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?

No doubt, case managers, doctors, social workers, and community organizations hear this question all the time. When the system of health care is changing so rapidly, how are front-line professionals prepared to handle the number of questions and the confusion when they may not have a grasp on what this new system is going to look like in the first place?

Almost everyone who has Medicaid in Illinois will be required to pick a coordinated care plan. These plans are offered by managed care organizations (such as Aetna and Blue Cross) and by provider groups (such as Be Well Partners in Health) that have chosen to start innovations projects, which try new ways of managing care. Collectively, they are referred to as managed care entities, but for the sake of discussion, we will refer to them here as Medicaid health plans.

Medicaid health plans must include all of the benefits traditionally offered by Medicaid, a plan can also choose to provide more benefits than Medicaid. In addition, all plans require that members choose a primary care physician. Members with more complex care needs will also be assigned a case manager, either a nurse or social worker.

Why the Change

This shift is happening because 50% of Medicaid recipients are required by law to enter into coordinated care by 2015. But aside from the legal requirement, the move into coordinated care has a number of additional drivers, including cost containment. Medicaid costs are high, often a result of inefficiencies, uncoordinated care, and a fee-for-service reimbursement structure. The hope is that the move to coordinated care will reduce costs.

As part of the move to coordinated care, the payment structure is changing. Many, but not all, Medicaid health plans will receive a capitated rate to coordinate and provide care for Medicaid members, meaning a per-member monthly reimbursement regardless of the services provided. Providers will then contract with Medicaid health plans and can negotiate their rates of reimbursement. So, Medicaid health plans receive a capitated rate, providers then negotiate reimbursement rates with the particular Medicaid health plan. Medicaid health plans are thus incentivized to control costs, because they are going to make money based upon members receiving quality care at a lower cost, rather than based upon the number of services provided.

What will all of this mean for Medicaid recipients? Each Medicaid member will receive a letter detailing health plan options available through Medicaid (many have already received them) from the Illinois Department of Healthcare and Family Services. Most will have to choose one of the plan options detailed in that letter. If they fail to choose a plan, a selection will be made for them based on their past providers, location, and previous health plan affiliation.

The choices in the letter will be based upon the Medicaid population group and where that particular member lives. For example, ACA adults have different options than Medicaid enrollees that qualified based upon disability or age; people who live in metro Chicago will choose from a different set of plans from those who live downstate. As members of these plans, there will be new rules to follow, such as using networks specific to their plan. But the plans are all Medicaid, so all of the services an individual previously had access to will remain available. And this is when the provider gets asked for help. How do they help someone choose?

The Client Enrollment Broker

Fortunately, the Illinois Department of Healthcare and Family Services has created something called the client enrollment broker. This is service that helps Medicaid members get connected to a Medicaid health plan. The client enrollment broker website (enrollhfs.illinois.gov) is where one can find information on all of the available plans, including any extra benefits that might be available, such as an allowance for over the counter products. The site has links to the website of each specific plan, where consumers can review the details of each plan.

Of course, not everyone is tech savvy, or even has internet access. So the client enrollment broker is also available to assist with enrollment by phone. The client enrollment broker can be reached at 877-912-8880 Monday to Friday from 8 am to 7 pm and on Saturdays 9 am to 3 pm. The call is free.

Before speaking with the client enrollment broker, Medicaid members will want to focus on the questions to ask. They may want to write them down – much like people are advised to write down what they want to ask the doctor during an office visit. Here are some things they will need to consider when choosing a Medicaid coordinated care plan, and to discuss with the client enrollment broker if they call:

• The letter received in the mail will have a primary care provider listed. That is the provider that will be assigned to them if they do not choose a primary care provider and plan themselves. If the person has a primary care physician at present, it will be important to ask about plans with this provider in network. Otherwise, they may want to choose one before calling the client enrollment broker.
• Anyone with special healthcare needs should ask if their specialists are in-network.
• Anyone who uses medical care centers like skilled nursing facilities or hospitals should ask whether those facilities are in-network.
• The person also should consider what medications they are taking. Although Medicaid-covered drugs should be included in the formulary for every plan, there could be variations in copays or in generics vs. brand-name availability.

The client enrollment broker will ask for a social security number and the Medicaid member should have that available for the call.

