Sign On in Support of SB 34 - A State Run Exchange in Illinois

Illinois Senate Bill 34 establishes a robust, 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. 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.  It is scheduled to be heard in subcommittee of the Senate Executive Committee today.

Please help signal broad support for this important health care bill by taking these 2 actions:

1. Sign on to the list of organizations supporting SB34

Click here to add your organization to the list of supporters for the passage of SB34.

2. Call the toll-free Marketplace Action line, 1-888-801-4426, and ask your state senator to cosponsor SB34!

If your state senator is already a cosponsor, please call him or her to thank them for their support. Here are the current co-sponsors:


David Koehler, Heather A. Steans, Don Harmon, Toi W. Hutchinson, William Delgado, Jacqueline Y. Collins, Michael Noland, Emil Jones, III, Julie A. Morrison, Steven M. Landek, Dan Kotowski, Patricia Van Pelt, Iris Y. Martinez, Mattie Hunter, Kimberly A. Lightford, Daniel Biss, Ira I. Silverstein, Thomas Cullerton, Terry Link, Melinda Bush, Donne E. Trotter, Bill Cunningham, Kwame Raoul, Napoleon Harris III

Please especially ask Senators Trotter and Clayborne and members of the Senate Executive Committee to pass SB34 out of committee.

SB34 must first pass out of the Governmental Operations Subcommittee and then the Executive Committee before going to a full vote.

Advocacy Materials:

You can find these materials and many others on our Health Insurance Marketplace page:

•     SB34 Fact Sheet
•     Health Insurance Marketplace Q&A
•     State Senator Co-sponsorship Form
•     Template for Co-sponorship request letter to senator
•     Template for Co-sponorship thank you letter
•     Multiple briefing resources

Jim Duffett
Campaign for Better Health Care

And Many Happy Returns: The Affordable Care Act Turns Three

The Affordable Care Act (ACA) is a historic law and its third birthday should be celebrated.
The law, each day, helps move the country from a 'sick care' system to a real health care system. Some of the lesser known but most important provisions of the ACA focus on preventing disease instead of treating people only after they become ill. Millions of Americans are already healthier because of the prevention portions of the law, including Community Transformation Grants (CTG), expanded coverage of preventive services and other measures focused on improving health in the ACA.

The law has also ensured that:

• Every new health plan, beginning in 2010, must include coverage of evidence-based, effective preventive services, such as screenings for type 2 diabetes, immunizations and mammograms, without co-pays;
• Seniors on Medicare receive many preventive services, starting January 1, 2011, with no co-payments - these services include annual wellness visits, cervical cancer screening, diabetes screening, mammograms and important immunizations such as for the flu and pneumonia; and
• The Prevention and Public Health Fund will invest $12.5 billion over 10 years (FY2013-FY2022) in locally-determined, evidence-based community prevention programs and will support public health job creation and training programs. The Fund will provide a coordinated, comprehensive, sustainable and accountable approach to improving the nation's health outcomes through the most effective prevention and public health programs.

One of the law's great prevention successes is the CTGs program -- one of the hallmark initiatives of the Prevention and Public Health Fund. CTGs provide communities with resources to focus on their top health priorities, including smoking cessation and obesity prevention.

In just three short years, the law has been an enormous benefit to Americans. In 2011, the Centers for Disease Control and Prevention (CDC) awarded $103 million in CTGs to 61 state and local public health or related organizations, and, in 2012, CDC funded CTG programs with $226 million, including approximately $70 million in CTG funding to 40 additional communities.

