The American Health Care Act Hurts

The American Health Care Act (2017) is a radical step back from progress made to provide health insurance for all Americans.  It breaks the federal government’s fundamental compact, where the federal government promised to pay its fair share in providing health coverage to the nation’s most vulnerable people. That includes the working poor, people with disabilities, older adults, and children.

The AHCA makes it harder to access health insurance

The Affordable Care Act provides support, through tax credits and subsidies, for millions of the working poor, Americans who earned too much for Medicaid but who cannot afford the premiums for individual insurance. The AHCA shatters that reality by promoting a system where financial assistance is slashed and fewer people will be able to afford coverage.

The AHCA moves financial assistance from the poor to the rich
The AHCA will punish the working poor. The current system of tax credits and subsidies will change radically. Tax credits based on income, and other factors, would become a flat amount based only on a person’s age. The Congressional Budget Office report details how a 21 year old living at 175% of the federal poverty level would see her current tax credit drop from $3,400 to $2,450. Cost-sharing subsidies to help pay out of pocket costs would  be eliminated, placing further burden on her and the millions living near the poverty line who need these critical supports to pay for health insurance.

The AHCA makes coverage more expensive for older adults

The AHCA is particularly hard on older Americans.  It allows insurance companies to charge seniors 67% more for their insurance premiums than what they would be charged today. The AHCA does this by giving insurance companies the right to charge seniors 5 times more for their coverage than they would for someone in their 20s. Even though the Republicans have proposed age rated tax credits to help seniors pay for their insurance, it won’t be nearly enough to help cover these increased costs.

Adding to these financial burdens, the AHCA also makes insurance more expensive if you have a gap in coverage. No matter how you look at it, the AHCA adds burdens to the working poor and older Americans instead of providing the support so many need.

The AHCA breaks the promise to provide care to the most vulnerable
The American Health Care Act breaks the federal government’s 50 year compact with the states in assisting in the cost of providing health coverage to low-income people, including children, pregnant women, people with disabilities and adults. Medicaid is the underpinning of the nation’s health care system; it is the safety net for 68 million Americans and financing the program has always been a shared responsibility between the federal government and states.

The AHCA siphons billions in federal dollars out of the Medicaid program, leaving states to pay up and make cuts

The CBO estimates that the AHCA would cut the federal government’s support for Medicaid by $880 billion, forcing states to accept a fixed funding formula for the Medicaid program.  This will leave states responsible for a larger percentage of their Medicaid costs. Since states must balance their budgets annually, reductions in federal funding will lead to state cuts in eligibility, benefits or payment rates.

The AHCA also allow doesn’t grow this set amount at a rate equal to Medicaid growth rates, which means states will have less money each year as expenses increase and funding doesn’t keep up.

The AHCA is a bad deal for Illinois, where Medicaid dollars are already stretched

Medicaid finance reform is happening at a time when Medicaid covers 1 of every 5 births, and 1 in 4 lives in Illinois. Medicaid spends nearly 30% of its total expenditures on services and supports that help people live independently in their communities. Illinois has been seeking a waiver from the federal government to bring in more dollars for much needed behavioral health services and supports. Illinois already has some of the lowest payment rates in the country.

Changing the Medicaid funding formula would dramatically impact Illinois’ ability to maintain current Medicaid funded services and supports which the state has already deemed inadequately funded. Further cuts to federal funding for the state would devastate an already ailing health delivery system.

Illinois can’t afford the AHCA

The AHCA hinders access to health insurance, curtails financial assistance to the most vulnerable, raises costs for older adults, and leaves our state in an even worse fiscal situation. Illinois residents can’t afford it. Our state can’t afford it.

We urge the Illinois Congressional delegation, and Governor Rauner to aggressively push back on the AHCA.

Related reading

• Analysis from Sen. Durbin's office: TrumpCare: Less for More
• Vox: The Republican plan to slash Medicaid, explained
• Washington Post: Sleeper issue of Medicaid’s future could prove health-care plans’ stumbling block
• Congressional Budget Office: report
• House Ways & Means Committee: Section by section summary
• Commerce & Energy Committee: Section by section summary

Our Section 1115 Recommendations

HDA's Emily Gelber-Maturo testified at a hearing September 9th and Barbara Otto submitted testimony at the joint hearing on September 20th on an 1115 waiver draft released the Illinois Department of Healthcare and Family Services. The waiver draft details a proposed overhaul of the behavioral health delivery system. Proposed expanded Medicaid benefits extend from care coordination in health homes to pre-tenancy services for supportive housing.

Recommendations to improve our 1115 Behavioral Health Transformation Waiver:

What’s an 1115 waiver?

Recently, the state proposed an ambitious plan to transform the Medicaid behavioral health system in Illinois. As part of its plan, the state proposes to use an 1115 waiver which would allow certain federal rules to be used so that federal funds could be used in ways that are otherwise not allowed. The catch is that the state must keep all efforts budget neutral for the federal government meaning that services provided have to be equal to what the feds would have spent within the state without the waiver.

The state plans to use both the 1115 waiver and state plan amendments to realize its transformation plan

As a reminder, Medicaid is paid for jointly by both federal and state funding. Illinois has proposed several things within this waiver, some of which will be allowed through the waiver, and others that will be included in state plan amendments. State Plan amendments are used to change program policies, benefits, or operational approaches of the Medicaid State Plan for Illinois. 1115 waivers and state plan amendments both change the way that Medicaid is delivered, but there is a significant difference between the two. The 1115 waiver is a demonstration that will last five years and allow the state to try new ideas within Medicaid that are not necessarily permanent, and can target certain populations. By contrast, the state plan amendment codifies (into law) Medicaid services that apply across the State. The 1115 waiver and state plan amendments will be used together to transform the Medicaid Behavioral Health delivery system.

