Governor Pat Quinn recently announced that the benchmark plan for Illinois’ Essential Health Benefits (EHB) package will be chosen by September 30, in order to meet the Federal deadline for selecting a plan. A public meeting on Wednesday, September 12th, will provide the public and other stakeholders an opportunity to weigh in on this crucial piece of the health care law’s implementation in Illinois.
The EHB package defines the baseline of services covered by health insurance plans offered to individuals and small businesses in the state.
Last December, The Department of Health and Human Services released a bulletin with guidelines for states to select their own EHB plans. The guidelines feature 10 different categories of benefits that each plan must cover, such as “emergency services,” “rehabilitative and habilitative services,” “prescription drugs,” and “mental health and substance abuse services.”
States must select a health insurance plan that is currently operating within the state to act as the EHB benchmark, with the largest small group market plan in the state acting as the default benchmark if the state fails to meet the September 30 deadline. If the selected plan does not provide adequate coverage of one of the ten benefits categories, that category will be supplemented with a coverage package from a different potential plan.
Once selected, the EHB will define the level of care that individual and small group insurance plans must offer in Illinois. Benchmark plans can specify the scope or duration of benefits, but they cannot place dollar limits on copays or deductibles, as well as lifetime annual dollar limits on coverage. Plans offered to consumers in health insurance exchanges will be required to meet the level of coverage ensured by the EHB package. However, insurance companies will have the opportunity to make substitutions within the ten categories of benefits, as long as those substitutions are not found to reduce the value of coverage offered.
The Illinois Health Care Reform Implementation Council will be hosting a meeting on Wednesday, September 12, 2012, where the public and other stakeholders will be able to make comments on the state’s EHB selection. The committee will continue to accept comments until September 19. Comments can be submitted through the Governor’s health reform website.
Check back soon for an update on the EHB selection process following Wednesday’s meeting!
Showing posts with label Gov Quinn. Show all posts
Showing posts with label Gov Quinn. Show all posts
Tuesday, 11 September 2012
Monday, 9 July 2012
Let’s Make Sure the Affordable Care Act Lives Up to Its Name
Low-income workers received a potentially devastating blow when the US Supreme Court decided to strike down the provision in the Affordable Care Act (ACA) penalizing states that do not expand access to Medicaid to families earning up to 133% of the poverty line. Unless states voluntarily expand Medicaid, many low-income workers will be left to shoulder the cost of mandated insurance on their own because few are likely to be covered through their employer.
According to the administrative rules for the ACA, employers (with 50 or more employees) have to pay a “shared responsibility fee” only when they neglect to cover full-time employees. Under this new law, full-time employees are defined as those who average 30 or more hours per week, and employers are granted ample leeway in defining the time period on which eligibility is based. Research I’ve conducted in several industries indicates that work hours in today’s hourly jobs are often scarce, with many workers expressing a preference for additional hours of work for additional pay. Because employers condition access to benefits on job status and hours worked, hourly workers, especially part-time workers, are often excluded from company-sponsored health insurance. The ACA is unlikely to do much to extend employer-sponsored coverage to hourly workers and may even heighten their risk of poverty given the incentive to employers to keep work hours below 30 a week.
Let’s make sure the Affordable Care Act lives up to its name by encouraging Governor Quinn and our legislators to voluntarily expand Medicaid. Because the federal government will pick up over 90% of the tab for the expansion, it makes good fiscal sense for both Illinois taxpayers and Illinois families.
Susan Lambert
Associate Professor
School of Social Service Administration
University of Chicago
(Portions of this letter were published in the Chicago Tribune, July 6 Voice of the People here)
According to the administrative rules for the ACA, employers (with 50 or more employees) have to pay a “shared responsibility fee” only when they neglect to cover full-time employees. Under this new law, full-time employees are defined as those who average 30 or more hours per week, and employers are granted ample leeway in defining the time period on which eligibility is based. Research I’ve conducted in several industries indicates that work hours in today’s hourly jobs are often scarce, with many workers expressing a preference for additional hours of work for additional pay. Because employers condition access to benefits on job status and hours worked, hourly workers, especially part-time workers, are often excluded from company-sponsored health insurance. The ACA is unlikely to do much to extend employer-sponsored coverage to hourly workers and may even heighten their risk of poverty given the incentive to employers to keep work hours below 30 a week.
