Does Rauner have any guiding principles on health care insurance?

WASHINGTON — The Senate Republicans released their health care insurance draft bill on Thursday — the House version to overhaul Obamacare passed in May — and once again, GOP Gov. Bruce Rauner isn’t doing much to make sure the final measure is good for Illinois.

A core element to GOP proposals is to shift to states the authority to reshape health insurance rules: for those who get it through employers; via Medicaid, the state/federal plan for the low-income medically needy; or through the exchanges established under former President Barack Obama’s Affordable Care Act.

Governors become far more important in the GOP vision of how health insurance should be delivered in this nation.

In Illinois, the politically explosive issue of rising premiums will become the fault of the governor and Illinois General Assembly — not Washington, if the GOP state-centric Obamacare overhaul plans become law.

Rauner is abdicating his responsibilities to the people of the State of Illinois by his silence — and he can’t blame this one on Illinois House Speaker Michael Madigan, D-Chicago, who doubles as the chairman of the Democratic Party of Illinois.

People should know: What are Rauner’s guiding health care insurance principles?

• Under GOP proposals, federal Medicaid funds flowing to Illinois would be curbed starting in 2021, though the Senate plan is more generous than the House version.

This could cause greater strain on a state budget — if Illinois had one. Rauner has now gone more than 700 days without sending state lawmakers a budget.

Medicaid funding is critical to providers such as Cook County and Mount Sinai Hospitals. What’s the Rauner plan to make up for less Medicaid funding at publicly owned hospitals and clinics?

Where would the money come from? If there is no more cash, what should be cut?

• Obamacare requires coverage for people with pre-existing conditions, with caps on how much they could be charged. The Senate bill would allow a state to limit the benefits allowed for someone with a pre-existing condition.

Would Rauner want to change current rules concerning capping coverage costs and for people with pre-existing conditions? Should any benefits be reduced?

• At present, Obamacare mandates coverage for 10 essential benefits. The Senate bill allows for states to apply for a waiver so an insurance plan could offer less. That may impact the price.

What is the Rauner view when it comes to the essential benefit current package? Should it be cut? Stay the same?

At present, Obamacare covers inpatient care; emergency room visits; prenatal and baby care; mental health treatment including psychotherapy; prescription drugs; physical and occupational therapy; lab tests; preventive health care services, and dental and vision care for kids.

In a June 6 letter to Rauner, signed by all the Illinois congressional Democrats, they have a point when they write the governor about his “failure” to provide information about how congressional GOP health care legislation could affect Illinois. They ask him to speak out about the “policies you either support or oppose to improve care for residents of our state.”

From the Senate floor on Thursday, Sen. Dick Durbin, D-Ill., said of the Senate bill, “you can put a lace collar on a pit bull, and it’s still a mean dog.”

What’s Rauner’s take?

Health care in Illinois should be a top issue in the 2018 race for governor.

Keep in mind no organized entity in Illinois is speaking out in support of the GOP health insurance overhaul measures — no hospital or medical or nursing home groups.

After the House bill passed in May, Rauner said in a statement the GOP measure “continues to be of deep concern to our administration.”

On Thursday, Rauner deputy chief of staff Lance Trover said in an email, “The Senate proposal is being reviewed. We will have no further comment. I will refer you to the governor’s previous comments on this issue.’’

The Democratic primary rivals, fighting to take on Rauner next year, haven’t yet realized in their unfolding campaigns the potential of health care as an issue of concern to voters from Chicago to Cairo — and the flank Rauner leaves exposed by his silence.