Update on SB 1194 (The Insurance Navigator Act)

Starting October 2013, an estimated 1.6 million Illinois residents will be eligible for new and affordable forms of public and private health insurance coverage under the Affordable Care Act. But the overwhelming majority of the newly eligible have no idea how to access these options. Many Illinoisans will need more information and guidance through the enrollment process.

The Affordable Care Act requires each state’s Health Insurance Marketplace to establish a Navigator Program that will guide these individuals through their new coverage and enrollment options. These Navigators will serve an important role in ensuring that individuals benefit from the ACA.

On January 30th, the potential efficacy of the Navigator program was threatened by the introduction of Illinois Senate Bill 1194, which would create overly restrictive criteria for organizations applying for and performing navigator functions.

Here are the issues with SB1194 (as it was introduced):

• SB1194 placed unnecessary restrictions on Illinois Navigators and In-Person Assistors, making it more difficult for low-income and hard-to-reach populations to connect to the application assistance that they need.  
• Illinois is currently preparing a Navigator training and oversight system that makes SB 1194 unnecessary. 
• Federal law already mandates some of what is outlined in SB1194, such as prohibiting Navigators from recommending specific insurance products. Once again, SB1194 is unnecessary.  
• Language in SB1194 prohibited Navigators from facilitating enrollment in a Federally Qualified Health Plan, (QHP), one of the five Navigator duties already specified by the ACA.

Consumer advocates and community based-providers recognized these issues, and successfully lobbied state Senators to make changes in the bill.

Here’s what changed:

• SB1194 now includes the Navigator duties as spelled out in the ACA.
• SB1194 now includes a certification, instead of a licensure, requirement.
• SB1194 excludes all prior language that restricted Navigator duties, (such as the ability to facilitate enrollment in a QHP).
• SB1194 is now in alignment with Federal regulations regarding the training and responsibilities of Navigators.
• SB1194 now allows for the training of Certified Application Counselors, (another type of Navigator not directly compensated by the Exchange), to be defined at a later date. This means that CAC training will align with federal guidelines.

What’s happening now?

These amendments were filed on April 22nd, passed in the Senate on the 24th, and were referred to the House Rules Committee earlier today. You can follow SB 1194’s status here.Thanks to all of the advocates for raising your voices against restricting the navigators in this new health care system.

Nadeen Israel
Policy Associate, Heartland Alliance for Human Needs & Human Rights

Please contact Nadeen at nisrael@heartlandalliance.org for more information on SB1194.

A New Year and New Medicaid Awaits Us

What an amazing and historic beginning to the start of 2013. This week an Illinois legislative body advanced a major piece of the Affordable Care Act (ACA), when the House Human Services Appropriation Committee passed HB 6253, Medicaid Financing for the Uninsured.

After the committee vote, the waning hours of the current term of the General Assembly did not provide enough time to advance the bill further. Nevertheless, our momentum continues with renewed commitment and excitement.

This effort brought together an unusual mixture of health care providers, business interests, patients and advocates, demonstrating as great a degree of consensus on an issue like this as you are likely ever to find. We know it is right and advantageous for Illinois to accept new federal Medicaid funding, fill a historic gap in the Medicaid program and provide health care coverage for hundreds of thousands of the lowest income uninsured Illinois residents.

The fight continues and we have laid the scaffolding for us to build upon as we enter the 98th General Assembly today. Illinois House and Senate members will file new Medicaid bills, and once the new General Assembly begins, your voices will need to be heard again with in-district meetings, emails and phone calls to your Senators and Representatives, many of whom will be new in office or serving from redrawn districts. It will be critical that these legislators hear from you.

Thank you for all you have done. And thank you, in advance, for all the help you will provide in helping to achieve federal Medicaid funding for the uninsured in Illinois.

Ramon Gardenhire
Director of Government Relations
AIDS Foundation of Chicago

Start Your Week Right! Contact Springfield Today.

 
Leveraging Federal Financing for the Uninsured (HB 6253) Reaches the Illinois House THIS WEEK!

This week (and possibly TODAY)  the Illinois House will consider HB 6253 House Amendment 1 (HA 1), a bill to leverage federal financing of the state’s Medicaid program in 2014 to cover the uninsured, made eligible by the Affordable Care Act (ACA).

In Illinois today, thousands of low-income adults without dependent children are not eligible for Medicaid. This major gap in healthcare coverage would be eliminated by HB 6253 under the ACA. This Medicaid option is expected to bring $4.6 billion additional federal dollars into the state of Illinois just in the first three years, making it a great fiscal deal for Illinois!

