Emergency Speak Out: Rally in Response to the U.S. Supreme Court’s Health Care Decision

The U.S. Supreme Court is expected to rule by Thursday of this week on whether two key provisions of the Affordable Care Act - the landmark health care law - are constitutional:

• The requirement for people to have health insurance as of 2014 and
• The expansion of Medicaid.

We can’t go backward on health care. Protections at risk include:

• Ensuring over 200,000 Illinoisans with pre-existing conditions can buy quality and affordable health insurance.
• Ensuring 102,000 youth under the age of 26 can stay on their parents’ insurance plan.
• Creating a Health Benefits Exchange so 1.2 million Illinoisans and small businesses can shop for quality and affordable health insurance in a transparent and competitive marketplace.

As we prepare for the Supreme Court decision on the Affordable Care Act, we need to keep mobilizing our base, getting stories to the media on the impact of the ACA, and continue pressuring our state and Federal elected officials. With that in mind, we are planning an Emergency Speak Out on the day of the decision.

When: The Day of the Decision, 5 PM (rain or shine)
(Decision can be any day in June: likely to be Thursday June 28)

Where: Daley Plaza, Chicago
(Located in Chicago on Washington Street, between Dearborn and Clark)

Regardless of the outcome, we will call upon Governor Quinn to move forward on health care reform, including the creation of the Health Benefits Exchange. We must speak out – We must win. For more information, contact me at info. below.

John Gaudette
Citizen Action - IL
(312) 427-2114 x208
john@citizenaction-il.org
Twitter: @citizenactionil

Small Business Health Care Consortium Touts Importance of ACA to Illinois Firms

The newly formed Small Business Health Care Consortium (SBHCC) announced today the results of recent Illinois polls regarding the small business provision of the Affordable Care Act and their call for Governor Quinn to establish an Illinois Insurance Exchange with key principle provisions by issuing an executive order.

The polls, conducted in conjunction with the Small Business Majority, found that:

• 63% of Illinois small business owners want to see the Affordable Care Act upheld, with minor or no changes. After learning more about the specifics of the law, support for keeping it as is or with minor changes rose to 68%.
• A 73% majority of small business owners say they would use or consider using the state exchange, and seven out of 10 Illinois small business owners support the state in applying for federal aid under the Affordable Care Act to set one up. 
• A majority of business owners say they’d be likely to purchase health care for their employees through a state exchange because it is the only place they can receive a tax credit beginning in 2014. 64% of those polled said qualifying for the tax credit would make them more likely to provide or continue offering coverage to employees.

(Links: IL ACA Poll Mini Report and ACA Wrapup poll)

Small businesses are the backbone of Illinois’s economy. In 2010, 203,600 businesses in Illinois had 25 or fewer workers, according to the Small Business Majority. The SBHCC, formed earlier this year, represents the voice of small business leaders throughout Illinois on health care reform.

Present SBHCC Steering Committee members include the Illinois Black Chamber of Commerce, Illinois Hispanic Chamber of Commerce, National Association of Women Business Owners – Chicago Chapter, McCormick Chamber of Commerce, Women’s Business Development Center, and small businesses including Old Mexico Restaurant (Rock Island), Gregg Florist (Peoria), Wirehead Technology (Chicago), Second Act Cancer Recovery Boutique (Chicago), MCCE Investments (Springfield), Linda Forman CPA PC (Evanston), and H.A King & Associates (Chicago.)

“Forming the Small Business Health Care Consortium to represent the diversity of small businesses throughout the state is overdue. I am working with the Small Business Health Care Consortium to ensure that all small businesses can afford health insurance,” said Howard Lee of Wire Technology in Chicago, a SBHCC steering committee member.

Another provision of the ACA is the development of a competitive healthcare marketplace, or insurance exchange, in each state. Small businesses want to support our employees and their families by being able to provide them with the quality, affordable healthcare they deserve, but the high costs make it difficult or impossible for many of us to do that. We need a strong marketplace to give us more control, quality choices, and better consumer protections when buying insurance - just like the big guys get.

