Supporting Chicago's Entrepreneurs: Marketplace Brings New Health Coverage Options

Finding the right healthcare plan can be stressful, and with all the noise surrounding the new healthcare law, it may seem downright overwhelming. But there’s good news coming out of Illinois. The state’s new health insurance marketplace is open for business, and it’s already providing small business owners and their employees with improved options for affordable coverage.

The new marketplace, Get Covered Illinois, is a partnership marketplace, which means the state and federal government run the marketplace together while Illinois prepares to run the marketplace on its own beginning in 2015. Get Covered Illinois has two branches – one for individuals, the other for small businesses. The individual marketplace is available to any self-employed individual or small business employee whose employer doesn’t offer insurance. Open enrollment for 2015 begins on November 15. In the meantime, employees and self-employed folks can use an online calculator to determine if they’re eligible for a subsidy to help cover the cost of insurance for coverage in 2015.

Many self-employed Chicagoans have already discovered the benefits of enrolling through the state’s marketplace, including Jade Phillips, a local children’s book author. After a brief stint with a precipitously high monthly premium and deductible from a private insurance company, Phillips says she spent the majority of her 20s uncovered. But this year, the self-employed entrepreneur was able to sign up for coverage through the individual market. For the first time in years, she’s enrolled in an affordable plan that allows her to continue doing what she loves while enjoying the peace of mind her new insurance brings.

There’s even more good news for small employers. The small business marketplace has year-round enrollment, so small business owners with fewer than 50 employees looking for a plan have plenty of time to determine if the new marketplace is the right choice. There are more than 230,000 small businesses in the Chicago metropolitan area, but in order for them to take advantage of this new option, entrepreneurs need to know what Get Covered Illinois’ small business marketplace can do for their businesses.

Here are some key facts about the marketplace to help get small employers up to speed.

• The new health insurance marketplace is one of the most important components of the Affordable Care Act for Chicago small employers. The small business marketplace allows small businesses with fewer than 50 employees to band together when buying coverage – giving them the kind of purchasing clout large businesses enjoy.
• The marketplace offers businesses more competitive choices, which can help lower premium costs, thus improving their bottom lines.
• Small employers that do offer coverage through the marketplace may also be eligible for a tax credit of up to 50 percent of your premiums. Check out our tax credit calculator to see if you’re eligible and to receive a tax credit estimate. 
• Illinois’ small business marketplace will offer employee choice in the future, which means small business workers will be able to choose from a number of plans from different carriers.

In order to begin the enrollment process, Chicago entrepreneurs can visit Get Covered Illinois’ site or Healthcare.gov and begin filling out a paper application, or visit contact a certified health insurance broker who can assist with the enrollment process.

What’s more, Small Business Majority’s certified educators can help answer questions regarding the enrollment process. Check out our state outreach calendar or the Small Business Health Care Consortium’s events page to find an event in your area.

To learn more about the small business marketplace, enrollment dates and coverage plans, visit our Health Coverage Guide (healthcoverageguide.org), which contains a wealth of information for small business owners regarding enrollment, the Affordable Care Act and the healthcare system in general.

The more small business owners know about the new marketplace, the easier it will be for them to get their employees and businesses more affordable insurance coverage. And then, instead of worrying about health insurance, they can do what they do best: run the companies that make up the backbone of our state and our nation. 

Mary Timmel
Midwest Outreach Manager
Small Business Majority

On COBRA? New Announcement from HHS Could Save you Thousands of Dollars

In mid-April, I received a call from a 62-year-old woman named Alice who had been laid off from her job quite a while back. She was paying around $650 each month to maintain her COBRA coverage. Turns out she got my number from her brother, Carl, whom I had helped enroll into a Marketplace plan. He, too, was paying a lot of money each month for COBRA coverage after his employer had cut his hours in half, making him ineligible for employer-offered coverage. By enrolling into a subsidized Marketplace plan, Carl saved more than $400 a month in premium costs. He hoped I could also help his sister. Unfortunately, she called me just a few weeks after open enrollment had ended.

Normally, this would mean that she would have to wait until the next open enrollment period or until she exhausted her COBRA coverage before she could qualify for a Special Enrollment Period which would allow her to enroll into a much more affordable Marketplace plan. It seemed she had missed this window of opportunity – that is until HHS announced new Special Enrollment Periods for folks currently enrolled into COBRA coverage.