To commemorate the third anniversary of the Affordable Care Act, we at the Trust for America's Health (TFAH) released a story bank featuring stories of successful prevention initiatives in action from around the country. Many of the stories focus on CTG awardees and show how this new program, made possible by the ACA, is already helping to improve the health of Americans. TFAH's Prevention and Public Health Stories in the States story bank includes more than 50 profiles in 28 states, including:

• The launch of the first Accountable Care Community (ACC) in Akron, Ohio, which builds on the idea of an Accountable Care Organization. In 2011, the nonprofit organization Austen BioInnovation Institute (ABIA) brought together a wide range of 70 different groups to coordinate health care inside and outside the doctor's office for patients with type 2 diabetes, and received500,000 per year for 5 years for a capacity building CTG. The ACC reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month over 18 months with an estimated program savings of3,185 per person per year. This initiative has also led to a decrease in diabetes-related emergency department visits.
• Oklahoma is using a CTG to work with a range of sectors to make healthier choices easier in the state. Nearly 70 percent of Oklahoma County's premature deaths are largely preventable, and the county spends about920 million every year to treat chronic disease. In September 2011, Oklahoma City was awarded a3.5 million CTG. Using a portion of those funds, along with additional outside resources, the Oklahoma City-County Health Department (OCCHD) created the "My Heart, My Health, My Family" program to provide prevention programs and services, specifically focused on cardiovascular disease. The CTG money will also support expanded walking and biking trails, a push to help schools offer healthy menu options and a physical education coordinator for city schools.
• Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) in Kentucky received a capacity-building CTG to help support this program which has delivered important results for a holistic, community-based approach to address substance abuse. UNITE was created a decade ago, however the CTG will help expand its work to support public health efforts aimed at reducing chronic diseases, promoting healthier lifestyles, reducing health disparities and controlling health care spending, and will serve 119 of the state's 120 counties. UNITE works to rid communities of illegal drug use and misuse of prescription drugs by coordinating treatment, providing support to families and friends and educating the public about the dangers of drug abuse.
• The West Virginia Department of Health is using CTG support to help local health departments in every county in the state implement targeted initiatives including: safe places in communities to work and play, Farm-to-School Initiatives to improve nutrition in school settings, Child and Day Care Center Nutrition Programs to educate and empower children to choose healthy lifestyles through physical activity and healthy food choices, and community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs so people can manage their health.

The ACA began a new era for public health. The law paves the way toward ensuring public health is no longer separated from the rest of the health care system. The ACA supports common-sense community approaches focused on connecting the care people receive in the doctor's office with opportunities to stay healthier beyond the doctor's office, where we all live, learn, work and play.

As the Affordable Care Act continues to benefit the country, in another year, we'll have an abundance of stories to share of communities turning their health around by focusing on preventing illness and thereby creating happy, healthy and thriving neighborhoods.

Jeffrey Levi, PhD

Associate professor of health policy, George Washington University

Executive Director, Trust for America's Health

(This article was originally posted in the Huffington Post blog here.)

Don't Restrict the Navigators!

The Affordable Care Act requires each Health Insurance Exchange to establish a Navigator program that will help people who are eligible to purchase coverage through the Exchange learn about their new coverage and enrollment options, including Medicaid, tax credits, and private insurance. In Illinois, the Navigator program will be paired with an In Person Assistor Program to help the 1.7 million uninsured residents in Illinois find coverage. The success of the ACA hinges on the ability of Navigators and In Person Assistors to reach eligible residents and provide culturally competent services. 

Two pieces of legislation currently being heard in the Illinois General Assembly - SB1194 & HB2608 – create barriers to this massive enrollment effort. The two pieces of legislation establish overly restrictive criteria for organizations and agencies that wish to serve as Navigators, making it more difficult for vulnerable populations to be connected with their new options for affordable health insurance coverage. For example, the bills require that Navigators be licensed by the state despite the fact that the Federal regulations specifically do not require licensing.

Additionally, SB1194/HB2608 are written to address a Navigator program operated by a state-based Health Insurance Marketplace. However, in 2014, Illinois will run its exchange in partnership with the federal government. Therefore, this legislation is unnecessary because HHS, not the Illinois Department of Insurance, retains ultimate authority over the Navigator grant process, including selecting Navigator grantees and awarding Navigator grants, and the approval of grantee activities and budgets.

