Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Thursday, March 31, 2011

Effective Exchange Key to Lower Health Insurance Costs for Illinois Families

It’s hard not to notice the out-of-control health insurance cost increases in recent years. Three out of every four individual-market policyholders saw a premium increase from early 2009 to early 2010.  Small businesses are particularly hard hit. They now pay 18% more for insurance than their larger competitors and have seen repeated double digit premium increases.

But what can Illinois policymakers do to help Illinois families? Turns out, there’s a lot they can do.

The Affordable Care Act (ACA) allows states to create a health insurance exchange for individuals and small businesses. Much the way a large employer negotiates insurance rates for their employees, an exchange would allow small businesses and individuals the ability to pool their buying power and negotiate a better as well, saving Illinois families billions of dollars.

An exchange works to lower costs because it increases competition and improves the choices customers have in the state’s insurance market. But it only works if the exchange is accountable to the public, and the individual and small business consumers it’s designed to serve, not the special interests.

As policy makers consider an exchange program over the coming months, the consumer advocacy group Illinois PIRG will be highlighting many of the important policy questions in a series of policy briefs.

The first in the series of seven details steps policy-makers can take to ensure that the exchange program is accountable to the public and operates in the best interests of consumers and businesses.

Take a look by going here.

Brian Imus
Illinois PIRG

Tuesday, March 29, 2011

America’s Health Care Law: Providing Security and Opportunity for All

It's been a year since the historic vote that made the Affordable Care Act (ACA) a law, putting America on the path towards a system of quality, affordable health care for all. We have a lot to celebrate as we continue to implement and enforce our consumer protections here in Illinois.

Through the passage of health insurance reform, we have brought some of the most abusive practices of the insurance industry to an end, and instituted new rights and benefits for all. From birth to death, Americans now enjoy health care security and protection in new ways. Already in Illinois:
  • 47,200 young adults in Illinois are now eligible to stay on their parents’ coverage through age 26
  • Tens of thousands of small businesses receive tax credits that help them offer their employees coverage
  • 7.5 million people in our state no longer need to worry about hitting a lifetime cap on benefits because of the ACA
  • 612,000 Illinoisans will not have their insurance coverage rescinded when they get sick and need it most
  • 1.8 million seniors are now eligible for free wellness care, and 109,421 of them received help in meeting the costs of their prescription drugs while in the Medicare Part D coverage gap
Despite all the benefits that the new law offers, the Affordable Care Act is not perfect, but it is a good start towards health care security for all Americans. It makes sense that the Illinois General Assembly builds upon the protections and rights of this law as we move ahead to work for a system of quality, affordable health care for all.

Now at the one-year mark, the Campaign for Better Health Care and our statewide coalition encourage our elected officials in Springfield to move forward with the implementation of the required components of this new law. Any delay will have a profound negative impact on quality of life for millions of Illinois' working families, children, seniors, individuals and small businesses.

Our State Representatives and State Senators in Springfield need to stand up for the middle class and small businesses, not the insurance industry. Did you know that the top Illinois insurance companies amassed surpluses in excess of $28.3 billion in 2010? Surplus is a company's total assets minus liabilities. In other words, it’s what's left after ALL other possible costs of doing business (including all possible future claims by policyholders, paying dividends to shareholders, etc) are accounted for. Their surpluses increased by an additional $2.5 billion from 2009, even in the current economic conditions we face.

We need to implement and strengthen the health care law at the state level in a few ways. First, let’s institute fair rate review laws as outlined in Representative Greg Harris’s proposal. Rate review means that insurance companies will have to justify their requests for rate increases to the state Department of Insurance and cannot raise your rates unless their request passes this review. Laws similar to this exist in 30 states, but Illinois currently has no oversight mechanism in place.

Rate review increases transparency in the process - insurance companies will have to prove the need to charge their customers more. With more information about the rationale for rate hikes, consumers will be better prepared to make an informed decision about whether or not to purchase insurance from a specific company. This will stimulate positive competition in the health insurance marketplace, and benefit consumers by lowering costs.

Second, the Illinois General Assembly needs to begin developing a competitive health insurance marketplace, commonly known as an insurance health exchange. St. Senator Dave Koehler’s proposal begins setting up the competitive health marketplace for Illinois.

The marketplace is voluntary – if you like the insurance you have, you can keep it and not use the marketplace. However, the marketplace is always available in case you want or need it. This approach will give consumers greater control, more choice, improve quality, increase transparency, and create much needed competition in the insurance marketplace.

On this milestone anniversary of new freedom and protection for American health insurance consumers, let's work together to make Illinois' health care laws work for us, not for the obscene and greedy surpluses of insurance companies.

Jim Duffett
Executive Director, Campaign for Better Health Care

Friday, March 25, 2011

Gov. Pat Quinn Gives Illinois Health Care Reform a Big, Fat Push Forward

In 2010, the Wisconsin Legislative Fiscal Bureau estimated that President Barack Obama's new health reform would save the state budget $365 million over the next five years.

In 2011, newly-inaugurated Tea Party Governor Scott Walker, despite a gaping budget deficit, ordered the state Attorney General to add Wisconsin to list of states suing in federal court to overturn the new health insurance law.

And so it goes with our northern neighbor, whose governor is giving the term "crank" a good name by comparison.

In Illinois, however, on the one-year anniversary of the new federal health law, Governor Pat Quinn has been blazing forward to implement its provisions. In fact, since taking office, Quinn has been on tear to reform Illinois health care more broadly.

