Something to Celebrate

What's better than one celebration? Two celebrations. Health & Disability Advocates, the parent organization for Illinois Health Matters, are tossing a party for their 20th anniversary, but they're sharing the stage with the national premiere of a critical documentary on the state of healthcare in America, Escape Fire: The Fight to Rescue American Healthcare. The event is on Friday, Oct. 5th from 5 to 7:30 p.m., at the AMC Loews theater in Chicago, IL. Tickets range from $20 to $120 and can be purchased here.

Most of you know what Health & Disability Advocates does. If you're like me, you've been influenced by their excellent work, directly or indirectly. I've worked with them to spread the word about the Affordable Care Act and about the high-risk pools for pre-existing conditions, helping people with diabetes or cancer or any of dozens of other conditions. Perhaps you've been the beneficiary of legal counselling through the Chicago Medical-Legal Partnership for Children or had a Illinois Warrior to Warrior Volunteer Veteran reach out to you in support. They've touched our lives in so many ways, and I'd like to invite you to come and honor their first 20 years of helping our communities.

Escape Fire, on the other hand, is brand new, and you have a chance to be the first to see this critical look at the American healthcare system. Healthcare policy wonk and recently retired head of Medicare and Medicaid under President Obama, Dr. Don Berwick, famously compared saving our healthcare system to a counterintuitive way to fight a fire, inspiring the name for the movie. Join us as we jump into the fire and see stories that highlight where the problems are and where Health & Disability Advocates are fighting every day to ensure problems like these don't persist.



Get your tickets for next week's event now, and I look forward to seeing you there!

David Zoltan,
Guest Blogger, Illinois Health Matters

More info on the event can be found here.

The State Budget Aftermath - What's Next?

On May 25, 2012, the Illinois legislature voted to pass Senate Bill 2840, which will make drastic cuts to the state’s Medicaid program, in order to help close a $2.7 billion deficit. The news has been confusing, but the bottom line is that many of the programs which provide necessary health coverage to vulnerable populations of Illinoisans have been terminated or reduced, which will result in thousands of people losing health care coverage.

While those cuts are devastating, we remind ourselves that there are over 2 million people covered by Medicaid in Illinois—many of them covered through important expansions including the 100% Campaign, All Kids, Health Benefits with Disabilities, and FamilyCare. These coverage expansions largely remain intact and protected. We are heartened by the fact that our advocacy efforts, along with our colleagues, also staved off worse proposed cuts including the loss of coverage for tens of thousands of undocumented children with no health care alternatives.

Along with Senate Bill 2840, several other bills were passed which also affect Illinois’ Medicaid program including:

• HB5007: Amends the December 2010 Medicaid reform law that placed a moratorium on Medicaid expansions until 2013. This amendment extends that moratorium for two more years, until January 25, 2015. However, the bill also creates an exception for expansions that are federally approved and funded solely by federal and local government funds. This exemption was specifically designed to allow the Cook County 1115 waiver proposal (currently waiting for approval from CMS) to move forward, which would expand Medicaid to 250,000 low income, currently uninsured Cook County residents.
• SB 2194: Limits the number of unpaid Medicaid bills that can be rolled over from one year to the next, capping the dollar amount at $700 million in FY 2013. SB 2194, HA 3 sets more substantial definitions of charity care, so that hospitals will know what services they can provide to meet that definition, and thus retain tax exempt status 
• SB 3261 HA 2: Sets standards for eligibility for free care at non-profit hospitals

Moving forward toward the implementation of health care reform in 2014, Health & Disability Advocates will continue working to ameliorate the effect of these cuts by counseling individuals on their coverage options and training providers to build their capacity to help their patients access alternative coverage. There is not a solution to every cut but, in many instances, there are alternative programs to get necessary health care coverage to our populations.

We think it is important that while we all continue to fight against these cuts, we must immediately spring into action to help individuals transition to other coverage if at all possible.

For example, the elimination of the Illinois Cares Rx program is expected to affect over 100,000 low income older adults and people with disabilities who use the program to help them pay the premiums, deductibles, and cost-sharing of the Medicare Part program. If you or your clients have Illinois Cares Rx stories to share, please have them submit them to a special Facebook page here.

We have scheduled a webinar for June 15th to train providers how to ensure that their clients and patients use past medical bills to meet Medicaid spenddown, thus making them eligible for the federal Extra Help program which will cover all cost-sharing. We expect that tens of thousands of Illinois Cares Rx recipients could become eligible for Extra Help under this strategy.