This is a lot to consider, and the Medicaid population was not prepared to make these decisions alone. For someone who has never enrolled in a health plan before, or has only ever had one choice, these changes may prove overwhelming.

Provider Participation Is Essential

So it is not surprising that providers will be called upon to assist clients in making smart choices. Without provider participation, individuals may not be able to make appropriate and educated enrollment decisions that directly impact access to and continuity of care. And just as important, providers can do their best to simplify these decisions by joining networks and being knowledgeable about their own health plan network membership. Even after members are enrolled, providers can help them navigate the new and narrower networks to avoid the costs of going out of network for care.

If one thing is clear it's that providers need to be engaged in the evolution of Medicaid. Without their involvement, foreign language speakers will not find providers that can speak to them, people with complex illness will not connect with physicians and specialists who have experience with those conditions, and patients with long-established doctor-patient relationships will suddenly be unable to see their doctor. Provider participation and networking is the solution to all of these issues.

But ultimately, providers need to be participating in the coordinated care system for reasons that go above and beyond making health plan choices easier for people on Medicaid. Right now, the entire Medicaid system – both traditional and expanded Medicaid – is rapidly transforming into a coordinated care system. That means that many clients or patients will be in that system, and they will be restricted to those networks. To keep their Medicaid patients, providers need to be in that system as well.

Another benefit is that billing can be simplified with Medicaid health plans. Back office billing functions – which are notoriously complicated and slow with fee-for-service Medicaid – could start to become more straightforward. In fact, Medicaid health plans should actually reimburse efficiently since they are contractually obligated to pay in a timely manner. Wouldn’t that be nice?

Care coordination is here and it is happening now. It’s time to participate. Providers can either play a part, or patients will feel the consequences. And really, so will providers.


Emily Gelber, MSW, LSW
Health Policy Analyst
Health & Disability Advocates

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Learn more about Medicaid Care Coordination.

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.

By way of example, on HelpHub, the Illinois site that provides technical assistance to enrollment specialists, we have heard many stories about people who are beginning to obtain insurance after being told for years that they are were “uninsurable.” Families USA estimates that 64.8 million non-elderly Americans—or 1 in 4 people—have been diagnosed with pre-existing conditions that could have led to denials of coverage in the past. That’s over 5.6 million people in Illinois alone who can no longer be turned down or charged more for health insurance.

Though over half of the public know about this “gift” from the ACA, according to a January 2014 Kaiser Family Foundation tracking poll, 53% of the uninsured remain unaware of this provision. We need to continue to publicize this incredible benefit of the law.

2. Financial Help to Obtain Insurance

Aside from pre-existing condition exclusions, another major barrier to accessing health insurance has been cost. Since employers have not been required to offer coverage, many low-wage workers never received an offer of coverage and were priced out of the individual insurance market.

Through the new Health Insurance Marketplaces, the ACA created three new ways to make health insurance more affordable. The first is premium tax credits, which can be taken by Marketplace consumers in advance to lower the amount of premium the individual or family must pay for their coverage. Consumers with incomes under $45,960 for a single individual and $94,200 for a family of four are eligible for these credits. The Department of Health and Human Services reports, for example, that nearly 5 in 10 uninsured single young adults eligible for the Marketplace could pay $50 or less per month after tax credits for coverage in 2014.

The second form of financial help provided by the ACA is cost-sharing reductions. These reduce the out-of-pocket costs, such as deductibles, copays, and co-insurance, that health care consumers can expect. Cost sharing reductions are available to health insurance Marketplace consumers who make between 100% and 250% of the federal poverty level who purchase a Silver plan. Why does this matter? It means lower prices for doctors’ visits, prescription drugs, and other care that people need—which is particularly important for people who utilize a high amount of services.

Recent enrollment numbers indicate that people are signing up for these subsidies, too. As of February 2014, 85% of Healthcare.gov enrollees qualified for premium tax credits, while 67% consumers chose Silver plans, indicating that they may also qualify for cost sharing reductions.

