Showing posts with label Illinois. Show all posts
Showing posts with label Illinois. Show all posts

Thursday, November 8, 2012

The Cook County Health & Hospitals System (CCHHS) 1115 Medicaid Waiver—What is CountyCare?

Blog Post by Margie Schaps, Executive Director, Health & Medicine Policy Research Group 

Last month the Cook County Health & Hospitals System received word from the Federal Centers for Medicaid and Medicare that their request for an 1115 Waiver to the Illinois Medicaid system had been conditionally approved, pending the State of Illinois officially accepting the “terms and conditions” of the Waiver. So, as of right now, the expectation is that the State will make this official within the next couple of weeks.

CountyCare, as the new Medicaid program will be known, has been provided for through the Affordable Care Act. CountyCare will allow the CCHHS to enroll tens of thousands of currently uninsured people into this Medicaid Program. People can begin applying on November 5th by phone 312-8648200 or toll free at 855-6718883. Coverage will start January 1, 2013.

This provides a great opportunity and enormous challenge for the health system to transform care by creating patient-centered medical homes rather than relying on expensive and inefficient use of emergency rooms. The focus of the program will be primary care centric with all specialty care, diagnostic and inpatient services coordinated through the medical home.

Eligible people include:
  • Live in Cook County 
  • Be 19-64 years old 
  • Have income at or below 133% FPL 
  • Not be eligible for “state Plan” Medicaid 
  • Not be eligible for Medicare 
  • Be a legal immigrant for 5 years of more or a US citizen 
  • Have a social security number of have applied for one 

Not all doctors within the CCHHS system will be part of the network, and there will be many community health centers that will be part of the network (this list has not officially been released yet)

The CCHHS website has a list of answers to Frequently Asked Questions: http://www.cookcountyhhs.org/patient-services/county-care/


Advocates, providers and patients still have unanswered questions, many of which have been submitted by us to the CCHHS leadership and consultants. We anticipate getting answers to these in the coming weeks and will provide updates to this blog post as we get the information.

Tuesday, September 11, 2012

Illinois Begins Essential Health Benefits Discussion

Governor Pat Quinn recently announced that the benchmark plan for Illinois’ Essential Health Benefits (EHB) package will be chosen by September 30, in order to meet the Federal deadline for selecting a plan. A public meeting on Wednesday, September 12th, will provide the public and other stakeholders an opportunity to weigh in on this crucial piece of the health care law’s implementation in Illinois.

The EHB package defines the baseline of services covered by health insurance plans offered to individuals and small businesses in the state.

Last December, The Department of Health and Human Services released a bulletin with guidelines for states to select their own EHB plans. The guidelines feature 10 different categories of benefits that each plan must cover, such as “emergency services,” “rehabilitative and habilitative services,” “prescription drugs,” and “mental health and substance abuse services.”

States must select a health insurance plan that is currently operating within the state to act as the EHB benchmark, with the largest small group market plan in the state acting as the default benchmark if the state fails to meet the September 30 deadline. If the selected plan does not provide adequate coverage of one of the ten benefits categories, that category will be supplemented with a coverage package from a different potential plan.

Once selected, the EHB will define the level of care that individual and small group insurance plans must offer in Illinois. Benchmark plans can specify the scope or duration of benefits, but they cannot place dollar limits on copays or deductibles, as well as lifetime annual dollar limits on coverage. Plans offered to consumers in health insurance exchanges will be required to meet the level of coverage ensured by the EHB package. However, insurance companies will have the opportunity to make substitutions within the ten categories of benefits, as long as those substitutions are not found to reduce the value of coverage offered.

The Illinois Health Care Reform Implementation Council will be hosting a meeting on Wednesday, September 12, 2012, where the public and other stakeholders will be able to make comments on the state’s EHB selection. The committee will continue to accept comments until September 19. Comments can be submitted through the Governor’s health reform website.

Check back soon for an update on the EHB selection process following Wednesday’s meeting!

Thursday, April 26, 2012

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

Wednesday, April 18, 2012

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 IllinoisAccess LivingAgeOptionsAIDS Foundation of Chicago
American Cancer Society (Illinois Division)Campaign for Better Health Care, Chicago ADAPT, Citizen Action IllinoisCJE SeniorLifeDoctors Council SEIUHaymarket CenterHealth and Disability AdvocatesHealth and Medicine Policy Research GroupHeartland Alliance for Human Needs & Human RightsIL Alcoholism and Drug Dependence AssociationIL Alliance for Retired AmericansIL Association of Public Health AdministratorsIL Association of Rehabilitation FacilitiesIL Chiropractic SocietyIL Coalition for Immigrant and Refugee RightsIL Iowa Center for Independent LivingIL Maternal and Child Health CoalitionIL Partners for Human ServiceIL Primary Health Care AssociationIL Public Health AssociationIL Society for Advanced Practice NursingIllinois Society for Public Health EducationIL Valley Center for Independent LivingIllinois Network of Centers for Independent LivingImpact CILLatino Policy ForumNational Organization of Nurses with DisabilitiesNew Age ServicesOunce of Prevention Fund

