A joint Committee of License and Zoning unanimously approved an ordinance consolidating various business licences as recommended by a mayoral task force, but urged the Department of Business Affairs and Consumer Protection to find ways to increase local control to deter bad actors from gaming the system. A second ordinance removing barriers for where gun ranges are allowed to locate also advanced out of committee despite overwhelming objection from aldermen present.

The potential repeal and replacement of the Affordable Care Act (ACA) is as much about municipal budgets and economics as it is about the individuals who rely on it for coverage. Federal Medicaid reimbursements, newly created preventive care grants, and financial incentives for neighborhood clinics have been a boon for Illinois hospitals and health centers. In a special 36 minute episode of The Aldercast, we take a deeper dive into this topic to explain what the healthcare landscape was like in Illinois before the ACA, how it changed, and what taxpayers, governments, and providers stand to lose from a potential repeal.

Click to listen to the podcast.

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Across the state, the healthcare industry generates about $13 billion a year in economic activity, according to the Illinois Health and Hospital Association (IHA). A majority of that output is concentrated in the Cook County and Chicago-metro area. 

For Illinois, the stakes of a potential repeal are especially high–the state hasn’t had a budget in two years, has already seen the shutdown of dozens of social service agencies, and has one of the fastest rates of population loss in the country. In a letter addressed to U.S. Senator Dick Durbin dated December 21, 2016, IHA’s President and CEO, A.J. Wilhelmi, warned a repeal of the health care law could mean the potential loss of $11 to $13 billion in annual economic activity in the already beleaguered state. Between 84,000 and 95,000 jobs could be lost.

“For every dollar hospitals spend, there is an additional $1.41 generated in spending in the local and state economies,” Wilhelmi says. “For every hospital job in Illinois, nearly one and a half jobs are created in other sectors. So of course with $3.2 billion coming into the state through Medicaid expansion, as well as the impact of people getting coverage through the Marketplace, you can see where there’d be an upside gain to the upstate economy and jobs, and we’ve certainly seen that reflected in the hospital community.”

More than 260,000 Illinoisans are employed by the state’s hospital system. When adding the indirect jobs–from companies that service the hospitals to local businesses where hospital employees spend their paychecks–the number jumps to 500,000, IHA estimates.  

Cook County alone is home to more than 75 hospitals, 160 Federally Qualified Health Centers, along with dozens of health centers, nursing homes and hospice organizations. Recent U.S. Census data found that 7.5% of the county’s employees work in the healthcare field. Half of the county’s annual $4.5 billion budget is dedicated to healthcare. And because of the expanded Medicaid provisions, which reimbursed states up to 100% of the additional costs for covering low income adults for the first years of the program, CCHHS moved its books into the black three years in a row for the first time in its history.

With the influx of federal dollars, the local taxpayer contribution to support CCHHS has decreased by $370 million. Cook County started its own Medicaid Managed Care Organization, CountyCare, which brings in Medicaid reimbursements and new patients. For the first time in its 200 year history, CCHHS has operated in the black for three years in a row. Thanks in part to the financial stabilization of the ACA, CCHHS launched an ambitious Central Campus redevelopment plan, a more than $100 million investment.

Should the ACA be repealed, Cook County would have $300 to $500 million hole in its budget, county officials have warned. This, after the county board pledged not to raise taxes again until 2020.

Chicago’s public health department has benefitted from more than $10 million in new federal prevention grants. Because of the ACA, the Centers for Disease Control spends 12% of its annual budget dispersing federal dollars to local governments for vital public health initiatives, and Chicago has received $12.8 million from the CDC’s Prevention and Public Health Fund since it was established. Public Health Commissioner Dr. Julie Morita has said this helped bring the city's teen pregnancy rate to an all-time low, increased the number of checkups from the low 60s up to 80 percent, and resulted in close to 700 fewer diabetes-related hospitalizations between 2010 and 2014.

In a joint hearing of the city’s and county’s workforce committees, Morita warned the knock-on effects of a repeal–which expanded insurance to 480,000 people in Cook County–would further burden local jails, homeless centers, and emergency departments.

In this episode, we’ll tell you how neighborhood clinics benefitted from an influx of the newly-insured, from the perspective of local clinic, Erie Family Health, and Norwegian American Hospital, a safety net hospital in Humboldt Park. Both were able to use ACA funds to digitize records, expand and coordinate care, and, most importantly, eliminate one of the largest drains on their resources: uncompensated care.

