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What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Friday, February 11, 2011

Top Ten Things You Should Know About lllinois Health Care Reform

On February 7, 2011, Governor Quinn's Illinois Health Care Reform Implementation Council held a public hearing to release its initial recommendations on the implementation of the Affordable Care Act in Illinois. The recommendations, which include issues that the state must address immediately and decisions that will be made after the Council gathers more information from stakeholders and the federal government, were offered to the public to review and comment; however, the recommendations will be fine-tuned before final recommendations are presented to the Governor.

The report is a fairly short 19 pages and easy to read, but if you want the "Cliffs notes" version, here are the top 10 main take-aways from the meeting:
  1. The Council recommends that Illinois (rather than the federal government) create a state based Health Benefits Exchange, which is the centralized marketplace that in 2014 will provide individuals and small businesses with access to more affordable, comprehensive health insurance coverage options.
  2. The Council recommends that the Exchange should be run by a quasi-governmental entity led by an appointed board of directors. This administrative structure is similar to the Illinois Comprehensive Health Insurance Plan Board and the Office of Health Information Technology.
  3. The Council does not recommend a preferred way to finance the administration of the Exchange at this time although it specifies that funding should not come from the state general revenue funds. The Council is still considering an assessment on insurance companies, providers and others who will benefit from broader health insurance coverage, as possibilities for revenue sources.
  4. The best current estimate of the number of uninsured in Illinois is about 1.5 million. Of these, the Council estimates that in 2014, between 500,000-800,000 people will be added to Medicaid, between 200,000 and 300,000 people will purchase subsidized coverage through the Exchange and between 300,000-600,000 people will remain uninsured. Another 1 million Illinoisans who are currently insured will get private insurance through the Exchange, much of it with some subsidy. Unlike in the past, Medicaid and private insurance will be merged into one centralized marketplace.
  5. The Council recommends that the state continue to engage employers, consumers and insurers, because successful implementation of the Exchange will necessitate a strong outreach and education component, including working with community-based Navigators and insurance brokers.
  6. The Council recommends that the state take all available avenues to review and control rate increases in the insurance premium market as soon as possible. Additional information can be found on the Illinois Department of Insurance website.
  7. The Council recommends convening a Healthcare Workforce work group to develop an aggressive, comprehensive plan to professional and paraprofessional healthcare and public health worker shortages statewide, now and in the future.
  8. The Illinois Health Information Exchange (HIE) strategic and operational plan was approved by the federal government in December 2010. It focuses on the adoption and meaningful use of electronic health records; ensuring that providers who wish to begin exchanging health information electronically in 2011 can do so; developing an all payer claims database and other priorities which can be found here.
  9. The Council recommends waiting for further guidance from HHS before deciding whether to require benefits beyond the “essential benefits” defined by HHS.
  10. The Council does not recommend early implementation of Medicaid expansion in Illinois (i.e., beginning to enroll people under 133% FPL before 2014) but remains open to considering changing the moratorium on new expansions if a financially advantageous opportunity for the State arises.

Stephanie Altman
Health & Disability Advocates

Monday, February 7, 2011

To Repeal or Not to Repeal

While Congress has spent time debating repeal of the Affordable Care Act (ACA), many policymakers in the states are focused on moving forward and evaluating how best to take advantage of the ACA to lower health care costs.

In Illinois, Governor Quinn’s Health Care Reform Implementation Council released initial recommendations on January 31st, a first step in indentifying policies Illinois can take to ensure the ACA delivers on the promise of increased access to high quality, cost-effective health care for all Illinoisans.

It’s a good thing that Illinois is looking forward rather than rehashing the partisan fights we saw in Washington D.C. last year. There are real-world consequences that repeal or roll-back of the ACA’s key initiatives would have on consumers and small businesses.
Illinois PIRG explored these issues in a recent report that draws on official research and statistics, and projections from independent sources.
Based on this analysis, repeal would strip tax credits from 159,900 Illinois small businesses. And over the longer term, the cost of offering employer-based health insurance could jump by more than $3000 a year over current law.

In today’s economy, the higher costs that would result from repeal are the last thing that Illinois consumers and businesses need.

As the Illinois Health Care Reform Implementation Council moves forward, it will be a forum for policymakers to work together to solve our health care problems and not get our state wrapped up in refighting last year’s Washington debate over health care.

