Illinois Senate Takes First Major Step To Passing A State Based Health Insurance Marketplace

Springfield - The State Senate Insurance Committee passed HB3227, formerly SB34, today, a major step in establishing a health insurance marketplace that helps small businesses and individuals in Illinois.

State Senator David Koehler (D-46 Peoria), chief sponsor of SB34 which was folded into HB3227, said, "To live up to the intention of the Affordable Care Act, we need to expand our help and support for the small businesses and consumers who will be using the new Illinois Health Insurance Marketplace. My bill does this, and I am pleased that my colleagues on the Insurance Committee were able to pass it."

Mark Burris of Springfield, the owner of MCCE Investments and owner of seven Subway Sandwich franchises, said, "Small businesses need a level playing field and there must be checks and balances with the insurance companies."

Burris continued, "In this bill, financing of the health insurance exchange under is through assessments of the insurers, as it should be. The insurance industry will benefit from the tax dollars used to create the infrastructure of the how the exchange is set up. It is only appropriate that they finance the day to day operations of the insurance health marketplace when an estimated one million new insurance customers will be purchasing private health insurance."

HB3227, formerly SB34, establishes a pro-consumer and pro-small business health insurance marketplace in Illinois. The health insurance marketplace will be the one-stop insurance shop for more than a million Illinoisans.

Jim Duffett, Executive Director of the Campaign for Better Health Care, said "This new marketplace will offer small businesses access to more affordable health insurance plans. Instead of paying 18% more than larger businesses, they will have a chance to compete for and retain good employees by providing affordable insurance. A win-win for small businesses and their employees because of the Affordable Care Act (ACA), commonly referred to as Obamacare."

HB3227, formerly SB34, ensures that the marketplace is governed by a diverse board that represents women, small businesses, communities of color, labor, public health, people with disabilities, and consumers, and provides for accountability of the insurance industry selling plans on the new marketplace.
 

Speaking on behalf of the National Association of Women Business Owners Chicago (NAWBO Chicago), Linda Forman said, "Who sits on the insurance exchange governing board is very important. We believe that a statewide governing board will be better able to understand the needs of women and the diversity of backgrounds and geography of small businesses throughout this state if the governing board is composed of the types of people who will be using the health insurance exchange marketplace."

"We can all agree that what we had has not worked very well, and to continue to do nothing is a bad mistake. We are excited to support HB3227, formerly SB34, and proud to be part of the Small Business Health Care Consortium. Our members are proud to see us take a step in the right direction on behalf of small business all across the state," said Larry Ivory, President of the Illinois Black Chamber of Commerce. "We congratulate the members of the Insurance Committee for taking that step for Illinois small businesses and individuals today."

ADDENDUM

HB3227 (containing SB34 language) Fact Sheet

Kathleen Duffy
Campaign for Better Health Care

The ACA is Coming – How Can I Help Enroll People?

The past few weeks have brought a flurry of activity from the federal and state government agencies who are reaching out to community-based entities to solicit their assistance in Affordable Care Act outreach, education and enrollment. In Illinois, it’s even more confusing because there are three possible “helper” groups: Navigators, In Person Counselors and Certified Application Counselors. 

This blog is intended to answer some of your frequently asked questions about these enrollment helpers and how you can get involved.

What’s a Navigator and How Can I Be One? 
“Navigator” is the term that has been given to people or organizations charged with providing guidance to individuals enrolling in the Health Insurance Marketplaces created by the Affordable Care Act. Many of you have been wondering how you can become one of these entities. Unfortunately, there are no actual “navigator positions” right now. This is because various entities have to apply for funding (grant application due June 7) to become navigators and receive training.

What do you mean by “entity”?
Many types of groups/entities can be Navigators. Self-employed persons and public or private organizations are eligible to apply for funding to operate as Navigators (see the FAQ here). In each Marketplace there must be at least two sub-sets of entities and at least one will be a community and consumer-focused nonprofit. There are some restrictions, however: navigators cannot have conflicts of interest. Therefore, navigators cannot be health insurers, have affiliations with health insurers, or accept any form of payment from insurers that is related to enrollment inside or outside of the marketplaces.

What if I don’t want to or am not eligible to apply for these Navigator grants?
If you don't think you or your organization would qualify for this funding alone, you could consider reaching out to another organization in your area that might be applying. Check out this consumer assistance matchmaking spreadsheet to meet up with other groups. Another option would be to wait until the grants have been decided upon and then reach out to see if the recipient organizations need any additional staff.

