Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Tuesday, September 29, 2015

Chicago needs a plan to sign up its uninsured; here's what to do

Health care coverage has an impact on the economic well-being of lower- and moderate-income people; therefore enrolling the uninsured should be considered a key economic strategy for Chicago and all of Illinois. Unfortunately, this isn't the case.

Sixty-three percent of Illinois' working population eligible for a private path to health coverage under the Affordable Care Act is still uninsured, with large swaths residing in Chicago (see a breakdown of the numbers across Illinois here).

Given those statistics, Mayor Rahm Emanuel needs all hands on deck—from business leaders to health insurance brokers, from community institutions like public libraries to religious leaders—to encourage people to sign up.

Open enrollment for 2016 health insurance coverage starts Nov. 1, so the city is in serious need of a plan. We propose a Commission for Healthy Chicago, similar to the mayor's effort on violence prevention, comprising city staff and community, business, faith and health care leaders to build a cross-sector strategy for outreach and enrollment. Emanuel can improve the economic security of working-poor Chicagoans simply by putting the clout of his office behind such a strategy.

Chicago shouldn't expect the state to lead. In the midst of the state's fiscal disarray, Get Covered Illinois has lost most of its staff and has stated it will rely more heavily on “partners” such as providers, brokers and nonprofits for enrollment support. GCI's limited capacity can't get the job done; nor should the city and state expect nonprofits and health care providers to fill the gap in funding or leadership.

The Task Ahead

With only 37 percent of the estimated 942,000 marketplace-eligible residents having enrolled, Illinois ranks 20th out of the 37 states that operate their marketplaces using the federal HealthCare.gov website.  

Here's another way to look at it: Two years into ACA's health insurance efforts, almost two-thirds of Illinois' marketplace population—the lower- to moderate-income people for whom the ACA was created—remain uninsured. Almost half of them are eligible for a tax credit or subsidy to make their plan more affordable.

Overall, about 73 percent of the nearly 600,000 people who are eligible but still uninsured live and work in the Chicago metro area. Within these areas there are significant proportions of the population who do not speak English as their primary language. In nearly half the metro area, at least one-third of the population speaks Spanish or another non-English language. In several of these areas, primarily in Chicago and suburban Cook County, more than 50 percent do not speak English as their first language. Notably, the areas with the highest proportion of non-English speakers are the same areas with the lowest share of eligible population enrolled.

 Other states have successfully enrolled low- to moderate-income people in the ACA health insurance marketplace. They have done this through:
• Use of data to target communities with large, underserved marketplace-eligible populations.
• Exploiting numerous local avenues to provide extensive education and outreach, including through events and local media, to directly connect the uninsured with help to enroll in coverage.
• Meaningful collaboration with brokers and the small-business community.

A healthy Chicago economy goes hand in hand with a healthy population that is ready to learn, work and is not burdened by health care costs. Let's not let Chicago and Illinois fall behind when it comes to covering working families.

This article originally appeared in Crain's Chicago Business.

Barbara Otto
Health & Disability Advocates
Blogger Tricks

Monday, August 31, 2015

Stay the Course with SHIP

State budget cuts are not the only threat to seniors and people with disabilities. Federal reductions may be coming as well.

The US Senate is considering a 42% reduction in funding to the State Health Insurance Assistance Program, which counsels seniors and people with disabilities on their Medicare health plan options. SHIP funding would drop to a mere $20 million, diminishing the numbers and quality of the SHIP workforce.