Pattie Sheehan, Certified Mastectomy Fitter and sole proprietor of Second Act Mastectomy Boutique in Chicago, serves cancer patients and survivors. “Every day I see and hear from women who did not catch their cancer early because they did not have access to healthcare. Women who battle cancer also work at small businesses and that means that they are less likely to have health insurance coverage, just because their employer is small. It is time for the inequality of insurance access to be erased and for the needs of small businesses to be met so that our employees can afford good insurance. That is why I have joined the Steering Committee of the Small Business Health Care Consortium.”

Since 2010 under the ACA, companies with fewer than 25 employees and average employee wages of less than $50,000 can get tax credits for the health insurance they provide their employees. These tax breaks have already lightened the load on small businesses so we can get back to what we do best...creating jobs that will stay here in our communities.

“I am the owner of MCCE Investments and I also own several Subway stores in the Springfield area. The main reason I am spending time on this project, the Small Business Health Care Consortium, is to be sure small business has a voice in the process from the beginning. We have to be sure health care for all Americans is not done on the backs of small business but must be shared by all,” said Mark Burris.

“Contrary to political spin and popular belief, small business owners in Illinois do not want the U.S. Supreme Court to throw out the Affordable Care Act. Illinois small businesses see this law as helping everyone have coverage and bringing down healthcare costs—something that has been one of their top concerns for years. We hope Supreme Court justices understand how important this law is to small businesses who need relief from high healthcare costs,” said Jim Duffett, Executive Director of the Campaign for Better Health Care.

Duffett continued, “Since the General Assembly has abdicated its responsibilities, Governor Quinn needs to step up to the plate and enact an Executive Order to begin the process for an Illinois Marketplace (exchange). Small businesses are committed in taking personal responsibility; it is time for our political leaders to do the same.”

Right now, Illinois could access over $200 million in federal funds to implement the new marketplace. It won't cost the state a penny if we use these federal funds. This past legislative session, the General Assembly took no action on implementing a marketplace in Illinois. This means the federal government will implement one for us, unless Governor Quinn takes immediate action.

David Whitaker, Chair of the Health Committee for the Illinois Black Chamber of Commerce, said “Small businesses are diverse throughout Illinois and yet we all have the same problem when it comes to buying health insurance—it is very difficult and we spend more for it than larger businesses. The Illinois General Assembly failed this past session to enact legislation to establish an Illinois marketplace, or insurance exchange. It is time for action and leadership.”

“The SBHCC is calling on Governor Quinn to sign an executive order to set the standard for this
marketplace and it must include the following principles:

1) No insurance industry representataives on the Governing Board.
2) The right to negotiate rates with insurers - there must be real cost containment measures.
3) The Insurance industry must pay for the Marketplace, not small businesses and consumers.”

Joyce Harant, SBHCC Project Director said, "Small business owners are so busy keeping their businesses operating that they have very little time to navigate what is happening about health care reform. Most of them wish they could afford health insurance for their employees and yet when the rubber meets the road, for many of them the obstacles are too great. My hope is that we can learn the needs of small business owners and, in a collective way, make sure their needs and opinions are heard and become part of the legislation passed in Illinois."

Full statements by small business owners on today's telebriefing are available via Kathleen Duffy. The audio of today's telebriefing is available on the Campaign for Better Health Care's Audio Archive.

Today is World Blood Donor Day

The Affordable Care Act includes many provisions aimed at increasing individuals’ ability to access health care.  However, even if the financial and other external barriers are overcome, problems with accessing health care will still exist if health care facilities do not have the supplies they need to treat patients, including sufficient blood products.  Today is World Blood Donor Day, a day to celebrate Illinois’ blood donors and inspire those in good health to begin donating blood.

Every year the transfusion of blood and blood products helps save millions of lives.  Transfusions also improve the quality of life and life expectancy for patients suffering from life-threatening conditions, and support surgeries and complex medical procedures such as cancer treatments.  All of these benefits cannot be realized without timely access to safe blood.  Although 60% of the population is eligible to donate blood, only 5% actually do.  The American Red Cross has reported that blood donations are down for 2012, and more donations are needed now to ensure there will not be any blood shortages this summer.