HB 6253 authorizes Illinois to take advantage of the ACA to provide Medicaid to about 342,000 low-income Illinois citizens who are currently uninsured. Because of the ACA, Illinois can offer Medicaid to this population at no expense to the state for the first three years, and in later years the state will never pay more than 10% of the cost of this coverage (with federal funds covering the remaining 90%). Learn more about HB 6253 HA1.

2 Ways to Take Action TODAY:

1. Tell your Illinois Representative to support HB 6253 today! Call the easy and toll-free ‘Illinois Affordable Health Care Hotline’ 1-888-616-3322 to be connected to your legislator. Need some talking points? Click here.  You can also look up your Illinois Representative’s contact information directly using this easy online tool!  Click here.
2. Submit an electronic witness slip in favor of the bill: You can click here to file an electronic witness slip today.  Click on the icon on the right of the Appropriations committee to find the listing for HB 6253. Once you find HB 6253, click on “Create Witness Slip.” You should check the “proponent” box for House Amendment #1 (HA #1) and the “Record of Appearance Only” box.

*The 'Illinois Affordable Health Care Hotline’ is a function of the AARP Hotline. Please, do not be alarmed by the AARP phone recording. This phone line is open to everyone.
*The original House bill number (HB 5019) has changed since the recording of the Hotline to HB 6253, and may change again! Please, do not be alarmed by the incorrect bill number. This phone line is still active to support 'Medicaid Financing for the Uninsured'.
Thank you!

Questions? Contact Stephani Becker (312.265.9072) or Stephanie Altman (312.265.9070) at HDA.

The State Budget Aftermath - What's Next?

On May 25, 2012, the Illinois legislature voted to pass Senate Bill 2840, which will make drastic cuts to the state’s Medicaid program, in order to help close a $2.7 billion deficit. The news has been confusing, but the bottom line is that many of the programs which provide necessary health coverage to vulnerable populations of Illinoisans have been terminated or reduced, which will result in thousands of people losing health care coverage.

While those cuts are devastating, we remind ourselves that there are over 2 million people covered by Medicaid in Illinois—many of them covered through important expansions including the 100% Campaign, All Kids, Health Benefits with Disabilities, and FamilyCare. These coverage expansions largely remain intact and protected. We are heartened by the fact that our advocacy efforts, along with our colleagues, also staved off worse proposed cuts including the loss of coverage for tens of thousands of undocumented children with no health care alternatives.

Along with Senate Bill 2840, several other bills were passed which also affect Illinois’ Medicaid program including:

• HB5007: Amends the December 2010 Medicaid reform law that placed a moratorium on Medicaid expansions until 2013. This amendment extends that moratorium for two more years, until January 25, 2015. However, the bill also creates an exception for expansions that are federally approved and funded solely by federal and local government funds. This exemption was specifically designed to allow the Cook County 1115 waiver proposal (currently waiting for approval from CMS) to move forward, which would expand Medicaid to 250,000 low income, currently uninsured Cook County residents.
• SB 2194: Limits the number of unpaid Medicaid bills that can be rolled over from one year to the next, capping the dollar amount at $700 million in FY 2013. SB 2194, HA 3 sets more substantial definitions of charity care, so that hospitals will know what services they can provide to meet that definition, and thus retain tax exempt status 
• SB 3261 HA 2: Sets standards for eligibility for free care at non-profit hospitals

Moving forward toward the implementation of health care reform in 2014, Health & Disability Advocates will continue working to ameliorate the effect of these cuts by counseling individuals on their coverage options and training providers to build their capacity to help their patients access alternative coverage. There is not a solution to every cut but, in many instances, there are alternative programs to get necessary health care coverage to our populations.

We think it is important that while we all continue to fight against these cuts, we must immediately spring into action to help individuals transition to other coverage if at all possible.

For example, the elimination of the Illinois Cares Rx program is expected to affect over 100,000 low income older adults and people with disabilities who use the program to help them pay the premiums, deductibles, and cost-sharing of the Medicare Part program. If you or your clients have Illinois Cares Rx stories to share, please have them submit them to a special Facebook page here.

We have scheduled a webinar for June 15th to train providers how to ensure that their clients and patients use past medical bills to meet Medicaid spenddown, thus making them eligible for the federal Extra Help program which will cover all cost-sharing. We expect that tens of thousands of Illinois Cares Rx recipients could become eligible for Extra Help under this strategy.