Since March 23, 2010, the federal government has awarded $89.4 million in health reform funding to Illinois, and the law has delivered to 151,922 Illinois Medicare beneficiaries a one-time, tax-free $250 rebate to help pay for prescriptions in the "donut hole" coverage gap. In 2011, they will receive a 50% discount for covered brand-name prescriptions in the hole.

By August 20, 2010 Quinn had opened enrollment for the Illinois Pre-Existing Condition Insurance Plan to provide transitional coverage until 2014 for 5,000 Illinois residents who are currently uninsured with pre-existing conditions. So, far 2,000 individuals have filed applications and 943 have secured coverage.

One of those is David Zoltan, 33, of Chicago.

"As a diabetic of 25 years, I can breathe easier for the first time since I lost my insurance two years ago," said Zoltan.

Between 500,000 and 800,000 individuals will be covered under the state's Medicaid program with full federal funding. An additional 200,000 to 300,000 people will purchase their insurance through the health insurance exchange, with premiums subsidized by the federal government.

To fully implement the law here, Quinn's Health Care Reform Implementation Council, which held five public hearings since the governor established the panel on July 30, 2010, rolled out its first set of recommendations a few weeks ago on March 2, 2011, including calls for the state regulators be given the authority to approve or deny health insurance rate increases, and that insurance companies be required to spend at least 80% of premiums on health care for policy-holders. Those steps will require legislative approval.

"Governor Quinn has directed the state agencies that will play a role in implementing health care reform to work together to deliver on the promise of the Affordable Care Act," said Michael Gelder, chair of the council and Governor Quinn's senior health policy adviser.

In addition to the federal health reform, Quinn has acted on multiple other fronts to reshape Illinois health care, including electronic health records, Medicaid reform, private managed care, and chronic disease management, to name several.

On July 27, 2010, Quinn signed legislation, House Bill 6441, that will allow health care providers and insurers to share health records electronically. The law will provide providers with a secure system to access a patient's comprehensive medical history, avoid duplicate tests and procedures, and assure the accuracy of prescription drugs and other medical orders.

Medical information sharing is already saving Illinois big money. The state's medical home program, which centralizes patient information around one home base and one primary care provider, saved the state $220 million over 2008 and 2009, according to a recent study from the Robert Graham Center.

On January 25, 2011, Quinn overhauled the state's Medicaid program by signing a new law, House Bill 5420, which aims to expand coordinated care in Illinois, improving the efficiency of the prescription drug program, tightening the integrity of the eligibility process and increasing civil penalties for recipients who abuse the system. The reforms are expected to save $774 million over five years.

Quinn has also launched a private managed care pilot project for approximately 38,000 seniors and disabled Medicaid beneficiaries from Northeastern Illinois. The new program will save the state an estimated $200 million over the next five years, according to Quinn Administration estimates.

"We embarked on this initiative -- which was recommended by the Taxpayer Action Board -- to increase government efficiency and improve care for seniors and persons with disabilities," said Quinn.

And on January 25, 2011, Quinn approved another measure, House Bill 1444, that created the Chronic Disease Nutrition and Outcomes Advisory Commission. This panel, once the governor makes the appointments, will advise the Illinois Department of Public Health on how to incorporate nutrition as a chronic disease management strategy into state health policy, aiming to avoid costly Medicaid hospitalizations and to measure health care outcomes.

The commission, the brainchild of Deborah Hinde, the president and CEO of Chicago-based non-profit Vital Bridges that provides food and nutrition counseling to individuals with HIV/AIDS, will aim to develop a state nutrition strategy in chronic disease management, particularly for Medicaid-insured patients, given the treatment of chronic disease represents 80¢ of every dollar spent on health care.

"Medically appropriate nutrition can slow chronic disease progression, avert disability, minimize intensive health care utilization, and decrease costs to the state," said Hinde. "Because a state nutrition strategy can drive down Medicaid costs and improve health out comes, Governor Quinn was wise and forward-looking to sign this bill."

Meanwhile in Wisconsin, small business owner Martin Huennenkens, owner of Pilgrim Imports Inc., a Milwaukee wholesale company, is looking for Quinn-like gubernatorial wisdom on health care reform. "I feel like health care reform would at least give me a more level playing field," Huennenkens said. "I would love if the government would push more people in what I consider this good and correct direction."

Martin, Illinois is open for business.

David Ornsby
Public relations consultant and political strategist
(Originally posted in the Huffington Post Blog)

Wednesday, March 23, 2011

Affordable Care Act Anniversary

America's health care law, the Affordable Care Act, turns one year old on March 23rd. That's good news for Illinois' four-year-olds -- and forty-four-year-olds, and lots of other Illinoisans too. That's because the law imposes consumer protections on the hugely unregulated health insurance industry, and promises to cover over half of the uninsured by allowing states to create insurance marketplaces that provide transparent, comprehensive, affordable health plan choices; makes federal subsidies available to ensure middle class families won't break the bank to pay for their plans, and expands Medicaid to low-income adults.

Illinois' leaders have worked hard to build a track record of success on access to health insurance coverage. Democrats and Republicans have put partisan politics aside and worked together to reform Medicaid and to enact consumer protections in the private insurance industry, such as dependent care coverage for young adults. Now it's time for our leaders in Springfield to again make some critical decisions -- this time about how the Affordable Care Act works in Illinois. And we all have a role in ensuring that the law works for Illinois' families and individuals.