The World Health Organization designated June 14 as World Blood Donor Day, an international event to raise awareness of the need of safe blood and to thank voluntary blood donors.  This year’s theme is “Every blood donor is a hero.”  Individuals who choose to donate even when it may not be convenient put the needs of others before their own in a life-saving gesture of human solidarity.  Blood donors are indeed heroes; the donation of one pint of blood can save up to three lives.  To celebrate this day, organizations all over the world are planning events to raise awareness and thank donors.  LifeSource, Chicagoland’s blood center, created a Blood Donor Photo Tribute to thank those heroes who save lives by donating regularly.  The Red Cross, Nexcare, and supermodel Niki Taylor have partnered together to celebrate and thank blood donors by offering limited edition Nexcare GIVE bandages to those who present to give blood this June.

Whether you’re considering donating blood for the first time or are a regular donor looking to schedule your next appointment, knowing how to get started can make the donation process much easier for you.  Most organizations enable you to schedule appointments online, and you can choose from a list of donation centers and blood drives close to you to find the location and date that is most convenient.  You could also host a blood drive at your place of work, worship, community center, or school.  All you need to provide is a room or a place to park a donor coach vehicle, some tables and chairs, a contact person and a couple volunteers to recruit donors. 

Additionally, Illinois law also helps to make blood donation more convenient for people by permitting eligible employees to, upon request, use one hour of paid leave to donate blood.  This is available to full-time employees who donate blood and who have been employed for six months or more by any unit of local government, board of election commission, or any private employer in Illinois who has 51 or more employees.  Your employer can provide you with more information about whether this option is available to you and, if it is, what documentation you will need to provide to take advantage. 

It is easy to become an everyday hero and help save lives right in your own community.  To be eligible to donate blood, you must be at least 17 years old, weigh at least 110 pounds, and be in good physical health.  Individuals with certain health conditions or who have engaged in certain behaviors or traveled to certain places may be ineligible to donate.  Please see the websites for the American Red Cross (national), LifeSource (Chicagoland), the Central Illinois Community Blood Center (central Illinois), or Community Blood Services of Illinois (east-central Illinois) for more information on eligibility and how you can donate.

The selfless act of donating blood is incredibly important to the health and well-being of Illinoisans, and Illinois Health Matters wants to thank all of these life saving heroes.

Amanda Swanson
Guest Blogger

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

Illinois Health Information Exchange: Legal and Policy Issues

The adoption of electronic health records and a health information exchange (HIE) in the U.S. healthcare system, and the improvements in quality and cost that will result, has caused quite a stir across the country.  Even amidst all of the excitement and optimism, many people are concerned about potential negative consequences, and much of the controversy centers around the interplay between individuals’ privacy rights and the effectiveness of these new technologies.

The Illinois Office of Health Information Technology was created in 2010 by executive order to coordinate and direct Illinois HIT and HIE initiatives.  The OHIT and the Illinois Health Information Exchange Authority are working together to create the Illinois HIE (ILHIE).  To ensure that patient privacy rights are adequately protected, OHIT created an ILHIE Legal Task Force to identify and address Illinois laws raising complex challenges to the exchange of health information.  

While the Health Insurance Portability and Accountability Act’s (HIPAA) Privacy Rule lays out federal requirements governing the disclosure of a patient’s protected health information (PHI), this law sets a floor.  States are free to enact more strict privacy regulations, and Illinois has done so in a number of areas. The Legal Task Force has created ten workgroups, each assigned a specific disclosure issue which the group will investigate and then recommend improvements to the Illinois disclosure laws in that area.  These workgroups include PHI pertaining to behavioral health, substance abuse, HIV/AIDS status, and genetic testing. 

In addition to the legal barriers, OHIT is currently investigating key policy questions impacting the information put in the ILHIE and access to information.  