What is the In-Person Counselor (IPC) Program?
In-Person Counselors (IPCs) are the same as Navigators, in that they will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. They are different than Navigators because funding for these entities comes from the state instead of the federal government and they will receive training directly from the state.

The IPC grant application just came out and applications are due May 30th. Entities in Illinois can apply for these funds and hire new personnel or use existing staff as In-Person Counselors in the community. Find more information and access to the application here. The Illinois Health Insurance Marketplace will be conducting a webinar for those interested in the IPC program on Thursday, May 9 at 10 am. You must register to participate. 

But how is a Navigator and In Person Counselor different from a Certified Application Counselor (CAC)?
CAC's have been defined as “trusted community-based organizations, providers, or other organizations with expertise in social service programs.” CACs allow organizations that would likely aid consumers anyway (such as hospitals or clinics) be involved more formally in the process of finding health coverage. Unlike Navigators and IPCs, CACs are not eligible for public funding but the Marketplace will be required to certify CACs to help people apply for Medicaid and plans sold through the exchange.

So what should I do now if I want to be one of these helpers?

• Read the IPC application
• Look at the Illinois Consumer Assistance Matchmaking Spreadsheet to see who else wants to apply to be a Navigator or IPC
• Participate in the webinar on May 9th about the IPC program
• Stay tuned for more information about the CAC program in Illinois 

Feel free to email us at info@illinoishealthmatters.org with any questions!

Stephani Becker & Alexa Herzog
Illinois Health Matters

New Study Builds Case for Expanding Medicaid

A new study in the New England Journal of Medicine confirms what consumer health advocates have known for decades: Medicaid is essential for keeping low-income households on stable financial footing. This should come as no surprise, since protecting families from unexpected and devastating medical costs is exactly what health insurance is meant to do. The study also proves that Medicaid coverage significantly improves beneficiaries’ mental health.

But opponents of Medicaid have distorted the study’s results; they claim it supports their agenda to block millions of low-income, uninsured families from accessing this vital coverage program. Their arguments are misinformed at best. The new study only strengthens the case for expanding Medicaid.

What the study tells us: Medicaid Works!

The researchers looked at the health and finances of low-income, uninsured Oregon residents who were given the opportunity to enroll in Medicaid through a one-time lottery, and compared it to their peers who remained uninsured.

The study shows that Medicaid virtually eliminated all catastrophic medical expenditures (medical expenses exceeding 30 percent of household income) for its beneficiaries. It also indicates that people with Medicaid coverage are significantly less likely to face any medical debt, borrow money to pay bills, or skip payments.

These results are extremely promising, especially in light of the fact that medical bills currently prompt more than 60 percent of U.S. bankruptcies. If we want to reduce the drag bankruptcies create on our economy and the ruin they leave behind in our communities, providing low-income families with Medicaid coverage is a good place to start.

The study also found that Medicaid is a powerful tool in combating mental illness. Medicaid beneficiaries in the study were 30 percent less likely to suffer from depression than those who remained uninsured. Given that suicide takes more lives in the US than any other form of injury and that depression accounts for more than $83 billion in the US between lost productivity and medical expenses, the impact of Medicaid on depression deserves attention and celebration.

File Under: Non sequitur

Instead of celebrating, opponents of Medicaid are arguing this study makes the case for withholding Medicaid coverage from millions of low-income, uninsured families. They base this on the study’s failure to detect statistically significant improvements in a handful chronic disease measures — blood pressure, cholesterol, or hemoglobin levels — in those with Medicaid compared to those without coverage.

That’s like saying because your blood pressure didn’t go down, we are going to prevent you from getting coverage for cancer treatment or a pap smear.

It’s certainly true that the U.S. health care system needs to be better at managing chronic conditions. We routinely lag behind other industrialized nations on measures of chronic care management, such as following medical guidelines for treating hypertension and diabetes. Plus, this study only looks at the impact of two years of coverage; significant improvements in these persistent chronic illnesses may take much longer to materialize.

This is hardly a reason to block millions of low-income families from gaining health coverage they need and deserve. We have no evidence that people with private insurance or Medicare fare any better than Medicaid beneficiaries on these measures, yet no one is suggesting we should all drop our health insurance.

Getting people covered is the first step in creating an effective health care system that works for everyone, but it is not the only step. The ACA contains numerous initiatives to improve the quality of health care.

File under: extremely relevant

Meanwhile, dozens of states are still trying to decide whether or not to take up the option to extend Medicaid coverage to millions of low-income, uninsured adults. This study confirms Medicaid can give beneficiaries peace of mind that they won’t go bankrupt when they experience that unexpected illness, and make staggering improvements in their mental health. It adds to the growing list of reasons why this decision should be a no-brainer for all 50 states.