Let’s make sure the Affordable Care Act lives up to its name by encouraging Governor Quinn and our legislators to voluntarily expand Medicaid. Because the federal government will pick up over 90% of the tab for the expansion, it makes good fiscal sense for both Illinois taxpayers and Illinois families.
Susan Lambert
Associate Professor
School of Social Service Administration
University of Chicago
(Portions of this letter were published in the Chicago Tribune, July 6 Voice of the People here)
Thursday, 21 June 2012
How Quinn can save the day on health care
There is plenty of confusion and debate about the Affordable Care Act. One element of the 900-plus-page legislation is crystal clear, however: Each state must establish an insurance exchange or the federal government will step in to fill the void.
The insurance exchange is the cornerstone of the ACA. It is an online marketplace for consumers to shop for insurance just as they shop for an airline flight. Those who qualify for federal health care subsidies will be able to use them only to purchase plans offered on the exchange. This will attract relatively healthy individuals and help drive down premiums for everyone shopping there.
When the spring legislative session adjourned recently in a welter of debate over pension funding, the possibility of bipartisan design of the Illinois' exchange vanished. Reasoning that part or all of the ACA could be stricken down by the Supreme Court this month, our legislators decided to delay action. But they're taking a grave risk: If the exchange-related parts of the ACA survive, Illinois will need to provide a detailed blueprint of an exchange by November. We have been awarded $38 million toward exchange planning. There's just one glitch—our legislators haven't authorized the establishment of an exchange.
If Illinois is to have any chance of a state-designed exchange, Gov. Pat Quinn immediately must issue an executive order to establish one.
The authority operating the exchange (an entity our state should design) would ensure that only plans providing the full range of benefits required by the ACA participate. A state exchange could take a more active role, limiting participation, for example, to the lowest-cost and highest-quality plans.
The broker industry is rightly concerned that exchanges will put them out of business, just like Orbitz and Expedia decimated the travel agent industry. Once the insurance market becomes transparent, individuals and small groups will need the services of brokers less and less, and insurers will not be willing to pay their high commissions. Cutting brokers out of the equation should reduce premiums by 5 to 7 percent—no small feat given how hard it is to cut health care costs.
We have $38 million in hand, and more funding is available if we apply by the end of the month. Illinois will be responsible for financing the exchange regardless of whether we operate and design it ourselves. Should we not seize the opportunity to use these funds to craft something that suits our circumstances and tastes?
The Legislature has effectively cut itself out of the picture. The question now is: Will the governor move in time to protect the public interest?
Leemore S. Dafny
Associate Professor of Management and Strategy
Kellogg School of Management, Northwestern University
(Original article posted here at Crain's Chicago Business, June 21, 2012)
The insurance exchange is the cornerstone of the ACA. It is an online marketplace for consumers to shop for insurance just as they shop for an airline flight. Those who qualify for federal health care subsidies will be able to use them only to purchase plans offered on the exchange. This will attract relatively healthy individuals and help drive down premiums for everyone shopping there.
When the spring legislative session adjourned recently in a welter of debate over pension funding, the possibility of bipartisan design of the Illinois' exchange vanished. Reasoning that part or all of the ACA could be stricken down by the Supreme Court this month, our legislators decided to delay action. But they're taking a grave risk: If the exchange-related parts of the ACA survive, Illinois will need to provide a detailed blueprint of an exchange by November. We have been awarded $38 million toward exchange planning. There's just one glitch—our legislators haven't authorized the establishment of an exchange.
If Illinois is to have any chance of a state-designed exchange, Gov. Pat Quinn immediately must issue an executive order to establish one.
The authority operating the exchange (an entity our state should design) would ensure that only plans providing the full range of benefits required by the ACA participate. A state exchange could take a more active role, limiting participation, for example, to the lowest-cost and highest-quality plans.
The broker industry is rightly concerned that exchanges will put them out of business, just like Orbitz and Expedia decimated the travel agent industry. Once the insurance market becomes transparent, individuals and small groups will need the services of brokers less and less, and insurers will not be willing to pay their high commissions. Cutting brokers out of the equation should reduce premiums by 5 to 7 percent—no small feat given how hard it is to cut health care costs.