3. Medicaid Expansion

The ACA mandated a Medicaid expansion to all qualified adults below 138% of the federal poverty level (about $15,800/year for a single individual); this mandate filled a huge coverage gap in Medicaid eligibility for low-income adults. In June 2012, however, the United States Supreme Court made this expansion optional, and currently just half the states and Washington, D.C., have expanded Medicaid. Illinois is one of those states; last July, Governor Quinn signed the Medicaid Expansion (SB 26) into law, and according to reports at the recent Illinois Health Reform Implementation Council meeting enrollment into Medicaid has already exceeded expectations.

The number of Illinois residents enrolled in ACA Adult Medicaid is now at 200,000. This includes all Supplemental Nutrition Assistance Program (SNAP) auto-enrollment and enrollment in CountyCare, the early expansion of Medicaid in Cook County, the largest county in Illinois )which includes Chicago and some of its collar suburbs). Of pending applications, the state expects another 150,000 will be eligible for ACA Adult Medicaid. Overall for 2014, it is anticipated that Illinois will enroll over 400,000 adults into the new Medicaid program. 

Together, the Premium Tax Credits, Cost Sharing Reductions and the ACA Medicaid Expansion provide low-income families with the gift of affordable health care. 

4. Essential Health Benefits

The ACA gift that people probably know the least about is the 10 Essential Health Benefits (EHB) that must be included in Medicaid and health plans in the individual and small group markets. Under EHB, not only must plans now include a range of free preventive services and screenings, but also prescription drugs, lab tests, dental and vision care for children, and mental health and substance use disorder services, among other critical services. The Essential Health Benefits package ensures comprehensive services are included in your policy so you aren’t left paying premiums for shoddy coverage.

These gifts have already started to make a huge difference to the American people. The uninsured rate is decreasing; and stories from around the country are streaming in about people who are able to see a doctor when they hadn’t for years, families who are able to afford their premiums every month, and individuals who finally have peace of mind because they have a good health insurance policy when they need it.

We can’t wait to see what the next four years of the ACA brings.

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:

First, I like helping people. Prior to starting the training for this job, the only thing I knew about the Affordable Care Act was that it would help people like my Mother get cheaper healthcare. My Mom had a heart attack a few years ago and since then, her health insurance premiums went through the roof. And by roof, I mean they were more than a mortgage payment on a 3 bedroom house!! Yikes! That seemed crazy to me. So, I wanted to do this job to help people like my Mother and clients like Kathy. Kathy* is a small business owner and has a pre-existing condition. Her business has been quite profitable in the past, but since 2008, things have been rough. Due to the high costs of health insurance, especially with her pre-existing condition, she could not afford to pay her rent and eat if she purchased a health plan. So, she hasn’t had health insurance for years. She has been going without her medication and has just been hoping that her condition has not progressed. We met and completed an application together and found out that she is eligible for a tax credit and reduced out of pocket expenses.  She is thrilled to be able to purchase a health insurance plan for $ 150 a month. These stories are my every day.

Second, I’m all about saving money. I love to shop for the best price for everything. I wait for sales, clip coupons and save my money for a rainy day. I get a little thrill out of helping someone save hundreds of dollars on their health insurance. It’s fun for me.

Third, I like to know the facts. This has been quite the topic of conversation. Almost everyone has an opinion. Over the years, it seems our news sources now always have a particular slant one direction or another. It is pretty difficult to find someone that will give you both sides to a problem or issue. So, my solution was to get boots on the ground and learn about the ACA myself and make my own decisions.

This job is not for the faint of heart. The reason that I have kept this job is that I am persistent and resilient. On a typical day, I get to see a formerly stressed, worried and confused individual walk out of my office with a little less weight on their shoulders, a little more money in their pocket and much more confident about their future. But getting there isn’t always easy. The rules to the Affordable Care Act are complex and each person’s situation is different, but that has been the fun part of being “The Obamacare Lady.” I meet so many interesting people and have a bird’s eye view of the diversity in our state. Illinoisans are beautiful, generous and hard-working.

Back in October, when the website wasn’t working very well, every person asked me if people were treating me okay. They were concerned that someone would take their anger and frustration out on me. Not a single person did. Then, people were concerned about all “those people” that might be taking advantage and defrauding the system. They wanted to make sure there were ways in place to catch the “cheaters.” After a while, all these questions made me laugh. No. Everyone I meet with is just like you. We want the same things. We want to provide things like health insurance for ourselves and our family. We are willing to sacrifice and work hard to do it. We want to obey the law. We want to be honest and tell our truth. We want to pay our own way and don’t want anything for free. Our politics and opinions on this Affordable Care Act are varied to be sure, but the similarities among us are so close. We are too hung up on headlines and sensationalism to see it.    