If you enjoy the episode and are interested in additional information, some useful links are below.

Federal:

• American Hospital Association Report on Impact of Repeal without Replace


• Statement on Introduction of the American Health Care ACT (AHCA) (Speaker Paul Ryan)


• Section by Section Summary of the AHCA (Energy/Commerce Committee)


• Official Bill (American Health Care Act)


• Health & Human Services Budget Briefing (FY 2018)

State:

• Rauner Admin Letter to Congress Re: Repeal


• Preliminary Economic Impact of Affordable Care Act Repeal (IHA)


• IHA Advocacy on ACA/Medicaid/Medicare


• Durbin Hears From Southern Illinois Healthcare Leaders On Local Impact Of Repealing Affordable Care Act


• Families USA Stats on Illinois

Local:

• SEIU Healthcare Talking Points


• Jay Shannon Prepared Remarks, Joint Press Conference with SEIU


• Board President Toni Preckwinkle Remarks, Joint Press Conference with SEIU


• IHA Testimony at Joint City/County Hearing on Impact of AHCA

A joint committee of the Council’s Zoning and License Committees meets today to consider numerous code changes and consolidations. This includes one ordinance that’d allow those under 18-years-old to enter a shooting range facilities if they’re accompanied by and under the direct supervision of the a guardian or instructor.

Plans to boost police presence at Chicago train stations and parks will be under consideration Monday by the City Council Committee on Public Safety. The plans are in the form of two ordinances that’d renew intergovernmental agreements with the Chicago Park District and the Chicago Transit Authority.

The CTA agreement is part of CPD’s Voluntary Special Employment Program (VSEP), which allows sworn officers to volunteer their off-duty hours to sister agencies. The Park District agreement expands existing “baseline services” CPD provides through routine patrols of public green space. The agreements detail the salary reimbursements, maximum number officers allowed, and other standard IGA language.

 

• IGA WITH CTA O2017-1953 - CPD would provide up to 11 dedicated full time supervisors to CPD’s Public Transportation Section with CTA, reimbursing the city for “the actual salaries and benefits associated with those supervisors”. CTA would have the authority to request up to 60 police officers to patrol train and bus stations or along transit routes. The limit on officers does not include those who are part of CPD’s transit division, whose normal full-time duties include patrolling CTA area.

 

• IGA WITH PARK DISTRICT O2017-1956 - Similar the agreement with the CTA, additional police officers would be offered to the Park District, “through dedicated police patrol watches primarily at mutually determined Chicago park locations along the lakefront as deemed necessary and for other law enforcement purposes including, but not limited to, eliminating violent crimes and drug-related crimes, and improving safety and security for Chicago residents.” Under the agreement, the Chicago Park District would reimburse CPD up to $2 million for 2016, $4 million for 2017 and 2018, and $2 million for 2019.

 

 

The committee will also take up an ordinance (O2017-1968) introduced by Committee Chair Ariel Reboyras (30) on behalf of the Department of Fleet and Facilities Management that donates an “outdated Department of Aviation / Chicago Fire Department Triage Unit” to the 5-11 Club, Inc., a nonprofit that provides food and beverages to first responders on the scene of an emergency. (The organization’s website further details these “canteen services.”)

 

Happy Saturday!

Two long-brewing topics, Chicago school debt and police reform got a little bit more tangled this week as Chicago Public School officials skipped out on a Council hearing and Chicago police officers elected a new union president who promised to fight “the anti-police movement in the city.”

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CPS Won’t Show For Council

Last week, City Council’s Education Committee attempted to hold a hearing on Chicago Public School finances. Even though it was the committee’s first scheduled meeting since August of last year, nobody from CPS showed up, causing one aldermanic staffer to claim the absences were, “because the district is on spring break.”

Alderman Rick Muñoz (22), a member of the committee, didn’t take too kindly to CPS ignoring him. He said district leadership has been unreliable when it comes to revealing their finances, saying that “One day, they say they’re $200 million short, another day they’ll say they’re $250 [million] short, another day they’ll say they’re $130 [million] short. Million. We’re talking about a lot of money. And the difference is huge.”

But City Council literally has no authority over CPS, since the general assembly restructured CPS in 1995, giving the mayor total authority over selecting the school board, as well as unlimited power over the school budget and bonding. Council has no oversight powers whatsoever. So why would CPS leaders show up for a Council hearing?

