WUIS Health Desk: Health Exchange Update

healthIllinois is faced with a steady stream of deadlines as it prepares to roll out a marketplace where small businesses and the uninsured can shop for health care coverage.   Just last week, Illinois won conditional federal approval to move forward with its so-called insurance exchange.   But even as officials dig into the complexities of getting it up and running, they’re also negotiating to change it in the future.

Given that it’s President Barack Obama’s home state, there’s pressure on Illinois to get it right with his signature health care program.
One of the most visible parts of the Affordable Care Act will be the insurance marketplace —  the online store where those without insurance will be able to go to compare prices, and purchase plans.

SEBELIUS “Today I’m pleased to announce our department is conditionally approving the blueprint that’s been submitted by the state of Illinois for a state partnership marketplace…”

That’s Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services. She came to a Chicago health clinic to give Illinois federal approval to implement its version of the exchange. She says it’ll allow hundreds of thousands of people without insurance to sign up for coverage they need and deserve.

SEBELIUS “The market will make finding the right health insurance plan less complicated and more affordable than ever before.  Comparing and understanding plans will be easy and straightforward.  People with pre-existing conditions – and a lot of our citizens have preexisting health conditions – won’t be turned away or locked out or shut out.”

Notice though, Sebelius said CONDITIONAL approval.
Illinois has a lot of work to do first. Jennifer Creasey is with A-A-R-P:

CREASEY “We needed this announcement, and now the real work begins.  Open enrollment to purchase insurance the exchange will start in October of this year … and the first plans will go into effect on January 1, 2014. Which sounds like a lot of time, but really it is not.”

While some states are letting the feds run the marketplace for them … Illinois applied for what’s known as a “partnership.”
Illinois’ letting the federal government do a lot of the work.
But it’s up to the state to manage the insurers and the plans they offer on the exchange, and to provide key customer service functions to shoppers.
Nonetheless … it’s a lot less responsibility than Illinois originally intended to take on.
A 2011 state law makes clear the original plan did NOT involve splitting control with the feds.  The law says “The General Assembly finds that the State is best positioned to implement an exchange that is sensitive to the coverage gaps and market landscape unique to this State.”
There are various theories about what happened.
The most popular is that Obamacare became so controversial, even Democrats’ from Obama’s home state who were running for election themselves, didn’t want to touch it until the U.S. Supreme Court ruled on its constitutionality.  And by the time that happened, it was too late for anything but a partnership.
Senator David Koehler, a Peoria Democrat, appreciates having the extra bureaucratic cushion.

KOEHLER “Which I think is going to be a good transition for us because that first year we need to make sure that something is in place but knowing that we really want to do it right, to do it the best way, that is going to be advantageous for both patients, consumers and for the industry is to have our own exchange so we can control just really how it works within Illinois.”

He called it a “transition.”  Koehler, as well as health care advocates, insurance companies and state officials still WANT a state-run exchange. Koehler is sponsoring a measure that’d put Illinois in control of its insurance marketplace come 2015.

KOEHLER “My goal really is that Illinois take the lead on working at a cooperative way to address the implementation of the Affordable Care Act and that we become the lead state that others look at and say, ‘yeah we can do that.’ ”

But even without an election, that’s proving difficult.  Negotiations among industry insiders have yet to yield a consensus.
There’s debate as to who should pay for the marketplace, how much control the state board chosen to run it should have, and even who’s on that board.

DUFFET “Is this board going to be a smoke and mirrors board that’s going to be dictated by the insurance industry? Or is this board going to really have some ability to make judgments?”

That’s the director of the Campaign for Better Health Care, Jim Duffet, who says Illinois should allow its future exchange board to negotiate what insurance companies charge their new customers. THAT concerns the Illinois Hospital Association’s Danny Chun.  He says if rates are low, reimbursements to medical providers will be low too.

CHUN “A key part of this is for all the plans that are put on this exchange you have to have an adequate network of providers including doctors and hospitals.”

Chun says if doctors and hospitals aren’t paid enough, they won’t participate in the plans.
And what good is insurance if you can’t find a doctor willing to see you when you get sick.
But that’s a concern for the future when, and if, Illinois splits from the feds and creates its own health insurance marketplace.
(Amanda Vinicky)

This entry was posted in Government Performance, Health Desk, Health Desk Features, Statehouse, Uncategorized. Bookmark the permalink.

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