CHICAGO -- With millions of Americans losing health insurance and crying for relief from soaring medical costs, Illinois is considering a bold and once-unthinkable proposal - extending medical coverage to all state residents.
It's a daunting, politically divisive and potentially expensive prospect, with 1.8 million uninsured people in the state. But experts say health care reform might stand a better chance of passing in Illinois than almost anywhere in the nation.
"The odds are long, but they're much better in Illinois than most other states," said Alan Weil, executive director of the National Academy for State Health Policy.
An unprecedented public debate is under way, with hearings on health care issues being held in each Illinois legislative district. Meanwhile, a new 29-member task force has been meeting regularly and plans to deliver a report on reform proposals to the Legislature as early as August.
A wide range of options is likely to be considered, including expanding Medicaid to cover more low-income adults, providing health insurance subsidies or tax incentives to small businesses, and letting the uninsured buy coverage through new insurance pools, several task force members said.
"The process in Illinois is unique, and we're all closely following what is happening there," said Mark Blum, executive director of America's Agenda, a coalition of 20 national and international labor unions.
Last year, Illinois became the first state to promise medical coverage to all children. But some experts suggest the time is ripe for even more aggressive action.
"Medical providers are taking it on the chin. Consumers are taking it on the chin. Employers are taking it on the chin. And there's a real feeling out there that this could be the last great chance we have to do something," said Howard Lerner, who heads the new health care task force and is president of the Rehabilitation Institute of Chicago.
"The sense of physicians at this point is if we don't find a solution for these problems, a solution will be imposed on us," said Dr. Craig Backs, another task force member and president of the Illinois State Medical Society. "That's not something we want to see happen."
Illinois' political climate is especially favorable for health reform, with a governor who has made health care a signature issue and a Legislature controlled by Democrats, who tend to make medical issues a priority. Still, here as across the country, there are deep ideological and partisan divides over how to fix a dysfunctional medical system and enormous concerns about potential costs.
"I think the business community would very much like to see government undertake initiatives to help the market work better. But unfortunately, when something happens in this state, it almost always is an expansion of government-provided health care, and we have great difficulty supporting that," said Todd Maisch, a vice president at the Illinois Chamber of Commerce.
The current debate was jump-started by the Health Care Justice Act, a little-known piece of legislation passed in 2004. For the first time, the act affirmed that "it is a policy goal of the state of Illinois to insure that all residents have access to quality health care at costs that are affordable."
The act went further by setting up a process for debating health reform throughout Illinois and a timetable for coming up with a "health care access plan" for the state Legislature to consider.
The key dates are approaching. More than half the legislative districts in the state have held public hearings. The task force was due to present a report on reform proposals to the Legislature this month, but that deadline has been pushed back to the end of summer because of funding delays. Meanwhile, the act strongly encourages lawmakers to vote on a proposed plan by the end of this year and start implementing reforms by July 2007.
"This is a process we have never formally engaged in before in Illinois, and a groundbreaking opportunity," said Dr. Lawrence Haspel, senior vice president of the Metropolitan Chicago Healthcare Council.
What's really new is the fact that consumer and business organizations, medical providers, health insurers, lawmakers and others are working together for the first time to consider reform options. In the past, the groups have held widely divergent views and made little effort to collaborate.
Consensus is by no means guaranteed. Virtually every other state that has attempted significant health reform has seen its efforts founder under the weight of competing special interests. And though some experts argue that health care is a local concern that needs local solutions, others maintain problems are national in scope and beyond any individual state's ability to manage.
"Can you imagine every state having its own unique health care system? That would be a disaster," said Kim Maisch, Illinois state director for the National Federation of Independent Business.