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Political campaigns are heating up and health is once again a major issue for candidates to debate. Nationally, the director of Medicare and Medicaid resigns and in Illinois the debate rages over whether to import prescription drugs from Canada and the cost of a new program that guarantees health insurance to all the children.

Dr. Robert F. Rich, director of the Institute of Government and Public Affairs at the University of Illinois, is an expert in health law and policy. It addresses Illinois’ role in shaping the health care debate across the country.

Illinois has passed several health care policies in recent years, including ISaveRx, the Health Care Justice Act of 2004, and the AllKids insurance program. What impact have these initiatives had on the national debate on health care?

All of these programs have in fact served as a national model, in different ways. The Rx program is a national model that has received a lot of negative attention from the federal government because Governor Blagojevich has proposed importing drugs from Canada and the government is against it. The federal government opposes it, as do the pharmaceutical companies, because there is no possibility of recovering their research and development costs. It didn’t reach many people; we’re talking about very few prescriptions that have been filled.

The other programs, AllKids and the Health Care Justice Act are positive national models, as here the governor puts Illinois on the map as tackling one of the top three health issues. The three main issues are access, cost and quality. The governor said he places the highest priority on access. The Justice Act and the AllKids program are about access – providing health care insurance to a wide range of uninsured people.

Do these initiatives promise long-term success, or will they create liabilities that the state will find difficult to pay?

It depends on the criteria you use. If the criterion is: “Do these programs address the issue of access; do they have the potential to have fewer uninsured children or families? Yes, they have the potential. The problem is, and it’s coming out of the gubernatorial campaign, it’s ‘How is this going to be paid for?’ There are two controversial issues. The governor would tell you there is a sliding scale. If you are middle class and can afford to pay part of the premium, you will be asked to pay. On the other hand, if you cannot afford to pay, insurance will be provided. Republicans would say wrong on two counts. We are wrong to say that we cannot afford to provide the insurance to the uninsured and that we do not charge the middle class enough because it is a significant discount from what they would pay for insurance private. If the criterion is financial responsibility, the answer is that the AllKids program creates substantial financial responsibility.

What awaits policy makers? Can we create a health care policy that limits financial exposure while guaranteeing access?

The answer is no, I don’t think we can have health care policy that is successful in both increasing access and reducing financial liability. Medicaid is Exhibit A. All governors in the United States will tell you that Medicaid is the most significant liability they face for any program. Yet it is the program that increases access. It increases access to and provides health care in a country where health care is not a legal right.

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