We will continue to advocate as well as to move forward by counseling individuals, training providers and providing technical assistance to our partners to ensure that we maximize health care coverage and access in every way possible.

Stephanie Altman
Programs & Policy Director
Health & Disability Advocates

Choose Wisely, Illinois: Alternatives for Balancing the Medicaid Budget

On Thursday, April 19, 2012, the Governor released a proposal for the reduction of the current $2.7 billion Medicaid budget deficit. The proposal, developed with a group of legislators on the Medicaid Commission, includes $2 billion in cuts to eligibility levels, benefits, and payment rates to providers, and a $1 per pack increase in the cigarette tax. Some of the Governor’s most concerning proposals include eliminating the Illinois Cares Rx program, reducing eligibility for FamilyCare, eliminating the General Assistance Medical Program, eliminating the adult dental program, and requiring a co-pay from vulnerable populations utilizing federally qualified community health centers.

Many of these cuts will not be “fixed” by the implementation of the Affordable Care Act in 2014. For example, Illinois Cares Rx covers costs not covered under Medicare or the ACA such as premiums, deductibles, lower co-pays, and medications not covered in the Medicare formulary. The biggest misconception is that the ACA will fill the Medicare “donut hole.” It gradually reduces costs in the donut hole over the next 8 years but never completely eliminates that cost-sharing as Illinois Cares Rx does.

Other cuts may be “repaired” by the implementation of health care reform, such as coverage for low income parents, but at what cost? How much preventative care will be missed in the next 18 months which will cost the state more in expensive emergency or acute care after January 1, 2014?

Medicaid is a vital source of health care for many Illinoisans. Although the Medicaid program must become more efficient to safeguard taxpayer dollars, there are other alternatives to the proposed cuts. Solutions such as cutting prescription drug coverage, eligibility, or optional services are unacceptable and will drive up long-term state costs. The General Assembly and Governor have underfunded Medicaid for 20 years and the cuts do not need to all happen immediately; a multi-year solution is needed to balance the program budget. Furthermore, short term solutions, such as cutting prescription drug coverage, eligibility or optional services are unacceptable, and will only drive up long-term state costs. It is important for Illinois legislators to keep in mind that transformative Medicaid reforms currently being implemented and require time to work, and that The Medicaid budget cannot be balanced with Medicaid cuts alone. New revenue and savings from legislative changes in other budget areas must be applied to Medicaid.

Some of the proposed alternatives are:

Medicaid system Delivery reforms: Reforms such as the Care Coordination Innovations Project, Integrated Care Program, and other projects to better manage the care of some of the highest-need Medicaid patients need time to be implemented to see the full scope of savings and improved health outcomes.

Changes for Nursing Home and IMDs: Nursing homes and Institutions for Mental Disorders (IMDs) have excess capacity, resulting in thousands of empty beds across the state. Reducing the number of licensed beds could save Medicaid money. Refocusing efforts on community-based services, rather than institutional placement, would also reduce costs, and in some cases, qualify for more Federal funding. Also, Illinois could implement the nursing home bed tax, already approved by the federal government, which has not yet been implemented because the nursing home industry has not agreed on a formula to redistribute funds.

Stop paying for medically unnecessary, elective C-sections: C-sections are significantly more costly, require a longer recovery time for both the mother and often the infant, and can lead to complications due to premature birth. Nearly half of all C-sections in the U.S. are medically unnecessary, and it is estimated that Illinois’ Medicaid program spent between $54M and $76M on medically unnecessary C-sections in 2009.

For more information, see the Responsible Budget Coalition's fact sheet on alternatives to the cuts here.

Stephanie Altman
Program and Policy Director
Health & Disability Advocates

Moving Forward: Current Waivers for Coordinated Care Projects in Illinois

“Care Coordination,” along with related terms like “managed care” and “medical home” have become the buzz words of health care reform. The terms refer to new types of health care delivery models that many states and programs are turning to as the key to reforming the costly and arguably inefficient health care system.  Currently, the health care system mostly operates as a “fee-for-service” model, which critics argue incentivizes overutilization of medical services and shifts the focus away from effective preventative care, leading to excessive costs. Organizing groups of health care providers around patients, with a greater level of communication between doctors and a greater focus on care that keeps patients from getting ill could streamline health care delivery in a way that lowers costs and improving quality of care (for a more in-depth look at coordinated and managed care, go here or here).

