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.

An Exchange Is Coming Your Way!

After months of negotiation, Governor Quinn on Friday signed SB 1555, the piece of legislation that will establish the Illinois Health Benefits Exchange. The bill’s passage marks a tremendous step in moving forward the Affordable Care Act in Illinois.

That’s because the new law (known as Public Act 097-0142) will make Illinois the 13th state to begin to build a health benefit exchange, which is the cornerstone of healthcare reform. An exchange - also known as a competitive healthcare marketplace – will primarily let individuals and employees of small businesses shop for a range of affordable health insurance choices, and will give lower and middle-income uninsured Americans more affordable insurance options.

When fully in place, exchanges will provide access to health insurance for 24 million Americans, says Timothy Jost, a professor of law at Washington and Lee University. In Illinois, 11 percent of the insured, nonelderly population (roughly 1.1 million) will have coverage through the exchange by 2016, according to a recent RAND report.

How will exchanges work?

Consumers will shop online on a website that will look similar to Consumer Reports or Travelocity. They’ll have access to easy-to-understand information to make real comparisons between plans so they can find the one that best meets their needs and budget. The site will be closely monitored to prevent fraud and protect consumers, and members of Congress also will be required to get their insurance through this marketplace—giving them the same options as millions of Americans for the first time ever.

An exchange will give Illinois consumers more control, quality choices, and better protections when purchasing insurance for themselves, their families and their small businesses. This is definitely a step forward for Illinois consumers.

What’s in the bill?

As legislation goes, SB 1555 is a short bill that establishes the exchange as well as the option of health savings accounts for state employees. Here are four key action items for the exchange in Illinois that we’ll see put into place in coming weeks and months.

1.   The state of Illinois will run its own exchange rather than having the Federal government run it. This comes as no surprise: The Quinn administration has stated in the past that it believes state control is in the best interest of of employees and families in Illinois, and will give Illinoisans better oversight and consumer protection.

2.   Illinois will create a Legislative Study Committee that will conduct a study on how to best implement and establish the exchange. Each party leader in the House and Senate may appoint three of their members to this twelve-member Committee, who will make decisions on key aspects of the exchange, including the size of the employer to be offered coverage and the development of standards for employee coverage. The report detailing the results of the study must be completed in less than 90 days (September 30, 2011).

3.   The exchange will separate the coverage pools for individuals and small employers of up to 50 employees. Consumer advocates had recommended that the exchange merge the two pools, which could result in lower or more stable premium costs. The Department of Insurance has hired a consultant to study the existing Illinois health insurance marketplace so it remains to be seen what the impact is of merging or separating the coverage pools.

4.   The Illinois Department of Insurance and the Commission on Government Forecasting and Accountability is authorized to apply for and receive federal grant money to meet the October 1, 2013 deadline to have an operational health benefits exchange. This is a critical move, as it will allow Illinois to proceed as planned without forcing the conversation of whether state budget dollars should be allocated to establish the exchange.

What's next for consumers and small businesses?

If you haven't gotten involved in the implementation of the Affordable Care Act in Illinois, now is the time to start. First, you’ll want to learn more about whether the exchange will affect you. The Kaiser Family Foundation has put together a nice flowchart.

You can also attend the Legislative Study Committee meetings (we'll post the dates of the public meetings on Illinois Health Matters). Important decisions will be made that could affect how you, your business or your family will purchase health insurance.

Furthermore, you may want to contact your state senator or representative and tell them what you want out of an exchange, such as good governance and high-quality health plans. Check out these talking points from Community Catalyst.

Above all, check back on our site as we continue to closely monitor the Illinois Health Benefits Exchange news and how it impacts you, your business and your family. Sign up for our newsletter, facebook page and twitter feed for up-to-date information.

Stephani Becker

Health & Disability Advocates, the public-private partnership that powers Illinois Health Matters

New Report Confirms that Medicaid Matters for Americans

The August deadline to negotiate a deficit reduction package is on the horizon. As many already know, the discourse seems to have boiled down to this weighing of Medicaid costs versus the justness of taxing the wealthiest Americans. In an attempt to break the legislative stalemate, President Obama offered to cut billions in Medicaid spending if Republican leaders would make concessions on the tax issue. It wasn’t a shocking offer, Medicaid has long been the victim of budget cuts, and this year is no different. However, a well timed, landmark study on the actual impact of Medicaid has made the detriment of this decision more clear than ever.

Just last week researchers from Harvard School of Public Health, Massachusetts Institute of Technology, the National Bureau of Economic Research and Providence Health & Services released the results of the Oregon Health Insurance Experiment, which unequivocally demonstrates the value of the Medicaid program. This landmark study is the first ever randomized-control trial of Medicaid—the gold standard of scientific research. The Experiment concludes that expanding access to Medicaid “substantially increases health care use, reduces financial strain on covered individuals and improves their self-reported health and wellbeing.”


We cannot overlook the relevance of this study in the current political and economic context. In Illinois alone, 1.8 million children, adults, elderly, and people with disabilities are covered by this safety net program. That is 14% of the population. Cutting Medicaid means that thousands of people will be forced to go without basic medical assistance. Even worse, it means those who must access care could face financial ruin in the face of ballooning healthcare costs and much of the risk will fall back on working class Americans.