SHIP is Necessary Now More than Ever

Every day, 10,000 Americans become eligible for a Medicare system that is increasingly more complex. Medicare beneficiaries pay the price for the confusion:
  • 700,000 Medicare are paying the Part B Late Enrollment Penalty because they missed the deadline to sign up,
  • Medicare Part D beneficiaries in Low-Income Subsidy are often unaware of lower priced options,
SHIP counselors are trained to sort through the mess of enrollment rules and multitude of health plan options. The Illinois program includes 600 SHIP counselors located across the State. These counselors provide free, unbiased counseling on Medicare, Medicare supplemental policies, Medicare managed care and long-term care insurance. Seniors can turn to SHIP counselors for assistance with fraud and abuse issues, billing problems and filing appeals. Annually, the Illinois SHIP creates a comparison guide for all Medicare supplemental policies, a vital resource to figure out the alphabet soup of options.

Poorer Trained, Less Helpful

The federal cuts would compromise SHIP's ability to adequately serve everyone who needs help. One and a half million fewer people would receive assistance. Moreover, most of the SHIP counselors are volunteers who donate almost two million hours of help. Cuts could also result in reduced or compromised volunteer training, which increases the risk of erroneous advice and reduces the quality of services beneficiaries receive.

No Substitute

Those in favor of the cuts claim there are less costly alternatives to SHIP. This is untrue. The materials suggested as substitutes, 1-800 Medicare, Medicare.gov and the Medicare Enrollment Handbook, all list SHIP as a resource for people to use with additional questions. A brochure is no substitute for one-on-one, expert advice.

What You Can Do

Tell your Senator to fight cuts to the SHIP program, that your family, friends, even you personally, benefit from the free services that SHIP counselors provide. It's easy:
  • Send our Senators this model letter drafted by the National Council on Aging. Just copy and paste the text into their contact forms:  Sen. Kirk's form  Sen. Durbin's form (remember to sign your name!)
  • Tweet your advocacy with this graphic we created – and tag @SenatorKirk @SenatorDurbin
  • Feel free to personalize with your story, or the story of loved ones. Personal stories make a difference!
Go ahead, spread the word, fight the cuts. And as you do, share your efforts with Illinois Health Matters!

Bryce Marable MSW
Health Policy Analyst
Health & Disability Advocates

Thursday, August 6, 2015

Patchwork of Short-Sighted Solutions Leave the State's Most Vulnerable at Risk

The following letter to the editor originally appeared in the Chicago Tribune.

The expectation that Medicaid-funded long-term care providers will continue to provide care to low-income and vulnerable citizens without payment for those services is short-sighted and doesn’t fully consider the strains that it places on them - and the direct care staff who provide the hands-on care to elders and people with disabilities.

For providers that can keep their doors open without Medicaid funding, it may mean cutting costs by laying-off staff, leaving the remaining nursing assistants to work longer shifts at the nursing home. Or, it may result in a consumer getting care from a new home care aide when her regular aide – who knew her schedule and needs – had to quit after losing her day care subsidy – another casualty of Gov. Rauner’s and the legislature’s inability to act and pass a budget.

For those providers that cannot keep their doors open without Medicaid payment, where are the people who relied on them for housing, for a meal, for a bath, or transportation to a medical appointment supposed to turn for care?  In many instances the home care aide is the professional who checks in to make sure that her client is well, taking her medication, and isn’t at risk for injury.  And for those receiving care in a nursing home, there is often not another option for them to receive 24-hour care.

These are realities that lawmakers are not taking into consideration as the budget impasse lingers on without a solution in sight. While ensuring that Medicaid providers in Cook County who serve children continue getting paid was a great solution, none seems to be in sight for the thousands statewide who rely on Medicaid services for care in nursing homes or to live safely and with dignity in their communities.

A patchwork of short-sighted solutions will only leave the state’s most vulnerable at risk.  It is time to pass a budget with sufficient revenue to fund the services that seniors and people with disabilities rely on and to stabilize the long-term care employers and workers who provide the services.

Tameshia Bridges Mansfield
Midwest Director
Paraprofessional Healthcare Institute

Thursday, July 9, 2015

Illinois Must Continue to Provide Vital Benefits, Regardless of Failure to Pass State Budget

The following originally appeared on The Shriver Brief from the Sargent Shriver National Center on Poverty Law.