Over a million Illinois residents will be eligible for new health insurance starting October 2013. For a successful marketplace, rather than putting into place restrictions that would deter and prevent community-based organizations from serving as Navigators, we should work to ensure that broad efforts are in place to connect these individuals with coverage. For that reason, we ask that you OPPOSE SB 1194 & HB 2608. See here for a fact sheet on the bills.

SB 1194 will likely be called for a vote in the Senate Insurance Committee on Wednesday, March 20th @ 5 pm. Don’t restrict the Navigators; please slip in opposition to SB 1194 and HB2608.

Kathy Chan, Illinois Maternal and Child Health Coalition
Nadeen Israel, Heartland Alliance for Human Needs & Human Rights
Ramon Gardenhire, AIDS Foundation of Chicago
Stephanie Altman, Health & Disability Advocates

Finding the Pot of Gold at the End of the Navigator Rainbow!

News that a new proposed rule on Navigators is under review at the Office of Management and Budget (OMB) hopefully means it won’t be long before we see model navigator training, conflict of interest and privacy standards. With any luck, release of the proposed standards should pave the way for the federal navigator grant solicitation.

The navigator funding opportunity announcement (FOA) will seek proposals from qualified organizations in the 33 states where the federal government will operate the exchange, including states that have opted for State Partnership Exchanges. Navigator grants in the 17 states (and D.C.) that are building their own state-based exchanges will not be included in this solicitation. The level of funding has not been disclosed but CMS officials have said the total amount will be allocated to states based on a formula that establishes a state minimum and factors in the number of uninsured people in the state. So there will be a larger pot of money for navigator grants in states with higher uninsured rates.

Any organization considering applying for a navigator grant should complete the registration process as soon as possible. Given the dwindling timeline, it’s not clear how long applicants will have to prepare their proposals but potential applicants – particularly those who have never applied for a federal grant – can register now. This doesn’t obligate you to apply but it gets the basics out of the way so you can concentrate on the substance of your response to the grant solicitation once it is announced. While applying for a federal grant might seem as daunting as finding a four-leaf clover, www.grants.gov provides step-by-step registration instructions in this checklist. There are five steps for registration and while most of the steps can be completed online the same day, Step 2 – registering with the System for Award Management (SAM) – can take up to two weeks.

A word of encouragement to small community-based organizations. Keep in mind that federal regulations require there to be at least two types of entities selected as navigators in any given state and one of those types must be a community or consumer-focused nonprofit organization. Capitalizing on the experience and passion in organizations that assist people with Medicaid and CHIP coverage is the best way to build a network of navigators to reach key populations of vulnerable and uninsured people and connect them to coverage. CMS officials have emphasized that all proposals – small and large – will be considered, so securing a grant could be a lot easier than catching a leprechaun!

If you want to learn more about navigators check out these two briefs:
“Countdown to 2014: Designing Navigator Programs to Meet the Needs of Consumers”
“Designing Navigator Programs to Meet the Needs of Consumers: Duties and Competencies”

For those of you who decide to apply for navigator funding, may the luck of the Irish be with you! Remember, registering now will put you five steps closer to the end of the rainbow.

Tricia Brooks
Senior Fellow
Georgetown University Health Policy Institute, Center for Children & Families

This blog was originally posted on Say Ahhh! a health care policy blog

Illinois Should Accept Federal Funds to Fill the Gap in Medicaid

We strongly encourage the General Assembly to accept new federal Medicaid funding that will be made available to Illinois in 2014 to fill a historic gap in the Medicaid program and provide health care coverage for hundreds of thousands of the lowest income uninsured Illinois residents. The measure will strengthen the financial health of our hospitals and other health care providers and boost our local economies as federal funds create jobs.

Medicaid has never covered all low-income individuals. It has always had a gap. Even if you are very poor, you do not qualify for Medicaid unless you are also elderly, disabled, pregnant, parenting or a minor child. Eliminating this gap in Medicaid opens the door for coverage to people with income under $16,000 who are ages 18-65, not officially disabled and not raising a minor child. For example, vital health coverage would be available to young adults just coming out of high school or college and starting their working lives; other young adults experiencing underemployment after a tour in the military (Illinois has 43,000 uninsured veterans); older adults whose children have passed age 18 who are not high earners; and people troubled with mental health and other issues that block their efforts at employment.