In recent years, federal health programs, like CMS, have started to investigate the potential of care coordination via demonstration projects, grants and waivers for states or health care providers willing to participate. The Affordable Care Act also encourages exploration of these new care delivery models. In 2011, Illinois passed Public Act 096-1501, also known as Medicaid Reform, and began the Illinois Innovations project. As a part of that reform, the state is currently utilizing these waivers and grants:

The Integrated Care Program (ICP) is a 5-year pilot program that transfers all Medicaid (but not Medicare) eligible adults in Suburban Cook County to a Managed Care organization (MCOs). The 40,000 people included in the program, have two MCOs to choose from, one Aetna Better Health and IlliniCare Health Plan, Inc. The program is currently in Phase I, which focused on medical care. Phase II will focus on long-term care (set to begin September 2012), excluding long term care for those with developmental disabilities, which will be the focus of Phase III (no current implementation date).

Coordinated Care Entities (CCE) is a project intended to help Illinois enroll 50% of Medicaid clients into coordinated care projects (as called for by Public Act 096-1501). The CCEs are looking to cover at least 500 enrollees in a Health Home, FFS, Shared Savings or Bundled Payment model of care delivery. Illinois decided to release a request for proposals to medical care providers, in order to test the interest and capacity of community health organizations to offer coordinated care to patients, instead of simply enrolling Medicaid clients into Health Maintenance Organizations (HMOs). In January, Illinois released requests for proposals for Health Homes for chronically ill adults. Awards are expected to be announced by May 2012. HFS plans to release requests for proposals for CCEs to target children with complex medical needs by June 2012.

The proposed Cook County 1115 Waiver, currently pending with CMS, seeks to cover up to 200,000 uninsured patients who will become eligible for Medicaid once Affordable Care Act Medicaid Expansion takes place in 2014.

The Dual Eligibles program targets those who are eligible for both Medicaid and Medicare. The program would integrate the care that dual eligibles receive into one Managed Care Program. The proposal was open to a 30-day public comment period that closed in late March, and will be sent to CMS for approval.

Under the We Choose Health Community Transformations grant, the Center for Disease control has given the Illinois Department of Public Health $4,781,121 to serve the state of Illinois, excluding large counties. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. This grant will dovetail with Illinois’ State Health Improvement Plan (SHIP), a prevention-focused, comprehensive approach to improving the health of Illinois residents.

The State has proposed changes and possible mergers of the Home and Community Based Waiver programs including the DORS Home Services Program and the Community Care Program. The major proposal affecting the HCBS waivers is a proposed change from a Determination of Need (DON) threshold of 29 to 37 in order to obtain services. DORS has also proposed reducing the Service Cost Maximums in the HSP program to the levels in the CCP program.

What’s Next for Health Care Policy in Illinois?

The past two weeks were a non-stop affair for health care policy—the ACA saw its 2nd anniversary right before the Supreme court heard oral arguments for the historic case against the law, and here at IHM we premiered our data visualization tool. However, health care reform news has not stopped. Here’s a brief overview of what the next few months have in store for health care in Illinois:

Health Insurance Exchange: State legislators made little progress towards votes on the establishment of a competitive health care marketplace, though negotiations on HB 4141 are underway. Legislators still have time to establish an exchange, but the Federal deadlines are looming closer, and to miss deadlines could cause Illinois to lose out on important Federal grant money. If the group waits to move forward with the exchange until the Supreme Court announces its decision on the ACA case -- a prospect that interests some legislators -- , there may not be enough time to set up a functioning exchange. Governor Quinn has said that he would establish the exchange via an executive order if necessary.

Potential Cuts to Medicaid: The Illinois Medicaid program faces a $2.7 billion deficit in the coming fiscal year. In order to deal with that budget, the Department of Healthcare and Family Services has proposed a list of possible cuts to Medicaid services in order to balance the budget. As legislators go into the upcoming spring sessions, many advocates are calling for other methods of fixing the Medicaid budget deficit that do not compromise important health care services that the program provides.

The Illinois General Assembly starts its April sessions on the 17th.. Follow the progress of these health policy issues with IHM!

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 8^th, 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.

Making the Grade: A Scorecard for State Health Insurance Exchanges

According to the Illinois Department of Insurance, health insurance premiums have risen on average 181 percent since 2005. This could be the week action is taken in Illinois to fix our health insurance marketplace for Illinois families and small businesses.