Expanded benefits and new initiatives

The long-term vision for Illinois’ behavioral health system as articulated in the Behavioral Health Transformation 1115 waiver draft deserves applause. It includes a commitment to addressing social determinants of health, and expanding the Medicaid benefit package for people with serious mental illness and substance use disorders.

Expanded benefits proposed in the draft waiver include supported employment services and pre-tenancy supportive housing services, and new initiatives such as loan forgiveness and training for providers, integrated behavioral health homes, and expanded use of telemedicine. There’s even more, if you would like to read the draft yourself.

Recommendations for the transformation of the behavioral health system in Illinois

With any great system transformation, we need to contend with the realities of the short term. In order to implement many of the benefits and initiatives proposed in this waiver, we need to address systemic capacity, clarify roles of payers and providers, as well as improve infrastructure and accountability.

Invest in Mental Health Workforce and Infrastructure

Illinois would be wise to use the waiver to make much needed strategic investments in workforce and infrastructure in the short and long term. In order to enhance access to services and reduce unnecessary expenditures, prioritizing the assessment and diagnosis of mental illness and substance use disorders outside of the Emergency Department, the most expensive entry point to the health system, is paramount. Assessment and diagnosis should happen in community and outpatient settings. Because eligibility for services proposed in the waiver is closely tied to diagnoses, Illinois’ workforce challenges must be adequately addressed. Without much needed workforce improvements, the work simply can’t be done, and Illinois will fail to take full advantage of services promised through the proposed waiver.

Further, while the services are critical to proposed cost savings, Illinois needs enough providers, who are paid enough to cover their costs. This is not the current reality. Illinois needs rate reform for behavioral health providers, as well as reform to allow providers to work at the top of their license. Loan forgiveness and training, as described in the 1115 waiver draft, by themselves, are simply not enough. Though the waiver does reference expanding telehealth, which will likely help increase access to care, adequate rates are still needed to pay a provider on the other end of the screen.

The state should incorporate Medicaid infrastructure dollars to allow providers to keep pace, build capacity to bill, contract, and hire to provide services. We need to make sure that providers are sufficiently armed to do what is expected and best within their roles by investing in the infrastructure of the behavioral health system.

Clarify Roles of Providers and Payers

The waiver as drafted needs greater clarity on the roles of Managed Care Organizations vs. the roles of providers. As currently crafted, it appears the State is outsourcing a good deal of responsibility to MCOs and that Managed Care Organizations will be expected to implement service delivery. But the problem is that MCOs are payers, not providers. When the waiver addresses implementation of health homes and subsequent creation of a state plan amendment, providers and other stakeholders must be at the forefront of designing them. We don’t call our MCO when we need care, we call our doctor because that’s where the expertise lies.

Establish an Illinois Behavioral Health Transformation Team

In line with providing greater clarity of roles, the State needs to remain accountable for service delivery. The State should establish an Illinois Behavioral Health Transformation Team, comprised of stakeholders representing providers, advocates, and consumers, to provide guidance on the implementation of the waiver. With our state at a crossroads, operating with limited resources, taking advantage of the time and expertise of smart, dedicated, caring providers, advocates, and consumers, can help to shape the long-term transformation envisioned within this demonstration waiver. Advocates and others stand ready to help.

This waiver proposal contains several promising elements, but more is needed. The State must have a commitment to:

• Increase capacity in the short term with Medicaid infrastructure investments and rate reform
• Clarify roles - to make sure the right people are doing what they are best suited to do
• Create responsive mechanisms for accountability

Without this, all the good ideas within this proposal will lack the critical support necessary to transform our behavioral health system for the better.


Emily Gelber-Maturo
Associate Director, Strategic Health Initiatives
Health & Disability Advocates

Food Keeps Illinois Families Healthy: Help Illinois Reduce the SNAP Gap

Forty-eight million Americans live in food insecure households, meaning they worry about where and how to find their next meal. Many of these individuals and families are covered by Medicaid but are not receiving critical nutritional support. They are eligible for SNAP which could help support their nutrition and improve their health, but they are not enrolled.

What is SNAP?

The Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) helps low-income households purchase adequate, nutritious food. Benefits are distributed monthly on an Electronic Benefits Transfer card, known as “Link” in Illinois, which acts much like a debit card. Money from SNAP can be spent at authorized retailers, and some farmers markets, on any foods that recipients prepare and eat at home. SNAP recipients nationally spend over 85 percent of benefits on fruits and vegetables, grains, dairy, meat and meat alternatives. Beneficiaries also increase the amount of money they spend on groceries each month, instead of simply replacing their food budget with SNAP dollars. By supplementing, not replacing, grocery budgets and allowing for the purchase of more nutritious food, SNAP reduces food insecurity in low-income households. This is particularly true of households with children.

Why Help Consumers Apply for SNAP Benefits?

