As Shriver Center President John Bouman stated:

Passage of this measure helps everyone in the state because it is a key part of the overall reform of the health care system and controlling its costs. But make no mistake: it is also the single most significant blow against poverty struck in Illinois in the last 50 years.

It was clear from the floor debates that these thoughts, as well as the moral conviction that health care should be for all, were prevalent among the supporters of the bill. Opponents of the bill largely cited unsubstantiated fears about future costs and the speculation that the federal government might someday renege on the funding promises in the Affordable Care Act. In fact, however, the opposition was partisan. The Republican caucuses took “caucus positions,” meaning that individual members were not free to vote their consciences or their opinions about wise public policy. 

Enacting this legislation means Medicaid coverage and increased access to quality and affordable health care to those who are uninsured with incomes under 138% of the federal poverty level (roughly $15,856 for an individual). This would make an exponential improvement in their quality of life and economic opportunity. This measure is a crucial part of the overall health reform taking effect since March of 2010. With passage of this law, Illinois joins 28 other states that have supported extending Medicaid to those newly eligible under the Affordable Care Act.

The Affordable Care Act provides that the Federal Medical Assistance Percentage (FMAP) rates for newly eligible individuals are 100% for calendar years 2014 through 2016. Federal financial support will then phase down slightly over the following several years so that, by 2020 and for all subsequent years, the federal government will pay 90% of the costs of covering these individuals (meaning that Illinois will pay just 10% of the cost of care for this new population). Medicaid coverage for the newly eligible group will start statewide January 1, 2014, with enrollment starting in October 2013. (The new coverage took effect January 1, 2012, for Cook County, Illinois, residents.).

 In addition to health improvements for the newly eligible, the law’s implementation will also:

• Ease the financial burden on health care providers. Through 2016, this legislation will bring an estimated $4.6 billion into Illinois in the form of Medicaid provider payments for newly eligible adults, with no net state costs for the care.
• Help stabilize Illinois’s state budget. The Illinois State Budget, Townships, and General Assistance providers will be relieved from paying for coverage of those who are uninsured and are currently ineligible for Medicaid.
• Benefit family economic well-being. New Medicaid will help reduce the financial burden that those who have private insurance pay towards the cost of uncompensated care. According to a report from Families USA, the average family with private health insurance pays an annual “hidden tax” of over $1,000 annually to offset the cost of uncompensated care.
• Create new jobs in Illinois. Adding the new eligibility category to Illinois’s Medicaid program will bring in a large amount of federal funds, which will result in more economic growth and jobs. In Illinois, the total amount of federal Medicaid funding anticipated to accompany the expansion is over $21 billion dollars from 2013 to 2022, which could finance hundreds of thousands of new health care jobs.
• Provide health insurance coverage to veterans. About 13,000 of the newly eligible for the Medicaid Expansion are returning veterans who will not be helped by the U.S. Department of Veterans Affairs.

This new adult coverage legislation, Senate Bill 26, sponsored by Senator Heather Steans and Representative Sara Feigenholtz, was supported by hundreds of business, health care, faith-based, community-based, and patient/consumer advocacy organizations. These supporters conducted public outreach, wrote articles and blogs, and attended the legislative sessions. Thank you to all of the legislators who voted yes on a bill that tackles one of the most fundamental justice issues of our time: access to health care. 

Obamacare, the Affordable Care Act (ACA), had

The ACA, of course, is usually discussed in terms of its impact on the health care system. And it is already doing a significant job on that front. In its birthday editorial, the New York Times aptly summarized the important contributions to reform of the health care system that the ACA has already produced:

• 6.6 million young adults covered through their parents’ health insurance (3 million of whom were previously uninsured);
• 71 million Americans received at least one preventive care service without co-payment (including 34 million older adults through Medicare);
• 17 million children protected from discrimination by insurance companies due to pre-existing conditions;
• 3 million more patients served by community clinics due to ACA-funded expansion;
• private premium increases dramatically slowed and $1.1 billion refunded to customers due to the ACA’s limit on premiums;
• 6.3 million seniors saved $6.3 billion in spending on drugs as the ACA fills in the notorious “donut hole” co-payment requirement in Medicare;
• growth of the overall cost of the health care system dramatically slowed; and
• promising improvements in health care quality. 

