A Helping Hand for Small Businesses: Health Insurance Tax Credits

The Affordable Care Act (ACA) established a tax credit to help small businesses provide health insurance for their employees. According to a new study released today from Families USA and the Small Business Majority, 3.2 million small businesses, employing 19.3 million Americans, will benefit from these tax credits. Out of the 198,910 small businesses in Illinois, 137,900 will be eligible for a small business tax credit—that’s 69.3%.

The cost of health insurance is often the prohibitive factor when it comes to coverage for small business employees. Whereas almost all businesses—99 percent—with 200 or more employees offer coverage for their workers, small business have a much lower rate: 71% of businesses with 10-24 workers, and 48% of businesses with fewer than 10 workers offered employee health coverage.

The small business tax credit is an integral part of the ACA – created in order to help small businesses provide coverage for their employees. The credit is designed to provide assistance to the smallest businesses that face the highest premiums. In order to qualify, all businesses must cover at least 50% of each employee’s health insurance.

• Businesses with up to 25 FTEs and average wages of less than $50,000 will receive credits on a sliding scale. To see if your business qualifies, go to the Small Business Majority Tax Calculator here. 

• Businesses with 10 or fewer employees and average wages of less than $25,000 are eligible for the maximum 35% tax credit.. 

• Non-profit businesses are eligible for a 25% refund. In 2014, when health care reform is in full-force, the tax credits will cover up to 50% of small businesses’ health coverage plans, and non-profits will receive a refund up to 35%. 

Unlike individuals, whom the ACA mandates to have coverage, small businesses are not mandated to provide coverage to their employees. However, if a business of 50 or more workers has an employee who receives an individual subsidy to cover the purchase of individual plan insurance, that business will be levied a fee.

What does the small business tax credit mean for Illinois small businesses and their employees? 

1,206,000 Illinoisans are employed at small businesses. Out of that number, 757,300 (62.8%) are employed at businesses that are eligible for a tax credit, making it easier for their employers to provide health coverage for them. Overall, the state will receive $634,615,800 in tax credits, or about $838 per employee, on average.

54,130 (39.3%) of Illinois small businesses will be eligible for the Maximum (35%) credit. 220,400 people will benefit from the maximum credits, or 29.1% of those employed by a small business.

The country suffers from large ethnic and racial disparities in health care, and coverage is no different in small businesses, where a disproportionate number of African American and Latino small business employees are without insurance, as compared to white, non-Latino employees. Many of these workers could benefit from the small business tax credit. In Illinois, 188,090 Latino workers are employed by small businesses. 74.5% (140,040) of those workers will benefit from small business tax credits. 118,310 African American, non-Latino workers are employed at small businesses, of which 78,170 (66.1%) will benefit from tax credits.

As with many other aspects of the Affordable Care Act, the small business tax credit is still underused and unknown. We found in our Neighborhood Stories series last year that many small business owners and chambers of commerce in the South and West Sides of Chicago had not heard of the small business tax credit. The Families USA and Small Business Majority Report released today will help to continue to publicize the availability of the credit.

Keep Illinois Medicaid Strong: Principles for Financial Stability

The Illinois Medicaid program provides life-saving health coverage to nearly 2.7 million
low-income children, parents, seniors, and people with disabilities and behavioral health
needs, including addiction and mental illness. However, the program faces a $2.7 billion deficit this year, and legislators are exploring a range of solutions. We all need to ask: How much does each of these “solutions” actually cost us in health and long-term care outcomes and state funds? Our organizations endorse the following principles for stabilizing the Illinois Medicaid program.

Solutions such as cutting prescription drug coverage, eligibility, or optional services are unacceptable and will drive up long-term state costs. The services people on Medicaid receive now reduce future state health spending by providing prevention services and early intervention. 

Transformative Medicaid reforms are being implemented but need time to work. To improve the health and lives of Medicaid recipients while reducing costs, Illinois is contracting with commercial managed care companies and networks of providers to implement robust care coordination models. However, these programs cannot be in place overnight.

The General Assembly and Governor have underfunded Medicaid for 20 years; a multi-year solution is needed to balance the program budget. Medicaid reforms enacted in 2011 already establish a decade-long glide path to pay old bills, and this plan should be followed.

The Medicaid budget cannot be balanced with Medicaid cuts alone. New revenue and savings from legislative changes in other budget areas must be applied to Medicaid. Medicaid cannot be firewalled from the rest of the state budget; it is an economic engine that supports families, creates jobs, and helps children learn.