The Affordable Care Act has already delivered important wins for Illinois' residents. Illinoisans diagnosed with cancer or other serious conditions can no longer be denied care because of annual or lifetime insurance limits and insurers cannot deny coverage outright for children. Parents can keep their college-aged children on their family health insurance policies. And Illinoisans with private insurance can get the screenings and check-ups they need to stay healthy, without the out-of-pocket costs that encourage fix-it care instead of health care.
And the Affordable Care Act can deliver even bigger wins for Illinois in the coming years. It authorizes new insurance marketplaces or "exchanges," to make private insurance work better. Exchange subsidies can make care more affordable for middle-class families. The law authorizes improvements to Medicaid that can make health care a reality for hundreds of thousands more Illinoisans who are uninsured today.

But these gains for Illinois' families and individuals are not automatic. Our leaders in Springfield will make decisions over the next few years that will have consequences for decades to come. They will decide whether Illinois' exchange provides adequate access to health care for patients, families and employers in Illinois in a manner that is in the best interest of such individuals, and they'll decide whether the exchange offers coverage parents can afford.

They'll decide whether insurance consumer protections actually work and whether Medicaid reaches more uninsured Illinoisans, or whether they will be left behind. And they'll make dozens of other decisions that will determine how -- or even if -- the Affordable Care Act works for Illinois.

Every Illinois resident who cares about their access to health care can help our leaders in Springfield make the right choices. Policymakers need to hear that it's time to embrace Illinois' long-standing tradition of putting access to health care ahead of partisan politics. They need to hear that the cost of failure is too high. They need to hear that they must keep implementation moving forward, and that making the right choices for Illinoisans is the best way to define success.

The Affordable Care Act's first birthday is the perfect time to send a strong message to Illinois' leaders. If we get off the sidelines and into the game today, Illinois will be the big winner.

Andrea Kovach
Sargent Shriver National Center on Poverty Law
(Originally posted in Huffington Post Chicago Blog)

Health Care Reform Anniversary - It's Personal

Today is the one year anniversary of the Affordable Care Act. No matter who you are, you know someone who has benefited or will benefit from this law. I am no different. At Health & Disability Advocates, every year we talk to hundreds of clients who are in need of access to medical care that they have been denied because of a pre-existing condition. For example, there is Haley White, a 22 yr old young woman from Wauconda, IL, who as a result of Hodgkin’s lymphoma as a teenager, could not get insurance and faced crushing debt from periodic hospitalizations. As of March 1, thanks to the Affordable Care Act, she is on the Illinois Pre-Existing Condition Insurance Plan and can get the tests she needs to monitor her health.

This client case, in particular, is personal to me. In March 1995, when I was 25 my boyfriend (then a graduate student) was diagnosed with non-Hodgkin's lymphoma. Time stopped as our realities shifted from making plans for our future together to making plans for oncologist visits, biopsies, stem cell transplants. We moved through what seemed like a nightmare. In retrospect, we didn't even realize how lucky we were. We didn't have to think once about whether or not he would be able to pay for his appointments or get the life-saving treatments he needed: he was a student and was covered by his university's (as it turns out generous) health insurance plan.

Fast forward 16 years -- the boyfriend is now my husband (who has been in remission since 1995). Over the past 16 years, I have thanked his doctors, our parents, family and friends for their care and support during that difficult time. I never thought to thank his university for providing such amazing health insurance. I didn't realize how fortunate we were. Now that I'm in the health care field and have my own children, I think about that all of the time. I think about the Haley Whites of the world who didn't have health insurance and had to worry about her health AND her health care. It shouldn't have to be that way.

Imagine if you or someone you know -- a relative, neighbor or friend -- was diagnosed with a disease and then was denied health coverage years later because of it. Thanks to the Affordable Care Act, it doesn't have to be that way anymore.

Stephani Becker
Health & Disability Advocates

Thursday, March 17, 2011

Commonwealth Survey Underscores Need to Move Forward on ACA and Hold Steady on Medicaid & CHIP

A survey released today by the Commonwealth Fund underscores the need for states to hold steady in their commitment to health insurance programs such as Medicaid and CHIP while families struggle to find solid footing in the aftermath of the recession.  It also provides solid evidence that 2014 and full implementation of the Affordable Care Act can't come soon enough for those trying to find stable, affordable health insurance coverage that won't disappear when they lose a job or become sick or injured. 
The Commonwealth Fund 2010 Biennial Health Insurance Survey found that about 9 million people lost their jobs and their health benefits last year putting their financial security and access to health care at risk.
The survey also found:
  • Few affordable insurance options are available for the newly uninsured. Because access to Medicaid coverage for adults is limited in most states and few people enroll in COBRA, many have had to turn to the individual market to meet their health needs. 
  • Most adults who tried to buy health insurance on the individual market faced roadblocks such as higher premiums or benefit exclusions due to a pre-existing condition. Many were turned down. 
  • Seventy-five million adults did not get needed health care in 2010 (a 60 percent increase from 2001). This included insured adults struggling to pay for higher premiums and out-of-pocket costs as well as uninsured adults.
  • Seventy-three million people reported problems paying their medical bills or were paying off medical debt, up from 58 million in 2005.  Of those, 22 million were unable to pay for basic necessities like food, heat and rent.  About 4 million of them declared bankruptcy. 
Loyal Say Ahhh! readers know that we love data and Commonwealth is one of our favorite sources.  If you love data as much as we do, check out Commonwealth's interactive chart and chartpacks that accompanied the report. 

Monday, March 14, 2011

Why We Must Save Illinois Cares Rx

Governor Quinn's proposed budget includes the elimination of the entire Illinois Cares Rx program, which provides prescription drug assistance to low income seniors and people with disabilities.