We will continue to advocate as well as to move forward by counseling individuals, training providers and providing technical assistance to our partners to ensure that we maximize health care coverage and access in every way possible.

Stephanie Altman
Programs & Policy Director
Health & Disability Advocates

On This Memorial Day, Don't Forget Uninsured Veterans

A recent study released by the Robert Wood Johnson Foundation finds that 1 in 10 of the 12.5 million veterans in the U.S. is currently uninsured. Those veterans are more likely to be younger, less likely to be married and are less connected to the labor force—all factors that contribute to lower insurance rates.

In Illinois, 25,000 veterans, or 10.1% lack health coverage.  Add to that their family members, and that’s 68,000 men, women and children in military families without adequate access to health care. 

The Affordable Care Act has the potential to make a sizable dent in those numbers. Nearly half of uninsured veterans will become eligible for Medicaid under the program’s extension in 2014, when all citizens below 138% of the Federal Poverty Level will gain coverage.  Another 40% of those veterans will receive subsidies to use toward purchasing insurance in state health insurance exchanges. (For more information, see the Illinois Health Matters map of where all of those who are newly eligible for Medicaid live in Illinois.)

The RWJF report also found that insurance rates among veterans were higher in states that had made more progress toward implementing health insurance exchanges, as called for by the ACA. The opposite is true for those states that have made the least progress toward implementing health reforms, which are home to 40% of uninsured veterans. Illinois has made "moderate progress" toward implementation of an exchange -- the Illinois General Assembly tabled efforts to establish an exchange earlier this month, opting to wait until the Supreme Court releases their decision on the ACA before attempting to move forward.  Advocates still are urging Governor Quinn to sign an Executive Order to establish the Exchange.

Progressing forward with health reform efforts, the study claims, will be crucial to getting coverage for uninsured veterans.  In addition, other barriers to health care, such as a lack of nearby health centers,  or potential disruptions on coverage from public benefits, or a lack of awareness of potential benefits, need to be addressed.

At Health & Disability Advocates (HDA), we have seen firsthand that this is reality for service members in Illinois. For Veterans who are not insured it is important for them to have a good understanding of other state and local programs that could provide services for them and their families. HDA's Illinois Connections program assists veterans and military families connect to community services including health benefits. We have worked closely with the Illinois National Guard since those that have not been deployed are not eligible for veteran’s services, including health care through the federal VA system.

HDA's new volunteer veteran program, Illinois Warrior to Warrior, brings volunteers to Illinois National Guard units who are trained in community resources - including health care. This partnership with the National Guard allows trained volunteer veterans to be assigned to individual National Guard units and offer assistance to soldiers and their families in locating resources to meet their needs. This program is in a pilot stage in the Chicago area but will be expanded state-wide.

How military and veteran programs interact with civilian programs is complicated. At HDA, we provide tools and trainings to service providers in military/veteran and civilian systems.  See our complete list of trainings and services here and our YouTube video of our program here. If you know of a veteran in need of health insurance or health services, have them contact HDA at 312-223-9600.


Laura Gallagher Watkins, Director
Illinois Connections: Assisting Veterans & Military Families
Health & Disability Advocates

Safety Net Hospitals Spared, But Not Much Else in Medicaid Bills

Although Medicaid is a state & federal program, the City of Chicago got involved in the raging debate in Springfield. On Tuesday, May 22, 2012, Alderman George Cardenas (12th Ward) called a meeting of the Chicago City Council Committee on Health and Environmental Protection to discuss the way Governor Quinn’s proposed Medicaid cuts would affect medical care providers, specifically Safety Net Hospitals. Those hospitals have a client base that is primarily those without insurance, or those insured via Medicaid, which puts the hospitals in a position to be disproportionately affected by any Medicaid cuts.

Hospital CEOs, including those representing St. Anthony's, Mercy Hospital and Norwegian American Hospital and others, and community leaders including Metropolitan Chicago Healthcare Council, Health & Disability Advocates, Catalyst Schools, Lawndale Christian Development Center and the National Latino Education Institute, testified in front of the committee. Each person spoke about the impact of the cuts to their constituencies. The cuts would not only mean a loss of accessible healthcare in Chicago communities but also a steep decline in jobs, as many of the hospitals fuel the economic engine in the communities they serve.

Turns out some of the voices were heard: SB 2840, the final Medicaid budget bill (Named the "Save Medicaid Access and Resources Together (SMART) Act"), softens the original blow—sparing safety net hospitals from proposed provider reimbursement cuts, and lowering cuts overall from $240 million a year instead of $675 million. Passed by both houses on May 24, 2012, it will go to the Governor's desk for signature and will most likely be signed.