Connecting more Medicaid recipients with SNAP benefits can address food insecurity and inadequate nutrition, which this population experiences at high rates, and improve health outcomes. In addition to helping a family afford healthier food, children who receive nutrition supports are healthier and more likely to finish school while participating in the program. A report recently released by the White House Council of Economic Advisers details the long-term benefits of this program, including: for mother’s receiving support during pregnancy, reductions in incidences of low birth-weights; and for adults who received support when they were children, reductions in obesity rates and metabolic syndrome, increased likelihood of having completed high school, and significant improvements in overall health and economic self-sufficiency among women.

New Opportunities in Illinois to Reduce the SNAP Gap

The Affordable Care Act has made it easier for low-income individuals and families to access public benefits by helping states pay for electronic systems to apply for benefits. In Illinois, the new Application for Benefits Eligibility enables applicants to submit a single application for both SNAP and Medicaid. However, despite this improved online application, we have not fully reduced the “SNAP Gap”—the number of Medicaid clients who are income-eligible for SNAP but do not receive this benefit.  We need to work with medical providers, medical plans, social service organizations and other partners to make sure that everyone who is eligible for SNAP gets the help they need to pay for healthy food.

The newest change to the Illinois SNAP program is that on January 1, 2016, Illinois raised the gross income limit for SNAP from 130% to 165% of the federal poverty level, making nearly 40,000 low-income working families newly eligible for SNAP. With more families in Illinois now eligible for SNAP and the ability to submit a single application for both SNAP and Medicaid benefits, it’s time to close the SNAP Gap and make sure families have the food they need to stay healthy. If you’re not familiar with SNAP’s application process join us on HelpHub for more information and resources for both providers and consumers.

MacKenzie Speer
Advocacy Program Associate
Sargent Shriver National Center on Poverty Law

Connecting Navigators to Jobs so They Can Continue Connecting Consumers to Coverage

Navigators are key to health care outreach and enrollment across the country, but in Cook County the number of working Navigators is on the decline as grant funding slows. This is not only bad for individual Navigators unable to find work, but compromises the success of future enrollment cycles. In-person assisters of all stripes — including Navigators, Certified Application Counselors, agents, and brokers — play a crucial role in helping people apply for coverage. An Enroll America study found that people who got in-person help were nearly 60 percent likelier to enroll. To help keep assisters in the community, through the Health Insurance Workforce Pipeline Initiative, Health & Disability Advocates and the Chicago Cook County Workforce Partnership are connecting unemployed Navigators with jobs in the health insurance field — specifically as brokers.

Health & Disability Advocates is leveraging its connections in the health insurance community to bring employees and employers to the table. Meanwhile the Chicago Cook Workforce Partnership contributes Workforce Investment Opportunity Act (WIOA) dollars that pay for job-readiness training, workshops, and on-the-job training that new hires may need once they start their jobs as brokers. Since its formation in early May 2015, the Health Insurance Workforce Pipeline Initiative has hosted Rapid Response Workshops that describe the resources available for unemployed or soon-to-be unemployed enrollment assisters. HDA and CCWP also organized an exclusive job fair where Navigators could meet and interview with employers looking to hire.

Former Navigators are already transitioning into new jobs thanks to this initiative. A group of eight new hires who had previously collaborated as enrollment assisters to connect 51,000 people with Medicaid and marketplace coverage will now be working together as brokers, drawing on their experiences as Navigators. According to Tearalla, a new hire, “As a broker, my Navigator skills are transferable and aligned with my current responsibilities. I will continue to provide outreach, education, and enrollment assistance to newly enrolled consumers and consumers seeking to re-enroll in the Marketplace.”

These transitioning Navigators will be doing outreach and drawing on their strong connections — including with Navigators — in the communities where they worked for the first two enrollment cycles where they already have strong connections. Said Tearalla, “Networking with existing community stakeholders is ongoing.”

Everyone wins — employers and Navigators alike — when these Navigators transition into new roles as brokers. According to one hiring manager, they were able to hire more former Navigators because money spent for training was covered by WIOA dollars. The hiring manager was also excited that the new hires have great working relationships with groups and community leaders.

New hires are eager to continue enrollment work. They are already reaching out to previous community contacts to spread the word about their new role and the ongoing opportunity to get health insurance. Said one former enrollment assister, Olivia, “I’m excited about the opportunity to continue to enroll folks in the ACA.” It’s a wonderful opportunity for the overall enrollment push in Illinois, too. Having seasoned pros with strong community connections on the front lines of Affordable Care Act outreach like Olivia and Tearalla can help set up a strong foundation for the upcoming enrollment cycle and get even more people connected to health insurance.

This post originally appeared on Enroll America's blog.

Bryce Marable
Health Policy Analyst
Health & Disability Advocates

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

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

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

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

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

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

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

Tameshia Bridges Mansfield
Midwest Director
Paraprofessional Healthcare Institute

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

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

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

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

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

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

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

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

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

Where the costs go

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

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

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

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

How to save the state money

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

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

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

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

Related reading:

• Community-Based Long-Term Services & Supports at Medicaid.gov
• Gov. Rauner's Health Benefits for Workers with Disabilities site
• Kansas to break new ground in demeaning the poor? column by Michael Hiltzik in the LA Times
• ACA, Medicaid and Unintended Consequences for People with Disabilities post at the IHM blog
• Disability Rights Advocates Deliver Coffin To Rauner, Decry 'Deadly' Human Services Cuts in Progress Illinois

What Really Happens After Enrolling in Medicaid Managed Care?