The benefits of the Illinois Cares Rx Program to its enrollees are crucial to their health and well-being. Without this assistance, many seniors and people with disabilities on fixed incomes will not be able to afford their needed medications. They will be forced to ration their medications or make choices between paying for rent, food, or medications.  There simply is not a lot of “wiggle room” in their budgets to take on the cost of what the Illinois Cares Rx Program provides.  

For most, Illinois Cares Rx is a benefit that assists in paying the premium and initial co-pays under Medicare Part D, which can get extremely high, especially if a person is taking several medications.  For Illinois Cares Rx enrollees, this assistance has literally meant the difference between going with or without their medications.  In addition to the Part D premium, Illinois Cares Rx pays the deductible ($310 this year) and helps with the co-pays; each prescription filled costs much less with this coverage (e.g., $6.30 instead of $50).  It is an enormous savings, especially valuable for individuals with multiple health problems and multiple medications, which is common among Illinois Cares Rx consumers.

A few important things to know about Illinois Cares Rx:
  • Illinois Cares Rx serves approximately 200,000 low income older adults and people with disabilities each year to pay for necessary and costly medications.
  • Governor Quinn has proposed eliminating the entire program without seeking cost savings from other measures first.
  • The health care reform law - the Affordable Care Act (ACA) - does not fix the problem that Illinois Cares Rx addresses. The ACA only addresses the Medicare Part D donut hole by closing that gap slowly over the next several years. Low-income older adults and people with disabilities in Illinois still need help paying for premiums, co-pays and donut hole coverage in 2011 and beyond. In other words, even if the donut hole were closed this year, low income seniors and people with disabilities would STILL need Illinois Cares Rx.
The Chicago Tribune published the following story about the cuts to Illinois Cares Rx and the Circuit Breaker program and how the elimination of these programs affects an already vulnerable group of older adults and people with disabilities. The issue was also recently profiled in the StatehouseNewsOnline.com. Please contact the Governor and your state legislators. Ask them to take Illinois Cares Rx off the chopping block and consider other cost saving measures first.

John Coburn
Co-Director, Make Medicare Work Coalition

Rate Review YES!

Illinois consumers want more control, stronger protections, and greater transparency in the insurance process. Rate review provides just that. It means that insurance companies will now have to prove the need to charge their customers more, and will not be allowed to do so unless they meet strict criteria.

Insurance companies will have to justify their requests for rate increases to the state Department of Insurance, and they cannot raise your rates unless their request is found to be reasonable and justifiable. The state Department of Insurance will act as a watchdog to ensure that rate increases are fair, needed, and enacted in accordance with the rules. That is strong protection for insurance consumers in Illinois.

The process is fair for both insurance companies and insurance consumers. Rates cannot be raised unless the review says they can, but insurance companies whose increases are denied, or consumers who disagree with a decision to allow rate increases, will have the opportunity to appeal the decision.

With more information about the rationale for rate hikes, consumers will be better prepared to make an informed decision about whether or not to purchase insurance from a specific company. This will stimulate positive competition in the health insurance marketplace, and benefit consumers by lowering costs.

Without rate review, health insurance premiums in Illinois rose 73% from 2000-2007. The rate review process will slow down sudden exorbitant cost increases for insurance, allowing all health insurance consumers including working families and small business owners the ability to obtain quality, affordable insurance for themselves and their families.

Health care reform is the key to economic security and opportunity for American families. Rate review is just one of the ways we will make the system more fair for everyone.

Friday, March 11, 2011

Top Ten Health Care Reform Terms You Should Know (but were afraid to ask...).

On March 23, 2011, we will be celebrating the one year anniversary of the Affordable Care Act (ACA). Although we at Health & Disability Advocates are in the thick of ACA implementation, we know that many Illinoisans still are confused about the law. In fact, according to a recent Kaiser Tracking Poll, just over one in five Americans (22 percent) think that the law has been repealed. It has not, and many provisions are already in place and working. In honor of the one-year anniversary of the law, we have compiled the Top Ten Health Care Reform Terms You Should Know (but were afraid to ask...).

See our list below. If you have questions about how these and other "terms" will affect you now or in the years to come, submit your question to Illinois Health Matters (where it says "Get Answers") and our team of experts will answer it for you.

