“The Illinois Senate could vote next week on implementing a crucial piece of the federal health insurance reforms passed in 2010, but two competing bills could lead the state in opposite directions.
The federal Patient Protection and Affordable Care Act of 2010, sometimes called “Obamacare,” calls for each state to set up public health insurance exchanges in which insurance companies sell plans that meet basic state standards. Part of a larger plan in which most people in the U.S. would have health insurance, the exchanges would offer insurance plans to small businesses, people whose employers don’t provide insurance and people who otherwise wouldn’t qualify for insurance.
On Feb. 13, Illinois Gov. Pat Quinn and Kathleen Sebelius, U.S. Secretary of Health and Human Services, announced approval of a state-federal partnership in which the federal government will manage Illinois’ exchange when open enrollment starts in October 2013. Sandy Praeger, regulatory commissioner of the Kansas Insurance Department, says that means the state will retain the ability to certify which plans can be included in the Internet-based exchange, but the federal government will handle enrollment and eligibility of consumers. Praeger is a member of the National Association of Insurance Commissioners, which represents insurance regulators nationwide.
Illinois’ partnership with the federal government isn’t meant to be permanent, however. In order for Illinois to take control of its exchange, state lawmakers must decide on the makeup of the “governing board” to oversee it.
There are at least two bills that would establish the governing board, but neither one will please everyone involved in the issue. On one side are insurance companies which say they should have a seat on the governing board to provide valuable insight about the insurance market. On the other side are consumer advocates who want the governing board to operate with input from insurers, but with no insurers actually holding a voting seat.
Jim Duffett, executive director of the consumer advocacy group Campaign for Better Healthcare, likens the issue to allowing a prosecutor to vote with the jury in a trial. Duffett says his group supports Senate Bill 34, which would establish the governing board without any insurance groups occupying a voting seat. That bill, sponsored by Sen. David Koehler, D-Peoria, could come up for a vote next week, Duffett says, following a revision by Koehler.
Sen. William Haine, D-Alton, sponsors a different bill, Senate Bill 1717, to create a governing board, which would include representation for minority groups, women, and disabled people, but also insurance providers.
Business groups have in the past expressed support for insurers holding a voting seat on the governing board. When a panel of state experts was studying how to implement health care reforms in 2010, a business coalition comprised of the Illinois Chamber of Commerce, Illinois Manufacturers Association, Illinois Retail Merchants Association and others told the panel that the exchange governing board should “allow for broad representation and expertise, including employers, consumers and those with expertise in the small group and individuals markets, including agents and brokers.”
Before the governing board issue is decided, however, Jim Duffett with the Campaign for Better Healthcare, says Illinois will likely try to tackle another health reform: a bill to expand Medicaid coverage to individuals making up to 138 percent of the federal poverty level. Under the federal health reforms passed in 2010, the federal government will pay 100 percent of the cost of Medicaid expansion for the first three years, then gradually decrease that percentage to 90 percent by the seventh year. To take advantage of the federal funds, however, Illinois must lift a moratorium on Medicaid expansions that was put in place in 2011. The moratorium lasts until 2014.
Duffett says the expansion would cover between 380,000 and 500,000 single and childless adults who don’t make enough money to afford health insurance, but who don’t currently qualify for public assistance. He says the public already pays for the uninsured through higher health care costs.
“We’re already paying for them,” Duffett said. “This would be a better, organized way to put a lid on rising health care costs.”