Tuesday, February 21, 2012

Toward a More Inclusive, Healthy Union

Two and a half years ago Congressman Joe Wilson called out across the well of Congress, "YOU LIE, Mr. President." If the never-ending news cycles leave you struggling to recall exactly what President Obama was accused of lying about, it was the inclusion of undocumented immigrants in the yet-to-be-passed healthcare reform bill.
Thanks to this comment and the resulting uproar when healthcare reform begins in 2014 undocumented immigrants will be barred from purchasing healthcare on the regulated insurance exchanges -- even with their own money. They won't qualify for Medicaid, contrary to a popular myth. Moreover, many of their legal immigrant spouses, parents, cousins, etc. will also be ineligible for Medicaid. The unbelievably complex rules for immigrant healthcare could easily result in one family having their various members regulated by five separate sets of eligibility rules.
Eventually our nation will need to decide if we really want the people who clean our office buildings, care for our children, serve our food, and whose children attend school with our children to have significantly worse healthcare. Meanwhile, down in Florida, Governor Romney and Speaker Gingrich argue over the laughable notion of "self-deportation" and spar over who the anti-immigrant is.
But Illinois can move ahead, and make sure that healthcare reform is both rational and humane. While we cannot change the enormously complicated federal eligibility guidelines, we can reduce the confusion for families here in Illinois and promote healthcare access to the fullest extent possible.
We can ensure that immigrant families understand what their new healthcare options will be in 2014 by developing an infrastructure of community organizations to assist immigrants to understand their complicated eligibility and guide them towards other options if they don't qualify for or can't purchase health insurance. We must make sure we have a strong, stable safety net that includes not just preventative care but the acute care that left untreated results in high medical bills and throws many low-income individuals into medical debt and hurts our overall economy.
For all those who are still learning English, we can make sure the system supports provides language access so that patients can navigate their healthcare options. Finally, here in Illinois we've made a strong stand that all children should have access to healthcare. Let's keep it that way.
For more info on immigrants and the ACA, check out this IHM Resource.
Written by Joshua Hoyt, Director at the Illinois Coalition for immigrant and Refugee Rights. Follow Joshua Hoyt on twitter at www.twitter.com/icirr
This post originally appeared on the Huffington Post

Friday, November 4, 2011

Latest Developments in the implementation of an Illinois Health Benefits Exchange: Senate Bill 1313

Back in the spring, the Illinois General Assembly passed a bill enacting the intent to create a health benefits exchange, a state-wide marketplace called for by the federal Affordable Care Act that will act as a tool to aid consumers to shop for insurance. The exchange has the potential to create a competitive and regulated environment that will keep health insurance costs at reasonable levels, and thus more available to individuals and small businesses, while also making the process of shopping for insurance more straightforward and manageable. In order for the health benefits exchange to operate this way, it is important that the exchange is created with the needs and protection of consumers and small businesses in mind. Earlier this fall, the study committee on the exchange released a report on their findings.  This past week, during the Illinois General Assembly Fall veto session, steps were taken to establish the exchange. State Representative Mautino introduced his amendment (House Amendment 2) to SB 1313, a bill which dictates the makeup of the health benefits exchange governing board.

Decisions that have been made in SB1313, House Amendment 2:

The composition of the health exchange governing board has been outlined in the amendment to SB 1313 in a way that supports a board that is likely to take interest in consumers and small businesses. The board, as outlined in the amendment, will be made of 9 members:

·         2 from the Attorney General’s office
·         1 small business owner
·         1 employee of a small business
·         1 consumer representative
·         1 community-based health care provider who primarily serves individuals under 200% of poverty
·         1 health actuary or economist
·         1 member of organized labor
·         1 individual who qualifies for Medicaid

None of the seats on the board will go to legislators, brokers, or insurers. There are also pieces in the amendment that support the creation of a racially and geographically diverse board, as well as clauses that protect against board members who have conflicts of interest in the governing of an exchange board.

Decisions not made in SB 1313:

The amendment puts the board in charge of deciding how the exchange will be financed.  There are many options outlined in the amendment, some that support the interest of the consumer, such as a fee levied on insurance companies, and some that are less supportive, such as a fee to users of the exchange.


What will happen next:

Now that the bill has been filed, it needs to be approved. On November 8th, the House Insurance Committee will be holding a hearing to discuss SB 1313.   The Committee has 11 Democrats and 9 GOP members.  In order for the bill to pass the House, it will need to get support from 71 votes, opposed to the normal 60, due to rules of the veto session. If you want to see a health benefits exchange that supports the interests of individuals and small businesses, call your state representative and tell them to vote Yes on SB1313.