That is a substantial list of accomplishments; moreover, the health care system is due for its most important improvements in the coming year. The upcoming big changes, however, will have an impact that should be understood in more than just health care terms. The progress that will be made in the fight against poverty will be truly remarkable. 

Half of the gain in covering the uninsured will be directed at people in the deepest poverty in our country. Since Medicaid began in 1965, it has had a gap. It never offered coverage to people aged 19-64 who are not officially disabled and not caring for a child in their home. These are young adults leaving high school or college (whose parents do not have employer-supported coverage); empty nest parents whose children are over 18; tens of thousands of veterans not covered by VA health programs (over 12,000 would gain Medicaid coverage just in my home state of Illinois); chronically unemployed people with serious mental and physical impairments who are not officially disabled; many of the homeless; and others. The ACA will fill that gap in Medicaid , providing coverage to all with income under 138% of the Federal Poverty Line ($15,415 per year for an individual and $26,344 for a family of three) in the states that choose to take the federal money that the ACA offers them to pay for it.

For many people in poverty, health coverage not only means health, reduction in pain, and expansion of life expectancy, it also means employability and productivity and upward mobility. It can improve learning capacity. It reduces family stress. It can be a major factor in reducing family and community violence. It is a vast improvement in quality of life and quality of opportunity.

The ACA also ends the high cost for Medicaid beneficiaries of making more money. Currently, when a Medicaid beneficiary succeeds in the workplace and escapes poverty, there is a penalty: the loss of health coverage when earnings exceed allowed Medicaid levels. Starting in January, though, the Healthcare Marketplaces in every state will offer affordable private insurance coverage to replace Medicaid when earnings call for termination of Medicaid eligibility. This private coverage removes a barrier to upward mobility. It also acts as a net to keep workers in the middle class if they lose employer-supported insurance, when a health emergency might otherwise mean a free-fall into poverty. And it is there to provide coverage for budding entrepreneurs who want to try for the American Dream and start their own businesses, but who currently are blocked because they cannot risk losing either Medicaid or employer-supported coverage.    

Obamacare already fights poverty by helping seniors on Medicare make ends meet and by helping young adults make their way in the workforce by staying on their parents’ insurance. And in the coming year, at least in the states that implement it thoroughly, Obamacare will make its biggest inroads against poverty.  

In February, the 

Since 2010, the ACA has started to gradually close the “donut hole” or Medicare prescription drug coverage gap. More than three million Medicare beneficiaries in the “donut hole” received a 50% discount on covered brand name drugs and a 14% discount on generic drugs. These reductions will continue to increase until the gap is completely closed by 2020. On average, a Medicare beneficiary will save about $5,000 on prescription drug spending by 2022.

When the ACA was signed into a law it outlined ways to improve Medicare by saving money for its beneficiaries, removing unnecessary barriers, and lengthening the life of the program. Under the law, the cost of Medicare premiums remained moderately low. In fact, some individuals paid lower premiums in 2012 compared to what they paid in 2010. For Medicare beneficiaries, these savings meant lower prescription drugs costs and improved access to benefits.

Furthermore, the ACA focuses on efficient long-term cost containment strategies. One way it does this is by increasing access to preventive health services. Last year, through an ACA provision, Medicare beneficiaries accessed preventive services with no deductibles or co-pays. Vaccinations, screenings, and other preventive service are important because they help identify diseases, detect illnesses in their most treatable stages, and allow for the best chance of recovery. This provision removed the out–of-pocket cost barrier to preventive services, thus encouraging seniors to take a proactive approach to their health.