Illinois Maternal and Child Health Coalition has always stood in support of Medicaid beneficiaries and this study supports what we have been saying for a long time--MEDICAID MATTERS! We must seize the excellent timing of this report and become even more adamant in our demands that legislators take a responsible approach to the deficit that does not fall on the backs of the most vulnerable Americans. Take action today and help us to make the message clear--Medicaid matters!

Kathy Waligora
Illinois Maternal and Child Health Coalition
(Originally posted here.)

Illinois Could Create a Whole New Competitive Health Care Marketplace

Earlier this week, a new report was released that highlights how Illinois policy makers can address rising health care costs by implementing an effective health insurance exchange.  The federal reform law requires states to create health insurance exchanges and can improve health care and lower costs by pooling consumers’ bargaining power.

Fortunately, the federal law allows Illinois leaders the flexibility to craft an exchange that enhances choice and competition. The report, Building a Better Health Care Marketplace, details the steps policy-makers must take to ensure that the exchange lives up to its promise.
  
To succeed, this new health insurance marketplace must be run by and for Illinois businesses and consumers, not by and for the insurance lobby. It needs to have the power to negotiate for lower premiums and push for reforms that improve the quality of care.  It needs to be consumer friendly. And it needs to be big and stable. As Illinois policymakers create our exchange, they should focus on delivering results for consumers.

Senate Bill 1555, passed by the Illinois General Assembly last month, would create a legislative committee to further evaluate and make final recommendations by September 30th on how best to set up an Illinois health insurance exchange. The bill still must be signed into law by Governor Quinn.

Insurers and other special interests will try to undermine the exchange by preventing it from negotiating and keeping consumers in the dark about the value of their coverage. But our leaders have to stand up for consumers. Making the health care marketplace more competitive is the best opportunity we have to give consumers more power and lower costs.

Brian Imus
Illinois PIRG the Illinois Public Interest Research Group
For more on Illinois PIRG’s Making Health Care Work Campaign click here.
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Starting July 1 in Illinois: "Some" Kids Instead of "All Kids"

In 2010, a study conducted by the University of Illinois at Chicago showed that over 95% of Illinois’ kids had insurance coverage, making Illinois a state with one of the lowest rates of uninsured children in the nation. Much of this success can be attributed to the All Kids health insurance program, which provides for affordable, comprehensive health insurance for all Illinois children (up to age 19) who need coverage, regardless of family income or immigration status. Higher-income families pay monthly premiums ranging from $15 - $300/child, along with co-pays for doctor visits and other health care services.

Unfortunately, starting this Friday July 1st, All Kids will only allow for “some kids” to qualify for coverage. Legislation passed by the Illinois General Assembly and signed by the Governor in January places an income cap on the program at the start of July, effectively cutting off eligibility at 300% of the federal poverty level (FPL). This is equivalent to about $5,500/month or $66,000/year for a family of four.

Children enrolled in All Kids at or above 300% FPL by June 30th, 2011 are allowed to continue All Kids coverage for up to 12 months until July 1st, 2012, when NO children above 300% FPL will be allowed to continue their coverage.

While the Illinois Department of Healthcare and Family Services estimates that fewer than 4,000 children are enrolled in All Kids above the income cap, it’s likely that many of these families enrolled their children in All Kids because private insurance was unaffordable or inaccessible or because coverage options were insufficient for their child’s health care needs.

So where does this leave families who will no longer be able to qualify for All Kids?

Families can pursue employer-based insurance or insurance on the individual market. The Affordable Care Act included a provision, effective September 23, 2010, that no longer allows insurance companies to deny children health insurance because of pre-existing conditions.

Some children may be eligible for the Illinois Pre-existing Condition Insurance Plan (IPXP) if they have a pre-existing condition and have been uninsured for at least six months. The Illinois Comprehensive Health Insurance Plan may also be an option for some families.

However, these options may be unaffordable or inaccessible to many families. If this is the case for you or for a family you know, the Illinois Maternal and Child Health Coalition is interested in hearing your story. These stories can help us with advocacy efforts to persuade legislators to revise the changes to All Kids in upcoming legislative sessions. Contact Kathy Chan at kchan@ilmaternal.org or at 312-491-8161 x 24.

Kathy Chan
Illinois Maternal and Child Health Coalition

Stop Right There: “Medicaid Glitch” Not a State Budget Problem

Earlier this week, the Associated Press reported an alleged “glitch” in the new health care law, proclaiming it would allow some early retirees with Social Security benefits and other income to qualify for Medicaid in 2014. While we may agree or disagree with expanding Medicaid for a small population of 62-65 year olds with Social Security benefits we need to agree on one thing: this glitch is not a state budget problem.

What’s alarming about this reported glitch is that it will be used as ammunition – yet another example of a federal burden put on states that must be lifted through a radical restructuring of Medicaid itself. The call to action will be to convert Medicaid to a block grant and eliminate current requirements that states not restrict Medicaid eligibility through 2014, known as “maintenance of effort.”  