Unfortunately, many other health care programs for low income people and those with disabilities in Illinois were not spared in the bill. A full list can be found here, but the cuts include:

• Elimination of Illinois Cares Rx
• Family Care Eligibility reduction to 133% FPL (from 185%-400% FPL)
• Elimination of General Assistance Medical
• Adult Dental Eliminated (except in emergencies)
• 4 Prescription per month limit

These cuts will be devastating to many vulnerable populations and advocates are gearing up for the anxious phone calls from clients and providers.

The one silver lining in yesterday's legislative action is that the Cook County 1115 waiver (HB 5007) passed both houses which will allow Cook County Health and Hospital System to expand access to care for about 250,000 low income adults (below 138% FPL) in the area. Under the Affordable Care Act, their health insurance will be covered by the federal government so this will save the State $36 million per year. Of course, this is dependent on the Supreme Court upholding the ACA. Assuming it does, this early expansion of Medicaid is a huge kickstart toward ACA implementation in Illinois.

One baby step forward, two giant steps back:

So, while we mourn the Medicaid losses in SB 2840, we need to celebrate the gains in HB 5007. Nevertheless, it's important to keep talking about the life-threatening and costly implications of the stunning loss of access to affordable, quality health care that will be triggered by the signing of this "SMART" law. We also need to share clear information about the potential benefits of implementation of the Affordable Care Act, even though the ACA will not completely undo the economic cost and harm set forth in yesterday's decision.

Stephani Becker
Health & Disability Advocates, project director of Illinois Health Matters

Schools: The Missing Link in Promoting Healthy Children

On May 9^th, 2012, Healthy Schools Campaign and Trust for America’s Health, along with a group of partner organizations (including Health & Disability Advocates), released policy recommendations to Secretary of EducationArne Duncan and Secretary of Health and Human Services Kathleen Sebelius. The recommendations called on the departments to “further support the critical connection between health and learning, and build this priority into the Department’s infrastructure and leadership.”

A strong connection exists between children’s health and education. A child who is healthy is more likely to attend school and engage in learning. However, many schools lack things necessary to promoting health, such as access to clean air and water, nutritious food and school nurses; and do not provide an opportunity for students to be active throughout the day.  

School’s lack of emphasis on health comes at a time when promoting health is of the utmost importance. Rates of chronic diseases, such as asthma, diabetes or obesity, have doubled among kids in the last several decades. Students with a chronic condition often need extra care to manage their condition, and school—a place where many kids spend most of their time—could play an important role in their health.

Our nation faces a growing achievement gap in our nation’s students—which recent studies have shown to be linked to health issues. Low-income minority students are more likely to suffer from health issues, as well as more likely to attend a school without a healthy environment.

Healthy Schools Campaign, Trust for America’s Health and their partner organizations crafted their recommendations with these strong connections between health and learning in mind. The recommendations focus on actions that are within the government’s role to make and can have an immediate impact on the health of students and the achievement gap:

Recommendations to the Department of Education:

1. Expanding the mandate of the Office of Safe and Healthy Students (OSHS) and appointing a Deputy Assistant Secretary to the office in order to build up the office’s capacity for leadership.
2. Support pre-service and professional development programs for teachers and principals by making health a priority in grants and other training programs.
3. Make health an important factor of the standard of excellence for the Blue Ribbon Program.
4. Developing and disseminating best practices for colleges and universities to support teachers’ and school leaders’ abilities to address student health needs
5. Support the development of resources for schools to effectively engage parents around school health and wellness issues.
6. Support the development of educational data systems and school accountability programs that incorporate student health.

Recommendation to the Department of Health and Human Services:

1. Reduce barriers schools face in providing health care to students: Currently, restrictive regulations limit the reimbursements schools can receive from Medicaid. Removing these restrictions, which HHS itself deemed “unenforceable,” would allow schools to expand the health care schools can afford to provide to students.
2.   Include Schools in the National Prevention Strategy: The strategy emphasized the importance of making good health a priority in all areas of life, not just within a health care setting. It is important for HHS to acknowledge how important schools are to an effective prevention strategy, and to fully investigate the role schools may be able to play in promoting health.

At the event, Secretary of Health and Human Services Kathleen Sebelius announced a $75 million investment in the establishment of school health centers, as a part of the School-Based Health Center Capital (SBHCC) Program, created by the Affordable Care Act. These health centers offer disease prevention and health screenings to students. This announcement marks one of many necessary steps in the right direction towards the integration of health and education.