We have $38 million in hand, and more funding is available if we apply by the end of the month. Illinois will be responsible for financing the exchange regardless of whether we operate and design it ourselves. Should we not seize the opportunity to use these funds to craft something that suits our circumstances and tastes?
The Legislature has effectively cut itself out of the picture. The question now is: Will the governor move in time to protect the public interest?
Leemore S. Dafny
Associate Professor of Management and Strategy
Kellogg School of Management, Northwestern University
(Original article posted here at Crain's Chicago Business, June 21, 2012)
Thursday, 24 May 2012
Strengthen Home Care
Recently, legislators made the prudent decision to pass the Budgeting for Results law, holding Illinois accountable to fund only programs with proven effectiveness. Budgeting for Results lays out the state’s commitment to home and community-based care, including through Medicaid programs.
The development of Illinois home-care system has been a challenging venture over the past several decades; and yet the home-care system is hardly prepared for the aging of the baby boom generation. The proposed cuts to home-care programs through Medicaid budget proposals contradict the call to responsibility outlined in Budgeting for Results.
Proposals include increasing the eligibility threshold for Medicaid community-living waivers. However, our recent research for a report reveals that community-living waiver cuts will result in an increase in utilization of hospitals, emergency rooms and nursing facilities — more costly options than home care.
We call upon our legislators to strengthen, not weaken, their commitment to community living for Illinois’ most vulnerable citizens.
Kristen Pavle,
Associate Director, Center for Long-Term Care Reform
(originally posted as a Letter to the Editor here in the 5/23/12 Chicago Sun Times)
Thursday, 17 May 2012
Medicaid plan would shake up the way hospitals are paid
A draft copy of Medicaid reform legislation closely resembles a proposal that Gov. Pat Quinn made last month. However, it appears that it would reform the way some medical providers are paid and potentially avoid immediate cuts to their rates.
The plan would transition hospitals to a payment plan known as an All Patient Refined Diagnosis Related Groups (APR-DRG) system, according to a draft version of the amendment obtained by Illinois Issues. The legislation covers more than 400 pages.
Quinn’s office did not respond to questions about the draft amendment.
APR-DRGs were created by 3M Health Information Systems for the Center for Medicaid and Medicare Services. “The design and development of the [Diagnosis Related Groups (DRGs)] began in the late '60s at Yale University,” said an overview of DRGs from 3M. “The initial motivation for developing the DRGs was to create an effective framework for monitoring the quality of care and the utilization of services in a hospital setting. The first large-scale application of the DRGs was in the late '70s in the state of New Jersey. The New Jersey State Department of Health used DRGs as the basis of a prospective payment system in which hospitals were reimbursed a fixed DRG specific amount for each patient treated.” The system takes into consideration the complexity of the health issues facing patients that hospitals are treating.
Starting in October 2012,The Department of Health and Family Services would determine the reimbursement rates for inpatient services at hospitals under the APR-DRG payment plan, but Hospitals would still get paid current rates. DHFS would work with the Illinois Hospital Association and a "hospital technical advisory group" on a path to transitioning to the APR-DRG rates by the end of Fiscal Year 2014.
Danny Chun, vice president of corporate communications and marketing for the Illinois Hospital Association, would not comment on specifics of the amendment but said rate cuts to medical providers should be a “last resort.” “There are other options and alternatives that we have been talking to everybody about over the past weeks and months that we think can generate substantial savings and revenues,” Chun said.
Quinn’s original plan would have cut provider reimbursement rates by $675 million. Quinn also proposed a $1-a-pack cigarette tax increase to protect the program and providers from deeper cuts. Such a tax increase would likely be moved in separate legislation.
The draft amendment calls for savings in areas that Quinn outlined in his original proposal. Under the plan:
Sen. Dale Righter, a member of a legislative working group charged with finding Medicaid savings, said he had not seen the amendment. He said he expects Quinn to file his plan by the end of the week. Righter said the rates paid to Medicaid providers have been a pivotal part of negotiations. “I know there is still a lot of talk going on about [provider reimbursements], and I think we’re going to learn a lot more in the next couple of days,” he said.
