There's more to fixing ailing programs such as Medicaid than just passing a law.
A little more than a year ago, with great fanfare, state legislators overwhelmingly passed and Gov. Quinn signed what they described as a significant reform of the state's Medicaid program that would save $800 million over five years.
The legislation established a managed care program for some Medicaid recipients to determine if that approach could deliver quality care at a lower cost. Legislators also decided to place a moratorium on expanding new programs and eligibility.
Two other ground-breaking reforms were — get this — rules that required applicants to show they were residents of Illinois and had an income low enough to meet eligibility rules.
The skyrocketing cost of Medicaid is just one of a series of major financial issues facing the state. Along with $85 billion owed to underfunded public pension programs and roughly $8 billion in unpaid bills, Medicaid is a dagger pointed at the heart of Illinois government.
That's why what happened next is so appalling.
The Obama administration notified Illinois that the state's new rules violate requirements established in Obamacare, the mandate that will determine how health care is delivered in this country.
Being required to live in Illinois to qualify for an Illinois program is a violation of rules? Being required to meet the clearly outlined financial eligibility rules is another violation of the rules?
Those findings by President Obama's hirelings are a violation of common sense just begging for a state appeal. But until last week, Julie Hamos, director of the Illinois Department of Health and Human Services, did nothing.
In a recent commentary outlining the administration's intransigence, state Rep. Chad Hays, a Catlin Republican, said department officials claimed they had not pursued a rules waiver because of "a lack of manpower in the agency."
That's not the reason. The department has more than 2,000 employees. Hamos and Gov. Quinn didn't seek a waiver because they just didn't — Lord knows why.
Once word leaked out and political pressure became inevitable, the Quinn administration got religion. Hamos announced that she had not only had requested the required waiver, but also plans to implement the changes even before they're approved.
The waiver fiasco shows an astounding lack of urgency on the part of the Quinn administration. Medicaid is the state's most costly program, $14 billion a year. The Medicaid rolls have exploded from 1.4 million in 2000 to 2.7 million in 2012 — one in five state residents.
Even more disturbing, the problem is growing worse. In defiance of last year's reform that mandated a freeze in eligibility requirements, the Quinn administration is planning to add another 100,000 Cook County residents to the Medicaid rolls as a political favor to Cook County Board chairwoman Toni Preckwinkle.
Millions more will come on the Medicaid rolls when Obamacare is fully implemented. Even though it's a federal mandate, Illinois taxpayers will be required to pick up the added costs after three years.
What this all adds up to is more financial disaster for Illinois.
Things already are bad. Illinois has the lowest bond rating of any state. The Civic Federation of Chicago estimates that the state's unpaid bills will quadruple from roughly $9 billion to $35 billion over the next five years, an increase attributed mostly to higher Medicaid and public pension costs.
Meanwhile, legislators who are running for re-election are trying to figure out how to avoid addressing these issues because they don't want to make voters angry.
Gov. Quinn is scheduled to give his annual budget address on Wednesday, and he's hinted that he'll be making a lot of tough recommendations on a variety of subjects, including Medicaid. While he's urging action on Medicaid in the coming year, he might explain why he and Hamos were so passive this past year as Illinois' financial standing continued to decline.