1. Affordable Care Act (or ACA) – a short name for the Patient Protection and Affordable Care Act of 2010 which is the federal health care reform bill which passed Congress and was signed into law by President Obama. Some provisions went into effect immediately on March 23, 2010 and others will be phased in for the next 8 years. On March 1, 2011, the Illinois Health Care Reform Implementation Council presented a report to Governor Quinn with their initial recommendations for implementation of the ACA in Illinois.
2. Accountable Care Organizations (ACOs) – a group of health care providers such as physicians, hospitals or clinics that have entered into a formal arrangement to assume collective responsibility and financial risk for the care of a specific group of patients and receive financial incentives to improve the quality and efficiency of health care. You are not alone if you are uncertain about what an ACO actually looks like (see this recent article in Politico). The Centers for Medicare & Medicaid Services Administrator Don Berwick said in a speech earlier this week that the pending rules on ACOs will be out soon.
3. Essential Health Benefits – This is the minimum level of coverage that must be offered by qualified health plans operating in state health insurance exchanges. Essential benefits are defined in relation to the classes of services and benefits covered, the level of financial protection against deductibles, and cost-sharing protection they provide. The ACA lists ten categories that HHS must include as essential, such as prescription drug coverage and emergency hospitalizations. But HHS has broad discretion within those categories to require generous coverage or allow limits. Health care policymakers and medical experts at the Institute of Medicine are studying this issue and will make recommendations on the criteria and methods for determining the essential health benefits package.
4. Health Care Exchange (sometimes called Health Insurance Exchange (HIE) or Health Benefits Exchange) – a competitive health insurance marketplace for individuals and small employers to purchase insurance or enroll in Medicaid after 1/1/2014. Exchanges will be an easy-to-use website, similar to Travelocity or Consumer Reports. They will be responsible for calculating premiums, enrollment, quality oversight, and certification of qualified health plans. By standardizing health insurance products, enrollment, operations, and oversight, exchanges are also meant to make the process of selecting insurance easier, less expensive and more transparent. The site will be closely monitored to prevent fraud and protect consumers. Members of Congress will be required to get their insurance through this marketplace—giving them the same options as millions of Americans. The Illinois Department of Insurance has established workgroups to solicit feedback from stakeholders regarding how an exchange should function in Illinois. A piece of legislation will be introduced soon in the Illinois General Assembly to establish the Illinois Health Benefits Exchange.
5. Health Information Technology (sometimes called Health Information Exchange (HIE) or Electronic Health Records) – Technology that allows the management of health information such as health records, laboratory tests, and radiology records, to be communicated electronically among health professionals, consumers, health care providers, health care payers, and public health agencies. A new study completed by the Office of the National Coordinator for Health Information Technology and published in the journal Health Affairs this week finds growing evidence of the benefits of Health Information Technology on key aspects of care including quality and efficiency of healthcare. In February 2010, Governor Quinn established the Illinois Office of Health Information Technology which developed a strategic plan for Health Information Exchange in Illinois.
6. High-risk pools – High-risk pools are operated by states during the period prior to the implementation of health insurance Exchanges in 2014 as a means of offering health insurance to individuals who otherwise cannot buy health insurance in the individual market because they have a pre-existing health condition. Illinois' federally funded high risk pool, established by the ACA, is called the Illinois Pre-Existing Condition Insurance Plan (IPXP). Illinois also has another high risk pool called the Illinois Comprehensive Health Insurance Plan, which is not federally funded and existed before ACA, but it serves a similar function.
7. Individual Responsibility (also called the Individual Mandate) – this is the term that refers to the requirement in the ACA that by January 1, 2014, individuals must purchase insurance if they are not otherwise covered by public programs or group health insurance.
8. Maintenance of Effort (MOE) – The ACA includes an important protection that prohibits states from reducing their Medicaid eligibility levels or changing the rules to make it harder for people to enroll in Medicaid. This protection is referred to as the “maintenance of effort,” or MOE, requirement.
9. Meaningful Use – this is a yet to be determined critical level of use of electronic health records (EHRs) and related technology within a healthcare organization to deliver coordinated and quality health care to patients. Through the ACA, Medicaid and Medicare will require that providers increasingly utilize "meaningful use" health information technology in their practice in order to receive reimbursement. If you are a health care provider in Illinois and you have questions about meaningful use incentive payments, visit the State of Illinois' Electronic Health Records page here.
10. Medical Loss Ratio – A medical loss ratio (MLR) is the proportion of premium dollars that an insurer spends on health care services and certain recognized plan administration costs relative to health insurance premium paid by subscribers. The ACA requires health insurers offering health insurance coverage in either the group or individual (non-group) market to submit an annual report to the Secretary of Health and Human Services on their MLR and to provide rebates in circumstances in which losses exceed permissible levels (80% in the individual market and 85% in the group market). Illinois State Senator Heather Steans has proposed a bill, SB 1618, which would bring Illinois law into conformity with this core consumer protection established by the ACA.

For more terms and definitions, see http://www.healthreformgps.org/glossary and http://www.healthcareandyou.org/glossary/.

Stephanie Altman and Stephani Becker
Health & Disability Advocates

STAND UP FOR WHAT IS RIGHT! March 23, 2011 Rally to Celebrate the One Year Anniversary of the Affordable Care Act

Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.
These were the words of President Harry Truman when he sent a message to Congress on the need for national health care.  He delivered his message on November 19, 1945.  It took sixty-five years for President Truman’s words to ring true with President Barack Obama’s historic signing of the Affordable Care Act (ACA) on March 23, 2010.

On the evening of March 23, 2011 at the Chicago Temple,  77 Washington, from 6:00-7:30 PM we will join together for a rally in celebration of  the one year anniversary of the ACA.  Hundreds of healthcare activists and leaders such as Congresswoman Jan Schakowsky, Governor Pat Quinn, State Representatives Greg Harris and Lou Lang, Keith Kelleher of SEIU Illinois/Indiana Healthcare, William McNary of Citizen Action/Illlinois, will come together to commit to the important work ahead of us.

We must fight to make Illinois a leader in creating a strong, transparent Health Benefits Exchange that will maximize the ability of individuals and small businesses to access the best insurance at the most competitive price.  We must fight to support strong consumer protections against excessive premium increases for health insurance in Illinois.

And we will celebrate the success of the ACA and its impact on Illinois.  One year after the signing of the law millions of Illinoisans are already reaping the benefits:

  • 1.8 million seniors will receive free wellness visits
  • 109,000 seniors already received prescription drug rebates
  • 47,000 young adults under 26 can stay on their parents’ insurance
  • 612,000 Illinoisans no longer have to fear losing their insurance
  • 3,000 Illinoisans with pre-existing conditions have access to insurance with the Illinois Pre-Existing Condition Plan (IPXP) 
While we celebrate our victories we know that our fight is far from over.  We are already witnessing the entrenched power of the insurance industry’s impact on pro-consumer legislation that is making its way through Springfield.  The forces that want to fight for the status quo are attempting to stop our progress.  This consummate struggle has raged in our country for a century. 