The State of Illinois, its localities, and all of the rest of us have been filling this Medicaid gap. We do it through charity care programs, safety net healthcare arrangements funded by property taxes, and state-funded human services programs that could be covered by Medicaid if the individual were eligible. The average U.S. family and their employers pay an extra $1,000 in health insurance premiums each year to compensate for health care for the uninsured. The Kaiser Family Foundation estimates that total uncompensated care in Illinois will decline by approximately $953 million from 2013 - 2022. Townships and General Assistance providers will be relieved from paying for coverage of those who are uninsured and are currently ineligible for Medicaid.

The brunt of the Medicaid gap also falls on those not covered – poor health, premature death, lowered employability and productivity, lost opportunity, medical bankruptcy and more. SB 26 will allow the State of Illinois to use federal funds to close the Medicaid coverage gap, address these health inequities, and begin to address the problem of rising health care costs due to uncompensated care for the uninsured.

The Federal government will provide 100 percent of the cost of filling the Medicaid gap for the first three years ($4.6 billion for the Illinois economy), and 90 percent of the cost after that ($21 billion over the first ten years). This means nearly 20,000 new jobs, which means paychecks being spent in stores and restaurants. The tax revenue resulting from this federal investment in our state’s health care system will more than cover the state’s small financial contribution.

In announcing that she would accept the federal money to fill the Medicaid gap in her state, Arizona’s Governor Jan Brewer simply said, “I did the math”. Seven Republican governors, all at one time vocal opponents of the measure, have now joined this pragmatic and sensible chorus. It is just too obviously in the best interests of their people and their states to reject.

Health care coverage keeps people healthier and reduces overall health system costs. That’s why we, the undersigned organizations – a diverse constituency of consumers, providers, hospitals, local governments, businesses and insurance companies throughout the state – support SB 26 and urge the Illinois General Assembly to pass this bill.

Signed,

AARP Illinois
Aetna, Inc.
AIDS Foundation of Chicago
Heartland Alliance for Human Needs & Human Rights
Illinois Hospital Association Illinois Maternal and Child Health Coalition
Illinois Primary Health Care Association
Meridian Health Plan of Illinois
Sargent Shriver National Poverty Law Center
SEIU Healthcare Illinois Indiana

Dual Eligibles Next to Move into Managed Care in Illinois

On February 22, the U.S. Department of Health and Human Services announced a Memorandum of Understanding (MOU) with the state of Illinois for a demonstration project that will enroll approximately 136,000 dual eligibles in northeastern and central Illinois into managed care plans. (“Dual eligibles” are individuals who have coverage through both Medicare and Medicaid.) Illinois is the fourth state to receive an MOU for this demonstration, known nationally as the Medicare Medicaid Financial Alignment Initiative (MMAI).

AgeOptions and other organizations that serve older adults have been following the development of this new project, as it will significantly affect the lives of our clients. Here is what we have learned about this new initiative from our research and communications with the entities involved, including the Illinois Department of Healthcare and Family Services and various managed care organizations:

The MMAI project is part of a national effort to better coordinate care for dual eligible beneficiaries. Dual eligibles tend to be sicker and cost more than other Medicare and Medicaid beneficiaries. To address this, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services created a Medicare-Medicaid Coordination Office (MMCO) to “make sure Medicare-Medicaid enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible.” One of the MMCO’s first projects has been working with states to implement initiatives to coordinate care for dual eligibles.

Currently, dual eligibles must navigate and manage multiple systems of coverage in order to access the health care they need (Medicare, Medicare Part D prescription drug plans, and Medicaid). This can be very complex and taxing for individuals who have multiple complex health needs. Therefore, the goals of the MMAI project are to simplify this process and provide higher quality and more coordinated care for dual eligibles.