By Barb Silnes

In-Person Counselor

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)

An Illinois Navigator's Experience Finding Lower Premiums in the Marketplace

I decided I might as well enroll myself with a Qualified Health Plan on the Marketplace before I sat down as an In Person Counselor (with a client) so I tried for a few days right after Oct. 1.

Since the site was so slow, I decided to wait until some of the excitement wore off and tried again in mid-October. I sat down after dinner and put in an hour on the computer. I quickly verified my identity, similar to the online process for requesting your free credit report. I answered simple questions about what streets I have lived on, former cities I lived in, etc. They were all multiple choice questions, and I got them all right!

Then I was able to compare the plans for my county and sort them based on certain features: metal, HSA eligible, out-of-pocket costs, etc. At that point there are fewer plans to choose from and I checked off the "compare box" on three that I thought seemed to be a good fit. After looking at the plans, side by side I was able to click on a link with each that took me to the website for each plan so I could do a provider search. I entered my current doctor and to see if my doctor was in-network. This made it pretty easy for me to decide. The pages did load slowly so I folded laundry while they loaded.

Once I enrolled in health coverage, I had to decide to elect or not to elect to access dental. I went through the same process with the dental coverage, but did find that the links did not work for all the dental plans. I eventually decided on a plan and enrolled. Then I put the laundry away while it loaded and waited.

At the end, I got the page where it said my application was complete. I printed out the page along with my application ID# and am excited to let people know that my premiums are going down!

I self-pay for insurance now and will still do so in 2014. I currently pay just over $340 a month for health and dental. Starting in January, I will only pay $185.10 for health and dental. I make too much money for any tax subsidy, so even without assistance I am seeing a huge benefit. I still get to see the same doctor and dentist that I have had since I was a kid and really cannot complain too much. Buying insurance before privately took more time as I would have to research and deal with the insurance brokers and then the underwriters questioning of any of my possible health issues.

I look forward to helping my clients find affordable options on the Marketplace, too.

Joann Boblick
Certified In Person Counselor
La Grange, IL

Young Invincibles in Illinois

From Visualizing Health Reform,
Illinois Health Matters

Two months ago, Young Invincibles launched our Midwest Regional office here in Chicago. One of the main reasons why we chose to come to Illinois is that it has one of the highest numbers of uninsured young adults. In Cook County alone, over 158,000 19-35 year olds could be eligible for Medicaid and another 190,000 could be eligible for tax credits to make health insurance more affordable. Across the state, 286,000 19-35 year olds could receive Medicaid. Another 345,000 young adults in Illinois could receive tax credits.

Young Invincibles was founded around providing a voice for young adults in the Affordable Care Act (ACA) debate. Since then, we’ve worked hard to educate our generation about the benefits of the ACA, even as we expanded to work on other economic issues that affect young adults. As of October 1st, the launch of the health care marketplaces, we’ve been hard at work with Illinois Health Matters and many other organizations here in Illinois to spread information about the ACA to many uninsured young adults.

To help with that effort, we’re dispelling a few myths about young adults and health insurance that we’ve heard a lot.

Myth #1: Young adults choose not to get health care because they think they’re young and invincible.
This misconception is actually how Young Invincibles got its name! For the most part, our generation does not believe we are invincible, but instead have been shut out of buying insurance because it traditionally had been too expensive for many people. In fact, over 70% of young adults say that health insurance is very important to them. But, many young adults are just beginning their careers and may be working part-time jobs where they aren’t offered health coverage by their employer and can’t afford it on their own. With the ACA, that will change a lot. Now, a majority of uninsured young adults will be eligible for Medicaid or new tax credits to help reduce the cost of health insurance.

Myth #2: Young adults are young and healthy and won’t get sick or injured.
With more accessible health care, we will be able to take care of ourselves. While injuries can come at any time, like a broken finger playing softball or partially collapsed lung from falling on a speaker (both of which are true stories), it’s harder to predict when you’ll get hurt or sick. Coverage offers protections against those catastrophes. Moreover, many preventive services are now covered under the ACA, such as blood pressure tests, cholesterol screenings, HIV screenings, and many common immunizations. By taking advantage of these new, free benefits, you can prevent and treat diseases and conditions before they become a major issue, saving you money and improving your health.