Health & Disability Advocates (HDA) is monitoring the rollout of the Medicare-Medicaid Alignment Initiative (MMAI) and has heard from frustrated case managers working with consumers who are confused about the enrollment process and their rights. In response, HDA developed an enrollment timeline that explains what new enrollees can expect from Managed Care Organizations (MCOs) and plan representatives upon enrollment. To produce the timeline, HDA researched the MMAI demonstration contract developed by the State of Illinois and approved by the Center for Medicare and Medicaid Services (CMS)  HDA also solicited input from health plans on whether their on-the-ground practices were accurately reflected in the timeline.

The finished product outlines important points for case managers and their clients to consider.

One Day Changes Everything

Consumers who are enrolled in a managed care plan after the 12th day of the month will not see their coverage start until the month after next. This is relevant for consumers choosing a specific managed care plan in order to see a particular provider or specialist in that plan’s network. Submitting paperwork after the cut-off date means consumers would have to wait longer than expected for necessary treatment. Helping consumers submit required documents in a timely manner can guarantee they are connected to the medical treatment they need, which promotes continuity of care.

Stratification Sets Up Future Contact Standards

Once enrolled in a plan, all enrollees can expect to complete a Health Risk Screening within 60 days. The screen collects information on the enrollee’s physical and mental health conditions and identifies their current medical providers. This is what IlliniCare’s Health Screen looks like. Health plans use the screen to establish intensity of services and frequency of contact with Care Coordinators by stratifying the enrollee as low, moderate or high risk.

Enrollees stratified as low risk will receive annual follow-ups from their Care Coordinators while those stratified as moderate or high risk will have quarterly follow-ups. Moderate and high risk enrollees will also complete a Health Risk Assessment and create an Individualized Care Plan within 90 days. These enrollees will help form their own Interdisciplinary Care Team of healthcare providers that meets quarterly to review the Individualized Care Plan.

The Care Coordinators’ Role

Care Coordinators focus on enrollees’ healthcare needs by connecting them to necessary tests, doctors and treatment. They also facilitate information sharing among providers by leading the Interdisciplinary Care Team. Addressing enrollees’ medical needs is their priority. Care Coordinators direct less attention to linking enrollees to social supports, like housing and public benefits.

It’s also important for case managers to know that Care Coordinators must manage a substantial caseload of up to 600 enrollees. Caseloads include a blend of low, moderate and high risk enrollees, with each risk level weighted differently.

Understanding what a care coordinator can—and cannot—be expected to do is advantageous to case managers. When roles are clearly recognized, case managers know how care coordinators can be used as a resource. And in what instances an alternative referral would be more appropriate. This establishes a stronger professional relationship between case managers and care coordinators, which ultimately benefits the enrollee.

Case managers and Care Coordinators are on the front lines of healthcare reform and fostering solid working relationships between these two players will be a critical component of the success or failure of these efforts. Knowing what case managers and their clients can expect from managed care plans can lay the foundation for a strong relationship that supports the health of individuals while also furthering the goals of healthcare reform.

Bryce Marable MSW
Health Policy Analyst
Health & Disability Advocates

The Future of Enrollment in Illinois: Where We’ve Been and Where We’re Going

When Get Covered America came to Illinois before the first open enrollment period for the Affordable Care Act in 2013, there was a lot of work to be done. At that time 78% of the uninsured had not heard of the health insurance marketplace and were unaware of the new health coverage options or opportunities for financial help available to them for the first time. The initial awareness gap was daunting, but hundreds of thousands of Illinoisans stood to benefit from the marketplace and needed to know how the Affordable Care Act could help them.

Many Milestones Through Collaboration

Fortunately, there were a number of stakeholders like Health & Disability Advocates (HDA), the Campaign for Better Health Care (CBHC), Alivio Medical Center and the AIDS Foundation of Chicago, among others, eager and ready for the challenge ahead. This commitment helped achieve many of the goals laid out in the beginning. After two successful open enrollment periods, nearly 350,000 Illinoisans have enrolled in health insurance through the marketplace, and hundreds of thousands more have received coverage through expanded Medicaid and CHIP. Working together towards the same mission, Get Covered America and its partner organizations increased awareness and provided enrollment resources for consumers across the state.

Stepping Back to Move Forward

Because of the great work that has happened on the ground in Illinois, Get Covered America will be stepping back with full confidence in capable partners like HDA, CBHC and many others—such as Family Guidance Centers and Ada S. McKinley—to continue this important work to make health care enrollment a permanent part of communities. It’s clear that the coalition of partners who have come together on this issue have made great strides over the past two years. As the insurance landscape changes and the number of uninsured Illinoisans continues to decrease, Get Covered America wants to make sure that resources are allocated in the smartest and most effective way.

While Get Covered America won’t have an active outreach presence on-the-ground in Illinois moving forward, the organization will continue to support partners in the state with cutting edge data, best practices, tools and resources. Get Covered America will refine and continue to offer digital tools like the Get Covered Connector while also introducing new programs, like  training and support for local partners and health insurance literacy resources for the newly insured.

The Enrollment Challenge Ahead

Just released by Get Covered America, the State of Enrollment Report takes a critical look at the lessons  learned and what still needs to be done to get Illinois covered. Using on-the-ground knowledge and data analysis, the report identified several key initiatives integral to maximizing the number of Illinoisans who enroll in coverage. This is a great resource for partners on the ground and the foundation for a sustainable coalition for years to come.