The Medicare program is working and it is becoming stronger, thanks to the Affordable Care Act. You can read the full CMS report here. 

This blog post was coauthored by Viviane Clement.

Welcome to the second blog in our series

This blog will focus on the ACA’s changes to the Medicaid program, which has the potential to extend coverage to more than 16 million low-income individuals across the nation. Medicaid is a state and federal health insurance program that provides coverage to certain categories of low-income individuals and families—namely, children, their parents, pregnant women, people who are disabled, and the elderly. Currently, Medicaid provides health insurance to about 60 million low-income Americans. However, there are millions of individuals who do not qualify for Medicaid no matter how poor they are because they don’t fit into one of these specified categories. This coverage gap causes millions of low-income individuals to postpone necessary care and prescriptions, over-rely on emergency rooms, and lack any relationship with a primary care provider to obtain preventive care and health care screenings.

The ACA offers states the opportunity to close this Medicaid gap starting in 2014 by offering insurance to persons age 19 through 65 who have household incomes less than 133% of the federal poverty level (which is $14,856 for an individual or $20,123 for a couple). Moreover, the cost of covering them will be 100% paid for by federal funds for the first three years. This 100% federal match rate will gradually decrease to 90% by 2020. With this enhanced federal match rate, Illinois, for example, can expect over $21 billion in federal funds over the next 10 years

States that have already committed to closing the Medicaid coverage gap have realized that it is a great deal. The significant federal funding will enable states and local governments to support programs delivered to the newly eligible population, and thereby saving states an estimated $92 to $129 billion over the next five years. Covering the Medicaid gap in states will help pay for hospitals’ uncompensated care costs, which translates to an estimated $1.5 billion in savings in one state. Medicaid coverage would make it possible for individuals to have a relationship with a primary care provider. This will result in a healthier population and lower mortality rates.  For more reasons of why states should opt in to the Medicaid expansion, read the National Health Law Program’s fifty reasons why Medicaid is good for your state. 

This blog post was coauthored by Viviane Clement.

The election is over, and

Let’s start with the basics. What is the Affordable Care Act? Signed on March 23, 2010, the Affordable Care Act sets forth provisions and regulations to reform our health care system in a way that offers more people access to health care. It is important to know that not all insurance plans are subject to the consumer protections rules of the ACA. Employer-sponsored health insurance plans that existed before March 23, 2010, are granted a “grandfather status,” which basically means that they have to abide only by some of the rules of the ACA. However, insurance plans created after that date must abide by all of the ACA’s regulations.

The ACA has decreased the number of uninsured individuals in the U.S., ensured that insurance companies spend at least 80% of your premium dollars on your medical needs, and has made it easier for small businesses to offer health insurance to their employees. These are just some of the existing reforms made by the ACA; in this first blog in the series we will talk about several more consumer benefits provided for in the Act.

1.     The ACA makes preventive services free of cost-sharing.

Too many Americans refrain from getting needed preventive care because of the expenses they must pay out-of-pocket. Preventive care is crucial for the simple fact that it helps individuals to avoid costly and deadly illness by detecting health issues early. The ACA requires health plans, excluding grandfathered plans, to offer you preventive services at no additional cost. This means that your immunizations, screenings, and checkups are covered—no out-of-pocket expenses. And for women, well-woman visits, mammograms, contraceptives, and other services are also free of cost-sharing. You can find the full list of preventive services that are now free of cost-sharing here.

2.     The ACA bans lifetime dollar limits.

Medical expenses are costly for a healthy individual; for millions of Americans living with a chronic medical condition, health care costs can lead to financial ruin and loss of health insurance. For years, it has been perfectly legal for insurance companies to impose a lifetime dollar limit on your health coverage. And once you reach that amount, they can stop paying for your health expenses. Now, because of the ACA, if you or someone you know has a medical condition, there is no longer a need to worry about losing insurance coverage because of lifetime dollar limit.  Because of the ACA, insurance companies are banned from imposing a lifetime dollar limit on your coverage. In addition, the use of annual dollar limits will be phased out over the next two years and banned entirely in 2014.