The first concern is whether patients should be granted a choice as to whether his/her information will be included in the ILHIE for use by health care professionals and others, and the extent of the effect given to this choice.  Next, if patients are given this choice, the question becomes whether all patients should be given the chance to affirmatively decline or consent to the inclusion of their PHI in the ILHIE.  If a patient decides he/she does not want to use the HIE, the permissibility and/or extent to which the patient’s data can be collected by the ILHIE for limited mandatory reporting (such as public health reporting) must also be addressed.    

Another issue arises when a patient may desire that only specific aspects of his or her medical record are not exchanged, or that specific providers can be denied access to the information, and whether this request can be accommodated or whether the patient’s entire record must then be excluded from the ILHIE.  Finally, if patients are given the choice as to whether or not to participate in the HIE, it must be determined what requirements, if any, should be placed on health care providers to inform the patient of the HIE and answer any questions, thereby ensuring the patient’s choice is truly meaningful.

Aside from the questions surrounding whether to include information in the HIE, barriers arise with respect to linking up the information within the HIE to the specific patient seeking health care.  One question being addressed is whether the ILHIE should use a unique patient identifier to enable patient records to be accumulated and matched to the patient with accuracy.  This is an important issue: problems can arise when other identifying information (such as name, birthday, gender, zip code, and/or all or part of the social security number) is used for this purpose, because patients having data in common, the entering of data in different formats at different facilities, and data entry errors can all prevent accurate record matching.  If a unique patient identifier is not created for the ILHIE, the question then becomes whether regulations should be imposed upon providers to ensure a certain degree of patient matching accuracy is achieved with the use of their EHR system with the HIE. 

The final policy question being addressed by OHIT concerns whether Illinois should enact its own laws and regulations governing patient rights with respect to their EHR, to supplement the rights already given to patients through federal law such as those giving patients the right to access their own medical records and request corrections.

For more information on the HIE or your information privacy and security, please visit the education page of the ILHIE or the Office of the National Coordinator.

Amanda Swanson, J.D., LL.M.

On This Memorial Day, Don't Forget Uninsured Veterans

A recent study released by the Robert Wood Johnson Foundation finds that 1 in 10 of the 12.5 million veterans in the U.S. is currently uninsured. Those veterans are more likely to be younger, less likely to be married and are less connected to the labor force—all factors that contribute to lower insurance rates.

In Illinois, 25,000 veterans, or 10.1% lack health coverage.  Add to that their family members, and that’s 68,000 men, women and children in military families without adequate access to health care. 

The Affordable Care Act has the potential to make a sizable dent in those numbers. Nearly half of uninsured veterans will become eligible for Medicaid under the program’s extension in 2014, when all citizens below 138% of the Federal Poverty Level will gain coverage.  Another 40% of those veterans will receive subsidies to use toward purchasing insurance in state health insurance exchanges. (For more information, see the Illinois Health Matters map of where all of those who are newly eligible for Medicaid live in Illinois.)

The RWJF report also found that insurance rates among veterans were higher in states that had made more progress toward implementing health insurance exchanges, as called for by the ACA. The opposite is true for those states that have made the least progress toward implementing health reforms, which are home to 40% of uninsured veterans. Illinois has made "moderate progress" toward implementation of an exchange -- the Illinois General Assembly tabled efforts to establish an exchange earlier this month, opting to wait until the Supreme Court releases their decision on the ACA before attempting to move forward.  Advocates still are urging Governor Quinn to sign an Executive Order to establish the Exchange.

Progressing forward with health reform efforts, the study claims, will be crucial to getting coverage for uninsured veterans.  In addition, other barriers to health care, such as a lack of nearby health centers,  or potential disruptions on coverage from public benefits, or a lack of awareness of potential benefits, need to be addressed.

At Health & Disability Advocates (HDA), we have seen firsthand that this is reality for service members in Illinois. For Veterans who are not insured it is important for them to have a good understanding of other state and local programs that could provide services for them and their families. HDA's Illinois Connections program assists veterans and military families connect to community services including health benefits. We have worked closely with the Illinois National Guard since those that have not been deployed are not eligible for veteran’s services, including health care through the federal VA system.