Stephanie Altman

Health & Disability Advocates; Program and Policy Director

Check back with Illinois Health Matters for more info on how the Department of Education and the Department of Health and Human Services integrate health into the nation’s schools. 

Choose Wisely, Illinois: Alternatives for Balancing the Medicaid Budget

On Thursday, April 19, 2012, the Governor released a proposal for the reduction of the current $2.7 billion Medicaid budget deficit. The proposal, developed with a group of legislators on the Medicaid Commission, includes $2 billion in cuts to eligibility levels, benefits, and payment rates to providers, and a $1 per pack increase in the cigarette tax. Some of the Governor’s most concerning proposals include eliminating the Illinois Cares Rx program, reducing eligibility for FamilyCare, eliminating the General Assistance Medical Program, eliminating the adult dental program, and requiring a co-pay from vulnerable populations utilizing federally qualified community health centers.

Many of these cuts will not be “fixed” by the implementation of the Affordable Care Act in 2014. For example, Illinois Cares Rx covers costs not covered under Medicare or the ACA such as premiums, deductibles, lower co-pays, and medications not covered in the Medicare formulary. The biggest misconception is that the ACA will fill the Medicare “donut hole.” It gradually reduces costs in the donut hole over the next 8 years but never completely eliminates that cost-sharing as Illinois Cares Rx does.

Other cuts may be “repaired” by the implementation of health care reform, such as coverage for low income parents, but at what cost? How much preventative care will be missed in the next 18 months which will cost the state more in expensive emergency or acute care after January 1, 2014?

Medicaid is a vital source of health care for many Illinoisans. Although the Medicaid program must become more efficient to safeguard taxpayer dollars, there are other alternatives to the proposed cuts. Solutions such as cutting prescription drug coverage, eligibility, or optional services are unacceptable and will drive up long-term state costs. The General Assembly and Governor have underfunded Medicaid for 20 years and the cuts do not need to all happen immediately; a multi-year solution is needed to balance the program budget. Furthermore, short term solutions, such as cutting prescription drug coverage, eligibility or optional services are unacceptable, and will only drive up long-term state costs. It is important for Illinois legislators to keep in mind that transformative Medicaid reforms currently being implemented and require time to work, and that 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.

Some of the proposed alternatives are:

Medicaid system Delivery reforms: Reforms such as the Care Coordination Innovations Project, Integrated Care Program, and other projects to better manage the care of some of the highest-need Medicaid patients need time to be implemented to see the full scope of savings and improved health outcomes.

Changes for Nursing Home and IMDs: Nursing homes and Institutions for Mental Disorders (IMDs) have excess capacity, resulting in thousands of empty beds across the state. Reducing the number of licensed beds could save Medicaid money. Refocusing efforts on community-based services, rather than institutional placement, would also reduce costs, and in some cases, qualify for more Federal funding. Also, Illinois could implement the nursing home bed tax, already approved by the federal government, which has not yet been implemented because the nursing home industry has not agreed on a formula to redistribute funds.

Stop paying for medically unnecessary, elective C-sections: C-sections are significantly more costly, require a longer recovery time for both the mother and often the infant, and can lead to complications due to premature birth. Nearly half of all C-sections in the U.S. are medically unnecessary, and it is estimated that Illinois’ Medicaid program spent between $54M and $76M on medically unnecessary C-sections in 2009.

For more information, see the Responsible Budget Coalition's fact sheet on alternatives to the cuts here.

Stephanie Altman
Program and Policy Director
Health & Disability Advocates

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

Cutting Illinois Cares Rx Would be Penny-Wise & Pound Foolish

The Chicago Tribune recent editorial, "Time to move on medicaid spending," correctly points out that Illinois must look at its Medicaid spending and implement innovative ways to cut costs while preserving care to its very poor and sick participants.

However, the suggestion to cut the small but extremely crucial program, Illinois Cares Rx, to assist in this important endeavor would be penny-wise and pound foolish. Illinois Cares Rx plays an important role in our medical safety net system. By assisting Illinois Cares Rx participants with deductibles and co-payments for their Medicare Part D plan, the cost of which are otherwise out of reach for them, we don’t force them to cut corners on taking their medicines or skip filling prescriptions altogether. This, in turn, keeps our Medicare beneficiaries healthier and out of hospitals and nursing homes, where Medicare beneficiaries quickly become Medicaid recipients. By investing in prescription access now, we avoid greater costs later.

Just because the federal government does not foot the bill does not mean it is not a good idea.

John V. Coburn
Senior Policy Attorney
Health & Disability Advocates