3.     The ACA provides for dependent coverage for young adults up to the age of 26.

The ACA’s dependent coverage provision allows young adults up to the age of 26, to stay or be added to their parents’ health insurance. The young adult population, or so-called “young invincibles,” often struggle to afford health insurance, and many just go without. Since the dependent coverage provision went into effect in 2010, 13.7 million young adults were able to remain or rejoin their parents’ health insurance. If you are under the age of 26, or a parent of a young adult under the under this age, check to see if your insurance plan offers dependent coverage up to the age of 26.

4.     The ACA will assure that pre-existing conditions will no longer be a barrier to coverage.

Several common health conditions—asthma, high blood pressure, arthritis—can be considered pre-existing conditions. Insurance companies, if they choose to, can refuse to cover you because of a pre-existing condition. Since the passage of the ACA, children can no longer be denied health insurance because of a pre-existing condition. Adults, on the other hand, must wait until 2014 to receive the same benefit. Luckily, the federal government, under the ACA, provided funding to the states for temporary high-risk pools. This funding provides health insurance for adults with pre-existing conditions who are unable to find coverage because of their conditions. In Illinois, this program is called the Illinois Pre-existing Condition Plan (IPXP), and you can enroll by contacting the Department of Insurance.

5.     The ACA will end gender rating.

In many states, women can be charged more for health insurance than men—as much $391 more annually! This surprisingly common practice—where insurance company charge more based on gender—is called gender rating. In states that do not already prohibit gender rating, 95% of the best-selling health insurance plans practice it. In Illinois, 100% of the best-selling health insurance plans practice gender rating. Starting in 2014, the ACA will ban gender rating in all states.

These five patient consumer benefits are only the tip of the iceberg. Once the ACA is fully implemented, Americans can expect health insurance to be more accessible, affordable, and comprehensive. Now you know some of the consumer benefits that may benefit you or your family and friends. So spread the word!

The next blog in this series will be about the changes in the Medicaid program that will offer health insurance to low-income single adults with no dependent children. So stay tuned!

This blog post was coauthored by Viviane Clement. 

Amidst the mixed news about poverty and income in the Census Bureau’s data released earlier this week, came

Overall, the rate and number of people without insurance coverage dropped in 2011 for the first time since 2007, in spite of the recession, contrary to most expert predictions (which were based on the assumption that loss of employer supported insurance due to job loss might increase the rate of uninsurance). 

The largest drop in the uninsured was among the 19-25 age group, clearly fueled by the ACA provision allowing young adults to stay on their parents’ health insurance as dependents up to age 26. The Obama Administration estimates that three million people have gained coverage through this provision.

While private and employer-based insurance did not decline for the first time in 10 years (due in large part to the impact of the young adult provision), it was an increase in public insurance enrollment that fueled the overall drop in the uninsured. Both Medicaid and Medicare enrollments increased, and children’s insurance held steady. The Medicaid and children’s insurance results can be attributed to the “stability provisions” in the ACA, which require states to hold the line on Medicaid and State Children’s Health Insurance Program eligibility (“maintenance of effort”). Medicaid and Medicare combined cover about one third of the country’s population.

On another front, one of the main messages of the Census Report was the ongoing exacerbation of income inequality in the U.S. (with the bottom four-fifths of the population losing ground, and the top fifth gaining). There is a health insurance side to that story. In 2011, the uninsured rate grew the lower a family’s income was: 25.4% of those with household income less than $25,000 were uninsured, compared to 7.8% of those in households with income over $75,000.

Thanks to the ACA, the country’s performance on health coverage improved in 2011, when it otherwise could have been dragged down by the recession. But there is a long way to go, with over 15% of the population and 9.7% of children still uninsured. Addressing income inequality will have a positive impact on insurance coverage. The ACA’s largest impact on coverage will come in 2014 and beyond, with implementation of the health insurance exchanges and the completion of Medicaid’s coverage of the poor. Faithful and vigorous implementation of those changes will make this story even brighter.