As I mentioned, normally a consumer has four options regarding COBRA coverage:

• Decline an initial offer of COBRA coverage
• Get a Special Enrollment Period and enroll in marketplace coverage
• Switch from COBRA coverage to marketplace coverage during open enrollment
• Wait until the exhaustion of COBRA coverage to get an Special Enrollment Period

Well, HHS recognized that folks just like Alice were confused about their options. So they decided to offer COBRA enrollees a Special Enrollment Period. If you or someone you know is on COBRA, he or she can qualify for a Special Enrollment Period to shop for a plan on the Marketplace until July 1 of this year.

Simply call the Marketplace call center at 1-800-318-2596 and tell them you are currently on COBRA and that you would like to explore your options in the Marketplace. Then fill out an application at healthcare.gov to see if you’re eligible for financial help. This could very well save you hundreds of dollars each month in premium costs. You have nothing to lose. I’ve already called Alice.

Jillian Phillipsr
Chicagoland Organizer
Campaign for Better Health Care

---

For more info on qualifying events:
http://illinoishealthmatters.org/wp-content/uploads/2014/04/Special-Enrollment-Periods-Explained.pdf

Can Non-Profits leverage the ACA to bring down health insurance costs?

The non-profit sector is a leading source of job growth in the United States and currently employs just under 11 million people nationally.[1]  Locally here in Illinois, we see  direct growth in this sector – now holding 10.6% of the private employment, up from 9% in 2005.[2]   However, in a recent survey of 600 national non-profit organizations, recent increases in employee turnover are indicated to be an ongoing concern.[3]  One of the greatest tools that organizations have available to them to attract and retain high quality employees is the compensation and benefits package.  Providing high value, yet affordable benefits is part of the ethos of most non-profit organizations.  However, as the cost curve of health insurance continues to rise, this proposition has become increasingly more challenging.  The Affordable Care Act created a small employer tax credit to help offset some of these costs – but many non-profits are left wondering how this might benefit them.

The ACA includes a provision that gives small employers, including nonprofits with fewer than 25 employees (with average salaries below $50,000), the right to access a tax credit for insurance premiums paid by the employer for their employees' health insurance.  For tax-exempt nonprofits the credit is treated as a refund on quarterly payments that the nonprofit has made to the IRS for income tax withholdings or Medicare withholdings from employee wages. For 2010-2013 the refund is 25% of the expenses paid by the employer towards employees' health insurance premiums; the refund increases to 35% after January 1, 2014.[4]  Non-profits should know that they are still able to retroactively apply for previous year’s tax credit if they meet all of the eligibility guidelines.

            To better understand the tax credit and available provisions under the ACA, you may want to explore the new small business page of Illinois Health Matters.  Here you can find additional information about the small employer tax credit and other key resources.

            Beginning in 2014, to obtain the tax credit – employers must enroll in a qualified health plan through the SHOP Marketplace.  These plans are competitively priced and cover all of the EssentialHealth Benefits that are important to you and the employees you are trying to retain. The Illinois SHOP Marketplace can be found at GetCoveredIllinois.gov.  Here you can find additional information about the plans available – but more importantly through their Get Help feature you can search for registered brokers in your neighborhood.  Brokers can assist you in applying for the small employer tax credit, evaluate your health insurance and employee benefit package, and assist you in enrolling in a plan that qualifies for the tax credit reduction.

The ACA offers two important tools to assist small employers – the SHOP marketplace, and the small business tax credits. Together, these two strategies can help non-profits begin or continue to offer quality benefit programs at an affordable price. As nonprofit organizations continue to play an integral role in the workforce and in the communities they serve – finding business partners that can assist in helping to leverage these resources will continue to be paramount for long term workforce and budgetary planning. Creating stability and financial sustainability in these areas will ultimately allow non-profits more freedom to focus on what’s important – fulfilling the mission of their organization and continuing to serve the community around them.

Michele Thornton, MBA
Insurance & Benefits Consultant

---

[1] Salamon, LM, SW Sokolowski and SL Geller. Holding the Fort: Nonprofit employment during a decade of turmoil. Nonprofit Employment Bulletin 39, Johns Hopkins University. January 2012.