That's not to say, however, that provider rate cuts would not be a part of the final legislation. Another possibility being considered would spare so-called safety net hospitals — which take a high rate of Medicaid patients and are often in underserved communities — from rate cuts while other hospitals would have to bite the bullet on reductions. Those close to negotiations say the overall plan is still a work in progress and that Quinn’s final proposal would likely see changes from the amendment that is currently circulating.
Righter, a Republican from Mattoon, said it is unlikely that the working group will present competing legislation. “I don’t think it will shake out that way. There will be competing ideas out there, but I don’t think you’re going to see a governor’s bill and a working group’s bill, I don’t think it will break out like that.”
By Jamey Dunn and Ashley Griffin
Illinois Issues Blog - The official blog of Illinois Issues magazine, published by the Center for State Policy and Leadership at the University of Illinois Springfield
(Originally posted here on 5/16/12)
The plan would transition hospitals to a payment plan known as an All Patient Refined Diagnosis Related Groups (APR-DRG) system, according to a draft version of the amendment obtained by Illinois Issues. The legislation covers more than 400 pages.
Quinn’s office did not respond to questions about the draft amendment.
APR-DRGs were created by 3M Health Information Systems for the Center for Medicaid and Medicare Services. “The design and development of the [Diagnosis Related Groups (DRGs)] began in the late '60s at Yale University,” said an overview of DRGs from 3M. “The initial motivation for developing the DRGs was to create an effective framework for monitoring the quality of care and the utilization of services in a hospital setting. The first large-scale application of the DRGs was in the late '70s in the state of New Jersey. The New Jersey State Department of Health used DRGs as the basis of a prospective payment system in which hospitals were reimbursed a fixed DRG specific amount for each patient treated.” The system takes into consideration the complexity of the health issues facing patients that hospitals are treating.
Starting in October 2012,The Department of Health and Family Services would determine the reimbursement rates for inpatient services at hospitals under the APR-DRG payment plan, but Hospitals would still get paid current rates. DHFS would work with the Illinois Hospital Association and a "hospital technical advisory group" on a path to transitioning to the APR-DRG rates by the end of Fiscal Year 2014.
Danny Chun, vice president of corporate communications and marketing for the Illinois Hospital Association, would not comment on specifics of the amendment but said rate cuts to medical providers should be a “last resort.” “There are other options and alternatives that we have been talking to everybody about over the past weeks and months that we think can generate substantial savings and revenues,” Chun said.
Quinn’s original plan would have cut provider reimbursement rates by $675 million. Quinn also proposed a $1-a-pack cigarette tax increase to protect the program and providers from deeper cuts. Such a tax increase would likely be moved in separate legislation.
The draft amendment calls for savings in areas that Quinn outlined in his original proposal. Under the plan:
- The Department of Healthcare and Family Services would no longer be required to provide adult dental care or eyeglasses. This does not mean that it would necessarily eliminate eyeglasses. It could also offer to scale back the program by offering replacements less often.
- Illinois Cares RX, a program that provides prescription drug health to seniors, would be eliminated.
- All patients would be limited to four prescriptions a month. Three of them could be brand name drugs. Patients would pay a $2 copay for generic drugs. They currently have no copay for generics.
- Coverage for group therapy in nursing homes, adult chiropractic care and in patient detox programs would be eliminated.
- Repairs to or replacement of medical equipment, such as wheelchairs and prosthetic devices, would require prior approval from DHFS. The proposal also contains provisions targeting fraud and calls for the state to contract with a vendor to help DHFS verify the eligibility of Medicaid patients.
Sen. Dale Righter, a member of a legislative working group charged with finding Medicaid savings, said he had not seen the amendment. He said he expects Quinn to file his plan by the end of the week. Righter said the rates paid to Medicaid providers have been a pivotal part of negotiations. “I know there is still a lot of talk going on about [provider reimbursements], and I think we’re going to learn a lot more in the next couple of days,” he said.
That's not to say, however, that provider rate cuts would not be a part of the final legislation. Another possibility being considered would spare so-called safety net hospitals — which take a high rate of Medicaid patients and are often in underserved communities — from rate cuts while other hospitals would have to bite the bullet on reductions. Those close to negotiations say the overall plan is still a work in progress and that Quinn’s final proposal would likely see changes from the amendment that is currently circulating.