This month,

In Illinois alone, health insurance carriers have to pay back about $62 million to their clients—the fifth highest amount in the nation—for not meeting the medical loss ratio in 2011. UnitedHealthCare, the second largest health insurance company in the state of Illinois, paid back $13.1 million to policyholders. Nationwide, there are estimates that at least $1.1 billion in rebates will be paid back to the consumers. The average rebate amount to a family that purchases their own insurance is $151—that’s a nice chunk of their own money they will be getting back! Insurers who failed to meet the requirements had to sent out their rebates by August 1, so the checks should have already arrived in many mailboxes. 

So, just who is receiving a check? To be clear, not everyone will actually receive a physical check—their refund could be issued to their employer if that employer pays for their health care, or it could be used to credit their account in the future or returned to their credit cards. Even if consumers do not actually receive the check in the mail, this is still money that goes back into the consumer’s pocket, thanks to the Affordable Care Act.

This blog post was coauthored by Viviane Clement.

These not-so-invincible young invincibles often struggle with obtaining, navigating, and affording health insurance. The uninsured rate among this group in 2009 was 14.8 million, an increase of 4 million from the past decade. This group is a large part of the 50 million people in 2010 living in the United States without health insurance and the ACA addresses their coverage directly. The dependent coverage provision encompassed in this law permits young adults under the age of 26 to remain on their parents’ private health insurance plan, even if the adult child lives in a different house in a different state, or even if the child is married. This policy went into effect on September 23, 2010; six months after President Obama signed the ACA into law. Since then, millions of young adults have gained or retained health insurance through their parents.

But young people must confront more than misconceptions about their own mortality—there are other reasons this group lacks health insurance. One unfortunate practice that serves as a barrier for young women’s access to health care is the practice of gender rating. Women are routinely charged more than double the premium compared to the amount men pay for the same health insurance coverage. This existing practice causes young adult women to delay getting needed health care because of the cost. Some states banned this practice, but in states where gender rating is not prohibited, 95% of bestselling health insurance plans charge women more for the same exact plan. The ACA makes it against the law in 2014 in all states for health insurance companies to charge women higher premiums solely based on gender. This provision reflects the ACA’s mission to make quality health insurance accessible and affordable.

Another reason this group often lacks coverage is simply the high cost of insurance. A national survey reported 40% of young adults had outstanding medical bills and were in medical debt. Often falling through the cracks of our healthcare system, there are many uninsured young adults in this country who lack reliable, affordable access to basic medical care. This is also a group that is likely to just be starting out in their careers, and making difficult choices about whether to pay for health insurance or rent. Luckily the ACA provides a new category of Medicaid eligibility for single, childless adults who have a household income at or below the 133% Federal Poverty Level (FPL) — or about $14,800 annual income for a single individual.  Currently, the eligibility criteria for Medicaid excludes low-income young adults from Medicaid if they do not have a disability or a child, thus leaving many young adults uninsured. For example, a 19-year-old who has just lost their AllKids insurance—Illinois public health insurance for children—may likely join the uninsured population. Under this ACA provision, however, the Medicaid program will change its eligibility criteria in 2014 to include single, childless adults.

