, “It’s not just that I don’t have enough police officers, I don’t have enough sergeants to manage my officers on the street well or enough lieutenants to manage my sergeants.” It’s not so simple as we need more officers on the street, we need a command structure that needs to be enriched and supported, so that’s a real challenge. You don’t provide continuing education. You don’t have enough officers, and then there’s a culture… I’m sorry, I think we have profound struggles with racism in our Police Department, not just here in Chicago, but across the country. This is a national issue. It’s one of the ways in which the pervasive racism in our country manifests itself, how black and brown communities get policed.

Police treat black/brown kids differently than white kids:

African Americans and Latinos are together 50% of the population of the county, but 86-87% of the people in the jail. It’s a reflection of how black and brown communities get policed particularly in the City of Chicago, where most of the people who have come into our criminal justice system reside. And you know, black and brown people get arrested for stuff that white people never get arrested for, low level drug possession.

I had a conversation with a judge who came to see me, a person who I had supported, and she said, “You have to understand our kids,” and she meant black and brown kids, “Are getting arrested for stuff like shooting dice on the sidewalk or having a few joints in their pocket.” These are things that white kids don’t get arrested for, and then you have a criminal record, you’ve been arrested. At every juncture in the criminal justice system, black people in particular get differential treatment than is accorded to whites.

The black caucus in Springfield did a study of outcomes in our criminal justice system at the statewide level and found consistently that African Americans had worse outcomes, having roughly the same background as white counterparts than whites did. There is a pervasive racism in this country that profoundly impacts our criminal justice system and results in what we call disproportionate impact on communities of color.

On the cost of incarceration vs. education:

We’ve put a lot of emphasis since I came in to office on looking at the criminal justice system. Again, it’s 41% of our budget and it costs $162-$163 a day to keep somebody in jail. That’s a lot of money. It’s more than $50,000 year in a society in which we spend $10,000 a year educating our kids on an annual basis. So we’re prepared to spend five times as much to keep people in jail as we are to educate our children in the City of Chicago. That’s profoundly disturbing to me.

On Sen. Raoul’s bill lengthening sentences for illegal gun possession:

I disagree with him on this bill. The bill is about possession, and what’s happened in Illinois is since 2000, so the last 17 years, we’ve increased the penalties for possession six times. We have tripled the number of people that we had in 2000 in prison for gun possession. I don’t see that that’s had a big influence on the levels of violence in Chicago. I mean what we need to do is focus on the shooters and the suppliers. This legislation is about possession. If the legislation was about penalties for shooters, penalties for suppliers I would be gung-ho in support of it, but I’m not in support of this legislation. And you have to understand, people buy guns in Indiana and adjacent states and come into our black and brown communities and sell them out of the trunks of their cars. We ought to be focusing on those people and putting them behind bars for as long as we can. They are doing a tremendous injustice to the communities where these young people who get possession of the guns live. We ought to come after them. We ought to come after the people who are shooters hard.

In conclusion, is Preckwinkle optimistic?

It is an extremely challenging environment because of what’s going on in Washington and what’s not happening in Springfield, but there’s still a lot of good that we can do and we’re trying.

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And here’s the full transcript: CN transcript May 18 2017