Katherine Howitt, Senior Policy Analyst
Community Catalyst

(This blog was first published on the Community Catalyst Blog)

Young People Get Covered in Big Numbers

Today, the Commonwealth Fund released the findings of its Biennial Health Insurance Survey, showing that a skyrocketing number of young people have gained insurance since the health care reform passed.

While it is clear that 2014 coverage options will be crucial – there are still high numbers of the population who were either uninsured, underinsured, or unprotected from high out-of-pocket costs – young people have already begun to see new reform benefits due to the earlier implementation of the dependent coverage provision.  Specifically, the report stated that:

• Approximately 3.4 million young adults have gained coverage since the dependent coverage provision took effect.
• About 79 percent of 19 to 25 year-olds were insured at the time of the survey, up from 69 percent in 2010.
• The number of people saying they had trouble with medical bills or debt climbed in the past decade, yet stayed statistically the same from 2010 to 2012.  According to Commonwealth, this is likely due to the increased coverage of young adults, since other age cohorts saw either no improvement or deterioration in coverage.

In other words, the ACA’s dependent coverage provision has increased coverage and saved young people from medical bills and medical debt.

The better news? The best is yet to come.  Over half of the potential new Medicaid enrollees are under the age of 35, and millions more will have access to subsidies on new health care marketplaces.  This survey makes clear: when offered good options, young people enroll in insurance.  And the ACA has some really great options coming down the pike.

Jen Mishory
Young Invincibles

(This post was first published on the Young Invincibles Blog here)
http://younginvincibles.org/2013/04/young-people-get-covered-in-big-numbers/

Funding Opportunity Announced for Illinois In-Person Counselors

Beginning October 1, 2013, the Illinois Health Insurance Marketplace will open for enrollment. Pursuant to the Affordable Care Act, the Marketplace will be a website where those seeking insurance coverage can shop for health care and determine if they are eligible for financial assistance with premiums and health costs. In Illinois, we are estimating that more than half of our Health Insurance Marketplace customers will want help enrolling in the program.

In order to meet their needs, Governor Pat Quinn and the Illinois Health Insurance Marketplace established the In-Person Counselor program (IPC). IPCs will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. IPCs will be instrumental in the Marketplace’s plan to create a statewide “Culture of Coverage” by engaging, educating, and enrolling the uninsured in Illinois in qualified health plans.

Today, the Illinois Health Insurance Marketplace is very excited to announce the release of the grant application for the In-Person Counselor program.

The Illinois Health Insurance Marketplace, in coordination with the Illinois Department of Public Health, will be accepting applications through the end of May 2013 from community groups and other qualified organizations who want to participate in the IPC program. The state has designated approximately $28 million in federal funds for grants to participating groups. Organizations that are selected through the online application process will participate in a training and certification process this summer.

For more information about the application process for the Illinois IPC Grant Program, go to: http://www2.illinois.gov/gov/healthcarereform/Pages/IPC.aspx.

Additionally, the Illinois Health Insurance Marketplace will also conduct an informational webinar on Thursday, May 9 at 10:00 AM. Interested groups can register for the webinar by going to https://www305.livemeeting.com/lrs/8002054163/Registration.aspx?PageName=hfhrvf978qb8w95p.

Thank you,

Brian Gorman

Director of Outreach and Consumer Education
Illinois Health Insurance Marketplace

A Simpler Way to Apply for Health Care

By Kathleen Sebelius, Secretary of Health and Human Services
Posted April 30, 2013

Today, we take one more step toward meeting the promise of helping millions of Americans access quality, affordable health coverage.

We have finalized the application you can complete later this year to learn what health insurance programs you are eligible for and the discounts to help pay for it. Starting in October, it will be the one application you can use to apply for the new Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program, and tax credits that will help pay for premiums.

I’m also pleased to say the application has been simplified and significantly shortened. The application for individuals is three pages, and the application for families is reduced by two-thirds, to seven pages. This is much shorter than industry standards for health insurance applications today.

Whether you choose to use this application to apply for coverage online, by phone, or on paper, the Health Insurance Marketplace will give you better options than they have today – with one destination to apply and many resources to get help. In-person counselors and a toll free phone line will be available to help you through every step of the process.

The online application that will go live on Healthcare.gov when the Health Insurance Marketplace opens for enrollment on October 1, can be found here: http://cciio.cms.gov/resources/other/index.html#hie

You can sign up to learn more and get ready to enroll at signup.healthcare.gov.

(This post was originally on the healthcare.gov blog here).

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.