Righter, a Republican from Mattoon, said it is unlikely that the working group will present competing legislation. “I don’t think it will shake out that way. There will be competing ideas out there, but I don’t think you’re going to see a governor’s bill and a working group’s bill, I don’t think it will break out like that.”
By Jamey Dunn and Ashley Griffin
Illinois Issues Blog - The official blog of Illinois Issues magazine, published by the Center for State Policy and Leadership at the University of Illinois Springfield
(Originally posted here on 5/16/12)
Monday, 30 April 2012
The Affordable Care Act: Dollars Flowing into Illinois
There’s no debating that Illinois could use some healthcare help. The state is ranked the 29th healthiest state—not the absolute bottom, but nowhere near the top. A recent poll also listed Illinois as the 31st most obese state and 25th for diabetes—not exactly stellar statistics. The same source noted that ,while Illinoisans benefit from high usage of early prenatal care and a comparative availability of primary care doctors, the state faces severe challenges, including prevalent binge drinking, high pollution levels, and a high rate of preventable hospitalizations.
These problems are not insurmountable. However, we all know the state is in a budget crisis. Governor Quinn has announced a plan to drastically reduce spending and raise revenues for Medicaid. We understand the state budget crisis, but obviously, people in Illinois need medical services, and the state is currently struggling to provide them.
Luckily, the Affordable Care Act is there to throw a lifeline out to health service providers and state agencies and especially to the real people who need healthcare. Thanks to the ACA, the states will spend about $90 billion less on healthcare with the implementation of the law than they would have spent without it. Thousands of people will still be getting the increased services mandated by the Act, but much of the funding will be federal rather than state.
It’s important to note that these benefits are not in the distant future; Illinoisans from birth to retirement are already benefiting from the Affordable Care Act.
Assistance from the ACA starts when kids are young; the ACA has already provided:
The ACA is also spending money putting people to work at improving healthcare! Illinois has received:
And the ACA helps elderly Illinoisans, too!
So far, Illinois has received $170.7 million in grants due to the Affordable Care Act. These grants are creating tangible improvements to the physical and fiscal health of our state. Thanks, Affordable Care Act!
These problems are not insurmountable. However, we all know the state is in a budget crisis. Governor Quinn has announced a plan to drastically reduce spending and raise revenues for Medicaid. We understand the state budget crisis, but obviously, people in Illinois need medical services, and the state is currently struggling to provide them.
Luckily, the Affordable Care Act is there to throw a lifeline out to health service providers and state agencies and especially to the real people who need healthcare. Thanks to the ACA, the states will spend about $90 billion less on healthcare with the implementation of the law than they would have spent without it. Thousands of people will still be getting the increased services mandated by the Act, but much of the funding will be federal rather than state.
It’s important to note that these benefits are not in the distant future; Illinoisans from birth to retirement are already benefiting from the Affordable Care Act.
Assistance from the ACA starts when kids are young; the ACA has already provided:
- $10.3 million for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals into individual homes to connect families to the services they need to raise happy and healthy kids. These services include prenatal care, pediatric care, education, and parenting skills.
- $191,000 for Family-to-Family Health Information Centers, organizations run by and for families with children with special health care needs.
- $4.9 million for expanding and improving school-based health centers. Illinois funds 38 school-based clinics that provide screenings, physicals, exams, and more to students.
- $555,000 to support the Personal Responsibility Education Program, which educates youth on abstinence and contraception to prevent teen pregnancy and sexually transmitted infections, including HIV/AIDS.
The ACA is also spending money putting people to work at improving healthcare! Illinois has received:
- $400,000 to support the National Health Service Corps, by assisting Illinois in repaying educational loans of health care professionals in return for their practice in health professional shortage areas. This program is designed to help medical, dental, and mental health providers who choose to work in needy communities to repay their student loans. This is a particularly critical program because these professionals provide medical and dental care that individuals desperately need; the program allows professionals to provide care to needy individuals without worrying about their reimbursement rates or their ability to pay back debt.
- $5.1 million for health professions workforce demonstration projects. This program is designed to supplement the workforce in areas that are either already short-staffed or expected to be in the future. The Illinois Workforce Investment Board’s report noted shortages of both registered nurses and licensed practical nurses in Illinois.
And the ACA helps elderly Illinoisans, too!
