Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Sunday, January 30, 2011

Welcome to the Illinois Health Matters Blog

Health care reform arrived in 2010 and now it is moving fast. Whether you agreed with the federal Affordable Care Act or not, it will touch your life in one way or another. Changes have already been implemented in Illinois which affect hundreds of thousands of people including those with pre-existing conditions, seniors & people with disabilities on Medicare, adults with college-age children, small business owners and others.

Each individual state is responsible for many aspects of health care reform implementation -- and every state will do it differently. For that reason, a group of health care policy and consumer organizations in Illinois decided to start Illinois Health Matters.org. With generous funding from The Chicago Community Trust, we designed this site to be a user-friendly, digital hub for information about health care reform implementation in Illinois.

We will provide insight into how health care reform impacts four different target populations: individuals and family, small businesses, community-based organizations and media & policymakers. We’ll post questions and answers and hope to be your trusted source of information.

Please visit us often and participate in the conversation!

Barbara Otto, Health & Disability Advocates
John Bouman, Sargent Shriver Center on National Poverty Law
Jon Lavin, AgeOptions
Jim Duffett, Campaign for Better Health Care
Margie Schaps, Health & Medicine Policy Research Group

Friday, January 28, 2011

Older Adults and People With Disabilities in Illinois Are Already Benefiting from Health Care Reform

Older adults and people with disabilities in Illinois are concerned about what they’ve been hearing about changes to the Medicare program and other healthcare reforms that affect them and their families. It is often hard to sort out the facts, so many are turning to trusted sources of unbiased information, like AgeOptions, to learn about changes that are already in place and others that are planned over the next several years.

The most frequently asked question is about how the changes from the Affordable Care Act (ACA) will affect Medicare benefits. The fact is that healthcare reform is not cutting benefits to people with Medicare to pay for the program. The law actually protects Medicare’s basic (Part A and Part B) benefits and improves coverage for many. The savings being drawn from the Medicare program over the next several years will come from: reducing fraud, keeping people healthier, and providing care that is better coordinated, like improving the communication among your healthcare providers and covering better follow-up care when you leave the hospital so you don’t go right back in (now, one in five people who are discharged are re-admitted to the hospital within 30 days.)

Some of the savings will also come from changes to how the federal government will pay Medicare Advantage plans starting in 2012. These plans, which are run by private companies paid by the government to provide Medicare benefits to members, may decide to make some changes, but they will still be required to provide all the Medicare Part A and Part B benefits you get now.

There are also significant positive changes for people on Medicare that start this year, including:
  • New coverage of preventive healthcare services at no cost to you. As of January 1, 2011, deductibles and co-pays are eliminated for many Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force These services include, for example, important tests like mammograms and colorectal cancer screening .
  • The ACA authorizes Medicare to pay for an annual wellness visit to your doctor – including a physical exam, tests and a personalized prevention plan (a schedule of screenings and health promotion activities) to help keep you healthy. 
  • The ACA is also beginning to slowly close the Medicare Part D "donut hole," the coverage gap people with a Part D insurance plan reach after they have used prescription drugs that cost a certain amount ($2,840 in 2011). During the donut hole, you continue to pay your plan premiums, but until this year, you have been responsible for the total cost of your drugs until you reach another cost level ($6440 in 2011). To help cover the costs last year, the federal government issued a $250 check to each person who fell into the donut hole in 2010; 130,426 Medicare recipients in Illinois received a check. Beginning January 2011, there will be no more checks. Instead, everyone who hits the donut hole will get a 50% discount on brand name drugs and 7% discount on generics. Over the next nine years, people in the donut hole will continue to get a 50% discount on brand names and higher generic discounts each year until there is no gap by 2019. Also, the Illinois Cares Rx pharmaceutical assistance program in Illinois will still be available in 2011 to help cover the costs of prescription medications for low income older adults and people with disabilities.

For older adults who are not eligible for Medicare, there is also some new help from the ACA. The group of people aged 55-64 have been especially hard hit by the economic downturn (layoffs, extended unemployment, early retirement) and have the hardest time finding private insurance. There are about 287,000 uninsured adults in Illinois in this pre-Medicare population. Under the ACA, the state is providing a new health plan for people under 65 with pre-existing conditions that have had no insurance coverage for 6 months—called IPXP (Illinois Pre Existing Condition Plan). The IPXP program is funded by the federal government and is less expensive than the current high risk pool, ICHIP.