Wednesday, October 19, 2011

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.

Wednesday, September 14, 2011

Medicaid Cuts Could Leave Hundreds of Thousands of Illinoisans Facing Life-Threatening Health Challenges

Report Details Number of Illinoisans with Cancer, Heart Disease, Stroke, Diabetes, and Chronic Lung Disease Who Depend on Medicaid for Treatment

Cuts to Medicaid would pose a specific and dangerous threat to hundreds of thousands of Illinoisans who depend on the program for regular treatment for such medical conditions as cancer, diabetes, chronic lung disease, heart disease, and stroke. Without Medicaid, many of these seriously ill Illinoisans would no longer be able to fill essential prescriptions, keep up with key screenings, or see a doctor if their condition worsens or recurs.

The importance of Medicaid to Illinoisans is detailed in a report released jointly today by the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Lung Association, and the health care consumer group Families USA.

Hundreds of thousands of Illinoisans are covered by Medicaid. Of this number:
  • An estimated 23,760 Illinoisans with Medicaid have cancer, including 1,000 children, 15,780 adults, and 6,980 seniors;
  • An estimated 97,170 Illinoisans with Medicaid have diabetes, including 7,360 children, 64,490 adults, and 25,320 seniors;
  • An estimated 263,750 Illinoisans with Medicaid have chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis, including 146,650 children, 100,610 adults, and 16,480 seniors; 
  • An estimated 243,990 Illinoisans with Medicaid have heart disease or stroke, including 23,540 children, 164,600 adults, and 55,850 seniors.
Although Illinois directly administers its own Medicaid program, every dollar the state spends for health coverage for low-income individuals is matched dollar-for-dollar by the federal government. Particularly during difficult economic times, this federal match helps Illinois to provide health coverage for hundreds of thousands of residents.

The treatment of chronic and life-threatening diseases can be extremely costly, and people with these illnesses often become eligible for Medicaid when they have exhausted all their financial resources paying for medical care. As an example, the average hospital charge nationally for a stay associated with a heart attack is nearly $63,000, and for people with no health insurance or with inadequate coverage, such costs can quickly drive them into poverty and qualification for Medicaid.

“Hard-working Americans with diseases such as cancer can get health coverage through Medicaid after having lost their health insurance because they are too ill to work or run through their savings,” said Christopher Hansen, President of the American Cancer Society Cancer Action Network. “This program is a safety net for American families, and losing access to the program could force them to stop treatment that could save their lives.”

“Diabetes has a disproportionate impact on the Medicaid population, because Medicaid provides important health coverage to people facing elevated health risks. Children and adults eligible for this valuable program are more likely to be in poor health and thus require the services Medicaid provides to a greater extent than individuals with private insurance,” said Gina Gavlak, RN, BSN, Vice Chair of the National Advocacy Committee, American Diabetes Association. “Cuts to Medicaid funding would be harmful to the millions of children, pregnant women, and adults with diabetes who rely on the program to manage their disease and avoid dangerous and costly diabetes complications such as blindness, amputations, and kidney dialysis.”

“Medicaid is the lifeline for millions of children, adults, and seniors who suffer from chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis,” said Paul Billings, Vice President of National Policy and Advocacy for the American Lung Association. “If denied this critical healthcare coverage, it will result in higher healthcare costs, such as increased emergency room visits. We need to set politics aside and protect the health of our nation’s most vulnerable population, particularly our children, who will be most impacted by cuts to Medicaid.”

“Medicaid is a program that works and a program that provides urgently needed care to hundreds of thousands of people in Illinois suffering from serious but controllable diseases. It helps Illinois children get a healthier start in life and school, it helps to maintain a healthy Illinois workforce, and it helps head off medical debt, a leading cause of bankruptcies and home foreclosures,” Ron Pollack, Executive Director of Families USA, said today. “It should be crystal clear that with rising health care costs hurting family pocketbooks and with the economic downturn driving more families to depend on Medicaid, that this is precisely the wrong time to cut Medicaid funding to Illinois and other states.”

Families USA contracted with The Lewin Group to develop the estimates in this report.

Dave Lemmon, Families USA, 202-628-3030
Alissa Havens, Anerican Cancer Society Cancer Action Network
Christine Fehely, American Diabetes Association
Mary Havell, American Lung Association

Monday, August 1, 2011

Illinois General Assembly Taking on Immensely Important Task: Creating Competitive Health Insurance Marketplace



The stage is set for the Illinois General Assembly to complete one of the most important tasks of its members’ legislative lifetimes: creating the competitive health insurance marketplace (officially called the Illinois Health Benefits Exchange) to begin operations in January 2014.