You can see it starting to surface: in the AP article, the former governor of Utah characterizes this as adding “fuel to the fire” and references Washington rules that don’t make sense. The article also mentions governors “clamoring” for change.  One can easily be left with the impression that Medicaid expansion in 2014 will lead to collapsing state budgets everywhere.  Yet the pending expansion will have no impact on states’ bottom line at first, and very little thereafter.  

So, let’s put this “state budget” issue to rest right now with actual facts:

Under current Medicaid, federal government and states share the costs of the program.  Today, states pay anywhere from just over 25% to 50% of the cost.  In 2014, funding for the Medicaid expansion will work very differently than the current funding formula: the expansion will be entirely paid for by the federal government for the first few years; states will pay a small percentage of the costs thereafter. 

State Share of Cost for Newly Eligible Medicaid

Year	State Share
2014	0%
2015	0%
2016	0%
2017	5%
2018	6%
2019	7%
2020 and beyond	10%

It is disingenuous to pretend the 2014 Medicaid expansion will be an additional burden to states, or that the size or scope of state obligations will be at all similar.  Addressing this “glitch” simply cannot be addressed by abandoning states’ obligation to Americans who rely on Medicaid as a health care safety net until health care reform through the Affordable Care Act is complete.

John V. Coburn
Health & Disability Advocates

Study Highlights Importance of Improved Medicaid Program

On June 17, Dr. Karin Rhodes and her colleague Joanna Bisgaier of the University of Pennsylvania released a report on access to subspecialty doctors by children covered by Medicaid in Cook County, Illinois. The authors also published an article about the study underlying the report in the New England Journal of Medicine.

Dr. Rhodes undertook and was paid for the study pursuant to a contract with the Illinois Department of Healthcare and Family Services, the state’s Medicaid agency. The study was part of the department’s compliance with a 2005 consent decree in the case of Memisovski v. Maram, which followed a 2004 federal district court ruling that the state was not in compliance with Medicaid Act requirements that children receive recommended levels of preventive care and treatment of diagnosed conditions, and that they receive care at least to the same extent as children covered by other forms of insurance.

Following the consent decree in Memisovski, Illiniois has undertaken very significant reforms of the primary and preventive care system for children on Medicaid. It improved the rates paid for office visits to primary care doctors and dentists, and it held the processing time for those services to a reasonable level, even during the recession (when all other state bills were being delayed for many months). It launched a statewide “medical home” initiative designed to match children up with primary care doctors, which has had considerable success. Other strategies to improve primary care have been launched, and the overall effort continues.

The consent decree was less specific with respect to access to specialty care to diagnose conditions or especially to treat diagnosed conditions. It provided that the department undertake a study to examine the extent of access problems, and it left the remedies for any such problems to be determined after the study was completed. However, Illinois was not idle on this front. It enacted a round of rate increases for some pediatric specialists, and it included children in a disease management program for people with chronic illness.

The study released last Friday, however, shows that there is a very serious problem with access to specialty care for children covered by Medicaid and other public insurance, particularly as compared to children covered by other forms of insurance (mostly employer-based private insurance). Using a “secret shopper” methodology, the investigators posed as parents seeking care for a child, saying in one call that the child’s coverage was Medicaid and in the next call that the same child’s coverage was Blue Cross Blue Shield PPO (which dominates the market in Illinois). The Medicaid-covered children had very significant disadvantages for almost all sub-specialties in both the ability to get an appointment and in the waiting time for the appointment if it was granted. The one exception was psychiatric care, where there was a severe access problem regardless of type of insurance.

At the time of the original court order and consent decree, Illinois authorities were dealing with an inherited problem resulting from decades of underfunding and neglect of access issues in the state’s Medicaid program. They have been working to comply with the decree and improve the program, in spite of the grinding recession-driven budget crisis in the state. Representatives of the children in the case look forward to working in cooperation with state authorities to find and implement solutions to these newly documented problems with specialty access.

Meanwhile, the study has resulted in media coverage, and some commentators are attempting to use it to bolster current attempts by conservatives to cut spending on Medicaid or relieve states of the duty to comply with Medicaid’s federal rules guaranteeing children access to all needed care. Medicaid is not “broke”; it is underfunded. The underfunding causes it to fall short on its ability to deliver the kinds of quality health care that, over the long term, would save money by supporting healthier people. And Medicaid is not “broken”; it is falling short of its full potential. It provides plenty of essential health care to millions of children, working adults, people with disabilities and seniors. Cutting them off of Medicaid would hurt them immeasurably. And starving the program of funds would only exacerbate the problems with access and the efforts to expand the health care workforce needed to provide adequate care to all beneficiaries. Just because there are flaws in the program does not mean the program must end for millions of beneficiaries. If we scrapped every governmental program that has flaws that need fixing, where would the armed forces, roads, or schools be? Medicaid is essential, but it can and should improve, especially on this issue of access to needed care.  

John Bouman
President, Sargent Shriver National Center on Poverty Law
(Blog originally appeared here in the Shriver Brief)

An executive summary of the report can be found on the Illinois Health Matters website.