As Illinois’s budget impasse continues, the failure of Governor Rauner and the state legislature to pass a fair, adequate, and fully funded budget is beginning to have an impact. Late last week, Illinois Attorney General Lisa Madigan filed a lawsuit seeking to clarify what payments the state can and cannot make in the absence of a state budget. At issue, among other things, is the state comptroller’s authority to continue to pay state workers.

Importantly, the state also has an obligation to millions of low-income Illinoisans who are recipients of public benefits or beneficiaries of health care coverage. Earlier in June, the Shriver Center formally reminded state officials of their obligations under existing consent decrees to continue to provide these important services. The agreed order entered yesterday by the court in People v. Munger authorizes and requires the comptroller to continue to provide cash assistance through the Temporary Assistance for Needy Families and Aid to the Aged, Blind and Disabled programs, medical assistance, and child care assistance regardless of the lack of a state budget.

Millions of Illinois residents who would suffer needlessly by losing their income and health care coverage due to the lack of an operational state budget can feel secure tonight that their benefits will continue uninterrupted. Now it’s time for the governor and the state legislature to work together toward a budget that serves all of Illinois and includes the sustainable revenue needed to fund the programs that families need.

Dan Lesser
Director, Economic Justice
Sargent Shriver National Center on Poverty Law

Wednesday, July 8, 2015

Medicaid: The Long-Term Costs of Short-Term Savings

The Rauner Administration’s decision to cut $1.5 billion in Medicaid spending to balance the state budget is like the proverbial cutting off the nose to spite the face. Central to the Rauner “plan” is to tighten eligibility for people with disabilities and older adults to access long-term care services and supports (LTSS). The Administration is proposing to increase the minimum eligible level of something called the “Determination of Need” score. The DON eligibility process determines how many hours of assistance an older adult or person with a disability can get in order to stay in their own home.

While the Administration views this as an appropriate cost-cutting measure, in reality such a move will ultimately reduce needed community-based services for people with significant disabilities, and will spread those costs to other parts of the healthcare delivery system.

Where the costs go

What happens to those costs? They get passed on to hospitals and urgent care providers, taxpayers (in the form of other social programs), and family members who are either under-employed or unemployed in order to help a loved one.

Persons who are aging or living with a disability require access to long-term care to live independently, and do not have other options to find support for their medical needs. Reducing access to home and community-based services means individuals who are at risk of living in more costly nursing facilities become desperate to find any help with activities of daily living, through friends or family members who may be able to assist with financial or personal healthcare needs.

This is easier said than done, however, as family members or friends who can volunteer to assist are often being forced to choose between their own employment and assisting their family member or a loved one. Creating a further burden is Rauner’s proposed elimination of funding for developmental disabilities respite care, a program that provides assistance for people who care for persons with disabilities,

Medicaid is not only the payer of last resort, but the program of last resort, for persons with significant medical needs – paying for as much as 49% of the country’s long-term care services.

How to save the state money

Keeping people out of emergency rooms and nursing homes ultimately saves the state money. Progress Center for Independent Living released data showing that home services remove pressure from Medicaid spending on nursing homes, saving the state more than $17,500 per person, per year in the Home Services Program for people with disabilities.

The cost savings for seniors in the Community Care Program are even greater, at more than $24,150 per person, per year. Consider the fact that the Home Services Program serves 30,000 people with disabilities, and the Community Care Program serves more than 80,000 people year round (based on the FY 2014 Public Accounting Report for both HSP and CCP from the Illinois Office of the Comptroller), and you have staggering numbers for cost savings. According to the Service Employees International Union, more than a third of people with disabilities now in the Home Service Program – some 10,000 people – will lose access to care in their homes, thereby creating a dependence on hospitals and institutions to address their long-term care needs. The Community Care Program will be losing more than 38,700 seniors.