Lawmakers are expected to consider legislation that would create an Illinois health insurance exchange that, if designed right, would help increase choices and lower costs for Illinoisans purchasing health insurance.

There’s no need to start from scratch though. Many states have already taken action to create health exchanges to deliver better value for consumers, and Illinois should follow their lead.

In fact, a report recently released by Illinois PIRG, "Making the Grade: A Scorecard for State Health Insurance Exchanges," closely examines the 12 states that have already created exchanges and rates them according to how accountable they will be to consumers and the public, how much they can do to lower premiums and improve the quality of care, how friendly they will be to consumers, and how stable they will be.

Not all exchanges are created equal.  That’s why it’s important to evaluate the policies that will matter most to consumers, including whether the exchange will be protected from insurance industry influence, and if it will negotiate with insurers for better rates.

Among the important policies to consider to make an Illinois exchange consumer-friendly include:

• Giving it the power to leverage enrollee’s buying power to negotiate with insurers for higher-value, more affordable coverage. 
• Barring insurers and other industry representatives from serving on the exchange board, so it will be more accountable to the public and to consumers.
• Making sure consumers will have an easier time shopping for coverage through easy-to-use tools and comparisons between plans.

For the sake of our pocketbooks, let’s hope Illinois lawmakers do their homework and ensure that our exchange makes the grade.

Brian Imus, Director
Illinois PIRG

Making Progress Toward a Health Insurance Exchange in Illinois

Last week was an important one for Illinois consumers and small businesses as lawmakers inched closer to establishing a state-run Health Insurance Exchange.  

Why is this important? As Timothy Jost, exchange expert writes in a Commonwealth Fund blog: “The health insurance exchange is the centerpiece of the private insurance reforms in the Affordable Care Act (ACA). If the exchanges function as planned, they will expand coverage to more Americans, reduce insurance costs, and improve the quality of coverage and perhaps of health care itself.”  However, if designed poorly, “experts warn, healthy people could avoid the exchanges, leaving them to sicker people with rising premiums."

First, some background:

On July 14, 2011, Senate bill 1555 was passed and signed by Governor Quinn, which created the Illinois Legislative Health Insurance Exchange Study Committee to aid in going forward with the establishment of a health insurance exchange (also known as the competitive insurance marketplace) in Illinois. The legislative study committee held five meetings, and commissioned two reports, one from Deloitte Consulting on the current state of healthcare in Illinois, and the second from HMA/Wakely Consulting Group, on the possible options and directions the exchange could take. On September 27, 2011, the Committee released a draft report of their findings from the five meetings and the two consultant reports. Although no definite decisions were made in the report, it is still the most substantive picture of the Illinois exchange to date.

Response to the Report:

Most of the report focused on the possibilities that Illinois must consider and decisions that must be made regarding the type of governance and the financing of the exchange. Many organizations weighed in with written comments in response to the report. Below are some of the issues and concerns that have been raised over the policy options outlined in the report:

·         The HMA/Wakely report listed two options for the operating model of the exchange: either as a “market organizer” or “market developer.” The market organizer approach means that the exchange would simply certify any health insurance plan that met the requirements for the exchange, relying on the competition of the marketplace to keep the cost of insurance down. The market developer style would have the exchange taking a more active approach to use their leveraging power in order to get the best possible value of plans from insurance agencies. Much support has been shown for the market developer option, aligning the exchange model with the interests of consumers for quality, affordable insurance.

·         Out of the three options presented for the governmental structure of the exchange, the overwhelming majority of opinions expressed have been in favor of a “quasi-governmental” model, as opposed to the “state-run” and “non-profit” models. The quasi-governmental model would keep the exchange in connection with other state-run agencies that it may need to coordinate with and promote a high level of transparency and accountability, while remaining a higher level of political neutrality.

·         The membership of the exchange governing board is one of the hot button topics in the report. The report underscores that members of the board should be well versed in the domain of health care, but should not have conflicts of interest, specifically noting that insurers, agents/brokers, HMOs, Prepaid Service Providers and other individuals with an interest in the Exchange should not be voting members of the board, though they could be members of an advisory committee. Some groups are advocating for a list of constituencies that must be represented on the board (for example, more representative of minority populations who are over-represented among the uninsured), while others think that a list of that nature would cause more problems for the board than it would solve.  Another major concern is whether or not legislators should be allowed on the board. Many groups have expressed their disapproval of legislators holding seats on the board – so that the exchange could be truly independent, non-partisan, and non-political — although some see their presence as non-voting members as a possibility. 