Recently enacted Illinois Public Act 97-0142 calls for the creation of a 12-member Legislative Study Committee tasked with reporting to the General Assembly and the Governor by September 30, 2011, on implementation and establishment of a centralized marketplace where individuals and small businesses can shop for affordable health insurance, qualify for public subsidies to purchase insurance, or be enrolled in public programs (Medicaid or All Kids). The full General Assembly will take up the Exchange legislation during the fall veto session, which begins October 26.

The leaders of the General Assembly should immediately appoint members to the Study Committee—legislators who understand that establishing this marketplace is extremely important to millions of Illinois residents (including the 1.7 million currently without insurance) and small businesses.

Once appointed, the Study Committee members need to educate themselves on what the different and better world of health insurance will be like in 2014. For starters, they need to recognize that by 2014 (sooner in some cases) due to insurance market reforms required by the federal Affordable Care Act, all health insurance companies must:

  • offer insurance to all applicants (no rejections  due to health status or pre-existing health conditions),
  • set rates based on applicants’ age, geographic location, and smoking status (no charging women or sick people more),
  • spend most of the premiums they collect on health care, not on administration, and
  • cover preventive health services with no deductible or co-payments, cover care in approved clinical trials, and have no lifetime or annual limits on coverage.
Come 2014, most Americans will be required to have health insurance; that means some 25 million new customers for insurers. The federal government will subsidize the purchase of insurance by people under 400% of the Federal Poverty Level (that’s $43,560 per year for one person and $89,400 for a family of four), and all citizens (and some non-citizens) with incomes under 133% of the Federal Poverty Level will be eligible for Medicaid. Insurers will be able to put their energies into competing by offering the best value and highest quality to customers rather than into avoiding insuring people with health problems, rescinding coverage, or not renewing policies when people file insurance claims.

Study Committee members also need to recognize that the Exchange is about both private health insurance and public health insurance programs. On the private insurance side, the Exchange needs to make it easy for individuals and small businesses to compare health plans, find out if they are eligible for subsidies, and enroll in a health plan that meets their needs. On the public side, the exchange needs to screen people seeking health coverage for eligibility for Illinois public health programs (Medicaid and All Kids), verify their eligibility, and enroll them and reach out to those newly eligible for Medicaid.
Committee members need to understand what the U.S. Department of Health and Human Services (HHS) expects from and offers to the states regarding exchanges, most of which is set out in the newly issued proposed rules announced by HHS head, Kathleen Sebelius, on July 11, 2011.

The Study Committee members also need to get up to speed on the substantial work already done or in progress in Illinois:
 

First, they need to review the Illinois Health Care Reform Implementation Council Initial Report (March 2011). The Implementation Council, established by Governor Quinn, was comprised of the heads of the several Illinois state agencies responsible for various aspects of federal health reform. In 2010 and early 2011, it held meetings around the state to hear from legislators, medical providers, individuals, and organizations on how to best implement the federal reforms, including the Exchange. The report contains detailed recommendations regarding the Exchange (most importantly, that Illinois establish its own Exchange as a quasi-governmental agency with power to negotiate with insurers and require them to compete on price and quality to sell on the Exchange), with accompanying discussion and summaries of the positions of various interests.

Second, they need to examine carefully Illinois Senate Bill 1729, the Illinois Health Coverage Exchange Act. It was the product of months of Department of Insurance-convened open meetings of five stakeholder working groups (patient and family advocates, employers, insurers, providers, and insurance agents). These groups met separately and then together on the key issues of Exchange governance options, operating models, and financing options. S.B. 1729 was based on all that thoughtful input. Study Committee members should also visit the Illinois Department of Insurance’s website pages on Health Insurance Reform, where they will find much important background information on Exchanges and statutes from other states.


Third, on the public programs side, the Department of Healthcare and Family Services (HFS) is moving ahead in developing the automated processes for screening people for eligibility for Medicaid and All Kids, verifying their eligibility, and enrolling them in the appropriate program via the Exchange. The Study Committee needs to invite HFS Director Julie Hamos to give a detailed briefing on those activities.


Finally, the Study Committee can learn from other states that are going down the same road—some far ahead of Illinois. The Study Committee should take advantage of all these existing reports and resources and should use its approximately 10 weeks to drill down into the issues, perhaps by inviting recognized experts to meet with it to answer questions members may have and debate various options. And, of course, it should allow the public to describe their needs and express their opinions. 

What it should not do is start from scratch, ignoring the work of the Council, the state agencies, and the input of the hundreds of individuals and organizations who already have participated in good faith in earlier processes. Its September 30 report should aim to educate the entire General Assembly about the importance of this competitive health insurance marketplace. It should be based on facts and sound economic and policy analysis, should explain the reasons for the policy choices that underlie its recommendations, and should include any substantial conflicting evidence, so that General Assembly members can have a full and fair understanding of the choices they will be making in passing Exchange legislation.