The Get Covered America team is thrilled at what has been accomplished in Illinois so far, but there’s still important work to be done. While more Illinoisans have health coverage than ever before, there are still too many who remain uninsured and need the facts about how the Affordable Care Act can help them and their families.  On-the-ground partners like CBHC, Family Guidance Centers and Alivio Medical Center will continue this work and make health care enrollment an institutional reality for years to come.  And Get Covered America  looks forward to supporting their efforts.

David Elin
National Fundraising Director
Enroll America

Rauner's Budget is Bad Medicine for State's Health Services

The following post originally appeared on Crain's Chicago Business.

The much-anticipated “turnaround budget” from Illinois Gov. Bruce Rauner feels more like a “look back,” parading out failed ideas from past years. Rauner says this budget "preserves services to the state's most vulnerable residents”—but a quick review suggests this is far from true. Instead, we see a budget that:

• Further decimates a fragile community mental health system
• Reduces access to lifesaving drugs for people living with HIV and prevention services for those at risk of HIV
• De-funds critical substance-abuse treatments
• Drastically reduces cost-effective breast and cervical cancer screening services
• Makes it harder, and in some cases impossible, for people with disabilities and seniors to get support to live at home
• Reduces funding for evidence-based tobacco prevention and cessation services
• Eliminates Medicaid benefits for preventive health services, including adult dental care
• Eliminates health insurance for workers with disabilities, coverage unavailable in the private marketplace
• Slashes funding for hospitals serving Medicaid populations
• Eliminates funding for care coordination, originally designed to contain costs
• Secures Illinois' position near the bottom of states for per-enrollee Medicaid funding

It's ironic the governor calls these cuts “tough medicine,” when the proposed budget would deny any medicine and critical health care services to so many. We've been down this road before, and here's what we learned:

• Cuts of $113 million to mental health and addiction treatment services in fiscal years 2009-11 increased state costs by more than $18 million due to increased emergency room visits, hospitalizations and nursing home placements.
• Elimination of Medicaid coverage for adult dental services in 2012 caused spikes in emergency department visits for dental problems. In-patient ER treatment for dental problems averaged $6,498, nearly 10 times the cost of preventive care delivered in a dentist's office.
• Disinvesting in HIV prevention will lead to new infections, for which the Centers for Disease Control estimates lifetime treatment costs of $379,668 per case.
• For every dollar Illinois spends on providing tobacco cessation treatments, it has on average saved $1.29. Cutting funding for smoking cessation services will increase costs by up to $32.3 million annually in health care expenditures and workplace productivity losses.

As proposed, the Rauner budget is not only bad for our health, but it's bad for businesses, too, likely resulting in decreased productivity, loss of jobs and economic activity, and greater health care costs for employers. Some examples:

• The proposed child care “intake freeze” and increase in parent co-pays will lead to increased absenteeism as employees will take time off to care for children. Such absenteeism already is costing American businesses nearly $3 billion annually.
• Planned cuts to Illinois hospitals are expected to result not only in the loss of more than 12,500 jobs but $1.7 billion in economic activity.
• Cuts in funding for health care services, such as cancer screening, most certainly will increase the health care costs of Illinois businesses. One study of major employers found that patients with cancer cost five times as much to insure as patients without cancer ($16,000 versus $3,000 annually).

We urge the governor to listen to the critics of this budget and learn from Illinois' past experiences. We stand prepared to support him on this learning curve.

Barbara A. Otto
CEO
Health & Disability Advocates

From Getting Insurance to Actually Using It

After the 2015 Open Enrollment Period 347,300 Illinoisans purchased plans through the marketplace, and 541,000 people have enrolled in Medicaid since its expansion in 2014. While connecting individuals to coverage is good news, the newly insured are often overwhelmed by having to navigate the overly complex healthcare system and understand the related insurance and medical jargon.  This confusion and lack of experience counteracts one of the healthcare reform law’s major goals: to reduce medical costs by increasing access to primary care. Obtaining coverage will not offset a lifetime of avoiding the doctor’s office and visiting the emergency room for primary care. The newly insured must learn how to find a doctor, fill a prescription and read a prescription label. Without that, they are subject to poor health outcomes and high costs. The newly insured must gain health literacy which can only happen through the combined efforts of consumers, communities, providers and governing bodies.

What is Health Literacy? 

The Centers for Disease Control and Prevention define health literacy as the degree to which an individual can obtain, process, communicate and understand health information and services. People with low health literacy are more likely to be uninsured. Similarly, uninsured individuals show lower health literacy scores compared to those receiving employer-based coverage.

So Why Does Low Health Literacy Matter? 

It is not altogether surprising that the uninsured and those with low health literacy are less likely to seek preventative care; more likely to experience poor health outcomes; and more likely to encounter higher medical costs. According to the Kaiser Family Foundation, only 1 in 3 uninsured adults said they had a preventive visit with their physician in the previous year, and uninsured adults experienced higher mortality rates than the insured. An Institute of Medicine report found a similar pattern of healthcare use for those with low health literacy, stating this group was less likely to seek preventive care. Research also found that lower health literacy in Medicaid managed care settings is connected with higher mortality. This shows that the uninsured and people lacking health literacy interact with the healthcare system in similar ways: poorly. Using the healthcare system is something people must learn. Giving someone a computer does not mean they know how to type. In the same way, connecting a person with healthcare will not alter their level of health literacy.