Myth #3: Obamacare and the ACA are two different things. Obamacare is a type of insurance to be purchased.
Many people are still confused by the use of different names for the Affordable Care Act, such as Obamacare and the ACA. The Affordable Care Act, ACA, and Obamacare all refer to the same law.

There is also no government insurance takeover of private insurance. The only government insurance are programs like Medicare and Medicaid. If you buy a plan on the Health Insurance Marketplace, you will be purchasing private insurance, but with new protections and preventive care to ensure that you are buying a comprehensive plan that truly does cover your health care needs.

While these are just some of the common myths and misconceptions out there about the ACA, we still have a lot of work to do to get more information out to the people who need it. Check us out at health.younginvincibles.org to see what resources and information we have available. You can also vote in our video contest! Don’t forget to check us out on Twitter and Facebook, too!

Brian Burrell
Midwest Regional Manager
Young Invincibles

(Posted originally on the YI Blog)

Be Covered Illinois Care Fair a Huge Success

On Sunday, October 6th, Be Covered Illinois hosted a Care Fair with many of its partners on Chicago’s southwest side. It was a sight to see! The doors opened at 11:00am, but by 9:45, a line of people stretched outside the building waiting to get in. By the time the event ended at 5:00pm, 5,227 visitors had attended the event. Fifty-two registered In-Person Counselors representing 15 community organizations staffed the enrollment area, the largest gathering of certified navigators yet to be seen in the nation. A big ‘thank you’ and a shout-out to the following agencies for supporting the event with navigators:

• AIDS Foundation of Chicago
• Chicago Childcare Society
• Children’s Home and Aid
• Chinese American Service League
• El Hogar del Nino
• Health Leads USA
• Illinois African American Coalition for Prevention
• Instituto del Progreso Latino
• Lawndale Christian Development Corporation
• Metropolitan Family Services
• Pilsen Wellness Center
• Puerto Rican Cultural Center and Prime Care
• Sinai Community Institute
• The Resurrection Project
• United Way of Metropolitan Chicago

Despite the fact that the federal site – healthcare.gov – was still having difficulties, the resourceful navigators were able to engage attendees in conversations about the law and make hundreds of follow-up appointments with those seeking to enroll in health coverage on the Illinois Health Insurance Marketplace.

In addition to navigators, there were six groups serving as subject matter experts to help answer questions about the new health care law, and 36 organizations that provided information on the resources they provide for communities. The event was supported by almost 200 volunteers, as well as dedicated medical professionals that provided seven different medical screenings, including 527 flu and TDAP vaccines. As a thank you for attending the event, each family left with a bag of healthy groceries, 2,000 bags in all.

The day’s events were a testament to the fact that there is both interest in and the need to secure access to health insurance, and more importantly, health care services for the many people who until now had few healthcare options. With ACA, they will now have many more opportunities to secure access to coordinated, high quality healthcare when they need it.

The Be Covered Illinois Care Fair provided an important opportunity for community organizations to educate attendees about health reform and the health insurance marketplace and how the law can benefit them. People who came were genuinely hungry for knowledge. Knowledge is power, and that Sunday we empowered 5,227 people to have the information they need to gain new access to health care – care that they told us in no uncertain terms – was not only wanted, but desperately needed. As the day wound down, their personal stories and the smiles on their faces were all I needed to confirm that this Be Covered Illinois Care Fair was truly a success.

Words, however, cannot do justice to the positive spirit and collaboration that infused the Care Fair. To get a better sense of that, please take a look at the story that Sarah Schulte of ABC-7 News did on the news that evening.

If you wish to join us as a Be Covered partner organization, request resources or learn more about what we’re doing, please visit: www.becoveredillinois.org

Donna Gerber

Chair, Be Covered Illinois Campaign
Vice President, Community Investments
Blue Cross and Blue Shield of Illinois

How the Affordable Care Act Helps Immigrants

There are at least 40 million immigrants in the United States, accounting for about 13% of our country’s total population. The Affordable Care Act (ACA, also known as ObamaCare) helps immigrants by providing new and strengthening current health insurance coverage opportunities. Below are six important points about the ACA that all immigrants need to understand.