Brian Imus
Illinois PIRG

Sunday, February 6, 2011

The Affordable Care Act: Before and After

The public debate around the Affordable Care Act has given rise to rumors and myths around how it will affect our lives, our families and our businesses. No surprise really, when you consider the fact that a single (2,600-page) document is well on its way to changing health care as we know it. So how will it affect your life? Do you know?

Let’s paint a before-and-after picture using data in a
new report from the U.S. Department of Health and Human Services. The report details how the Affordable Care Act will help families and small businesses save on health-insurance premiums and out-of-pocket costs in 2014.

It’s no secret that families and small businesses have long been grappling with rising insurance costs. From 1999 to 2009 alone, premiums more than doubled – rising by more than $7,500 for an average family getting insurance through an employer, according to HHS. Meanwhile, the percentage of small businesses offering health insurance to their employees dropped to 59 percent from 65 percent in this same 10-year period. A rough ride all around.

Just three years from now, middle-class families could save up to $2,300 a year when purchasing private insurance in the new state-based health insurance exchanges, which are designed, in part, to help people review and compare a variety of health insurance plans. Also, a family of four with an income of $33,525 will qualify for tax credits and reduced cost-sharing that could put as much as $14,900 a year back in their own bank account.

A read of this HHS report tells you that small businesses may be basking in the after-glow of the Affordable Care Act as well. In 2014, it says small businesses could save up to $350 per family on average and may be eligible for tax credits of up to 50 percent of their premiums. In fact, the tax credits are available to small businesses now. I’ll borrow an
example from the HHS: if you own a company with 10 employees earning an average of $20,000 annually, you could currently receive credits of $35,000 annually.

So there’s your (quick) before-and-after. Of course, the “after” picture is always so much prettier. In this case, it does outline just a handful of ways the Affordable Care Act can impact the health and the lives of families and small business owners in Illinois.

Megan McDonnell

Friday, February 4, 2011

A Birthday for America's Children's Health Law - With the Gift of Health for Illinois's Kids

It’s been two years since Congress and President Obama enacted legislation to strengthen the Children’s Health Insurance Program, known here in Illinois as All Kids. And at this birthday party, Illinois’s families no longer have to wish and hold their breath when they blow out the candles.

The children’s health law has helped Illinois cover more uninsured children through All Kids. As a result, 1.6 million children can get the checkups and preventive care they need to stay healthy and see the doctor when they get sick or injured.

That means parents struggling to keep their families afloat during tough economic times can have peace of mind that a playground injury or flu outbreak won’t drive the family deeper into debt. It means Illinois uses health dollars wisely – keeping kids healthy, rather than spending more on emergency room care for problems we should have prevented. And it means Illinois’s federal tax dollars come back into our economy, to protect local health care jobs.

Help us to celebrate this important anniversary. Thank your representatives in the General Assembly in Springfield for their continued support of All Kids and let them know that maintaining coverage for children should continue to be a top priority this year. Spread the word to parents and others in your community about All Kids, so we can help even more uninsured children to get the care they need to grow and thrive.

Andrea Kovach
Sargent Shriver National Center on Poverty Law 
(Originally posted in the Shriver Brief  on Feb. 4, 2011)

Florida Judge Rules Against Affordable Care Act

The Social Security Act, the Voting Rights Act, the Civil Rights Act and the Minimum Wage Act were all landmark laws that changed our country for the better. They secured essential freedoms for all Americans and improved our quality of life. All were initially struck down by lower court judges unwilling politically or unable intellectually to embrace the fact that our Constitution permits that kind of progress. An activist conservative lower court federal judge in Pensacola, Florida, has now made his contribution to this history.  

U.S. District Judge Roger Vinson ruled this week that the Affordable Care Act’s (ACA’s) provision requiring most Americans to obtain private health insurance, or else face a modest tax penalty, was unconstitutional. He is the only judge who has adjudicated challenges to the law to be so aggressively activist as to strike down the whole law. Unlike the other judges who have ruled the “individual mandate” to be unconstitutional, Judge Vinson went further and held that the individual mandate was so intertwined with the rest of the law that it could not be “severed” from it, and so he invalidated the whole law.

The Justice Department immediately announced that it plans to appeal the decision to the U.S. Court of Appeals for the 11th Circuit. The score in the cases now stands as follows: 13 challenges have been filed in federal courts since March 23, 2010; ten suits have upheld the law, and three rulings have found all or part of the ACA unconstitutional. So far, judges appointed by Republican presidents have ruled consistently against the ACA, while Democratic judicial appointees have ruled for it. And in the most recent case, all but one of the state officials who filed suit are Republican.