Old Habits Die Hard. The newly insured will continue receiving care in ways most familiar to them, which can translate to using the emergency room for non-emergencies. According to the Oregon Health Insurance Experiment, individuals who received Medicaid coverage increased their emergency room use by 40%. Asked to comment on the results, the state director of policy and programs for the National Association of Medicaid Directors alluded to the importance of promoting health literacy in the newly insured. She said, “this is not something that is unexpected” and “the key to getting inappropriate costs down for all patients is educating people about where they should go when it’s not an emergency.”

How to Address Health Literacy

Government Efforts
State initiatives, including an Illinois Emergency Room Diversion Grant are acknowledging the importance of patient education and using outreach to reduce ER use. In Illinois, hospital staff led outreach explaining the proper use of the ER and offered a 24-hour nurse triage line as an alternative. Meanwhile, Maine is targeting ER super-utilizers through community care teams that offer intensive case management including home visits and health coaching. Recognizing state efforts like that of Illinois and Maine, CMS listed patient education as a recommended component of programs targeting ER super-utilizers.

Health Professional Efforts
Beyond education on how to use their health insurance, health professionals can improve the usability of health services by reducing medical speak in patient interactions. Healthcare systems can also create plain-language pamphlets for patients to reference after leaving the doctor’s office. By speaking with patients in a relatable manner and sharing usable information, doctors better position healthcare consumers to adhere to medical recommendations.

Northwestern University’s Division of General Medicine and Geriatrics focuses on improving engagement between providers and patients and has developed plain-language materials that communicate complex health topics. For example, researchers created written information and videos available in Spanish and English that teach patients diabetes self-management. The modules use simple language and rely on pictures to communicate aspects of diabetes care, such as how the disease can impact a person’s eyes. By using these materials when interacting with diabetes patients, health professionals communicate vital aspects of care in an accessible manner, increasing the likelihood that patients adopt the healthy behaviors.

Community Health Literacy Efforts
The Be Covered Illinois campaign is promoting health literacy by generating easy-to-read written and online materials, creating short videos explaining critical concepts and utilizing community partnerships to expand the reach of their communications.  By producing written fact sheets on finding the right doctor and developing web content on using your coverage Be Covered empowers the newly insured with the knowledge to navigate health insurance and health care systems more effectively. Be Covered’s Dr. Lopez video series, presented in both English and Spanish, addresses health insurance topics, chronic disease, prevention and more. Be Covered broadens the reach of their education efforts by partnering with 82 organizations in Illinois, including Illinois Health Matters, that share information and materials with their own constituencies.  As part of that effort, Be Covered provides regular content for social media and shares copies of consumer friendly resources free of charge to partners.

Illinois Health Matters recognizes the importance of not only getting insurance but using insurance. The website features resources such as a Medical Cost Look Up, that allows consumers to estimate out-of-pocket costs for medical services and a resource on Immunizations and the ACA, outlining the vaccines children and adults can access for free because of healthcare reform. The website also has a tip sheet titled What to Know About Provider Networks, explaining steps consumers can take to avoid high medical costs associated with out-of-network care. These are just a few examples.

Illinois Health Matters is taking on the challenge of supporting a more health literate population, but we can’t do it alone. Join us. One great way to start: subscribe to our newsletter to stay informed and share the knowledge with your clients and coworkers. The healthcare community can achieve the vision of the Affordable Care Act, but only through the joint efforts of providers, policymakers and organizations supporting health literacy.

Bryce Marable MSW

Health Policy Analyst 

Health & Disability Advocates

Providers Will Make Medicaid Care Coordination a Success

If the opening of the health insurance marketplace taught people anything, it’s that choosing health insurance is tough. Suddenly, people had to make a thorough evaluation of their finances, the types of care they depended on, the medications they needed, and more.

Equally important, but receiving a lot less attention are the similar challenges facing people who are trying to pick a coordinated care plan under Medicaid. Generally, having choices is a good thing, but being unarmed to make the best decision is scary. So, how does one pick?

Four Gifts the Affordable Care Act Has Given Americans by Its Fourth Birthday

On March 23, 2014, the Affordable Care Act (ACA) turned four. In its relatively short life, the ACA has already accomplished a great deal. To celebrate, here’s a list of the top four gifts that the ACA has given to the American people:

1. No More Pre-existing Condition Exclusions

Before the ACA was law, insurance companies routinely denied people health coverage due to“pre-existing conditions,” which could range from common chronic conditions such as asthma and arthritis to diseases such as cancer or mental illness. However, as of September 2010, children could no longer be denied coverage due to a pre-existing condition, and as of January 2014, adults are now enjoying that same right.

The Obamacare Lady: What made me want this job?

Last year, I accepted a position to be an In-Person Counselor with the State of Illinois. You may also have heard the terms Navigator or Assister used to describe this job. I help people with the Affordable Care Act. A few people have called me, “The Obamacare Lady.”  Yes, I help people understand “Obamacare” and help them determine what help they may qualify for in obtaining health insurance.

What made me want this job you ask? Well, I was drawn to this job for a number of reasons:

Why We Built HealthPlanRatings.org – and What Makes it Different

Here at Consumers' CHECKBOOK, what we’ve always focused on is helping consumers make their best choices. And we felt that right now, choosing insurance plans on the Marketplace is difficult and confusing for most consumers, and that Healthcare.gov doesn't give consumers the key information they need to choose the best plan.

So what we did was build a model for how to get consumers to their best health plan choices – and get them there quickly. We launched this Health Plan Comparison tool at www.HealthPlanRatings.org.