Debate surrounding the state budget should be aimed at taking concrete strategic actions, rather than cutting low-cost and money-saving programs. Governor Rauner appears bent on forging ahead despite opposition from the Illinois house and senate.

The facts are clear. The cuts to the Medicaid budget are not cost-effective, and they isolate vulnerable populations. The notion that diminishing social safety nets is a good way to control state budget deficit is at best misguided, and we need to move on from this policy.

Related reading:

Thursday, July 2, 2015

Same-Sex Couples Celebrate New Marriage and Healthcare Rights

The Supreme Court of the United States has been awfully busy lately—after last week’s landmark
rulings to uphold the Affordable Care Act and legalizing same-sex marriage, SCOTUS is certainly living up to its name. And while these decisions have massive implications in completely different realms of the American social and political landscape, they both improve the future of healthcare for same-sex couples. After facing decades of coverage ineligibility and discriminatory practices, achieving marriage equality means that same-sex couples will finally receive equitable treatment in a number of different areas of the healthcare arena.

New Options for Enrollment and Coverage

Because same-sex marriage is now recognized under federal law, LGBT couples are entitled to utilize insurance enrollment and coverage options designated for married spouses. One such opportunity now available to same-sex couples is the special enrollment period. Newly married same-sex spouses previously needed to wait to apply for coverage until the open enrollment period but these couples are now eligible to apply for coverage within 60 days of their union. These special enrollment periods are available to applicants who have recently experienced a major life event, a category which now incorporates same-sex marriages in light of the Supreme Court ruling.

Same-sex partners across the nation are now eligible to receive coverage under their spouse’s employer. A recent study by the Kaiser Family Foundation showed that less than half of employers offer insurance to non-married same-sex couples. Now that same-sex marriages are recognized under federal law, married same-sex couples across the nation will be able to access the same coverage benefits as heterosexual couples.  Although coverage for same-sex spouses was previously available through many insurance providers, same-sex couples will now have equal opportunity to access these benefits.

Spousal Rights

Friday’s Supreme Court decision also marks a huge step towards equal rights for same-sex spouses in healthcare settings. Couples who were previously denied basic spousal rights such as default power of attorney will be entitled to the same privileges as heterosexual couples in healthcare settings.

Although this may seem like a small victory to couples that have faced this type of discrimination, this decision marks a giant leap forward in the fight for equality. Take the story of LGBT rights activist Janice Langbehn: while vacationing with their family in Florida in 2009, Janice’s partner of 18 years Lisa Marie Pond suddenly collapsed and was rushed to a local trauma center. Because they were not Lisa’s blood relatives, Janice and their three adopted children were not allowed to see Lisa and were in the waiting room while she received treatment. Although Janice had power of attorney and the documentation was faxed to the hospital within an hour of Lisa’s arrival, it was too late: Lisa had suffered a brain aneurysm and slipped into a coma, and died without her partner or her children by her side.

Unfortunately, Lisa and Janice’s story is not unique—hundreds of same-sex couples have similar heart-wrenching stories of being denied basic spousal rights in hospitals and other healthcare systems. This landmark ruling will hopefully put an end to these discriminatory practices and allow same-sex couples the same fundamental rights to which all married couples are entitled.

An End to Discrimination

The recent ruling will hopefully mark an end to the prejudicial practices often employed by hospitals and healthcare facilities in serving same-sex couples and their families. As illustrated by Lisa and Janice’s story, unequal treatment of same-sex couples has been an unfortunate part of our nation’s healthcare history. These practices will hopefully be left in the past with this monumental decision.

Although Illinois was ahead of the curve in officially recognizing same-sex marriage, our statewide healthcare institutions have not all been sensitive to the specific care needs of LGBT patients. In an effort to hold healthcare organization accountable for their policies and practices for serving LGBT communities, the Human Rights Campaign launched their Healthcare Equality Index (HEI), which evaluates the equitable treatment of LGBT patients in healthcare settings based on the presence of four criteria: providing staff training in LGBT patient-centered care, equal visitation rights for LGBT patients and their visitors and written patient and employment non-discrimination policies. Although 16 Illinois hospitals and healthcare systems ranked among the 427 national leaders in LGBT healthcare equality, 12 of the 50 Illinois facilities surveyed in 2014 failed to meet the majority of equality criteria.