·         To finance the exchange, there are many options on the table, including charging consumers a fee to access the exchange, assessments on health plans offered in the new marketplace, assessments on all Illinois health insurance companies, the use of state general revenue, levying a fee on all health care stakeholders in the state (a list that could include prescription drug and medical supply companies, providers, hospitals, etc.), or assessing a progressive surtax on the revenues of all insurance providers. Many advocacy groups are against the idea of a fee to consumers, as the exchange targets those who are currently uninsured, who typically tend to have lower incomes, and could be put off or prevented from using the exchange if there is a fee. However, there are doubts that a funding option like the insurance revenue surtax would be approved. Some groups have stated that the best option might be for the enacting legislation to leave open the description of funding, so as to allow for multiple sources. 

Stay tuned! The final report will be issued this week and we’ll let you know if there are any changes.

It’s Finally Happening

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

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

Don't let the insurance industry undermine reform: Tell our state leaders to stand strong for Illinois consumers.

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

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

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

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

Click here to make sure state officials hear from you.

Brian Imus
Illinois PIRG State Director

Illinois Starts Work On Health Care Reform

Looking forward to seeing her son one evening, Maurine Magliocco of Springfield got a call saying he had fallen ill and wasn’t going to come. He was debating going to the emergency room. Even though Peter Magliocco, a 28-year-old, had his own insurance, he didn’t think he could afford the trip.

As a concerned mother, Magliocco says she insisted that he go anyway, even if it meant she would cover the cost of the emergency room tests and procedures out-of-pocket.

“It made me realize … we could end up using all of our retirement savings taking care of our kids.”

Magliocco’s dilemma is common, yet there are alternatives on the way under the federal government’s health care insurance reforms. Josephine Underwood is Health Care Justice Campaign downstate organizing coordinator at Illinois Campaign for Better Healthcare (CBHC), the state’s largest grassroots health care coalition. She says individuals like Magliocco will be able to pick from insurance options with more opportunities for preventive care, which can offset the need for emergency care, and/or extended insurance coverage from parents who can have young adults up to age 26 stay on their plan.

Under the Patient Protection and Affordable Care Act, (ACA) each state can create and regulate its own health reform, or it can allow the federal government to run it, according to Kate Gross, assistant director for health planning at Illinois Department of Insurance.

“In these tough economic times, people want to make smart choices, they want to protect their family or protect their small business, but they don’t know how to do that right now because the market is very unhelpful for consumers,” Gross says.

Recently approved Illinois legislation sets up a 12-member legislative study committee to recommend a structure for the Illinois Health Benefits Exchange, which is essentially a competitive health care marketplace. The committee will look into issues like operation, structure and amount of power of the exchange, such as how independent it will be from state government, Gross says. The study committee must submit its report to the Illinois General Assembly and to the governor by Sept. 30.

In order for Illinois to receive full funding from the federal government through 2014, the exchange must be approved by law by June 2012, Gross says. Although partial funding is available, she says full funding is “absolutely critical.” The exchange will be set up online for consumers to compare insurance coverage plans on a website similar in structure to travel websites like Expedia or Travelocity.

Underwood says the tight deadlines are cause for concern, especially if those appointed to the committee take advice from special interest groups instead of from consumers.

“It’s not that the insurance industry shouldn’t be heard… but we really believe that it’s the consumer voice that should be at the foreground,” she says.

To encourage the consumer voice, CBHC held forums with citizens and organizations last year, compiling a list of principles that consumers want to see within the exchange. More forums will take place this summer, in an effort to educate consumers, including those who are frustrated or apathetic about health reform.

“If we were to have a concern, it’s not necessarily to mobilize or to get consumer voices heard, it’s more dealing with that sense of political exhaustion and political hopelessness,” she says.

Magliocco, vice president of the retirees chapter at University Professionals of Illinois, became a CBHC volunteer after sharing her own story. She says consumers don’t need to understand legislative policy to get involved.

“What they don’t realize is that what they need to do is just to tell their stories and the stories of the people that they know,” she says.

Hannah Douglas
Originally published in The Illinois Times
Contact Hannah Douglas at hdouglas@illinoistimes.com

For an example of another state’s health exchange that’s already implemented, visit Massachusetts’ exchange site: www.mahealthconnector.org.