As I have discussed in previous weeks, the Governor and General Assembly will face many difficult and painful choices in the coming months as we deal with pension and Medicaid liabilities which are major cost centers in our state budget. Setting our fiscal house in order for the short and long terms will not be an easy task….but each year the tough choices are put off, the alternatives only become more bleak.
I am honored to serve as a member of the Joint House and Senate Medicaid Committee, as well as with a bipartisan group of House members who are working to craft viable concepts to bring down current pension costs and reduce our unfunded liabilities.
Listed below are general topics of discussion among advocates and the legislature that eventually could be part of reform legislation:
Medicaid
- There are 3 major components of Medicaid cost: eligibility, provider payments and “optional” services offered. (The Federal Government considers such services as pharmacy benefits, hospice care, intermediate care for developmentally disabled, home- and community-based waiver services, among others as “optional”)
- The Department of Healthcare and Family Services is looking at the following areas, among others:
- Reducing fragmentation of services to clients and increased care coordination
- Better case management and care coordination for Seniors and People with Disabilities who are 15% of the client load, but account for 55% of costs
- Moving from fee-for-service to managed care
- Reforming payment methodologies for hospitals, nursing homes and other providers
- Moving persons from more-expensive institutional care to community-based settings when appropriate
- Reducing fraud and abuse, and upgrading eligibility determination systems
- As I said last week, FY13 cash outlay for Medicaid will be $8.5 Billion (with another $4.7 Billion in unpaid bills). When the Governor presents his budget message next week, we will see how significantly the department’s proposal reduces costs, or if more drastic changes to eligibility, provider payments or service changes will be required.
Pensions
- There are two elements involved in the issue of public pension reform: current year obligations and long-term funding of the currently (approximately) $88 Billion in unfunded pension liability for the 5 state operated retirement systems.
- The calculation of normal cost, shifts in actuarial assumptions, market fluctuations and the future value of money make any decision tremendously complex….and there is always the concern that shifting one section of the funding formulas could have unintended consequences for the employer, current employees and retirees so great care must be taken in implementing different strategies. Among the topics that are being discussed within the broader topic of current costs and benefit levels are (and I must stress that all of these are in the talking and evaluation stages still):
- Cost sharing of normal cost between employers and employees
- Hybrid plans (consisting of both defined benefit and defined contribution plans)
- Salary caps for defined benefit plans with defined contribution thereafter (consistent with Social Security caps)
- Retirement age
- Final average salary calculation
- Cost of living adjustment calculations
- Cash balance plans
- Transfer of employer share from the State taxpayer to the actual employer (mainly school districts outside of the City of Chicago)
- The following areas are among those being discussed when considering the unfunded liabilities of the plans (again all in the talking and evaluation stages):
- Pension Stabilization Fund to reduce the unfunded liability with guaranteed revenue streams
- “Hammers” to force the State to make required contributions such as independent quasi-governmental entities, constitutional amendment, 2/3 vote requirement to change appropriation, etc.
- Revisions to the funding targets and schedules and underlying market valuation fluctuations
- Differing amortization and/or smoothing models
- It is also important that as we evaluate these changes, we must be certain that we act within the various portions of the U.S. constitution and laws and State Constitution regarding diminishment of earned pension benefits, contract law and anywise otherwise illegal impairments to avoid long and costly court battles.
I look forward to updating you on the proposals as they come forward from the Governor’s Budget Address next week along with the subsequent legislative budget process, offer my evaluations, and as always seek your advice and suggestions. I can be reached in Chicago at 773 348 3434, in Springfield at 217 782 3835 or greg@gregharris.org