- $457,000 to support Aging and Disability Resource Centers (ADRCs). ADRCs help seniors and people with disabilities understand long-term care options including community care.
So far, Illinois has received $170.7 million in grants due to the Affordable Care Act. These grants are creating tangible improvements to the physical and fiscal health of our state. Thanks, Affordable Care Act!
This article, written by Caitlin Padula, was originally posted on The Sargent Shriver National Center on Poverty Law's blog, The Shriver Brief.
Thursday, 1 March 2012
Using Technology to Connect in New Ways in Illinois
According to the Pew Internet & American Life Project, 85% of all Americans 18 years and older own a cell phone; of these users, nearly a quarter (72%) of them “text”. A July 2011 report shows that nearly one-third of all adults are “smart phone” users.
Given that these statistics are only likely to increase as technology becomes more advanced and allows us to get information in even smaller and more portable devices, it’s important to consider how technology help in efforts to share important and relevant information, as well as connect individuals with services that fit their needs.
For the past two years, Text4baby, the first ever FREE mobile health service, has been using cell phones to share health tips with pregnant women and new moms. Moms sign up by texting BABY to 511411 (or BEBE to 511411 to receive messages in Spanish) to receive helpful messages that are timed to their due date or baby’s first birthday. These messages include reminders about check-ups, immunizations, oral health, and tips for good nutrition.
We here at the Illinois Maternal and Child Health Coalition serve as the statewide coordinator and have been working with health departments, community clinics, doctors’ offices, as well as local businesses to promote text4baby. To date, 
we’ve helped enroll nearly 13,000 users into text4baby and have made FREE outreach materials available for order from our website. We’ve heard firsthand from text4baby users about how direct and simple the messages are and how helpful they can be, especially for first-time parents.
we’ve helped enroll nearly 13,000 users into text4baby and have made FREE outreach materials available for order from our website. We’ve heard firsthand from text4baby users about how direct and simple the messages are and how helpful they can be, especially for first-time parents.Of the many useful messages provided by text4baby, several of them provide users with information about how they can get no-cost or low-cost health insurance for their children by providing them with the toll-free hotline 1-877-KIDS-NOW (1-877-543-7669).
Parents who call the 1-877-KIDS-NOW number in Illinois will be connected with the All Kids program, which provides affordable health insurance to children who live in Illinois and meet income requirements. Parents can request an All Kids paper application to be sent to their address or they can fill out the online application.
Nearly 1.7 million children in Illinois benefit from the All Kids program, which covers doctor visits, prescription drugs, hospital and emergency services, dental and vision care, and more. Some parents may qualify for FamilyCare coverage for themselves and pregnant women may be able to get benefits from the Moms & Babies program.
Even if text4baby or the All Kids or other health insurance programs may not be something that you need, consider sharing these resources on your Facebook page or sending out a Tweet to your followers about the benefits of these programs. With your help, we can ensure that more women, children, and their families have the best opportunity to lead healthy and productive lives.
This post, by Kathy Chan of the Illinois Maternal and Child Health Coalition, was originally posted on the MomsRising,org blog, here.
Friday, 4 November 2011
Latest Developments in the implementation of an Illinois Health Benefits Exchange: Senate Bill 1313
Back in the spring, the Illinois General Assembly passed a bill enacting the intent to create a health benefits exchange, a state-wide marketplace called for by the federal Affordable Care Act that will act as a tool to aid consumers to shop for insurance. The exchange has the potential to create a competitive and regulated environment that will keep health insurance costs at reasonable levels, and thus more available to individuals and small businesses, while also making the process of shopping for insurance more straightforward and manageable. In order for the health benefits exchange to operate this way, it is important that the exchange is created with the needs and protection of consumers and small businesses in mind. Earlier this fall, the study committee on the exchange released a report on their findings. This past week, during the Illinois General Assembly Fall veto session, steps were taken to establish the exchange. State Representative Mautino introduced his amendment (House Amendment 2) to SB 1313, a bill which dictates the makeup of the health benefits exchange governing board.