HDA's new volunteer veteran program, Illinois Warrior to Warrior, brings volunteers to Illinois National Guard units who are trained in community resources - including health care. This partnership with the National Guard allows trained volunteer veterans to be assigned to individual National Guard units and offer assistance to soldiers and their families in locating resources to meet their needs. This program is in a pilot stage in the Chicago area but will be expanded state-wide.

How military and veteran programs interact with civilian programs is complicated. At HDA, we provide tools and trainings to service providers in military/veteran and civilian systems.  See our complete list of trainings and services here and our YouTube video of our program here. If you know of a veteran in need of health insurance or health services, have them contact HDA at 312-223-9600.


Laura Gallagher Watkins, Director
Illinois Connections: Assisting Veterans & Military Families
Health & Disability Advocates

Safety Net Hospitals Spared, But Not Much Else in Medicaid Bills

Although Medicaid is a state & federal program, the City of Chicago got involved in the raging debate in Springfield. On Tuesday, May 22, 2012, Alderman George Cardenas (12th Ward) called a meeting of the Chicago City Council Committee on Health and Environmental Protection to discuss the way Governor Quinn’s proposed Medicaid cuts would affect medical care providers, specifically Safety Net Hospitals. Those hospitals have a client base that is primarily those without insurance, or those insured via Medicaid, which puts the hospitals in a position to be disproportionately affected by any Medicaid cuts.

Hospital CEOs, including those representing St. Anthony's, Mercy Hospital and Norwegian American Hospital and others, and community leaders including Metropolitan Chicago Healthcare Council, Health & Disability Advocates, Catalyst Schools, Lawndale Christian Development Center and the National Latino Education Institute, testified in front of the committee. Each person spoke about the impact of the cuts to their constituencies. The cuts would not only mean a loss of accessible healthcare in Chicago communities but also a steep decline in jobs, as many of the hospitals fuel the economic engine in the communities they serve.

Turns out some of the voices were heard: SB 2840, the final Medicaid budget bill (Named the "Save Medicaid Access and Resources Together (SMART) Act"), softens the original blow—sparing safety net hospitals from proposed provider reimbursement cuts, and lowering cuts overall from $240 million a year instead of $675 million. Passed by both houses on May 24, 2012, it will go to the Governor's desk for signature and will most likely be signed.

Unfortunately, many other health care programs for low income people and those with disabilities in Illinois were not spared in the bill. A full list can be found here, but the cuts include:

• Elimination of Illinois Cares Rx
• Family Care Eligibility reduction to 133% FPL (from 185%-400% FPL)
• Elimination of General Assistance Medical
• Adult Dental Eliminated (except in emergencies)
• 4 Prescription per month limit

These cuts will be devastating to many vulnerable populations and advocates are gearing up for the anxious phone calls from clients and providers.

The one silver lining in yesterday's legislative action is that the Cook County 1115 waiver (HB 5007) passed both houses which will allow Cook County Health and Hospital System to expand access to care for about 250,000 low income adults (below 138% FPL) in the area. Under the Affordable Care Act, their health insurance will be covered by the federal government so this will save the State $36 million per year. Of course, this is dependent on the Supreme Court upholding the ACA. Assuming it does, this early expansion of Medicaid is a huge kickstart toward ACA implementation in Illinois.

One baby step forward, two giant steps back:

So, while we mourn the Medicaid losses in SB 2840, we need to celebrate the gains in HB 5007. Nevertheless, it's important to keep talking about the life-threatening and costly implications of the stunning loss of access to affordable, quality health care that will be triggered by the signing of this "SMART" law. We also need to share clear information about the potential benefits of implementation of the Affordable Care Act, even though the ACA will not completely undo the economic cost and harm set forth in yesterday's decision.

Stephani Becker
Health & Disability Advocates, project director of Illinois Health Matters