In January 2014, dual eligibles in the greater Chicago area and parts of Central Illinois will be enrolled into managed care plans. These plans must provide care managers and other supports to coordinate their members’ care, in addition to paying for members’ medical services and long term services and supports (LTSS). In exchange, these plans will be paid a capitated rate by the state of Illinois and CMS. (“Capitated rate” means the plans will receive a flat rate for each member that they serve, instead of being paid for each individual service that a member receives.) The inclusion of long term services and supports in this project is significant, as these services may be ‘new territory’ to some managed care organizations. In addition to providing coverage for LTSS provided in long term care facilities, MMAI plans will be responsible for covering home and community based services, such as the Community Care Program. This may cause confusion for dual eligible beneficiaries who are used to receiving Community Care Program services through the existing system, so agencies working with older adults will have to provide education and assistance to help our clients understand these new changes.

Illinois has selected eight managed care plans to provide MMAI coverage. Those eight plans are:

• Chicago area: Aetna Better Health, Blue Cross/Blue Shield of Illinois, HealthSpring, Humana, IlliniCare (Centene), and Meridian Health Plan of Illinois
• Central Illinois: Molina Healthcare, Health Alliance

Dual eligible beneficiaries in the target counties will be able to enroll in these plans voluntarily beginning October 2013. In January 2014, the state will begin passively enrolling additional beneficiaries into the plans. This passive enrollment will be conducted in phases, so it will take about 6 months to enroll everyone who will be affected. After a beneficiary has been passively enrolled into a plan, s/he may change plans at any time and will have some ability to opt out of the program (though this opt out privilege may be limited in certain cases).

Counties that will be part of the MMAI project:

• Greater Chicago area: Cook, DuPage, Lake, Kane, Kankakee, and Will counties

• Central Illinois: Christian, Champaign, DeWitt, Ford, Knox, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell, and Vermilion counties

For more information about the Illinois MMAI project, please see the following resources:

CMS fact sheet
Illinois Memorandum of Understanding
Illinois Department of Healthcare and Family Services webpage on Illinois Care Coordination Initiatives (see section on MMAI)

Written by Erin Weir, Manager of Health Care Access at AgeOptions
erin.weir@ageoptions.org

For Better Healthcare Join The Small Business Healthcare Consoritum

Our changing health care system will have a profound effect on all of us. Now that the election is over and the Supreme Court has ruled, the Affordable Care Act (ACA) is not going away. It will not be repealed and it is up to us to make sure it will work for small businesses and individuals as it was intended to do.

That’s why I joined the Campaign for Better Health Care’s newly created Small Business Health Care Consortium (SBHCC). This consortium views the needs of small businesses and their employees as a top priority.

And, as a member of the Steering Committee of the SBHCC I am personally inviting you to join our network of small businesses who know that only through our collective voices that will assure that the Affordale Care Act live up to its goal of making healthcare affordable for all.

Discussions around health reform have been confusing and, sometimes, even misleading. It is the goal of the SBHCC to provide factual information about the changes that are already happening and those coming in the near future. The SBHCC discusses the benefits and opportunities of the ACA and what Illinois small businesses need to do to make sure this law will benefit them.

Many key components of the ACA are national in nature. For instance, small businesses currently providing health insurance to their employees could be eligible for a 35% tax credit. And, while employers with fewer than 50 full time employees are not required to provide health insurance, their employees can take advantage of the ACA’s benefits.

Other components will be implemented at the State level and these decisions will either enhance small businesses or provide another hurdle. One important component is that all states must implement a health insurance exchange (marketplace). These exchanges will include a rate review process with defined, easy to understand plans to consider and review side-by-side.

As small business owners we share many of the same, serious business challenges. It is my hope that you and your small business peers do want to learn more about the ACA. Let’s take this opportunity to act collectively to get control of health insurance costs and improve access to coverage. The opportunity to create positive change is now. It is about fairness and choices for small businesses. To that end I like for you to hear my own personal story about how the new healthcare law will effect me.

Howard Lee
CIO
Wirehead Technology