Lawfully present immigrants are eligible to purchase private health insurance plans in the health insurance marketplaces. Every state has made available to its residents access to a state or federal online marketplace where applicants will be provided a range of affordable private qualified health plans for them to enroll in. Essential health benefits, pre-existing conditions, and preventive care will all be covered under these qualified health plans. Open enrollment in these plans is from October 1, 2013, until March 31, 2014. Applicants must have enrolled in and purchased coverage by December 15, 2013, for coverage to start on its earliest date: January 1, 2014.

Lawfully present immigrants may qualify for federal financial help to lower the cost of their monthly premiums and cost-sharing (e.g., co-payments, deductible, co-insurance) to help them afford a private insurance plan through the Marketplaces. Lawfully present immigrants with household income between 100% and 400% of the federal poverty level (FPL) ($45,960 for an individual or $94,200 for a family of four) are eligible for premium tax credits and between 100% and 250% of the FPL ($28,725 for an individual and $58,875 for a family of four) are eligible for the cost-sharing reduction subsidies. The tax credit alone is estimated to provide $2,700 per family that purchases coverage on the Marketplace, reducing premium cost by an average of 32%. To qualify for this federal financial help, applicants cannot be offered affordable health insurance through their job or be eligible for Medicaid.

Most lawfully present immigrants who meet Medicaid program requirements, such as income and state residency, can enroll in Medicaid after they have been in the United States for 5 years or more. Some groups of lawfully present immigrants do not have to wait five years before they may enroll in Medicaid, including refugees, asylees, and pregnant women and children in some states. Immigrants will benefit greatly in states that choose to add the ACA’S new Medicaid eligibility category, which will expand that program to all adults under age 65 with household income of less than 138% of the FPL (about $15,800 for an individual and $32,500 for a family of four). In fact,more than half (52%) of uninsured Hispanics with incomes below this limit reside in states adding the new Medicaid eligibility category. Use of Medicaid does not affect one’s immigration status (public charge decision) unless the Medicaid use is for long-term care such as nursing home care.

Lawfully present immigrants with household incomes of less than 100% of the federal poverty level are also eligible for the private Marketplace coverage and can get help paying premiums and cost sharing if they are ineligible for Medicaid (either because they are not LPRs or because they are LPRs with less than five years of residency).

Undocumented immigrants may not buy health insurance through the Marketplaces, even at full cost. However, until this is remedied, undocumented immigrants need to know that
community health centers, strengthened by ACA funding, will still accept patients regardless of immigration status, emergency rooms will continue to treat undocumented immigrants for free or at very low cost, many hospitals have charity care obligations that essentially provide free care to low-income patients, regardless of immigration status, undocumented immigrants may purchase health coverage through an employer or a spouse’s employer, undocumented immigrants may purchase private health insurance off of the Marketplace, and some state-funded Medicaid programs are open to them regardless of immigration status.

Undocumented immigrants also need to understand that, if they have family members who are U.S. citizens or lawfully present, these family members are required to have health insurance under the law starting in 2014, or face a penalty at tax time, unless they qualify for some exemption. This means that undocumented parents who have lawfully present or U.S. citizen children must ensure that their children have health insurance (through a child-only private Marketplace plan or through Medicaid, for instance). It’s important to remember that only those individuals in a family who are applying for health insurance are required to provide citizenship and immigration status. So undocumented parents applying through the Marketplace for private or Medicaid coverage for their eligible family members will not be asked for a Social Security Number for themselves (only for the applicants).

There is no charge to individuals who receive in-person help in enrolling in Medicaid or Marketplace coverage. The ACA provides federal funding to train and certify in-person consumer assisters to walk individuals through all of their health insurance coverage options. You can find an in-person assister by going to your Marketplace’s website. These assisters cannot and will not charge individuals for this enrollment assistance, including answering questions post-enrollment. Lastly, enrollment information is not shared with immigration agencies for the purpose of enforcement.

Andrea Kovach
Sargent Shriver National Center on Poverty Law

(Reblog from the Shriver Brief)