The ACA also provides tax incentives and help paying claims to encourage businesses to continue to offer coverage to employees and former employees in this age group. The Alliance for Health Reform and AARP, answered many questions about ACA provisions of interests to 50-64 year olds in a briefing last week, which can be found here.

For more information on Medicare, health care reform implementation, and Illinois Cares Rx, please contact AgeOptions at: http://www.ageoptions.org/ or 1-800-699-1043.

Terri Gendel
AgeOptions, Director of Benefits & Advocacy and Director, Make Medicare Work Coalition

AgeOptions, the Area Agency on Aging of suburban Cook County, is designated by the Illinois Department on Aging to plan, fund and coordinate services and advocate for the more than 460,000 older adults and their families in the 130 communities in the suburban Chicago area. AgeOptions also co-leads the Make Medicare Work Coalition (MMW) in partnership with Health & Disability Advocates and Progress Center for Independent Living, providing education and policy advocacy for older adults and people with disabilities in Illinois about healthcare options. The coalition is made up of members from more than 250 organizations, including government agencies, healthcare and social service providers and a variety of community based agencies. 

To join the MMW listserv, contact information@ageoptions.org. To find area agencies on aging serving other parts of Illinois go to http://www.state.il.us/aging/2aaa/aaa-main.htm

Tuesday, January 25, 2011

Recent "Medicaid Reforms" in Illinois: How Do They Impact State Implementation of the ACA?

The Affordable Care Act (ACA) offers states financial and health care coverage opportunities but also imposes administrative and structural requirements for states to meet in a very short timetable. There is, however, substantial federal money available to modernize state data systems and to create a seamless Medicaid/Health Benefits Exchange system. This task requires careful and thoughtful planning and has the potential to maximize federal funding for health care in Illinois and reduce inefficiencies in Medicaid. Any changes to the Medicaid system now must be considered in that context.

While the state is embarking upon this critical planning process to implement federal health care reform by 2014, the state legislature and the Governor also made a possibly shortsighted decision to impose limits on health care programs in Illinois. The legislature passed the “Medicaid Reform” bill (HB 5420) almost unanimously earlier this year and Governor Quinn signed it on January 25, 2011.

The key provisions of the Medicaid Reform bill that affect health care reform implementation in Illinois are the following:

A moratorium on any expansions to Medicaid program eligibility or coverage until 2013. This means that the legislature would have to amend or repeal this provision in law in order to take advantage of any early implementation of health care reform -- such as a phase in of the childless adult population under 133% FPL or a waiver to offer Medicaid to HIV positive individuals not yet disabled by AIDS -- even if these opportunities would save state general revenue funds.

A cap on enrollment of any new children applying for All Kids health care coverage who have family incomes over 300% FPL (about $66,000 for a family of 4) after 7/1/2011. This provision will deny health care coverage under All Kids to children with pre-existing conditions who currently can buy Medicaid coverage; many of these families have no access to group health insurance, cannot buy private health care coverage and do not fit into the strict requirements of the high risk insurance pools. Children could still spend-down to Medicaid if they have high medical costs.

Termination of children on All Kids who have family incomes over 300% FPL (about $66,000 for a family of 4) after 7/1/2012. This would terminate coverage for over 3,000 children.

Imposition of strict eligibility and income verification processes for all Medicaid applications. These verifications will make it more difficult to prove eligibility for Medicaid and may have a chilling effect on new applications for Medicaid.

A requirement that 50% of the total Medicaid population receive their health care through a capitated care arrangement by 2015.

The Medicaid reforms passed by the state legislature in Illinois move the health care system in the opposite direction that the state needs to be moving towards in 2014 – efficient, streamlined eligibility, coverage and access for all uninsured populations. Over 75% of the uninsured in Illinois are under 400% FPL and will most likely be in Medicaid, a Basic Health Program, or subsidized within the health care exchange. This is precisely the population for whom the state wants to provide continuity of eligibility and coverage moving into 2014. Any interruptions in coverage as a result of caps and reductions in eligibility prior to 2014 only create gaps in continuity of coverage that will have to be mended by 2014.

