Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Wednesday, September 28, 2011

Policy to the People - Illinois Policymakers Weigh In about ACA Implementation in Illinois

Health care reform in Illinois may originate from the federal law, the Affordable Care Act, but it is up to each state to implement many pieces of the law. For that reason, we made Illinois' implementation of health care reform the focus of our latest multimedia Neighborhood Stories series. The video, Policy to the People (by Jay Dunn) is the third in our series, and is accompanied by an article, Making Health the Best Policy (by Jeff Steele).

As health reform policies take shape in Illinois, it is important to make sure they benefit the citizens of the state. In the video, Senator Donne E. Trotter (IL -17th District) explains what he sees as necessary to keep policy geared towards the people, specifically those who are currently uninsured or underinsured. He advocates a “three pronged attack,” that involves policymakers, medical care providers and the citizens and health care consumers themselves, in the establishment of reform. “What we’re looking at,” Sen. Trotter explains, “is not as much what this law is going to do for people like myself, but for the future of America. We’re going to have a healthier society.”

The accompanying article, Making Health the Best Policy, explains the steps that Illinois policymakers have taken since 2010 to establish health care reforms right here in the Prairie State. Those who back the Affordable Care Act are attempting to impart positive messages, to counter the law's opponents working daily to ensure its provisions never go into effect.

We spoke to key policymakers in the Governor's Office, the Department of Health & Family Services (HFS) and the Illinois General Assembly about their vision of how reform will impact west and south siders' ability to gain insurance. Under the new health care law, HFS Director Julie Hamos says: “We believe there will be one million more people who will have access to private health insurance through the exchange, or public insurance through Medicaid...These are people who have not had a doctor, or a health checkup, in many years.” Michael Gelder, Governor Quinn's senior health policy advisor and Chair of the Illinois Health Care Reform Implementation Council says, “People on the west and south sides should see this as an opportunity to get health insurance. They should also see it as an opportunity to make their elected representatives, both federal and state, hear that they’re enthusiastic about [reform], and that they expect us to deliver on that.”

Check out these two great new pieces, as well as the other articles and videos in the Neighborhood Stories section of the Illinois Health Matters website, or on our new high quality Vimeo channel here. Stay tuned for the next installment where we look at how the Affordable Care Act is impacting local community organizations.

Tuesday, September 20, 2011

"Ask Wendell" - Things To Consider If You Are Looking for Health Insurance

Earlier this month I wrote that the Center for Public Integrity and I would soon launch "Ask Wendell" to help people who are at wits end trying to resolve a problem with their health insurer or who are trying to find decent affordable coverage but don't know where to find it.

Your emails and tweets starting flowing in immediately. As I suspected, there will be no shortage of problems to tackle in the weeks and months ahead. We in the United States have one of the most complicated, confounding and unfair health care systems on the planet. But I hope to be of at least a little help to the people who write. So here goes.

Dear Wendell,

Our COBRA will run out next June and I've started to look for something cheaper. My 24-year-old daughter and I both have some made-up preexisting conditions, according to a few insurance companies that we've applied to, even though my doctor says that mine is not even a medical problem.

This has prevented us from getting individual plans. My husband and I are self-employed and my daughter's employer doesn't provide insurance. I don't really want to go without insurance for six months in order to get on Pennsylvania's high-risk plan so I have been looking into an indemnity plan. I know it's not major medical, but (the company has) a plan called "Hospital Confinement and Surgical Fixed Indemnity Plan". The premium is lower but I'm not entirely sold on what I was told about it. Is this an OK avenue to pursue?


Dear Audrey,

Your situation illustrates all too well why Americans who would like to go into business for themselves or to start a new business are reluctant to do so, especially if they've ever been sick in the past. That's what job lock is all about. Millions of our best and brightest are locked into corporate jobs because their employers offer health care benefits not available at an affordable price to small businesses and individuals.

That should change in 2014 when the state exchanges are up and running, as required under the health care reform law enacted last year. As you probably know, the law requires every state to have an exchange--an online marketplace where people can go to shop and compare health plans and buy coverage if it is not available to them through the workplace. If your state hasn't demonstrated by 2013 that it will have its exchange up and running by Jan. 1, 2014, the federal government will step in and operate it.

COBRA coverage--available to people who lose their jobs and, along with them, their employer-subsidized coverage--is extremely expensive, as you have found out. Federal law mandates that COBRA coverage is available to you, but because your former employer does not have to subsidize the premiums, you're on your own. As a result, only a small fraction of the people eligible for COBRA coverage takes advantage of it. And, of course, it runs out after several months.

The reform law also will eventually prohibit insurers from refusing to sell coverage to anyone because of a preexisting condition. The prohibition already applies to children. It will apply to adults in 2014. But because 2014 is still a long way off, your options are limited, unfortunately, as you have found out. The plan you are considering is a limited benefit plan. If the reform act is implemented as Congress intended, limited benefit plans, which are often very inadequate and often little more than junk insurance, will be phased out.