On March 23, 2010, President Obama dedicated the signing of the bill to his mother, who was forced to argue with insurance companies while she was dying of cancer.  It would heed us well at this critical time in the implementation of the law to remember President Obama’s words at its signing: 
We are not a nation that scales back its aspiration. We don’t fall prey to fear...we are not a nation that does things that are easy. We are a nation that does what is hard, what is necessary, what is right.
Stand up for what is right!   Join us to rally for healthcare on March 23, 2011.

Lynda DeLaforgue
Citizen Action/Illinois

Monday, March 7, 2011

Out-of-Pocket Spending Caps Protect Families in Illinois

March 23, 2011 marks the one year anniversary of the Affordable Care Act (ACA), landmark legislation in the fight to ensure quality affordable health care for all Americans. To celebrate this milestone, the Campaign for Better Health Care and the Health Care Justice Campaign have announced that March is Health Care Justice Month in Illinois.

"We want to look back at the new benefits that are already helping Illinois' working families and look ahead to the benefits that are yet to come," said Jim Duffett, Executive Director of the Campaign for Better Health Care (CBHC). "It is amazing that so many Illinoisans are already experiencing a positive impact from this law, and inspiring to realize how many more will in the near future."

To kick off Health Care Justice Month, CBHC co-released a report by Families USA examining how the health care spending caps in the ACA will positively affect Illinois families. The health care cost cap provision does not kick in until 2014, but until it does, the resulting analysis for Illinois spotlights the tremendous need for spending caps to protect family budgets:

  • In 2011, 590,500 Illinoisans under the age of 65 are in families that will spend more than the out-of-pocket caps for services that will be covered in the Affordable Care Acts essential benefits package.
  • The Affordable Care Act spending caps, when adjusted to 2011, would be $5,950 for individuals and $11,900 for families. Out-of-pocket health care spending by these Illinois families will exceed the caps by more than $1.0 billion in one year alone.

Health Care Justice Month will feature online activities like a poll on the benefits of the Affordable Care Act and events across the state, including a postcard campaign, a series of Minority Health Care Roundtable discussions, and the Campaign for Better Health Care Faith Caucus' annual Sound the Alarm Sabbath weekend. During Sound the Alarm, congregations of all faith traditions reflect upon the moral imperative of health care reform, and sound a traditional musical instrument 18 times to mark Illinois' 1.8 million uninsured.

The Families USA report, Worry Less, Spend Less: Out-of-Pocket Spending Caps Protect Families in Illinois, found that more than nearly three-quarters (71.7%) of the Illinoisans who will spend more than the out-of-pocket caps an estimated 423,700 people are in working families.

John Bouman, President of the Sargent Shriver National Center on Poverty Law said, "As demonstrated by Families USA's excellent report, the caps on families' out of pocket health care spending that will go into place under the ACA in 2014 will be extremely important to the financial well-being of working families and small businesses."

In particular, employees of Illinois small businesses, those with fewer than 100 employees, face the threat of high out-of pocket health care spending:

  • An estimated 239,500 Illinoisans in families where the head of the household is employed by a small business will spend more than the out-of-pocket caps.
  • More than two in five Illinoisans (40.6%) who will spend more than the out-of-pocket caps are in families where the head of the household works for a small business.
  • Of those Illinoisans in families of small business workers, more than four-fifths (82.0%) have a head of household who works for a business with fewer than 25 employees.
  • Families of Illinois small business employees will spend nearly $414.0 million more than the out-of-pocket caps in 2011 alone.

Janine Lewis, Executive Director of the Illinois Maternal and Child Health Coalition, added, "We applaud these caps which will help women and children afford access to critical health services to keep themselves and their families healthy."

"Two decades of rising health care costs have squeezed families into coverage with higher premiums, higher copayments, and higher deductibles, and sometimes these costs have forced families out of health coverage altogether," Ron Pollack, Executive Director of Families USA, said. "These families are terribly vulnerable to financial devastation caused by unexpected illness or injury, and they generally face only bad alternatives, including massive credit card debt, bankruptcy, even foreclosure."

"The report from Families USA clearly shows that 590,500 Illinoisans, and nearly 15 million people across the nation, will deal with this kind of health and financial crisis this year alone. The caps on out-of-pocket spending that will be put in place by the Affordable Care Act will have a profound, beneficial impact on the fortunes, finances, and futures of families in Illinois."

Pollack noted that between 2000 and 2010, the average premium for job-based family coverage grew from $6,438 to $13,770, an increase of 114 percent. These increases have been a special burden for small businesses, which, because of lower buying power and proportionately greater administrative costs, pay, on average, 18 percent more than large businesses for a comparable health insurance plan.

"These caps will be of special value to small businesses and the employees of small businesses," Pollack said.

The spending cap provision of the Affordable Care Act includes a sliding scale that will ensure those with lower and middle incomes will pay less out of pocket than those with higher incomes. "Access to affordable health coverage is the key to economic security and opportunity for the working families and small businesses of Illinois," said Jim Duffett. "This provision of the Affordable Care Act ensures that they will now be able to get a fair deal."

-- Kathleen Duffy, Campaign for Better Health Care

Top 10 List of Exciting Opportunities Available Through Health Reform

With the passing of the Patient Protection and Affordable Care Act one year ago, health professionals and consumers – providers, researchers, policy leaders, advocates, administrators, and others – have been coming together to determine the best way to implement the new health reform law. While no one person or group has the complete answer, we are moving ahead with reform.