I asked Muñoz this question Thursday. “It’s because they’re going to need us later. We’re going to have to pay for everything,” he said. On Tuesday, in fact, Ald. George Cardenas’ (12) Chicago Public Education Revitalization Ordinance–creating an official mechanism for the city to direct all surplus TIF money to CPS–is on the Finance Committee agenda. He’s said a TIF surplus could “conservatively provide the school district $100-150M to help address the current crisis.”

CPS still needs to fill a $215 million gap–at least that’s the last number CPS provided in January–or else schools will close three weeks early in May. It doesn’t look like the state legislature will get the funds past Gov. Bruce Rauner. So, that leaves Chicago City Council on the hook.

But if CPS leaders even show up for a Council meeting, Mayor Rahm Emanuel might as well hoist a big white flag for everyone in Springfield. The message would be clear: “We’re giving up on state money, we’re just going to pay for everything ourselves!”

Gov. Rauner could declare victory: His obstinace made Chicagoans pay their own bills. Nevermind that the rest of the state’s schools were getting a proportionately larger state subsidy, but that’s politics.

Mayor Emanuel and his Springfield allies have to keep up the hope that as CPS’ May doomsday draws closer, pressure will mount to do a deal in the statehouse. So, Emanuel and CPS CEO Forrest Claypool are saying as little as they can about alternative solutions, while continuing to bang on the table, demanding a statehouse solution.

But in Muñoz’s mind, this is all window dressing. He figures that it’s a done deal that aldermen will to have to vote for another tax hike to pay for CPS. Expect more aldermen to get agitated in the coming weeks as they work out the political math for themselves.

The Growing Rift Between Cops And The Black Community

Everyone knows that Chicago has a crime problem, but there are two opposing camps about the cause and what to do about it. One group believes Chicago has an enforcement problem, that if more bad guys were thrown in jail, then the criminal-minded would choose not to do criminal acts, bringing peace to the city of Chicago.

Another group sees the problem as socioeconomic, starting with a lack of opportunity, and compounded by overly-aggressive policing that divides society into criminals vs. non-criminals. This arbitrary sorting out forces many otherwise good people into a lifelong “criminal” label because of one or two bad decisions.

While this is a broad characterization, and there are many nuances in between, the two different frame references essentially define the divide between Chicago’s police union leadership and its black community. Like pro-life versus pro-choice advocates, the two groups have such different worldviews, they believe compromise is not possible, only domination of one over the other.

Everything to this point has been a prelude: The Department of Justice and Police Accountability Task Force reports were just pieces of paper. Then, Donald Trump’s election made a federal consent decree a non-starter: The feds won’t force police to make changes. Instead, Mayor Emanuel has made incremental changes on the margins of police reform, addressing training and starting a long process to revamp police oversight, but the thorniest problems reside in the police union’s contract with the city.

Under another presidential administration, the Fraternal Order of Police could expect the Department of Justice to force their contract negotiations to court, if there weren’t enough big changes, but under President Donald Trump, the FOP has been emboldened.

Two items in the police contract are under particular fire. From our story on the DOJ report in January:

Requiring a signed and sworn affidavit to file a misconduct allegation against a police officer undercuts accountability. And even though the FOP contract allows for an “override”, Independent Police Review Authority investigators told DOJ it’s not encouraged and they weren’t trained on the procedure. Override was used only 17 times in the last 5 years. And of the approximately 2,400 complaints submitted a year, 40% are closed because they lack a signed affidavit. “Collectively, through this patchwork of policies and practices, the City fails to conduct any meaningful investigation of nearly half of the complaints made against officers.”

The FOP contract fosters collusion among officers. The report explicitly states that the level of “witness coaching” by union attorneys for police officers is unprecedented in DOJ’s history of conducting these types of investigations. “We have not identified any other agency that permits witness coaching to occur in the very presence of investigators, much less requires those investigators to cooperate with others in the room to conceal such efforts from the tape recorder and omit any mention of them in the investigative file. At CPD, however, the practice is institutionalized, with IPRA investigators often starting their interviews by inviting officers to use a hand signal if they want the investigator to turn off the tape recorder. Under the FOP contract, officers are allowed to have an attorney present, which is usually a lawyer provided by the union, when they are being interviewed for an investigation. Usually, the same attorney will represent all the officers involved, making collusion not only easy, but common practice.

On Wednesday, FOP members elected a new union president, Kevin Graham, who pledges to oppose these reform efforts. In an interview on WGN-TV Thursday, Graham specifically mentioned the two above issues, promising to fight for them.