Before you decide, be sure you see in writing exactly what benefits are covered and what is excluded. Also be sure you know what your total costs will be, should you or a family member get sick or injured. Thousands of Americans lose their homes and file for bankruptcy because of medical debt, and many of those people have what they thought was adequate health insurance. They found out too late that it was not adequate--or they gambled too much that they would not get seriously sick or injured. The United States, by the way, is the only country in the developed world where people can go bankrupt and lose their homes because of medical debt.

Before making a final decision, I suggest you go to www.healthcare.gov. That's the new Web site created by the Department of Health and Human Services following the enactment of the reform law. This site has a wealth of information for anyone looking for coverage or who has questions about health care reform. When you visit the site, click on the tab, "Find Insurance Option." Then fill out the demographic information and hit "submit."

You will see a listing of the options available to you in your state and with at least some information that should help you make a more informed choice. You might find that you can qualify for better coverage than you thought.

But if you decide to go with the limited benefit plan, I suggest you call your state's insurance department and ask questions, such as how long the company has been operating in your state, how many complaints have been filed against them and how many enrollees they have in your state.

In 2014, if all goes as planned, you will have better options, and you'll be able to compare plans with each other in ways never before possible.

Good luck!

Wendell Potter
Analyst, Center for Public Integrity; Former insurance company executive; Author
(This article originally appeared here in the Huffington Post)

Have a health care question for Wendell? Email him at wpotter@iwatchnews.org

Thursday, September 15, 2011

It’s Finally Happening

A legislative taskforce is working right now on ways to increase competition in the Illinois health insurance marketplace, and they’ll make recommendations by September 30th. Insurance lobbyists have come to Springfield to prevent anything that might mean more competition and better choices for Illinois consumers. 

Specifically, a Springfield legislative taskforce is considering setting up what is known as an insurance exchange. Done right, this will pool the buying power of hundreds of thousands of Illinoisans so all of us can get a better deal on health care. Done wrong, the exchange will be an ineffective website with the same expensive plans and spotty coverage.

Done right, the exchange will level the balance of power between you and the health care industry — driving the industry to cut the waste and prioritize high quality, bang-for-the-buck care.

Done right, the exchange will also cut through the confusing clutter and allow you to compare different health care plans in a simple, apples to apples way. You'd even be able to take your plan from one job to another.

Done wrong, the exchange will be merely an online listing of the same over-priced plans and inadequate coverage.

The legislative taskforce will make recommendations by September 30th on how to create the exchange in Illinois. In the meantime, insurance lobbyists don’t want more competition and are working to kill an effective insurance exchange in our state.

Click here to make sure state officials hear from you.

Brian Imus
Illinois PIRG State Director

Wednesday, September 14, 2011

Medicaid Cuts Could Leave Hundreds of Thousands of Illinoisans Facing Life-Threatening Health Challenges

Report Details Number of Illinoisans with Cancer, Heart Disease, Stroke, Diabetes, and Chronic Lung Disease Who Depend on Medicaid for Treatment

Cuts to Medicaid would pose a specific and dangerous threat to hundreds of thousands of Illinoisans who depend on the program for regular treatment for such medical conditions as cancer, diabetes, chronic lung disease, heart disease, and stroke. Without Medicaid, many of these seriously ill Illinoisans would no longer be able to fill essential prescriptions, keep up with key screenings, or see a doctor if their condition worsens or recurs.

The importance of Medicaid to Illinoisans is detailed in a report released jointly today by the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Lung Association, and the health care consumer group Families USA.

Hundreds of thousands of Illinoisans are covered by Medicaid. Of this number:
  • An estimated 23,760 Illinoisans with Medicaid have cancer, including 1,000 children, 15,780 adults, and 6,980 seniors;
  • An estimated 97,170 Illinoisans with Medicaid have diabetes, including 7,360 children, 64,490 adults, and 25,320 seniors;
  • An estimated 263,750 Illinoisans with Medicaid have chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis, including 146,650 children, 100,610 adults, and 16,480 seniors; 
  • An estimated 243,990 Illinoisans with Medicaid have heart disease or stroke, including 23,540 children, 164,600 adults, and 55,850 seniors.
Although Illinois directly administers its own Medicaid program, every dollar the state spends for health coverage for low-income individuals is matched dollar-for-dollar by the federal government. Particularly during difficult economic times, this federal match helps Illinois to provide health coverage for hundreds of thousands of residents.

The treatment of chronic and life-threatening diseases can be extremely costly, and people with these illnesses often become eligible for Medicaid when they have exhausted all their financial resources paying for medical care. As an example, the average hospital charge nationally for a stay associated with a heart attack is nearly $63,000, and for people with no health insurance or with inadequate coverage, such costs can quickly drive them into poverty and qualification for Medicaid.

“Hard-working Americans with diseases such as cancer can get health coverage through Medicaid after having lost their health insurance because they are too ill to work or run through their savings,” said Christopher Hansen, President of the American Cancer Society Cancer Action Network. “This program is a safety net for American families, and losing access to the program could force them to stop treatment that could save their lives.”