Margaret Stapleton
Originally posted here in the Shriver Brief.

Wednesday, July 13, 2011

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.)

Friday, July 1, 2011

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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Sunday, June 26, 2011

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

Tuesday, June 21, 2011

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.

Thursday, April 21, 2011

Register now! Monday Conference Call with Senator Koehler!

Sen. Dave Koehler on SB1729 "Illinois' Competitive Health Care Marketplace: the Insurance Exchange"
Monday, April 25 12-1 PM

THE SCORE SO FAR
Round One - The passage of State Rep. Mautino's Exchange bill, HB1577, written by and for the insurance industry. No consumer participation, no consumer protections, no governance mechanism, eliminates IL's opportunity for $150-250 million in federal funding. Win for Big Insurance.

Round Two - HB1577, the insurance industry bill, has thus far been stopped in the Senate because of consumer involvement. A better, consumer-based alternative, SB1729, sponsored by Sen. Dave Koehler (D-Peoria) introduced as the first step in developing the Illinois exchange. Written by and for a variety of stakeholders, this competitive health care marketplace introduces a framework that includes a governance structure, some consumer protections, conflict of interest clauses, and begins to require insurance companies to meet strict standards for participation. SB1729 now numbers 17 co-sponsors and growing! WIN for Illinois consumers and small businesses!

Round Three - Consumers around the state are gearing up to win by making sure the insurance industry's bill is defeated and SB1729, the better consumer alternative, is passed in Springfield. We need to bring the same intensity to Springfield that we brought to the federal battle last year. JOIN US IN MAKING IT HAPPEN!

Register today to hear Sen. Dave Koehler explain SB1729 and how it impacts consumers and small businesses in Illinois. NOTE: Please update your calendar - this call is happening on Monday, April 25 at noon.

ABOUT SENATOR KOEHLER
Prior to making the jump to the Illinois Senate, Sen. Dave Koehler served as a minister for the United Church of Christ; was a staff member for the National Farm Worker Ministry and for Peoria Friendship House, served as Executive Director of the Peoria Area Labor Management Council (PALM), and the President for Labor Management Cooperative Health Programs, Inc. He served on the Peoria County Board from 1982 through 1988, and the Peoria City Council from 1989 to 1997. He is a current co-owner of the Peoria Bread Company. Sen. Dave Koehler (D-Peoria) serves as the Vice President of the Health Care Justice Act's Adequate Health Care Task Force.

UPCOMING CALLS
CBHC has conference calls every second and fourth Monday of every month. For more information on upcoming calls, speakers, and topics, visit our conference call webpage. Missed a call? Don't worry; you can listen to past calls on our audio archive!

HAVE AN IDEA FOR CALL TOPIC?
Let us know! These calls are meant to give you the information you want about health care reform in Illinois. Please let us know what topics you'd like to see us cover in future calls by emailing Kathleen Duffy with your ideas.

Jim Duffett
Campaign for Better Health Care

ACTION ALERT: Tell Senator Cullerton to Stand Up for Working Families & Small Businesses in Illinois!

1. Call IL Senate President Cullerton TODAY!
Toll-free number to the Capitol: 1.888.616.3322
Springfield Office: 217.782.2728
Chicago District Office: 773.883.0770

Tell him: OPPOSE the insurance industry supported health exchange bill - SUPPORT Passage of SB1729, The Consumer & Small Business Health Exchange
.

2. Call your state senator (http://ilga.gov/senate/) TODAY!

Ask them to be a co-sponsor of SB1729, The Consumer and Small Business Health Exchange
Toll-free number to the Capitol: 1.888.616.3322
(Not sure who your State Senator is? Find out here!)

The Illinois General Assembly is considering their next steps in implementing the health reform we fought so hard for last year. They need to hear from you today!

Background
One of the next big steps to take is the development of Illinois' competitive health care marketplace, commonly referred to as the Health Care Exchange. The exchange will be a easy to use website that is one centralized place for consumers to choose insurance plans and purchase the one that fits both your needs and budget the best, like Travelocity. It will enable small businesses to negotiate better rates for their groups, just like the big corporations do. Most importantly, it will make sure that consumers have a voice in the governance process by ensuring that there is a place at the table for them both during the creation of the Exchange, and when it is up and running.

Current Legislative Situation in Springfield
A. The Insurance Bill: HB1577 was developed by and for the insurance industry and has no consumer participation. It prevents small businesses from maximizing the same power of negotiation as larger corporations get. It does not include any consumer or small business protections, and it does not offer any means of helping consumers understand or use the Exchange. Most importantly, it does not establish a governance board of consumers and small businesses. This not only means the insurance industry gets to keep all their current advantages over consumers, but as written today, the State of Illinois will be unable to access between $150-250 million dollars of federal funding to develop this competitive health care marketplace through the Affordable Care Act - money Illinois sorely needs right now. Without these federal resources, Illinois will not be able to move forward. This bill has currently passed the House, and is awaiting legislative action in the Senate.