This tool actually compares every plan available in the Illinois Marketplace based on total estimated cost (not just premiums or deductibles), plan quality, doctor availability, and other key factors. But it's designed to take consumers with little or no knowledge of insurance through a few simple steps – which take about five minutes – to help them choose the best plan for them.

Although it is intended to be a model for the country, right now the Health Plan Comparison tool only includes plans in one state: Illinois. Our hope is that the Feds and states that are running the Marketplaces will learn from what we have done and make their Marketplaces work better for consumers for the next open enrollment period, this Fall. Meanwhile, we want to have as many Illinois consumers as possible use the tool right now.

Here are some examples of what we've done:

COST. This is the primary consideration for most consumers when purchasing health insurance. Right now, Healthcare.gov lets you compare plans, but it just gives you the premium and the amounts of deductibles, co-payments, coinsurance, etc., for various health care services and products. Since it is all but impossible to calculate the likely total cost for each plan based on this confusing mass of benefit information, consumers often choose based on premium alone, or some other unreliable shortcut. Instead, our model uses actuarial analysis of data from large health-care-usage databases to calculate an Estimated Average Total Cost (premiums plus out-of-pocket costs) for a family of the same size, ages, health statuses, and other characteristics. That gives you a single dollar amount for each plan, making it easy to compare plans.

RISK. The Marketplace gives a consumer little or no help assessing risks of having a "bad year," or what the cost of an event such as heart attack could be. We calculate the cost in bad years and the probability that a family like yours will have such a year, giving you an easy-to-understand, easy-to-compare measure of "Risk" with each plan.

DOCTORS. For many people, whether they will be able to keep their physician – or be able to have one they like – is a key consideration in choosing a plan. But it can be challenging finding out which plans have the doctors you care about available in their networks by going to each of the insurers' doctor directories one at a time. So we combined them into an "All-Plan Doctor Directory" and when you see the list of available plans, you see which of your preferred doctors are in each plan.

QUALITY. All plans are not alike in the quality of care or service their members get, and the Marketplace gives little or no information on the quality of each plan. But we actually provide quality ratings. For all the plans, we initially display a simple overall quality score, and you can personalize the score based on the aspects of plan quality that are most important to you.

We believe that the Health Plan Comparison tool will save many consumers thousands of dollars and connect them to good care and service. It was a lot of work creating this website. We launched it two weeks ago, and did a demo for about 200 Navigators at a meeting set up by Get Covered Illinois. We want to reach out and help as many consumers as possible before March 31. Please take a look at www.HealthPlanRatings.org. Here is a sample plan-comparison page:

One more thing. We have been asked why we, based in Washington, DC, chose Illinois for our model plan comparison tool. There are various reasons, including the fact that it is a large, diverse state, with major urban and rural populations; has a lot of creative, consumer-oriented leaders; and has a substantial number of plans in the Marketplace. And okay, I admit it: we have some personal connections: My mom and dad were both born and raised in Illinois (Lexington and Lincoln); I graduated from the University of Chicago Law School; the director of our health plan ratings work got a Masters in opera (very different from what he has done for many years for us) from University of Illinois and sang sometimes in Chicago before spending eight years singing opera in Europe; and we publish one of our regional versions of Consumers' CHECKBOOK magazine in Chicago, with ratings or service firms, from auto repair shops to plumbers to doctors and veterinarians, and thus have reason for frequent trips to do Chicago TV appearances talking about our findings.

We really hope that you will tell everyone who might still be looking for insurance, or helping others look for insurance, in the Illinois Marketplace about this tool. And of course, we welcome any feedback. You can email me at rkrughoff@checkbook.org

– By Robert Krughoff, President, Consumers' CHECKBOOK

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CBO on ACA: Devil is in the Details

On Tuesday, while driving between meetings, my favorite talk radio host shared shocking details from a new report – Obamacare, or the Affordable Care Act, is going to result in a loss of 2 million jobs in the United States over the next 10 years. Well, I thought, it's going to be a long day.

Later I learned that this reporter was sharing details from the latest Budget and Economic Outlook Report from the Congressional Budget Office. The CBO is an independent agency tasked with providing fiscal analysis for Congress with the intent of informing the budget-making process. Periodically, they release these reports which provide a 10 year forecast demonstrating the economic impact of many policies. Since 2010, they have included analysis on the impact of the ACA.

Needless to say, I was anxious to dig into this nearly 200 page behemoth and figure out what was going on. What I read in this report turned out to be great news. The report does not say that the economy will lose 2 million jobs. It says that, by making it easier to access affordable, high quality health insurance, more than 2 million people can make the choice to leave their job and pursue their passions, spend time with their families, start businesses, or find better jobs.

For those of us that have been following and championing the ACA, this isn't actually new information. Last year, the Robert Wood Johnson Foundation released a report, entitled The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment, which estimated that we could see as many as 1.5 million entrepreneurial spirits leave their jobs to become their own boss in 2014 alone!

Both reports highlight the same important fact: Because of the promise made by the ACA, that we can all access good health care, people will have the freedom to do what they want without fear of medical emergency and financial ruin.

