This is the third day of a five-day series where SJ-R heath care reporter Dean Olsen examines the Affordable Care Act and its expected impact. This series will be posted in its entirety at http://bit.ly/ACAseries. If you have questions about the ACA, email them to email@example.com. Olsen will round up the best questions and publish the answers in the newspaper and online in the coming days.
The Illinois Health Insurance Marketplace will be one of the proving grounds of the Affordable Care Act in 2014 and beyond, and the system isn’t expected to work flawlessly the first year.
“It’s a convoluted health-care system that we have. It’s not an easy thing,” said Jim Duffett, a supporter of the ACA and executive director of the Champaign-based Campaign for Better Health Care.
The federal government has given Illinois almost $155 million to set up the marketplace, also known as a health-insurance exchange, and the feds will fund the marketplace’s online portal for an enrollment period scheduled to begin Oct. 1. An additional $70 million in federal funds will be spent in Illinois on marketing, promotion and consumer-assistance programs to help the public learn about and sign up for the exchange.
Coverage will begin Jan. 1, and an estimated 70 percent of enrollees will qualify for out-of-pocket costs reduced through federal subsidies.
Because the General Assembly hasn’t been able to pass a bill establishing a state-operated exchange, the administration of Gov. Pat Quinn, which supports a state-operated exchange, agreed to a state-federal partnership for at least the first year.
Navigating the maze
The marketplace portal will provide comparisons of the four different tiers of coverage to be sold. The marketplace will dole out cost-reducing subsidies to insurers and individuals as well as keep track of the transactions, daunting tasks that will involve the Internal Revenue Service and state regulatory agencies such as the Illinois Department of Insurance.
With information typed in by applicants, the portal is supposed to determine whether people are eligible for Medicaid, and if so, transfer them online to the state agency that will help them sign up for that program. There are questions about how seamless that handoff will be, at least initially.
Also unknown is how federal officials will respond if they eventually determine that some applicants for coverage shouldn’t have received subsidies. Applicants could have experienced a change in income, or officials could conclude, after the fact, that the applicant’s employer offered coverage that fell within guidelines for affordability.
Whether all enrollees in these situations will have to repay subsidies they received or whether forgiveness will be offered the first few years, are unanswered questions, according to Laura Minzer, executive director of the Illinois Chamber of Commerce’s Healthcare Council.
Page 2 of 4 - The federal government will staff a call center to help answer such questions for potential enrollees after Oct. 1. The state plans to operate a call center of its own offering guidance, according to marketplace director Jennifer Koehler.
The federal government plans to award $2.3 million in contracts, and Illinois officials recently awarded $27 million in federal grants, to fund “navigators” and “in-person counselors,” respectively, who will work for local groups such as hospitals and other not-for-profit organizations around the state to help people choose the right plan in the marketplace.
Among the recipients of grants for services to central Illinois residents were the Springfield Urban League ($288,999), Campaign for Better Health Care ($250,000), Illinois Association of Community Action Agencies ($500,000), Southern Illinois Healthcare Foundation ($450,000), and Illinois Association of Public Health Administrators ($5 million).
In addition, Central Counties Health Centers’ Springfield site received $132,249 in separate federal funding for outreach and enrollment assistance related to the ACA. Southern Illinois University School of Medicine’s Center for Family Medicine in Springfield received $64,775 in federal funds for the same purpose.
Nothing is ‘perfect’
Details on the insurance plans and insurers to be involved in the marketplace could emerge in late August or September, though the Quinn administration says six insurance carriers have proposed selling a total of 165 health policies. Quinn aides won’t release more details, and many insurers won’t say whether they have submitted plans.
Health Alliance Medical Plans, Aetna and Blue Cross and Blue Cross of Illinois confirmed they have proposed coverage to be sold through the marketplace. So has not-for-profit Land of Lincoln Health, the only “consumer-operated and oriented plan,” or co-op, to receive federal approval as part of the ACA. Land of Lincoln also received a $160 million federal startup loan.
Land of Lincoln chief executive officer Dan Yunker said the co-op’s lack of a profit motive could provide competition to keep the price of coverage low in the marketplace. “Pricing is going to be very important,” he said.
Duffett contends that Illinois can deal more quickly with any unforeseen implementation problems by having a state-operated insurance exchange rather than a state-federal partnership.
A bill that would put a state-operated exchange in place in 2015 passed the Illinois Senate with no Republican votes but never was called for a vote in the Democratic-controlled House this year. The governor has said he supports a state-based exchange.
If the legislature fails to pass the bill in the fall veto session (Oct. 22-24 and Nov. 5-7), inevitable problems with the startup of the ACA’s key provisions in 2014 will make state lawmakers scared of supporting a state-based exchange for at least another five years, Duffett said.
“Nothing is going to be perfect,” he said. “If we have a state-based exchange, we will have more power to change it.”
Page 3 of 4 - But lawmakers in the Illinois House may be even less willing to support a state-based exchange with parts of the ACA’s implementation still in flux, Minzer said. She was referring to the recent decision by President Barack Obama’s administration to delay for a year the ACA’s penalties on certain employers that offer no insurance or coverage that is considered inadequate or too expensive.
The state chamber isn’t supporting a state-based exchange as currently proposed in the bill that the Senate passed and Duffett’s group supports.
Duffett, however, said the delay in penalties on employers has “no impact on a state exchange.”
Brief head: Confident in Obama
Lynn Williamson isn’t worried about potential problems with the state’s insurance exchange or other parts of Obamacare.
A former field organizer for Obama’s campaign organization, Williamson, 49, a Springfield resident, is uninsured and working full-time as a case manager for the Springfield Urban League’s summer youth program. The job came with no health benefits.
Williamson explained the benefits of Obamacare to prospective voters before Obama’s re-election in November. In recent months, she has received care at SIU and through the Sangamon County Medical Society’s Coordinated Access to Community Health Program for the uninsured. She said the local programs are “a blessing.”
“I don’t think it’s fair that Americans have to die in the street because they don’t have health coverage,” she said. “It is unacceptable.”
If Williamson doesn’t have a job with health insurance in the near future, she said she expects to find affordable insurance through Illinois’ marketplace or qualify for the Medicaid expansion.
“Either way, I’ll be insured,” she said. “I’m confident in my president.”
Dean Olsen can be reached at (217) 788-1543. Follow him at twitter.com/DeanOlsenSJR.
Enrollment projections for Illinois Health Insurance Marketplace
Year Individual Small Group* Total enrollment
2014 337,000 149,000 486,000
2015 489,000 203,000 692,000
2016 714,000 329,000 1,043,000
2017 933,000 357,000 1,290,000
2018 946,000 403,000 1,349,000
2019 952,000 443,000 1,395,000
Page 4 of 4 - 2020 958,000 443,000 1,401,000
*Small Business Health Options Program
Source: Deloitte LLP. More information is available at http://bit.ly/statemarketplace.