I’ve had the chance to attend a few conferences related to health reform implementation and have learned a lot about our health system in that process. I’ve learned that nobody really knows what an Accountable Care Organization is (something the law encourages), but that most people want to create one. I’ve learned that our health system is more fragmented than I could have imagined, but that everyone agrees we should improve coordination. I’ve learned that the politics that seem to divide us are only making things worse. But most of all, I’ve learned that there are thousands of committed individuals who truly believe in reform and are dedicated to improving the quality and accessibility of healthcare for all.

While the conferences have left me with a renewed sense that single-payer health care is the best way to align our financial incentives to create the kind of health system we really want and need, I do think there are many promising aspects of this new law. Based on what I know so far, I have put together my top 10 list of exciting opportunities available through health reform:

1.) We now have a national, state, and local platform for discussing health reform and innovative strategies for improving health.

2.) There are many new opportunities for health information technology! Not only is there a push to get electronic medical records, but the Department of Health & Human Services has spearheaded a Community Health Data Initiative to bring innovated IT programs into the health data world. Check out http://health.data.gov, http://healthindicators.gov, and see the new Health IT Developer challenge at http://health2challenge.org.

3.) “Safety Net” health care providers (those who serve uninsured, Medicaid, and vulnerable populations) are struggling and may continue to struggle financially, but also offer the best hope for providing culturally competent health care to our diverse and expanding population.

4.) There are many incentives in health reform to create healthcare provider teams, expanding the roles of nurses, physician assistants, patient navigators, community health workers, social workers, dentists, physical therapists, primary and specialty physicians, and more! An interdisciplinary approach to providing healthcare will increase our capacity to meet the needs of our population, especially those who are newly insured.

5.) We have an increased focus on health care quality and the reduction of health disparities. The health reform law will set standards for data collection related to health disparities and there are many new incentives and initiatives to improve healthcare quality.

6.) Consumers will be better protected from excessive rate increases, rescissions, and limits on insurance company products. This will help more people get and keep health insurance.

7.) We have a real opportunity to transform the way we provide coordinated care. There are opportunities in health reform to develop creative models for medical homes and coordinated care, ensuring that patients received comprehensive, quality care that is coordinated between all care providers and locations. Perhaps some of these models will even extend to social services and transportation too.

8.) We can greatly expand job opportunities within the healthcare field. With more people accessing care and the need for an interdisciplinary and diverse workforce, there should be many new opportunities for people to find jobs and develop careers in health.

9.) Health reform has highlighted the need for an expanded primary care workforce. It will take time to develop this workforce, but the law puts new money into education and training of primary care providers.

10.) Finally, the obvious, millions more people will have health insurance, providing our best hope that they will seek preventive health services and care early on for illnesses, therefore creating a healthier public and ultimately saving money.

Janna Stansell, MPH
Policy Analyst
Health & Medicine Policy Research Group

Thursday, March 3, 2011

What did the President Just Say??

On Monday, while addressing the nation's Governors, President Obama endorsed bipartisan legislation introduced by Sens. Wyden-Brown-Landrieu that speeds up the date by when states can apply for so-called "State Innovation Waivers" from 2017 to 2014.

Waivers come in many shapes and sizes and can be quite confusing. (Just watch the Members of the House Energy and Commerce Health Subcommittee try to wrap their heads around waivers at today's hearing if you need any convincing on that fact.) So the first point that needs to be made is that this is no "fait accompli".  Congress would have to enact legislation to amend the Affordable Care Act to change the date when these waivers become available. We don't know exactly how the Congressional Budget Office would score this, but The New York Times quoted a figure of $4 billion - not an insubstantial figure. And given that the House seems focused on a course of repeal not amend, it seems hard to imagine them coming up with any money to make a change which it seems like House leaders will reject as meaningless anyway.

What are State Innovation Waivers? State Innovations Waivers are a new, and at this point theoretical option.  They were created by the Affordable Care Act and currently the statute says they don't become available until 2017. State Innovation Waivers are not Medicaid and CHIP waivers but rather give states the opportunity to request a waiver of provisions of the new law related to exchanges, benefits and cost-sharing protections. A state could apply for this new waiver through a coordinated process with a Section 1115 Medicaid and/or CHIP waiver thus marrying the two into a "super waiver" proposal - hence some of the confusion.  But otherwise the Wyden-Brown-Landrieu legislation really doesn't impact the current Section 1115 Medicaid and CHIP waiver process.

Here is how a fact sheet from the White House accompanying the President's remarks describes State Innovation Waivers:

Under the Affordable Care Act, State Innovation Waivers allow States to propose and test alternative ways to meet the shared goals of making health insurance affordable and accessible to all Americans, including those living with pre-existing conditions.  Specifically, State Innovation Waivers are designed to allow States to implement policies that differ from the new law so long as they:
  •  Provide coverage that is at least as comprehensive as the coverage offered through Exchanges - a new competitive, private health insurance marketplace.
  •  Make coverage at least as affordable as it would have been through the Exchanges.
  • Provide coverage to at least as many residents as the Affordable Care Act would have provided.
  • Do not increase the Federal deficit.
The fact sheet goes on to say that the law also allows States to submit a single application that includes Medicaid waiver requests which could, for example, seek to give people eligible for Medicaid the choice of enrolling in Exchange plans. This line may have caused some more confusion because the Heritage Foundation, among others, has called for states to be allowed to move Medicaid beneficiaries into the exchange, receive federal tax credits in lieu of being Medicaid beneficiaries. But I don't think the Affordable Care Act allows that. What this statement means to me is that a state could choose to use exchange plans as a delivery system for Medicaid as long as Medicaid beneficiaries continued to receive the benefits and the cost-sharing protections for which they are eligible (in other words, as long as they remain Medicaid beneficiaries).

