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!

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 8^th, 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.

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