B. Consumer/Small Business Alternative: There is an alternative. SB1729 (chief sponsor: Sen. Dave Koehler, Peoria) was developed with the participation of providers, small businesses, consumers and insurers. It creates the first phase of a marketplace that is fair to individuals and small businesses, giving them the same access to information and power of negotiation as the big guys. It includes consumer protections against fraud and insurance industry abuses by establishing a strong independent oversight board that includes a consumer, small employer, and an employee of a small employer, among others. This bill offers the strong provisions of integrity, transparency and avoiding conflicts of interest that the insurance industry bill does not.

Senate President John Cullerton is making a decision within the next day as to which of these bills is going to be advanced for consideration by the General Assembly. We need to let him know that we want an Exchange that is designed to protect all of us, not just the insurance industry! Sen. Cullerton is being lobbied hard by the insurance industry right now - if we don't speak up NOW, they will be speaking for us.

Please call Senate President Cullerton and your State Senator TODAY and say you want them to support SB1729 and develop a fair Exchange for Illinois!

Jim Duffett

Campaign for Better Health Care

Wednesday, April 13, 2011

Illinois Needs a Competitive Health Insurance Marketplace - SB 1729 Will Establish One

The Illinois General Assembly has a lot of contentious, difficult, and time-consuming items on its 2011 agenda—the state budget, pensions, workers compensation to name a few.

But one item—passage of legislation establishing a competitive marketplace for health insurance where everyone will be able to find comprehensive coverage that is affordable—has already been researched and debated and is ready for a quick decision.

SB 1729, the Illinois Health Coverage Exchange Establishment Act of 2011, is the product of months of work by the Illinois Health Care Reform Implementation Council followed by open and robust discussions about the bill’s components and language in stakeholder working groups of patient and family advocates, employers, insurers, providers, and insurance producers convened by the Illinois Department of Insurance. SB 1729 is s sponsored by Senator David Koehler and, as of April 11, 2011, 13 other senators.

SB 1729 creates a marketplace in which individuals and small businesses can shop for high-quality, affordable health plans and individuals and families of modest means can enroll in public programs, such as Medicaid or All Kids, or obtain federal subsidies to purchase private health plans. Under the bill, this marketplace, officially called the Illinois Health Benefits Exchange, will be an independent body, governed by a nine-member board representing health care consumers, providers, small businesses, employees, labor, and insurance producers, who are appointed by the Governor and Attorney General, subject to confirmation by the Senate. Strong conflict-of-interest rules will keep board members focused on the public good, not narrow interests.

The Illinois marketplace needs to be up and running by January 1, 2014, when many of the federal Affordable Care Act insurance reforms (including no denials for pre-existing conditions and premium prices based only on age, geography, and smoking status and not on health condition) and expansions of coverage for lower income individuals go into effect. Illinois needs to have made substantial progress toward establishment of its marketplace by January 1, 2013, or the federal government will run it for Illinois.

SB 1729 will put Illinois on the road to having an effective exchange operational by 2014 and will allow Illinois to receive $150-200 million in federal funds for implementation. A competing bill, HB 1577, was drafted without any public input, lacks a governance plan, totally ignores the public program side of an exchange, makes preemptive decisions on insurance offerings, and delays Illinois’s progress toward establishing a health insurance marketplace that truly serves Illinois’s small businesses, employees, individuals, and families well.

Those interested in the future of affordable, comprehensive health coverage in Illinois should call their state senator and ask him or her to support SB 1729 and even become a sponsor. Call 1.888.616.3322 (AARP’s health line) to reach your senator.


Margaret Stapleton
Sargent Shriver National Center on Poverty Law
(Originally posted here in the Shriver Brief)

Tuesday, March 29, 2011

America’s Health Care Law: Providing Security and Opportunity for All

It's been a year since the historic vote that made the Affordable Care Act (ACA) a law, putting America on the path towards a system of quality, affordable health care for all. We have a lot to celebrate as we continue to implement and enforce our consumer protections here in Illinois.

Through the passage of health insurance reform, we have brought some of the most abusive practices of the insurance industry to an end, and instituted new rights and benefits for all. From birth to death, Americans now enjoy health care security and protection in new ways. Already in Illinois:
  • 47,200 young adults in Illinois are now eligible to stay on their parents’ coverage through age 26
  • Tens of thousands of small businesses receive tax credits that help them offer their employees coverage
  • 7.5 million people in our state no longer need to worry about hitting a lifetime cap on benefits because of the ACA
  • 612,000 Illinoisans will not have their insurance coverage rescinded when they get sick and need it most
  • 1.8 million seniors are now eligible for free wellness care, and 109,421 of them received help in meeting the costs of their prescription drugs while in the Medicare Part D coverage gap
Despite all the benefits that the new law offers, the Affordable Care Act is not perfect, but it is a good start towards health care security for all Americans. It makes sense that the Illinois General Assembly builds upon the protections and rights of this law as we move ahead to work for a system of quality, affordable health care for all.