My father, sister, and brother-in-law are all self-employed. Even my grandmother owned a small craft shop for the better part of my 26 years. While they were all brave (and maybe a little stubborn) enough to pursue these passions before the ACA, it has not been without sacrifice. After my self-employed and uninsured father had emergency eye surgery in 1992, my family filed bankruptcy as a result of unpaid medical bills. If the ACA had been around then, things would have been much easier for us and my dad certainly would have avoided a lot of sleepless nights worrying about keeping his business or providing for my sister and I.

I was shocked when I heard that radio report, but – as always – the devil was in the details. Except the devil isn't really a devil at all. The bottom line is that the ACA presents a new opportunity: an opportunity for people like my dad, to become their own boss; for someone who has put in their years and saved their pennies to retire early; or for a new parent to work part time so they can spend more time watching their child learn and grow. The CBO report means that what happened in my family, and millions like us, doesn't have to happen anymore – and that is why I will continue to be a proud champion of the ACA.

– By Kathy Waligora

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Kathy Waligora is the Manager of Health Reform Initiatives at EverThrive Illinois (formerly the Illinois Maternal and Child Health Coalition).

See the 2013 ACA Self-Employment Infographic in PDF.

Does Your Cab Driver Have Health Insurance? Why Not Ask…

In his State of the Union address, President Obama called on us all to remember that citizenship “demands a sense of common purpose… an obligation to serve our communities.” He went on to challenge us on how we exercise the “spirit of citizenship.” Today I started my own personal journey towards a “spirit of citizenship” by actually engaging with people I encounter everyday on health insurance. On this cold day, I started with cab drivers.

In my brief experience I learned cab drivers are really confused about the ACA. One gentleman told me “Obamacare” wasn’t for him because he had a job, and that it was only for poor or sick people. Another driver said that he tried to get insurance last year, but that he had high blood pressure so no insurance company would take him. Yet another driver disclosed that when his wife broke her wrist in July he flew her all the way back to Turkey for surgery because he had no health insurance. A quick discussion (five minutes tops –including stop lights) with all three of these drivers cleared up their misperceptions. All three were surprised to learn they would be eligible for either a subsidy in the Marketplace or, in the case of the driver originally from Turkey, Medicaid expansion or County Care.

Fortunately, I was able to tell them about a new initiative of Enroll Chicago that is targeting cab drivers. Every Monday and Wednesday the city’s Department of Business Affairs and Consumer Protection has information booths with trained Get Covered Illinois navigators to help cab drivers enroll in health coverage.

Each day, more than 300 drivers come into the BACP office at 2350 W. Ogden Avenue to renew their licenses. They typically have to wait up to two hours to complete the license paperwork. Learning about health coverage options and enrolling in health insurance must be an excellent way to kill time – because in the first two days since program started, more than a hundred cab drivers talked to the navigators about health coverage. Think about how we could amplify that number if each of us were to talk to our cab drivers about health coverage!

Kudos to Enroll Chicago and the BACP for recognizing how they can exercise the “spirit of citizenship,”  making it easy for cab drivers to become informed and take action. I’m doing my part by sharing information about what Enroll Chicago and BACP are doing at 2350 W. Odgen.

How are you harnessing your “spirit of citizenship” when it comes to myth busting around the ACA? Let us know at info@illinoishealthmatters.org.

– By Barbara Otto, CEO, Health & Disability Advocates

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If you have a media inquiry about this campaign, please contact Brian Richardson at the Chicago Department of Public health, Enroll Chicago 312-747-9805, brian.richardson@cityofchicago.org.

Photo credit: yooperann via photopin, cc license.

ACA Success Story in Southern Illinois

Laura Olmsted, a Certified Application Counselor (CAC), from Shawnee Health Services, had the great pleasure of helping Bill*, a 53 year old from Marion, Illinois, understand what the Affordable Care Act is all about.

Bill is a hardworking self-employed contractor -- making $23,000/year -- who works independent construction jobs, and has not been able to afford health insurance. However, health insurance is something that Bill desperately requires. In the past year and a half, he has suffered not one, but three heart attacks and a broken femur. Mounting medical bills are causing him incredible financial burden, and preventing him from accessing care that he needs.

Luckily, Bill recently met Laura, who helped him to complete an application on Healthcare.gov once he went through the Get Covered Illinois screener. Bill received great news: not only was he eligible for insurance, but he had options, ranging from the low end of paying nothing for a Bronze level or lower end Silver plan, to only $180 per month for a high-end Silver plan after the premium tax credit was factored in.

Laura’s client considered his choices and selected a Silver Multi-State plan through Blue Cross Blue Shield of Illinois where he pays only pocket change - $4.53 per month - for his premium. The plan has a $250 deductible and an out of pocket max of only $2,000 per year. Bill plans to pay for the premiums up front since the price was so affordable.

Should Bill have looked into buying health insurance prior to the enactment of Obamacare (the Affordable Care Act), he would have encountered a very different situation:

• No certified enrollment specialist would have helped him find and understand his health insurance options;
• Unless he was connected with an insurance broker, Bill would have had to shop for plans on his own, rather than being able to compare them all in one place;
• No tax credits or subsidies would be available to help him afford his premium;
• Bill may have been denied coverage based upon pre-existing conditions; and
• If Bill did find coverage, prior to Oct. 1 of this year, he likely would have found a plan with higher premiums and without the requisite 10 essential health benefits like the qualified health plan that he recently purchased.

Because of his new options through the Illinois Health Insurance Marketplace, Bill will now be able to receive the health care necessary to get well, and continue living a healthy, productive life in Illinois.
 
(*Bill is a fictional name to protect the client's anonymity)