Despite this, equitable healthcare treatment for the LGBT community on a national scale is closer now than ever before. The 2014 HEI survey found that 84% of the hospitals met all four criteria for LGBT patient-centered care. This is a 101% increase in the number of healthcare systems designated as national leaders in promoting LGBT equality in 2013.

The Supreme Court's legalization of same-sex marriage symbolizes a new era of equality, while the upholding of the Affordable Care Act marks a huge stride towards equal healthcare for same-sex couples nationwide. Now that the federal government has done its part in recognizing same-sex marriage, it’s up to healthcare systems across the nation to follow suit and ensure that their practices promote equitable treatment for LGBT patients and their families.

Dena Balk
Policy Intern
Health & Disability Advocates

Small Employers: Take Another Look at Wellness Programs

Small employers want a healthy workforce but wonder how and if they should promote healthy
behaviors among their employees.  Trends show that larger employers, who typically self-fund their health insurance programs, find a direct link between the benefits of wellness programs and their health insurance bottom line.  This provides clear motivation for internal programming and incentives to keep employees fit, eating healthy and smoke-free.  For small employers who traditionally provide fully insured health insurance programs, the direct return on investment from implementing a wellness program may be less obvious.

The Return on Investment

Research has consistently shown that unhealthy employees are less productive and take more sick days. In 2010, The Harvard Business Review made a compelling argument in favor of worksite wellness programs. In the programs they highlighted, they found improved health status, fewer sick days and workers' compensation premiums declining by as much as 50%.  Even though small employers are faced with a highly regulated premium environment because of the Affordable Care Act (ACA), wellness programs might allow small businesses a solution for lowering workers' compensation costs.

Healthy Employees, Happy Employees

The Centers for Disease Control and Prevention (CDC) identifies several ways that both employers and employees can benefit from work-based health programs.  At the top of their list for employees: increased well-being, self-image and self esteem.   This kind of indirect impact on the employee psyche can boost morale, reduce turnover and ultimately improve productivity. Calculating the cost of employee turnover can be tricky for a small business, but some estimate it to be between 150 – 175% of the annual salary depending on the job level.

The question for small employers comes down to the bottom line.  The actual cost of employer wellness programs can vary greatly. Questions to consider as you begin exploring the feasibility include:

Will the program be run in house or using an external vendor?
How extensive will the health interventions be?
Will you include health screenings?
What type of employee incentives will be provided?

In addition, small businesses may not be aware that the ACA has created new tax-based incentives for qualified employer wellness programs.   There are rules to comply with, as plans must be reasonably designed to “promote health or prevent disease.”  Additionally they must be made available to all “similarly situated” employees.  For more details see this Department of Labor Fact Sheet.

Small Scale Ideas Make a Big Difference

Still unsure about incorporating a more comprehensive wellness initiative into your business model? Some small scale initiatives can make a big difference.  Even something as simple as extending lunch hours can give employees time to make lunchtime fitness practical and possible.   Rather than allowing employees 30 minutes to grab a burger and fries, 90 minute lunch slots offer employees time to hit the gym. Small changes like this can give a boost to employees and the small business as a whole.

Worth the Time to Investigate

Small employers have a lot to consider when it comes to how to allocate their health related workforce dollars.  Finding a little room in the budget now as well as spending some time re-thinking a few basic workplace rules could ultimately pay off.   Proven reductions in workers' compensation premiums, employee turnover rates and new ACA tax incentives make it the perfect time for small employers to give worksite wellness programs a closer look.

Michele Thornton MBA
Insurance and Benefits Consultant