Stephanie Altman
Programs & Policy Director
Health & Disability Advocates

Monday, January 24, 2011

Why the Affordable Care Act is Important to Community Based Organizations in Illinois

Already the Affordable Care Act (ACA) has brought in millions of dollars to Illinois and to community based organizations (CBOs) in our state. Those already funded, along with the many who will receive funding over the next years of ACA implementation have the potential to make an enormous impact on the health of our communities. Some of the most significant elements of the ACA that will impact CBOs include:

Community Health Centers: Over the next 5 years of implementation of the ACA, we can expect Illinois to receive between $285 and $437 million for operational capacity expansion and $45-$69 million for physical expansion and construction. The legislation requires that private insurers contract with Federally Qualified Health Centers (FQHCs) and reimburse at no less than the Medicaid rate. $1.5 Billion has been allocated nationally to expand the National Health Service Corps by placing primary care providers in provider-shortage community areas. Illinois can expect several hundred newly funded physicians, nurses and dentists through this program.

Safety Net Hospitals:
Medicaid will now cover all people up to 133% of the poverty level, meaning that hundreds of thousands of people heretofore uninsured will be insured after 2014 helping to provide support for safety net institutions and community health center providers. Safety net hospitals will have the opportunity to collaborate with other community based providers to develop innovative programs and apply for any of the many grant opportunities under the CMS Innovations Center.

Health Care Workforce:
The legislation provides primary care providers with a 10% Medicare payment increase for primary care services for 5 years. This increased reimbursement should help ensure greater availability of primary care physicians. In addition, the legislation requires that primary care services through Medicaid cannot be paid less than the Medicare payment rates in 2013 and 2014. This too should expand the pool of primary care providers willing to see Medicaid eligible people.

The legislation authorizes $10.8 Million for geriatric education centers to provide training focused on geriatrics, chronic care management and long term care. The legislation authorizes $10 million for career incentives to foster interest in the fields of geriatrics, long-term care and chronic care management. Furthermore, $10 million is authorized for grants to provide advanced training opportunities for direct care workers employed in long-term care settings. ACA also authorizes demonstration projects for patient navigator programs within community settings. Beginning in 2011, the legislation increases the reimbursement rate for nurse-midwife services from 65% of the rate of a physician to the full amount.

Health & Medicine Policy Research Group is a Chicago based health policy research and advocacy center focused on improving health and health systems throughout Illinois. HMPRG will continue to provide analysis of the ACA, conduct policy forums on the ACA and work with state and local partners to maximize the potential of the Act in Illinois. For more information on HMPRG or to access our analysis of the ACA and upcoming forums, visit us at www.hmprg.org, or call 312-372-4292.

Margie Schaps
Executive Director
Health & Medicine Policy Research Group

Health Reform Will Help Small Businesses in Illinois

Did you know that almost 8 out of 10 small businesses in Illinois with 25 or fewer workers will receive financial relief because of the Affordable Care Act? If you want to see if your small business qualifies, check out the Small Business Majority's tax credit calculator at http://smallbusinessmajority.org/tax-credit-calculator/

Tax credits for purchasing health care coverage are just one of many important provisions in the Affordable Care Act that will help make high-quality health coverage more affordable and accessible for Illinois' small businesses. Here are some other provisions-

Health Insurance Exchanges for Purchasing Coverage: Starting in 2014, the Illinois health benefit insurance exchange will be up and running, creating a new marketplace where employers will be able to purchase high-quality, affordable health plans for their workers. In the exchanges, small employers will be able to view comparable and clear information on benefits and costs for each insurance plan so that they can find the policy that best meets the needs of their workers. This simplified system of shopping for and enrolling in health coverage will ease administrative burdens on small employers who may have limited staff and time for searching for health coverage.

A Prohibition on Charging Higher Premiums Based on Pre-Existing Conditions: Starting in 2014, when small businesses purchase coverage for their workers, insurers will be prohibited from charging them higher rates if their workers have pre-existing health conditions. This will make coverage more affordable for both the owners and the employees of small businesses.

The Campaign for Better Health Care is here to help link Illinois consumers and small businesses to affordable, quality healthcare. Visit our website at www.cbhconline.org or call our Health Care Helpline toll-free at 1-888-544-8271 to share your story. We use the poignant stories of ordinary Illinoisans to bring the human impact of the health care crisis home to legislators, news media and community leaders.

Jim Duffett
Executive Director
Campaign for Better Health Care