Decisions that have been made in SB1313, House Amendment 2:
The composition of the health exchange governing board has been outlined in the amendment to SB 1313 in a way that supports a board that is likely to take interest in consumers and small businesses. The board, as outlined in the amendment, will be made of 9 members:
· 2 from the Attorney General’s office
· 1 small business owner
· 1 employee of a small business
· 1 consumer representative
· 1 community-based health care provider who primarily serves individuals under 200% of poverty
· 1 health actuary or economist
· 1 member of organized labor
· 1 individual who qualifies for Medicaid
None of the seats on the board will go to legislators, brokers, or insurers. There are also pieces in the amendment that support the creation of a racially and geographically diverse board, as well as clauses that protect against board members who have conflicts of interest in the governing of an exchange board.
Decisions not made in SB 1313:
The amendment puts the board in charge of deciding how the exchange will be financed. There are many options outlined in the amendment, some that support the interest of the consumer, such as a fee levied on insurance companies, and some that are less supportive, such as a fee to users of the exchange.
What will happen next:
Now that the bill has been filed, it needs to be approved. On November 8th, the House Insurance Committee will be holding a hearing to discuss SB 1313. The Committee has 11 Democrats and 9 GOP members. In order for the bill to pass the House, it will need to get support from 71 votes, opposed to the normal 60, due to rules of the veto session. If you want to see a health benefits exchange that supports the interests of individuals and small businesses, call your state representative and tell them to vote Yes on SB1313.
Wednesday, 28 September 2011
Policy to the People - Illinois Policymakers Weigh In about ACA Implementation in Illinois
Health care reform in Illinois may originate from the federal law, the Affordable Care Act, but it is up to each state to implement many pieces of the law. For that reason, we made Illinois' implementation of health care reform the focus of our latest multimedia Neighborhood Stories series. The video, Policy to the People (by Jay Dunn) is the third in our series, and is accompanied by an article, Making Health the Best Policy (by Jeff Steele).
As health reform policies take shape in Illinois, it is important to make sure they benefit the citizens of the state. In the video, Senator Donne E. Trotter (IL -17th District) explains what he sees as necessary to keep policy geared towards the people, specifically those who are currently uninsured or underinsured. He advocates a “three pronged attack,” that involves policymakers, medical care providers and the citizens and health care consumers themselves, in the establishment of reform. “What we’re looking at,” Sen. Trotter explains, “is not as much what this law is going to do for people like myself, but for the future of America. We’re going to have a healthier society.”
The accompanying article, Making Health the Best Policy, explains the steps that Illinois policymakers have taken since 2010 to establish health care reforms right here in the Prairie State. Those who back the Affordable Care Act are attempting to impart positive messages, to counter the law's opponents working daily to ensure its provisions never go into effect.
We spoke to key policymakers in the Governor's Office, the Department of Health & Family Services (HFS) and the Illinois General Assembly about their vision of how reform will impact west and south siders' ability to gain insurance. Under the new health care law, HFS Director Julie Hamos says: “We believe there will be one million more people who will have access to private health insurance through the exchange, or public insurance through Medicaid...These are people who have not had a doctor, or a health checkup, in many years.” Michael Gelder, Governor Quinn's senior health policy advisor and Chair of the Illinois Health Care Reform Implementation Council says, “People on the west and south sides should see this as an opportunity to get health insurance. They should also see it as an opportunity to make their elected representatives, both federal and state, hear that they’re enthusiastic about [reform], and that they expect us to deliver on that.”
Check out these two great new pieces, as well as the other articles and videos in the Neighborhood Stories section of the Illinois Health Matters website, or on our new high quality Vimeo channel here. Stay tuned for the next installment where we look at how the Affordable Care Act is impacting local community organizations.
As health reform policies take shape in Illinois, it is important to make sure they benefit the citizens of the state. In the video, Senator Donne E. Trotter (IL -17th District) explains what he sees as necessary to keep policy geared towards the people, specifically those who are currently uninsured or underinsured. He advocates a “three pronged attack,” that involves policymakers, medical care providers and the citizens and health care consumers themselves, in the establishment of reform. “What we’re looking at,” Sen. Trotter explains, “is not as much what this law is going to do for people like myself, but for the future of America. We’re going to have a healthier society.”
The accompanying article, Making Health the Best Policy, explains the steps that Illinois policymakers have taken since 2010 to establish health care reforms right here in the Prairie State. Those who back the Affordable Care Act are attempting to impart positive messages, to counter the law's opponents working daily to ensure its provisions never go into effect.