Changing the Medicaid eligibility will finally allow many low-income young adults to receive much needed health care. Individuals who will be insured in 2014 because of the Medicaid changes will be called the newly eligibles, and the cost of their care is covered at 100% by federal funding until 2020, and after that, it will be covered at least at 90%.  This provision has the potential of covering 429,300 residents in Illinois

While many young adults will be newly eligible for Medicaid or eligible to remain on their parent’s insurance, not everyone will be. For young adults for whom neither Medicaid nor the dependant coverage provision is available, there is an alternative of signing up to buy health insurance from their state’s Exchange in 2014.   An Exchange is an online site that will offer many comprehensive health insurance plans. It will allow the consumer to shop and compare plans so that they can ultimately find the one that best suits their needs and budget. Through the Exchange, there will be a variety of private health insurance plans available in a central online location that is both easy to navigate and written in plain English to allow for full transparency. There will also be financial assistance in the form of subsidies and tax credits available for those who qualify. The financial assistance will be available for individuals who make an income of up to 400% of the FPL – that’s a monthly income of $3,723 for a young single person.  An Exchange can be created by the state, the federal government, or in collaboration by both state and federal governments to offer quality and affordable health plans.  Through the Exchanges, young people will have affordable and quality health insurance options to choose from.

Given the benefits and protection that it provides to young adults, we can see that the Affordable Care Act is working to help them access affordable and quality healthcare. By 2014 when the Exchanges are launched, the Medicaid expansion is in place, and all the other provisions are fully implemented, many more young adults will be able to take care of their health easily, affordably and efficiently. Unfortunately none of us are invincible, but the Affordable Care Act is a great tool in helping young adults (and everyone else) control their own healthcare.

This blog post was co-authored by Viviane Clement.

1. Providing great outcomes and preventing bad ones.
2. Caring for the whole person.
3. Fiscal sustainability.

This blog will focus on a change we think does achieve smart health care policy—Illinois Medicaid will now no longer pay an extra amount for medically unnecessary, or elective, Cesarean (C-section) births, but instead will cover them only at the normal vaginal delivery rate. Hopefully, this change will decrease the number of parents choosing C-sections for non-medical reasons by creating impetus for parents and health care providers to have a serious talk about why they would like to schedule a medically unnecessary C-section. Even though C-sections are very common and comprise about one third of all births in the United States and a similar percentage in Illinois, a Cesarean birth is still a major abdominal surgery. This means that a C-section comes with all of the risks associated with other common surgeries, including adverse reactions to medications and increased risk of infection for the mother, along with health risks for the baby. To top it off, billing for an uncomplicated C-section birth is almost double that of a vaginal birth. The State of Illinois estimates that eliminating medically unnecessary C-sections will save about close to $3 million in the next year. All those health risks and more expensive, too?  Sounds like a good place to start improving Medicaid. 

So why are medically unnecessary C-sections a choice for some people? Parents and doctors might schedule medically unnecessary C-sections for a variety of reasons, including wanting to deliver with a particular doctor or on a particular day, desire to avoid prolonged labor pains, or desire to avoid the uncomfortable last few weeks of a pregnancy.

However, the World Health Organization strongly cautions against medically unnecessary C-sections. Medical professionals say that medically unnecessary C-sections are more likely to cause problems for both the mother and the baby. Scheduling C-sections for reasons of convenience often result in the surgeries occurring prior to the 39^th week. Babies do better when their C-sections come no sooner than one week before their due date, if at all possible. This wait allows their lungs, brains and kidneys to finish developing. Babies born by C-section have, on average, more difficulty breathing after birth and have lower Apgar scores. Particularly at risk are those infants delivered before 39 weeks, a segment which includes one in three C-sections.  These infants are at risk for eating and breathing problems, jaundice, and temperature instability and are at greater risk of being re-hospitalized for poor weight gain or failure to thrive. Mothers have a longer recovery time and a higher risk of complications from C-sections than from vaginal births. Complications can include blood clots, excessive bleeding, infections, and injury to the bladder, uterus, or bowel. Of course, all of these avoidable but serious complications cost the Medicaid program more money. 

Some hospitals are already implementing procedures to cut down on their numbers of medically unnecessary C-sections. In Salt Lake City, Intermountain Hospital has implemented a program to encourage parents and health care providers to carefully consider the rationale for C-sections.  This successful program has kept their C-section rate below the national average, thereby   decreasing patient costs by more than $270 million over a 10-year period. The hospital states that $3.5 billion could be saved in annual medical charges if the national rate of C-section births was comparable to their own. In addition to saving money, Intermountain accomplished an even greater goal—better medical outcomes. 