Now at the one-year mark, the Campaign for Better Health Care and our statewide coalition encourage our elected officials in Springfield to move forward with the implementation of the required components of this new law. Any delay will have a profound negative impact on quality of life for millions of Illinois' working families, children, seniors, individuals and small businesses.

Our State Representatives and State Senators in Springfield need to stand up for the middle class and small businesses, not the insurance industry. Did you know that the top Illinois insurance companies amassed surpluses in excess of $28.3 billion in 2010? Surplus is a company's total assets minus liabilities. In other words, it’s what's left after ALL other possible costs of doing business (including all possible future claims by policyholders, paying dividends to shareholders, etc) are accounted for. Their surpluses increased by an additional $2.5 billion from 2009, even in the current economic conditions we face.

We need to implement and strengthen the health care law at the state level in a few ways. First, let’s institute fair rate review laws as outlined in Representative Greg Harris’s proposal. Rate review means that insurance companies will have to justify their requests for rate increases to the state Department of Insurance and cannot raise your rates unless their request passes this review. Laws similar to this exist in 30 states, but Illinois currently has no oversight mechanism in place.

Rate review increases transparency in the process - insurance companies will have to prove the need to charge their customers more. With more information about the rationale for rate hikes, consumers will be better prepared to make an informed decision about whether or not to purchase insurance from a specific company. This will stimulate positive competition in the health insurance marketplace, and benefit consumers by lowering costs.

Second, the Illinois General Assembly needs to begin developing a competitive health insurance marketplace, commonly known as an insurance health exchange. St. Senator Dave Koehler’s proposal begins setting up the competitive health marketplace for Illinois.

The marketplace is voluntary – if you like the insurance you have, you can keep it and not use the marketplace. However, the marketplace is always available in case you want or need it. This approach will give consumers greater control, more choice, improve quality, increase transparency, and create much needed competition in the insurance marketplace.

On this milestone anniversary of new freedom and protection for American health insurance consumers, let's work together to make Illinois' health care laws work for us, not for the obscene and greedy surpluses of insurance companies.

Jim Duffett
Executive Director, Campaign for Better Health Care

Monday, March 14, 2011

Rate Review YES!

Illinois consumers want more control, stronger protections, and greater transparency in the insurance process. Rate review provides just that. It means that insurance companies will now have to prove the need to charge their customers more, and will not be allowed to do so unless they meet strict criteria.

Insurance companies will have to justify their requests for rate increases to the state Department of Insurance, and they cannot raise your rates unless their request is found to be reasonable and justifiable. The state Department of Insurance will act as a watchdog to ensure that rate increases are fair, needed, and enacted in accordance with the rules. That is strong protection for insurance consumers in Illinois.

The process is fair for both insurance companies and insurance consumers. Rates cannot be raised unless the review says they can, but insurance companies whose increases are denied, or consumers who disagree with a decision to allow rate increases, will have the opportunity to appeal the decision.

With more information about the rationale for rate hikes, consumers will be better prepared to make an informed decision about whether or not to purchase insurance from a specific company. This will stimulate positive competition in the health insurance marketplace, and benefit consumers by lowering costs.

Without rate review, health insurance premiums in Illinois rose 73% from 2000-2007. The rate review process will slow down sudden exorbitant cost increases for insurance, allowing all health insurance consumers including working families and small business owners the ability to obtain quality, affordable insurance for themselves and their families.

Health care reform is the key to economic security and opportunity for American families. Rate review is just one of the ways we will make the system more fair for everyone.


Friday, February 11, 2011

Top Ten Things You Should Know About lllinois Health Care Reform

On February 7, 2011, Governor Quinn's Illinois Health Care Reform Implementation Council held a public hearing to release its initial recommendations on the implementation of the Affordable Care Act in Illinois. The recommendations, which include issues that the state must address immediately and decisions that will be made after the Council gathers more information from stakeholders and the federal government, were offered to the public to review and comment; however, the recommendations will be fine-tuned before final recommendations are presented to the Governor.