We spoke to key policymakers in the Governor's Office, the Department of Health & Family Services (HFS) and the Illinois General Assembly about their vision of how reform will impact west and south siders' ability to gain insurance. Under the new health care law, HFS Director Julie Hamos says: “We believe there will be one million more people who will have access to private health insurance through the exchange, or public insurance through Medicaid...These are people who have not had a doctor, or a health checkup, in many years.” Michael Gelder, Governor Quinn's senior health policy advisor and Chair of the Illinois Health Care Reform Implementation Council says, “People on the west and south sides should see this as an opportunity to get health insurance. They should also see it as an opportunity to make their elected representatives, both federal and state, hear that they’re enthusiastic about [reform], and that they expect us to deliver on that.”
Check out these two great new pieces, as well as the other articles and videos in the Neighborhood Stories section of the Illinois Health Matters website, or on our new high quality Vimeo channel here. Stay tuned for the next installment where we look at how the Affordable Care Act is impacting local community organizations.
Friday, 11 February 2011
Top Ten Things You Should Know About lllinois Health Care Reform
On February 7, 2011, Governor Quinn's Illinois Health Care Reform Implementation Council held a public hearing to release its initial recommendations on the implementation of the Affordable Care Act in Illinois. The recommendations, which include issues that the state must address immediately and decisions that will be made after the Council gathers more information from stakeholders and the federal government, were offered to the public to review and comment; however, the recommendations will be fine-tuned before final recommendations are presented to the Governor.
The report is a fairly short 19 pages and easy to read, but if you want the "Cliffs notes" version, here are the top 10 main take-aways from the meeting:
Stephanie Altman
Health & Disability Advocates
The report is a fairly short 19 pages and easy to read, but if you want the "Cliffs notes" version, here are the top 10 main take-aways from the meeting:
- The Council recommends that Illinois (rather than the federal government) create a state based Health Benefits Exchange, which is the centralized marketplace that in 2014 will provide individuals and small businesses with access to more affordable, comprehensive health insurance coverage options.
- The Council recommends that the Exchange should be run by a quasi-governmental entity led by an appointed board of directors. This administrative structure is similar to the Illinois Comprehensive Health Insurance Plan Board and the Office of Health Information Technology.
- The Council does not recommend a preferred way to finance the administration of the Exchange at this time although it specifies that funding should not come from the state general revenue funds. The Council is still considering an assessment on insurance companies, providers and others who will benefit from broader health insurance coverage, as possibilities for revenue sources.
- The best current estimate of the number of uninsured in Illinois is about 1.5 million. Of these, the Council estimates that in 2014, between 500,000-800,000 people will be added to Medicaid, between 200,000 and 300,000 people will purchase subsidized coverage through the Exchange and between 300,000-600,000 people will remain uninsured. Another 1 million Illinoisans who are currently insured will get private insurance through the Exchange, much of it with some subsidy. Unlike in the past, Medicaid and private insurance will be merged into one centralized marketplace.
- The Council recommends that the state continue to engage employers, consumers and insurers, because successful implementation of the Exchange will necessitate a strong outreach and education component, including working with community-based Navigators and insurance brokers.
- The Council recommends that the state take all available avenues to review and control rate increases in the insurance premium market as soon as possible. Additional information can be found on the Illinois Department of Insurance website.
- The Council recommends convening a Healthcare Workforce work group to develop an aggressive, comprehensive plan to professional and paraprofessional healthcare and public health worker shortages statewide, now and in the future.
- The Illinois Health Information Exchange (HIE) strategic and operational plan was approved by the federal government in December 2010. It focuses on the adoption and meaningful use of electronic health records; ensuring that providers who wish to begin exchanging health information electronically in 2011 can do so; developing an all payer claims database and other priorities which can be found here.
- The Council recommends waiting for further guidance from HHS before deciding whether to require benefits beyond the “essential benefits” defined by HHS.
- The Council does not recommend early implementation of Medicaid expansion in Illinois (i.e., beginning to enroll people under 133% FPL before 2014) but remains open to considering changing the moratorium on new expansions if a financially advantageous opportunity for the State arises.
Stephanie Altman
Health & Disability Advocates
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