[2] Salamon, LM, SW Sokolowski and SL Geller. Illinois Nonprofit Employment: An Update.  Nonprofit Employment Bulletin 21, Johns Hopkins University. January 2005.

[3] 2013 Nonprofit Employment Trends Survey Report. Nonprofit HR Solutions. Accessed at: http://www.nonprofithr.com/wp-content/uploads/2013/03/2013-Employment-Trends-Survey-Report.pdf

[4] Small Business Healthcare Tax Credit for Small Employers. IRS (2014).  Accessed at: http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers

Four Gifts the Affordable Care Act Has Given Americans by Its Fourth Birthday

On March 23, 2014, the Affordable Care Act (ACA) turned four. In its relatively short life, the ACA has already accomplished a great deal. To celebrate, here’s a list of the top four gifts that the ACA has given to the American people:

1. No More Pre-existing Condition Exclusions

Before the ACA was law, insurance companies routinely denied people health coverage due to“pre-existing conditions,” which could range from common chronic conditions such as asthma and arthritis to diseases such as cancer or mental illness. However, as of September 2010, children could no longer be denied coverage due to a pre-existing condition, and as of January 2014, adults are now enjoying that same right.

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

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

2. Financial Help to Obtain Insurance

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

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

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

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

3. Medicaid Expansion

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

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

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

4. Essential Health Benefits

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

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

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

The Obamacare Lady: What made me want this job?

Last year, I accepted a position to be an In-Person Counselor with the State of Illinois. You may also have heard the terms Navigator or Assister used to describe this job. I help people with the Affordable Care Act. A few people have called me, “The Obamacare Lady.”  Yes, I help people understand “Obamacare” and help them determine what help they may qualify for in obtaining health insurance.

What made me want this job you ask? Well, I was drawn to this job for a number of reasons:

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

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

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

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

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

By Barb Silnes

In-Person Counselor

Why We Built HealthPlanRatings.org – and What Makes it Different

Here at Consumers' CHECKBOOK, what we’ve always focused on is helping consumers make their best choices. And we felt that right now, choosing insurance plans on the Marketplace is difficult and confusing for most consumers, and that Healthcare.gov doesn't give consumers the key information they need to choose the best plan.

So what we did was build a model for how to get consumers to their best health plan choices – and get them there quickly. We launched this Health Plan Comparison tool at www.HealthPlanRatings.org.

This tool actually compares every plan available in the Illinois Marketplace based on total estimated cost (not just premiums or deductibles), plan quality, doctor availability, and other key factors. But it's designed to take consumers with little or no knowledge of insurance through a few simple steps – which take about five minutes – to help them choose the best plan for them.

Although it is intended to be a model for the country, right now the Health Plan Comparison tool only includes plans in one state: Illinois. Our hope is that the Feds and states that are running the Marketplaces will learn from what we have done and make their Marketplaces work better for consumers for the next open enrollment period, this Fall. Meanwhile, we want to have as many Illinois consumers as possible use the tool right now.

Here are some examples of what we've done:

COST. This is the primary consideration for most consumers when purchasing health insurance. Right now, Healthcare.gov lets you compare plans, but it just gives you the premium and the amounts of deductibles, co-payments, coinsurance, etc., for various health care services and products. Since it is all but impossible to calculate the likely total cost for each plan based on this confusing mass of benefit information, consumers often choose based on premium alone, or some other unreliable shortcut. Instead, our model uses actuarial analysis of data from large health-care-usage databases to calculate an Estimated Average Total Cost (premiums plus out-of-pocket costs) for a family of the same size, ages, health statuses, and other characteristics. That gives you a single dollar amount for each plan, making it easy to compare plans.

RISK. The Marketplace gives a consumer little or no help assessing risks of having a "bad year," or what the cost of an event such as heart attack could be. We calculate the cost in bad years and the probability that a family like yours will have such a year, giving you an easy-to-understand, easy-to-compare measure of "Risk" with each plan.

DOCTORS. For many people, whether they will be able to keep their physician – or be able to have one they like – is a key consideration in choosing a plan. But it can be challenging finding out which plans have the doctors you care about available in their networks by going to each of the insurers' doctor directories one at a time. So we combined them into an "All-Plan Doctor Directory" and when you see the list of available plans, you see which of your preferred doctors are in each plan.