At the heart of these lawsuits is the individual responsibility provision. This part of the ACA says that most individuals who can afford it will be required to obtain basic health insurance coverage or else pay a fee to help offset the cost of providing medical care to uninsured individuals. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. The individual responsibility provision is an extremely important tool to help ensure that healthy people have health insurance policies, too; otherwise, only the sick or old may choose to have coverage, which would drive up costs for consumers and insurers alike. Every insured family pays an average of $1,000 more a year in premiums to cover the care of those who have no insurance, and the cost of uncompensated care was an estimated $43 billion in 2008.

Like the Virginia judge, Judge Vinson did not issue an injunction against the ACA’s implementation. Indeed, Judge Vinson rejected a constitutional challenge to the part of the ACA that will expand Medicaid in 2014 to individuals with household incomes under 133 percent of the poverty level. The plaintiff state officials had argued that this expansion unlawfully imposes on their sovereignty; however the Judge Vincent held that there is no infringement because a state can choose whether to participate in the Medicaid program.

Nevertheless, Judge Vinson’s ruling invalidating the whole law (as “un-severable” from the individual mandate provision) means that the 26 state officials who are plaintiffs in the case are in an ambiguous position as to whether they will continue implementation activities in their states. They might gamble on the ruling of this fringe judge holding up on appeal. Wisconsin’s governor, a highly partisan Republican, has said he will stop implementing the law. That is unfortunate for the people who live in Wisconsin and in any other state where a governor decides to exalt his or her ideology over the needs of the citizens that are being addressed by the ACA.

Americans—including lots of them who live in Wisconsin—cannot afford to lose the benefits already flowing from provisions of the Affordable Care Act that have nothing to do with the individual mandate, including discounts for seniors struggling with the cost of lifesaving prescriptions, tax credits for small businesses struggling to provide coverage for employees, protections for children who have pre-existing conditions, and coverage for young adults up to age 26.

In the midst of our nation’s jobs crisis, Americans are counting on the Affordable Care Act to put them back in control of their own healthcare, stop insurance company abuses, and lower escalating healthcare costs. Judge Vinson and at least some of the state officials in the case have other priorities.

John Bouman
Sargent Shriver National Center on Poverty Law 
(Originally posted in the Shriver Brief  on Feb. 2, 2011)

Wednesday, February 2, 2011

The Health Care Law's Impact on Children and Families in Illinois

Welcome to Illinois Health Matters - the website for information and action advice regarding our state's implementation of the nation's health reform law. The law has a tremendous amount in store for children and families of all income levels and all kinds of health insurance coverage. As you may have heard, the Affordable Care Act (ACA) is a huge sprawling canvas, with provisions about many different reforms. It can be a hard thing to wrap your arms around. Don't worry, we'll have the information here.

Here are some of the things you will be able to find here:
  • What about all those insurance industry reforms? How will they affect Illinois families? When will they take effect -- or have they already? This includes issues like pre-existing conditions, lifetime caps, rescission of policies just when you need them the most, and controls on insurance industry profits.
  • How is Illinois doing on setting up the Health Insurance Exchange, where people will shop for insurance starting in 2014? Will the exchange help to make sure policies provide comprehensive, decent, affordable coverage? How will people be able to access the subsidies that will help them pay premiums for private insurance and keep their out of pocket costs to a reasonable limit? Will the Exchange be the place to go even if the family might be eligible for a public insurance program like Medicaid rather than private insurance? What if family income fluctuates in and out of the ranges for public and private insurance -- can people go back and forth smoothly?
  • There will be changes to the public programs, too. What will happen when Medicaid will expand to cover all those low income kids who used to just age off of Medicaid at age 18? How will children's insurance change when the Exchange goes into effect? How does Illinois' new Medicaid Reform law square with the implementation of national health reform for children and families? Are they consistent? 
  • As Illinois implements all of these changes, what can advocates and concerned citizens do? What are the deadlines? What are the recommended action steps? When are the key votes?
Stay tuned for this information here at Illinois Health Matters. We will have links to information, action steps, advocacy alerts, and more.

John Bouman
Sargent Shriver National Center on Poverty Law