So the next step is to see whether Congress takes up this proposal.

Originally posted by Joan Alker on Say Ahhhh! A Children's Health Policy Blog

Third Federal Judge Upholds Constitutionality of Affordable Care Act

On February 22, a federal district judge in the District of Columbia became the third federal judge to affirm constitutionality of the Patient Protection and Affordable Care Act, making the national scorecard 3-2 rulings in favor.

Judge Gladys Kessler dismissed the challenge to the individual mandate clause filed by five individuals representing the American Center for Law and Justice, a conservative legal group. The group argued that it is unconstitutional to require individuals to purchase health insurance and also claimed that the mandate is in conflict with their religious freedoms.

In her 64-page opinion, Judge Kessler "didn't mince words," writes Jonathan Cohn, health care writer and editor of the New Republic. The judge stated that the claim the law regulates "inactivity" is nothing more than semantics, saying:
"It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not ‘acting,’ especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something. They are two sides of the same coin. To pretend otherwise is to ignore reality.”To date, three judges have upheld the law, thirteen federal district judges rejected lawsuits charging that the Affordable Care Act is unconstitutional, and two have ruled against it.
Judge Kessler also points out the decision to not obtain health insurance results in higher premiums for all those who do pay for coverage. Her ruling upholds the model of individual responsibility that is vital to the Affordable Care Act. It is incorrect to think that individuals, even those without insurance, are not already in the health care marketplace. They are.

In addition, Judge Kessler takes a strong stance against the "broccoli argument" posed by Judges Henry Hudson and Roger Vinson, who both ruled again the ACA. If Congress can make you purchase health insurance, they argue, why can't it make you buy broccoli or a certain kind of car? Kessler responds:
"This second aspect of the health care market distinguishes the ACA from Plaintiffs’ hypothetical scenario in which Congress enacts a law requiring individuals to purchase automobiles in an attempt to regulate the transportation market. Even assuming that all individuals require transportation in the same sense that all individuals require medical services, automobile manufacturers are not required by law to give cars to people who show up at their door in need of transportation but without the money to pay for it. Similarly, food and lodging are basic necessities, but the Court is not aware of any law requiring restaurants or hotels to provide either free of charge."
In short, she recognized that the insurance market is much different than other kinds of markets, and that the rules governing them must be adjusted accordingly. This is "critical to understanding the ACA’s efforts to reform the health care system," writes Cohn. "The requirement placed upon medical providers by federal law to care for the sick and injured without recompense is part of the cost-shifting problem that Congress sought to redress by enacting the ACA. When a supplier is obligated by law to produce goods or services for free, there is bound to be a substantial effect on market prices if consumers’ behavior results in that obligation’s frequent invocation."

The Affordable Care Act has already made a difference in the lives of millions of Illinoisans. Over 2.5 million state residents under the age of 65 who have pre-existing conditions will now be able to get health insurance. All of Illinois’s 1,770,000 seniors and people with disabilities on Medicare will no longer have to pay for preventive services, and many will have more help paying for prescriptions. In total, 1,163,000 uninsured Illinoisans will gain insurance coverage.

"Health care is the key to economic security and opportunity, and the Affordable Care Act is finally bringing fairness to the health care system for American families,” says Jim Duffett, executive director of Campaign for Better Health Care.

To date, three judges have upheld the law, thirteen federal district judges rejected lawsuits charging that the Affordable Care Act is unconstitutional, and two have ruled against it.

-- Kathleen Duffy, Campaign for Better Health Care

Tuesday, March 1, 2011

Go back to the Wild West?

Just a year ago, children with pre-existing conditions like leukemia, or even asthma, could be denied health insurance. Seniors struggled to pay for prescription drugs when they reached the “doughnut hole.” And recent college graduates who could not find jobs with benefits were stuck paying an arm and a leg for insurance or even going without coverage because they just couldn’t afford it.

But we are now living in a whole new world thanks to the passage of the Affordable Care Act. Already, millions of seniors have received $250 checks to help them afford prescription drugs. Young adults are staying on their parents’ health care plan and those with new insurance plans are receiving preventive care—like mammograms and vaccines—free of charge.

In a recent hearing, Senate Finance Chairman Max Baucus elaborated on all of the new consumer protections Americans around the country are already enjoying. He said,
This year, insurance companies are barred from imposing lifetime limits on benefits. They can no longer arbitrarily end coverage for those who need it most.
But that’s not all. He said,
Last year, our health care system was on an unsustainable path. One in six Americans was uninsured. Health care spending accounted for nearly 20 percent of our economy, and costs were rising.
Today, we are moving toward a system that contains costs, a system that modernizes care, and a system that provides affordable coverage options to millions more Americans.
While opponents of health care reform work hard to repeal and defund the law, Americans are already seeing real changes in the health care system that mimicked the Wild West before Congress passed the Affordable Care Act.

If all of the new consumer protections we gain from the law aren’t reason enough to reject repeal, consider this,

Repealing health reform would add nearly a quarter of a trillion dollars to our deficit in the next ten years and another trillion dollars in the following decade. Our kids and grandkids would be saddled with that heavy burden.

Americans can’t afford to go back to the Wild West, and we certainly can’t afford to pay a quarter of a trillion dollars to do so.

Erin Kelly
Families USA
Originally posted at Stand Up for Healthcare