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Illinois Prepares for a New Insurance Marketplace

Illinois Prepares for a New Insurance Marketplace

Will healthcare for the uninsured really happen?
By Morgan Lord

Illinois is planning on more than a million uninsured residents receiving healthcare on Jan. 1, 2014. Some think it’s going to happen; others think it’s a long shot.

Back in March 2010, President Barack Obama signed a healthcare reform bill—the Patient Protection and Affordable Care Act (ACA)—into law. Twenty-five states chose not to set up their own insurance exchanges, Illinois took the opposite stance, and now the state is hustling to meet the deadline for launching its Health Insurance Marketplace.

Shopping for Insurance
The Marketplace, no longer called an exchange, will be available to the public through a website where individuals, families and small businesses can compare healthcare policies and premiums, and buy comprehensive health coverage. “It is set to be up and running by late summer,” says Mike Claffey of the governor’s press office.

How will this new coverage for the uninsured break down? About 200,000 to 300,000 people will select coverage from commercial insurers through the Marketplace, and about 500,000 to 800,000 will be covered under the newly restructured Medicaid program, according to the state of Illinois website.

On Oct. 1, Illinois residents can enroll online for health coverage when the Marketplace opens, and plans will become effective on Jan. 1.

But some aren’t so sure. “I do not believe that Illinois will open a Health [Insurance] Marketplace by Oct. 1,” says Dave Donovan, insurance agent at E.J. Coyne & Company. “We have a horrible reputation of not having enough funds, being generally opposed to change, antibusiness and the last to provide alternatives. “The recent inactivity in Springfield should be an eye-opener for those unfortunate folks waiting for Obamacare and [for] Illinois [to provide] an answer to their prayers.”

But Governor Pat Quinn and state officials seem confident. “We’re working very hard to ensure that we have a robust Health Insurance Marketplace in Illinois that delivers on the promise of the Affordable Care Act and makes good quality, affordable healthcare available to those who need it in every corner of the state,” Claffey says.

Stocking the Shelves
The Marketplace will include baseline coverage packages, standardized forms and transparent insurer comparisons in hopes that it will be user-friendly for residents.
Illinois received applications for 165 qualified health plans from six health insurance carriers—including Land of Lincoln Co-Op. Once the Illinois Department of Insurance (DOI) reviews the health plans as to compliance with the provisions of the ACA, they’ll be added to the Illinois Health Insurance Marketplace.

“The DOI is reviewing them (the health plans) and will report to the Feds [as to] which plans meet the requirements as well as which meet the provisions of the ACA by July 31,” says Claffey.

Under the ACA, all qualified health plans are required to include 10 Essential Health Benefits (EHB) that must be included in all health plans sold inside and outside the Health Insurance Marketplace.

The 10 Essential Health Benefits categories are: (1) ambulatory patient services (2) emergency services (3) hospitalization (4) maternity and newborn care (5) mental health and substance-use disorder services including behavioral health treatment (6) prescription drugs (7) rehabilitative and habilitative services and devices (8) laboratory services (9) preventive and wellness services and chronic disease management (10) pediatric services including oral and vision care State officials are taking the large number of health-plan applications—165—as a good sign.

“I am very encouraged that we have seen multiple plans being offered on the Illinois Health Insurance Marketplace,” said the governor in a May press release. “This means that people and families that have been struggling to obtain health coverage will have many options to choose from when we begin the open enrollment process beginning in October of this year.”

Changes that the State has Seen
The signing of the ACA gives Illinois the opportunity to advance reforms and hopefully ensure that we have a more efficient, transparent and cost-effective healthcare system.

Some change has begun. Already, more than a thousand Illinoisans have received coverage through Illinois’ federally funded high-risk pool, and over 120,000 Illinois seniors received a $250 rebate check to help cover the cost of prescription drugs, according to Quinn in a recent press release. Young adults in Illinois have the option to stay on their parents’ health insurance until the age of 26, and children can no longer be denied access to coverage because of a preexisting condition.

Projecting Hiccups
One of the goals of the national health reform is to make the purchase of health insurance simpler and more transparent for consumers. That said, many people are going to need assistance in navigating the website, learning about health insurance or thinking through these important and complex decisions.

“We know that far too many people, especially those who lack healthcare coverage, are simply not aware of the coming opportunity to acquire coverage as a result of the Affordable Care Act,” says Marketplace Director Jennifer Koehler. “We estimate that more than half of the Marketplace’s customers will require help sifting through the options and enrolling in a health plan that meets their needs.

To nip this issue in the bud, the state of Illinois has recently released a grant application through the Illinois Department of Public Health for the In-Person Counselor Program. Illinois residents can apply for these funds and hire new personnel or use existing staff as an In-Person Counselor in their community, according to the state’s site.

Politics at Play
The ACA will have a huge impact on healthcare for nearly 1.7 million people (13 percent of the population) in Illinois who are currently uninsured.

Taking a closer look at the number of uninsured in Illinois, Chicago takes the cake, with 19.4 percent uninsured. Some of the neighborhoods with the highest uninsured numbers are Avondale, Hermosa, Logan Square and West Town. It’s not an easy road ahead; the state does have some challenges.

“We essentially want to pay red-state taxes for blue-state services,” according to Deep Inside Health Care Reform, an article published by the University of Chicago, written by Harold Pollack and Mike Koetting. “And we have a tradition of poor governance in Illinois that poisons the sales pitch for some of the things that we need to do.”

“The problem with Illinois is politics,” Donovan says. “The perception is [that] we are one of the corrupt states, and nothing will change that.”

“When you have five of the last nine governors incarcerated, it becomes very, very hard to go to the electorate and say we need more resources, when in fact we do need more resources,” the U of C article continues. “Medicaid is one issue—the pension crisis is another one—where we have created a justified public cynicism about the capacity of government to accomplish what it needs to do.” Learn more about the changes in Illinois at chicagohealthonline.com

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