Supporters of this Statement: AARP Illinois, Access Living, AgeOptions, AIDS Foundation of Chicago, 

American Cancer Society (Illinois Division), Campaign for Better Health Care, Chicago ADAPT, Citizen Action Illinois, CJE SeniorLife, Doctors Council SEIU, Haymarket Center, Health and Disability Advocates, Health and Medicine Policy Research Group, Heartland Alliance for Human Needs & Human Rights, IL Alcoholism and Drug Dependence Association, IL Alliance for Retired Americans, IL Association of Public Health Administrators, IL Association of Rehabilitation Facilities, IL Chiropractic Society, IL Coalition for Immigrant and Refugee Rights, IL Iowa Center for Independent Living, IL Maternal and Child Health Coalition, IL Partners for Human Service, IL Primary Health Care Association, IL Public Health Association, IL Society for Advanced Practice Nursing, Illinois Society for Public Health Education, IL Valley Center for Independent Living, Illinois Network of Centers for Independent Living, Impact CIL, Latino Policy Forum, National Organization of Nurses with Disabilities, New Age Services, Ounce of Prevention Fund, 

Planned Parenthood of Illinois, Sargent Shriver National Center on Poverty Law, SEIU Healthcare Illinois Indiana, SEIU Illinois Council, SEIU Local 73, Statewide Independent Living Council of Illinois.

Moving Forward: Current Waivers for Coordinated Care Projects in Illinois

“Care Coordination,” along with related terms like “managed care” and “medical home” have become the buzz words of health care reform. The terms refer to new types of health care delivery models that many states and programs are turning to as the key to reforming the costly and arguably inefficient health care system.  Currently, the health care system mostly operates as a “fee-for-service” model, which critics argue incentivizes overutilization of medical services and shifts the focus away from effective preventative care, leading to excessive costs. Organizing groups of health care providers around patients, with a greater level of communication between doctors and a greater focus on care that keeps patients from getting ill could streamline health care delivery in a way that lowers costs and improving quality of care (for a more in-depth look at coordinated and managed care, go here or here).

In recent years, federal health programs, like CMS, have started to investigate the potential of care coordination via demonstration projects, grants and waivers for states or health care providers willing to participate. The Affordable Care Act also encourages exploration of these new care delivery models. In 2011, Illinois passed Public Act 096-1501, also known as Medicaid Reform, and began the Illinois Innovations project. As a part of that reform, the state is currently utilizing these waivers and grants:

The Integrated Care Program (ICP) is a 5-year pilot program that transfers all Medicaid (but not Medicare) eligible adults in Suburban Cook County to a Managed Care organization (MCOs). The 40,000 people included in the program, have two MCOs to choose from, one Aetna Better Health and IlliniCare Health Plan, Inc. The program is currently in Phase I, which focused on medical care. Phase II will focus on long-term care (set to begin September 2012), excluding long term care for those with developmental disabilities, which will be the focus of Phase III (no current implementation date).

Coordinated Care Entities (CCE) is a project intended to help Illinois enroll 50% of Medicaid clients into coordinated care projects (as called for by Public Act 096-1501). The CCEs are looking to cover at least 500 enrollees in a Health Home, FFS, Shared Savings or Bundled Payment model of care delivery. Illinois decided to release a request for proposals to medical care providers, in order to test the interest and capacity of community health organizations to offer coordinated care to patients, instead of simply enrolling Medicaid clients into Health Maintenance Organizations (HMOs). In January, Illinois released requests for proposals for Health Homes for chronically ill adults. Awards are expected to be announced by May 2012. HFS plans to release requests for proposals for CCEs to target children with complex medical needs by June 2012.

The proposed Cook County 1115 Waiver, currently pending with CMS, seeks to cover up to 200,000 uninsured patients who will become eligible for Medicaid once Affordable Care Act Medicaid Expansion takes place in 2014.

The Dual Eligibles program targets those who are eligible for both Medicaid and Medicare. The program would integrate the care that dual eligibles receive into one Managed Care Program. The proposal was open to a 30-day public comment period that closed in late March, and will be sent to CMS for approval.

Under the We Choose Health Community Transformations grant, the Center for Disease control has given the Illinois Department of Public Health $4,781,121 to serve the state of Illinois, excluding large counties. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. This grant will dovetail with Illinois’ State Health Improvement Plan (SHIP), a prevention-focused, comprehensive approach to improving the health of Illinois residents.

The State has proposed changes and possible mergers of the Home and Community Based Waiver programs including the DORS Home Services Program and the Community Care Program. The major proposal affecting the HCBS waivers is a proposed change from a Determination of Need (DON) threshold of 29 to 37 in order to obtain services. DORS has also proposed reducing the Service Cost Maximums in the HSP program to the levels in the CCP program.

What’s Next for Health Care Policy in Illinois?