Then, on Thursday, the City Council Black Caucus held a press conference, joined by county, state and federal black elected officials. Caucus leader Ald. Roderick Sawyer (6) promised that “The 18-member Black Caucus is committed to voting no on this contract if these recommendations are not publicly supported in the negotiation between the administration and the FOP,” and then they too, specifically mentioned the two above points.

As we reported in our Neighborhood Perspective series in January, there is a widespread demand for police reform in Chicago’s black community, and black leaders of all levels are cynical when asked if they believe Mayor Emanuel will be able to deliver. Meanwhile, voters in Chicago’s Northwest and Southwest Side neighborhoods share their neighborhoods with cops, and tend to share their worldviews.

Because the two communities have such divergent views, Mayor Emanuel will have to carefully negotiate this tricky political situation if he wants to remain mayor after 2019.

For roughly two hours Thursday, Chicago aldermen grilled officials from United Airlines and the Department of Aviation to determine who was at fault when a man was dragged off a plane and bloodied by airport security for refusing to leave his seat.

Budget committee spent three and a half hours Thursday considering a $160 million, four-year street light replacement plan and authorizing a much-touted new municipal ID program operated by the City Clerk’s office. While both items passed committee, opposition dug in hard, subjecting witnesses to hours of questions.

City Council License Committee speedily approved new measures Thursday to make it easier to revoke licenses for about 370 charter vehicles, or so-called “party buses”, licensed in Chicago, and to crack down on unlicensed buses operating in the city. The move comes after a series of highly-publicized shootings and violent incidents. The ordinance strengthens and increases penalties for charter operators who do not take steps to warn passengers of that unlawful weapons and substances are not allowed.

Members of the City Council Black Caucus were joined by African-American county, state and federal elected officials Thursday morning as they announced plans to vote against a future Fraternal Order of Police (FOP) contract if the contract did not include specified reforms, including removing restrictions on investigations of anonymous complaints, and removing the ban on rewards to police officers who provide information about misconduct.

 

County officials came prepared Wednesday for questions from the press and commissioners about $1.6 million in misspent funds at the Department of Homeland Security and Emergency Management (DHSEM). The problem, officials said, was that DHSEM didn’t get approval before spending the money. That meant the $1.6 million they already spent will have to come from the county’s corporate fund, instead of from a pot of grant money. The department’s interim executive director, Mark Edingburg, presented a multi-step plan aimed at making sure DHSEM–which is largely funded by federal grants–stays within those grant requirements so the county isn’t left holding the bag in the future.

Aviation Committee Chair Mike Zalewski (23) wants officials at United Airlines and the Department of Aviation to come before his committee to explain why a passenger was dragged off one of its flights by police at O’Hare Airport over the weekend. The Committee will also consider a plan to lift the restriction on mobile food trucks at city airports.

Two big ticket items are slated for the Budget Committee Thursday: an ordinance establishing a new municipal ID for Chicago and the first disbursement of funds from the city’s recently created Neighborhood Opportunity Bonus (NOB) fund. A long-stalled initiative to upgrade 85% of the city’s street lights with new energy efficient LED bulbs is also moving forward, as is a contract with a Chicago-area biotech firm.

A routine ordinance requesting the city fix a subdivision error for a privately owned collection of parcels in the city’s Galewood neighborhood barely made it out of Transportation Committee Tuesday because of a series of confusing title transfers that involves the UNO Charter School Network.

The Chicago Fraternal Order of Police changed their top leadership Wednesday after members elected 19th District patrolman Kevin Graham from the Blue Voice slate as the union’s president for a three-year term. Graham, in a runoff election, defeated incumbent Dean Angelo 56.21% to 43.79%. This is the second time in a row the FOP elected their president in a close election. Angelo defeated his predecessor, Mike Shields, in a 2014 runoff election.

Three meetings have been cancelled today: Workforce, Housing and Community Development, Zoning and Building, and Roads and Bridges. The Workforce committee was scheduled to discuss the county’s annual tax sale and “the impact this change has on communities hardest hit by the foreclosure crisis, senior citizens and homeowners of Cook County.” Treasurer Maria Pappas and Clerk David Orr were scheduled to appear.

The meeting was canceled at the request of Chairman Bridget Gainer. A staffer in Gainer’s office said they are accommodating Treasurer Pappas, who is in Greece celebrating the Easter holiday.