“Diabetes has a disproportionate impact on the Medicaid population, because Medicaid provides important health coverage to people facing elevated health risks. Children and adults eligible for this valuable program are more likely to be in poor health and thus require the services Medicaid provides to a greater extent than individuals with private insurance,” said Gina Gavlak, RN, BSN, Vice Chair of the National Advocacy Committee, American Diabetes Association. “Cuts to Medicaid funding would be harmful to the millions of children, pregnant women, and adults with diabetes who rely on the program to manage their disease and avoid dangerous and costly diabetes complications such as blindness, amputations, and kidney dialysis.”

“Medicaid is the lifeline for millions of children, adults, and seniors who suffer from chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis,” said Paul Billings, Vice President of National Policy and Advocacy for the American Lung Association. “If denied this critical healthcare coverage, it will result in higher healthcare costs, such as increased emergency room visits. We need to set politics aside and protect the health of our nation’s most vulnerable population, particularly our children, who will be most impacted by cuts to Medicaid.”

“Medicaid is a program that works and a program that provides urgently needed care to hundreds of thousands of people in Illinois suffering from serious but controllable diseases. It helps Illinois children get a healthier start in life and school, it helps to maintain a healthy Illinois workforce, and it helps head off medical debt, a leading cause of bankruptcies and home foreclosures,” Ron Pollack, Executive Director of Families USA, said today. “It should be crystal clear that with rising health care costs hurting family pocketbooks and with the economic downturn driving more families to depend on Medicaid, that this is precisely the wrong time to cut Medicaid funding to Illinois and other states.”

Families USA contracted with The Lewin Group to develop the estimates in this report.

Dave Lemmon, Families USA, 202-628-3030
Alissa Havens, Anerican Cancer Society Cancer Action Network
Christine Fehely, American Diabetes Association
Mary Havell, American Lung Association

Monday, September 12, 2011

5 Ways Health Care Reform Will Benefit Illinois Small Businesses

Illinois has strong, vibrant neighborhoods and small businesses play a vital part in those communities. However, while small businesses are working to meet their bottom line, it can be challenging for them to afford to provide health insurance for their employees. According to the Small Business Majority, an average of 86% of small businesses owners who don't offer health coverage to their employees say they can't afford to provide it. The Affordable Care Act (ACA) has put into place reforms – some right now and some rolling out later – that will make it easier for the owners of small businesses to buy affordable insurance. Below we list five ways that health care reform will benefit Illinois small businesses and their employees.

At Ruby's Restaurant, Health Care May Be On The Table - Images by Jay Dunn

1. RIGHT NOW: Since March 2010, tax credits are being offered to small businesses owners with 25 or fewer full time equivalent employees in order to help them offset the costs of providing health insurance. Until 2014, small businesses who pay for at least half of their employees’ health care premiums will receive a tax credit to offset 35% of those premium costs. Starting in 2014, the tax credit will increase: for those small businesses who buy insurance through the insurance exchange (see #5 below), the tax credit increases to 50%. September 15th is an important deadline for filing so check out the tax credit calculator here to see if you are eligible.

2. RIGHT NOW: Small businesses often struggle with unpredictable and often steep health insurance premium increases from year to year. One of the priorities of the Affordable Care Act is to implement consumer protections so that insurance companies are more transparent and accountable with things like premium increases. As of September 1, 2011, health insurers seeking to increase their premium rates by 10 percent or more must submit their request to state or federal reviewers to determine whether they are reasonable or not. This rate review program will bring more predictability to health insurance costs and in many cases will lower costs for small business owners.

3. RIGHT NOW: Many small business owners cannot purchase affordable insurance, because they have a pre-existing condition. A pre-existing condition is a physical or mental health condition, disability or illness that you have before you enrolled in a health plan. If you or your employees are uninsured and have a pre-existing condition, you may be eligible for the Illinois Pre Existing Condition Insurance Plan, which is an insurance plan that was established by the Affordable Care Act. Questions? Call the Toll Free Number: (877) 210-9167, or email your question directly to IPXPInquiry@healthalliance.org.

4. LATER: Under the Affordable Care Act, denying health coverage or excluding benefits due to a pre-existing condition will no longer be allowed. As a result, if you have a pre-existing condition that has prevented you from buying affordable insurance for yourself and your employees, on January 1, 2014, it will not make you uninsurable any longer. This change is already in place for children under age 19.

5. LATER: The new health reform law establishes a competitive healthcare marketplace, commonly known as an “insurance exchange” run by each state or the Federal government. Slated to be up and running by the beginning of 2014 in Illinois, the Exchange will make purchasing insurance easier for individuals and small businesses by giving them the power to compare health care plans in one digital hub. The Exchange will also ensure that quality health insurance options are available – and that subsidies are also available to those who need them. These online marketplaces will create competition among insurance companies that will help to drive down the costs of insurance. More information about Illinois’ progress toward establishing an Exchange, can be found here.

If you have questions about the new health care law and how it affects you or your small business, submit your questions here and we will write you back.

An employee and customer at Ruby’s. The owners of the restaurant currently can’t afford to pay for health insurance for their employees, but that could change with the Affordable Care Act reforms