The past two weeks were a non-stop affair for health care policy—the ACA saw its 2nd anniversary right before the Supreme court heard oral arguments for the historic case against the law, and here at IHM we premiered our data visualization tool. However, health care reform news has not stopped. Here’s a brief overview of what the next few months have in store for health care in Illinois:

Health Insurance Exchange: State legislators made little progress towards votes on the establishment of a competitive health care marketplace, though negotiations on HB 4141 are underway. Legislators still have time to establish an exchange, but the Federal deadlines are looming closer, and to miss deadlines could cause Illinois to lose out on important Federal grant money. If the group waits to move forward with the exchange until the Supreme Court announces its decision on the ACA case -- a prospect that interests some legislators -- , there may not be enough time to set up a functioning exchange. Governor Quinn has said that he would establish the exchange via an executive order if necessary.

Potential Cuts to Medicaid: The Illinois Medicaid program faces a $2.7 billion deficit in the coming fiscal year. In order to deal with that budget, the Department of Healthcare and Family Services has proposed a list of possible cuts to Medicaid services in order to balance the budget. As legislators go into the upcoming spring sessions, many advocates are calling for other methods of fixing the Medicaid budget deficit that do not compromise important health care services that the program provides.

The Illinois General Assembly starts its April sessions on the 17th.. Follow the progress of these health policy issues with IHM!

See into the future of health care reform

Illinois Health Matters has released a new data visualization tool, “Visualizing Health Care Reform in 2014,” for understanding the impact of the Affordable Care Act (ACA) in Illinois. This easy-to-use, interactive tool maps the State and shows who is currently uninsured, how many of those people will become insured, and how they will access health insurance as the major provisions of the ACA go into effect in 2014.

Infographics such as “Visualizing Health Care Reform” are valuable aids for understanding complex concepts, such as the impact of health care reform. By using data to illustrate public policy outcomes, people and policymakers can make informed, data-driven decisions.

This tool is the first of its kind to illustrate the future impact of health care reform at the state level. It also gives a valuable glimpse of how crucial these reforms will be for more than 1.6 million uninsured Illinoisans through Medicaid expansion and the new state Health Care Exchange (or “Marketplace). Clearly, businesses and communities across the state have a lot of work to do to gear up to meet the potential demand.

This is just part of the story. The impact of the new health law is even more far-reaching. For every Illinoisan who will gain access to coverage via Medicaid or the Exchange in 2014, there are others who already benefit, such as the young adults who get to remain insured via their parents’ insurance until age 26 or the children and adults whose health has benefitted from the wide range of preventative care services that insurance companies are now required to cover.

For information on how the law can help you or your community now, go to Illinois Health Matters, sign up for our monthly newsletter, or ask a question. For more on the data used in this tool, go here.

The Essential Health Benefits--Comments from Health and Disability Advocates

On December 16^th 2011, the Department of Health and Human Services released a much-anticipated bulletin on the Essential Health Benefits (EHB) package. Instead of containing information on what the package would contain, the bulletin deferred the task of defining EHB to each state. Supplementary information designed to clarify the approach taken in the bulletin was released on January 25, 2012.

Health & Disability Advocates, the organization which powers Illinois Health Matters, submitted their comments on these bulletins to HHS on January 31, 2012, reflecting specific concerns:

The role of the EHB package was to create a standard of health care covered by insurers for all Americans purchasing insurance through the state exchanges. This would mean a standard of adequate care for all, without discrimination due to age, gender, disability, chronic illness or geographical location.  It is the vehicle that would bring the goal of health care reform, that is, high-quality, comprehensive care, to many citizens.

The proposed plan gives states a vague benchmark system, with no federal oversight currently put in place, to use in defining the EHB. Although it is understandable for states to want flexibility in defining their EHB package, the degree of flexibility HHs is allowing could permit states the freedom to eliminate important benefits or the protection the EHB provides against insurance discrimination. Furthermore, to hand off all of the important decisions regarding the EHB package to the states goes against Congress’s intentions in the ACA of a federal standard, defined by HHS, for minimum coverage. As HDA states in their comments, “Simply said, the HHS EHB Bulletin is inadequate at best, and at worst, is an impediment to effective implementation” of health care reform.

HDA urges HHS to protect the potential of EHB plans by establishing an official, federal oversight process that involves a diverse range of perspectives, including those of people with disabilities and chronic illness. The HDA comments outline specific suggestions for the development of an EHB plan going forward that would safeguard the potential benefit of the EHB package, including the following:

•  Reflects an appropriate balance among the categories describes in such subsection, so that benefits are not unduly weighted toward any category
• Does not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life.
• Takes into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups
• Ensures that health benefits established as essential are not subject to denial to individuals on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree or medical dependency, or quality of life.

To read the full list of HDA’s specific concerns, read the full comments here.

Barbara A. Otto

Chief Executive Officer

Health & Disability Advocates

Neighborhood Stories: The Importance of Community-Based Health Organizations

Today, Illinois Health Matters launched the third release in their ongoing multimedia series, Neighborhood Stories. This installment reveals through video and investigative journalism the importance of community based organizations, such as neighborhood health centers and grassroots health coalitions. Such organizations provide a variety of comprehensive services to people in underserved communities, such as the South and West Sides of Chicago, who often do not have health insurance or access to quality, affordable care.
 