The report is a fairly short 19 pages and easy to read, but if you want the "Cliffs notes" version, here are the top 10 main take-aways from the meeting:
  1. The Council recommends that Illinois (rather than the federal government) create a state based Health Benefits Exchange, which is the centralized marketplace that in 2014 will provide individuals and small businesses with access to more affordable, comprehensive health insurance coverage options.
  2. The Council recommends that the Exchange should be run by a quasi-governmental entity led by an appointed board of directors. This administrative structure is similar to the Illinois Comprehensive Health Insurance Plan Board and the Office of Health Information Technology.
  3. The Council does not recommend a preferred way to finance the administration of the Exchange at this time although it specifies that funding should not come from the state general revenue funds. The Council is still considering an assessment on insurance companies, providers and others who will benefit from broader health insurance coverage, as possibilities for revenue sources.
  4. The best current estimate of the number of uninsured in Illinois is about 1.5 million. Of these, the Council estimates that in 2014, between 500,000-800,000 people will be added to Medicaid, between 200,000 and 300,000 people will purchase subsidized coverage through the Exchange and between 300,000-600,000 people will remain uninsured. Another 1 million Illinoisans who are currently insured will get private insurance through the Exchange, much of it with some subsidy. Unlike in the past, Medicaid and private insurance will be merged into one centralized marketplace.
  5. The Council recommends that the state continue to engage employers, consumers and insurers, because successful implementation of the Exchange will necessitate a strong outreach and education component, including working with community-based Navigators and insurance brokers.
  6. The Council recommends that the state take all available avenues to review and control rate increases in the insurance premium market as soon as possible. Additional information can be found on the Illinois Department of Insurance website.
  7. The Council recommends convening a Healthcare Workforce work group to develop an aggressive, comprehensive plan to professional and paraprofessional healthcare and public health worker shortages statewide, now and in the future.
  8. The Illinois Health Information Exchange (HIE) strategic and operational plan was approved by the federal government in December 2010. It focuses on the adoption and meaningful use of electronic health records; ensuring that providers who wish to begin exchanging health information electronically in 2011 can do so; developing an all payer claims database and other priorities which can be found here.
  9. The Council recommends waiting for further guidance from HHS before deciding whether to require benefits beyond the “essential benefits” defined by HHS.
  10. The Council does not recommend early implementation of Medicaid expansion in Illinois (i.e., beginning to enroll people under 133% FPL before 2014) but remains open to considering changing the moratorium on new expansions if a financially advantageous opportunity for the State arises.

Stephanie Altman
Health & Disability Advocates

Monday, January 24, 2011

Why the Affordable Care Act is Important to Community Based Organizations in Illinois

Already the Affordable Care Act (ACA) has brought in millions of dollars to Illinois and to community based organizations (CBOs) in our state. Those already funded, along with the many who will receive funding over the next years of ACA implementation have the potential to make an enormous impact on the health of our communities. Some of the most significant elements of the ACA that will impact CBOs include:

Community Health Centers: Over the next 5 years of implementation of the ACA, we can expect Illinois to receive between $285 and $437 million for operational capacity expansion and $45-$69 million for physical expansion and construction. The legislation requires that private insurers contract with Federally Qualified Health Centers (FQHCs) and reimburse at no less than the Medicaid rate. $1.5 Billion has been allocated nationally to expand the National Health Service Corps by placing primary care providers in provider-shortage community areas. Illinois can expect several hundred newly funded physicians, nurses and dentists through this program.

Safety Net Hospitals:
Medicaid will now cover all people up to 133% of the poverty level, meaning that hundreds of thousands of people heretofore uninsured will be insured after 2014 helping to provide support for safety net institutions and community health center providers. Safety net hospitals will have the opportunity to collaborate with other community based providers to develop innovative programs and apply for any of the many grant opportunities under the CMS Innovations Center.

Health Care Workforce:
The legislation provides primary care providers with a 10% Medicare payment increase for primary care services for 5 years. This increased reimbursement should help ensure greater availability of primary care physicians. In addition, the legislation requires that primary care services through Medicaid cannot be paid less than the Medicare payment rates in 2013 and 2014. This too should expand the pool of primary care providers willing to see Medicaid eligible people.

The legislation authorizes $10.8 Million for geriatric education centers to provide training focused on geriatrics, chronic care management and long term care. The legislation authorizes $10 million for career incentives to foster interest in the fields of geriatrics, long-term care and chronic care management. Furthermore, $10 million is authorized for grants to provide advanced training opportunities for direct care workers employed in long-term care settings. ACA also authorizes demonstration projects for patient navigator programs within community settings. Beginning in 2011, the legislation increases the reimbursement rate for nurse-midwife services from 65% of the rate of a physician to the full amount.

Health & Medicine Policy Research Group is a Chicago based health policy research and advocacy center focused on improving health and health systems throughout Illinois. HMPRG will continue to provide analysis of the ACA, conduct policy forums on the ACA and work with state and local partners to maximize the potential of the Act in Illinois. For more information on HMPRG or to access our analysis of the ACA and upcoming forums, visit us at www.hmprg.org, or call 312-372-4292.

Margie Schaps
Executive Director
Health & Medicine Policy Research Group