QUALITY. All plans are not alike in the quality of care or service their members get, and the Marketplace gives little or no information on the quality of each plan. But we actually provide quality ratings. For all the plans, we initially display a simple overall quality score, and you can personalize the score based on the aspects of plan quality that are most important to you.

We believe that the Health Plan Comparison tool will save many consumers thousands of dollars and connect them to good care and service. It was a lot of work creating this website. We launched it two weeks ago, and did a demo for about 200 Navigators at a meeting set up by Get Covered Illinois. We want to reach out and help as many consumers as possible before March 31. Please take a look at www.HealthPlanRatings.org. Here is a sample plan-comparison page:

One more thing. We have been asked why we, based in Washington, DC, chose Illinois for our model plan comparison tool. There are various reasons, including the fact that it is a large, diverse state, with major urban and rural populations; has a lot of creative, consumer-oriented leaders; and has a substantial number of plans in the Marketplace. And okay, I admit it: we have some personal connections: My mom and dad were both born and raised in Illinois (Lexington and Lincoln); I graduated from the University of Chicago Law School; the director of our health plan ratings work got a Masters in opera (very different from what he has done for many years for us) from University of Illinois and sang sometimes in Chicago before spending eight years singing opera in Europe; and we publish one of our regional versions of Consumers' CHECKBOOK magazine in Chicago, with ratings or service firms, from auto repair shops to plumbers to doctors and veterinarians, and thus have reason for frequent trips to do Chicago TV appearances talking about our findings.

We really hope that you will tell everyone who might still be looking for insurance, or helping others look for insurance, in the Illinois Marketplace about this tool. And of course, we welcome any feedback. You can email me at rkrughoff@checkbook.org

– By Robert Krughoff, President, Consumers' CHECKBOOK

---

CBO on ACA: Devil is in the Details

On Tuesday, while driving between meetings, my favorite talk radio host shared shocking details from a new report – Obamacare, or the Affordable Care Act, is going to result in a loss of 2 million jobs in the United States over the next 10 years. Well, I thought, it's going to be a long day.

Later I learned that this reporter was sharing details from the latest Budget and Economic Outlook Report from the Congressional Budget Office. The CBO is an independent agency tasked with providing fiscal analysis for Congress with the intent of informing the budget-making process. Periodically, they release these reports which provide a 10 year forecast demonstrating the economic impact of many policies. Since 2010, they have included analysis on the impact of the ACA.

Needless to say, I was anxious to dig into this nearly 200 page behemoth and figure out what was going on. What I read in this report turned out to be great news. The report does not say that the economy will lose 2 million jobs. It says that, by making it easier to access affordable, high quality health insurance, more than 2 million people can make the choice to leave their job and pursue their passions, spend time with their families, start businesses, or find better jobs.

For those of us that have been following and championing the ACA, this isn't actually new information. Last year, the Robert Wood Johnson Foundation released a report, entitled The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment, which estimated that we could see as many as 1.5 million entrepreneurial spirits leave their jobs to become their own boss in 2014 alone!

Both reports highlight the same important fact: Because of the promise made by the ACA, that we can all access good health care, people will have the freedom to do what they want without fear of medical emergency and financial ruin.

My father, sister, and brother-in-law are all self-employed. Even my grandmother owned a small craft shop for the better part of my 26 years. While they were all brave (and maybe a little stubborn) enough to pursue these passions before the ACA, it has not been without sacrifice. After my self-employed and uninsured father had emergency eye surgery in 1992, my family filed bankruptcy as a result of unpaid medical bills. If the ACA had been around then, things would have been much easier for us and my dad certainly would have avoided a lot of sleepless nights worrying about keeping his business or providing for my sister and I.

I was shocked when I heard that radio report, but – as always – the devil was in the details. Except the devil isn't really a devil at all. The bottom line is that the ACA presents a new opportunity: an opportunity for people like my dad, to become their own boss; for someone who has put in their years and saved their pennies to retire early; or for a new parent to work part time so they can spend more time watching their child learn and grow. The CBO report means that what happened in my family, and millions like us, doesn't have to happen anymore – and that is why I will continue to be a proud champion of the ACA.

– By Kathy Waligora

---

Kathy Waligora is the Manager of Health Reform Initiatives at EverThrive Illinois (formerly the Illinois Maternal and Child Health Coalition).

See the 2013 ACA Self-Employment Infographic in PDF.