In “Community-Based Organizations Play a Critical Role in Reform,” author Jeffrey Steele finds community organizations act as a vital link between the federal level ACA, the state-level policies that result from the act, and the people who will benefit from the health care reform. Steele describes various ways that community organizations in Chicago are helping to implement the ACA. For example, there is an individual in every community-based organization that Celine Woznica, program director for the Asian Health Coalition in Chicago, calls a “mother hen.” They are usually trusted and respected members of community that people come to and ask questions. Inquiries may range from where to go for a flu shot to how to get heating assistance to when to go for citizenship classes. “These staff are the very people who have to be well versed on the Affordable Care Act, and how to help people take advantage of it -- from preventive care to the health exchange,” Woznica says.

Community organizations are integral to distributing accurate information about the health reform process. At Erie Neighborhood House, a west side social service organization and community service agency, they are focusing on more “in person” workshops while other groups may utilize ethnic media and webinars. As Jim Duffett, Executive Director of Campaign for Better Health Care, sums up, “The more people who take ownership at the local level, the stronger we’ll all be in winning comprehensive reform.”

The video, “Wellness on the West Side,” profiles the story of Eliazar Mejia, a woman diagnosed and treated for diabetes at Lawndale Christian Health Center (LCHC). LCHC is a shining example of “coordinated care” – where they provide a multitude of different types of care and programs all in one place. Many people who do not have insurance, such as the 38% of LCHC’s patients, end up letting a health problem develop and worsen until it sends them to the emergency room. LCHC fills the gap between no care and the emergency room for its 60,000 patients. Bruce Miller, the CEO of LCHC, sums up the organization’s overall commitment to its patients: “Our goal as a community-based organization is to provide care for everybody who needs care. Whether they have insurance, whether they don’t have insurance, we’ve never cared. So, as we think about the future, what the impact could be of health care reform, it’s our hope certainly, that many of our uninsured patients will have…better access to care, and will use that care more frequently.”

“Wellness on the West Side” is just one in the Neighborhood Stories series, presented by Illinois Heath Matters. Previous videos profile individuals and families, small businesses, and the importance of a consumer-focused health policy in Illinois. All videos and articles are featured in the “Neighborhood Stories" section of the Illinois Health Matters website, along with articles that share how community organizations, including Health & Disability Advocates, local Chambers of Commerce and others are educating and informing underserved groups about their health care coverage options under the new law. The multimedia series is part of the Local Reporting Initiative, supported in part by The Chicago Community Trust.

Neighborhood Stories: The Impact of the Affordable Care Act on the South and West Sides of Chicago

“We don’t talk about health care much,” Henry Edwards admits.

Henry is a 24-year-old father, husband and life-long resident of Garfield Park and suffers from asthma. Henry works 30 hours a week – just under full-time – so employer-based insurance isn’t available to him. His wife, Renee, is hoping to be promoted to a full-time position soon so they can apply for insurance coverage through her job.

Henry and Renee have a six-month-old son, making them eligible for health insurance from FamilyCare, an Illinois Medicaid program. But the cost of living and caring for a family while trying to afford Henry’s more than $200-a-month asthma medication is a constant concern for the Edwardses.

Henry’s struggle is profiled in a new Local Reporting Initiative called Neighborhood Stories, released today by Illinois Health Matters and supported in part by The Chicago Community Trust. The Neighborhood Stories series will showcase articles and videos of people living and working in the underserved neighborhoods of Chicago’s South and West sides and how the Affordable Care Act affects them.

Neighborhood Stories also profiles small businesses, such as Ruby's in Garfield Park, formerly Edna’s, a soul food landmark. At one time, Ruby’s employees bought health benefits through AFLAC; today, Ruby’s owner Henry Henderson says he can’t afford to help out, even though he wants to.

To see and share the videos profiling Henry Edwards and Ruby’s restaurant, go here and here. Under the new health care law, people who have a pre-existing condition can no longer be disqualified from affordable private insurance. Health care reform will also provide a range of options for health coverage through a health insurance exchange to those who do not have such coverage through their employers. In addition, small business tax credits are now available for those who want to provide coverage.

Still, experts say that many individuals and small businesses on the South & West sides of Chicago either don't know much about the new health care law or are wary of how its provisions might affect them. To that end, Neighborhood Stories will also publish a series of articles that discuss how to better disseminate information about the Affordable Care Act. The first of these articles focuses on what small business leaders think about the new law, and how to help educate business owners.

For more information about the impact of the Affordable Care Act, check out our Individuals & Families and Small Business pages. And be sure to bookmark our Neighborhood Stories page – next month we’ll highlight what local policymakers are doing to implement the new health care law in Illinois.