Of course, some situations will call for a Cesarean section for reasons of medical safety, like some births involving multiple children, risky situations or older mothers. Medically necessary C-sections will still be covered at the higher rate under Medicaid; it’s only the elective C-sections that will be covered at the less expensive vaginal birth rate. This should cut down on the numbers of elective C-sections, saving money and improving health outcomes at the same time.  Healthier outcomes for moms and babies from a less expensive procedure?  Sounds like it fulfils all the prongs of our test! 

1.  The ACA’s expansion is aimed at covering some of the most vulnerable low-income adults who are otherwise unable to afford private insurance. Not all low-income Illinoisans are currently eligible for Medicaid. Instead, right now, to qualify for Medicaid, a low-income person must fit into a “category,” such as being 65 or over, or totally and permanently disabled, or pregnant, or a child under age 19, or a parent or caretaker relative of a child under age 19. But if you are a single, childless, non-disabled adult without a penny to your name, you do not qualify for Medicaid. This expansion adds another category—having household income less than 138% of the Federal Poverty Level (FPL), which would apply to an estimated 500,000 individuals in Illinois. People in a wide range of circumstances will belong to the “newly eligible” group. Many will be low-wage, part-time workers. Some will be unemployed, either recent or long term. Some will have health conditions that, if addressed by consistent medical care, could and would allow them to get jobs. Some are really destitute, even homeless. Some are young adults, perhaps having aged off Medicaid, which they received as children, but are not fortunate enough to have parents with insurance that would cover them until they turn 26. Others are middle-aged or close to 65. Some are people who had insurance coverage, but lost it through changes in circumstances such as job loss or divorce. 

Of the newly eligible population in Illinois, an estimated 431,000 Illinoisans with household incomes less than 100% FPL will be left in the cold without the Medicaid expansion. The ACA envisioned that these folks would qualify for Medicaid. That’s why the federal subsidy to help pay for private insurance premiums starts at 100% FPL and goes to 400% FPL. So, without the Medicaid expansion, these folks will likely be priced out of affordable health insurance through the Exchange because they won’t qualify for the federal financial help (unless they are lawfully residing residents ineligible for Medicaid). They will have to continue to access safety-net providers and emergency rooms for care, driving up costs for these providers and showing up sicker. And, these folks are still held responsible under the individual mandate to prove insurance coverage or why they are exempt.

2.  Minimal state investment will reap overwhelming benefit. The ACA increased the Federal Medical Assistance Percentage (FMAP) rates for the newly eligible individuals under the expansion to 100 percent for calendar years 2014 through 2016, and then gradually declining to 90 percent in 2020 where it remains indefinitely. By 2020, when Illinois will pay just 10 percent of the cost of care for this new population, the annual state cost is estimated at $157 million. (This is 10% of the current cost per adult beneficiary in Illinois, $3,157, times 500,000 new beneficiaries). But even as this cost will rise due to inflation, it will also be offset by benefits such as larger state tax revenues from increased employment and provider income and an increased insured population. It will also be offset by increased efficiencies due to the new system to simplify and coordinate eligibility and enrollment for Medicaid and the Exchange, which is nearly entirely paid for by the federal government. It may also be offset by the stabilization of the health of almost half of the newly eligible population in the event that the federal government gives permission for Cook County to expand Medicaid early, this year or next. If Cook County is allowed to expand Medicaid early, an estimated 250,000 folks will have medical homes and coordinated care, which would likely stabilize chronic conditions, prevent disabilities, and therefore reduce future Medicaid costs. Finally, state costs can be further minimized by increasing efficiency through care coordination initiatives, especially for persons with chronic conditions and for dual eligibles (persons eligible for both Medicaid and Medicare). The Lewin Group estimates that the ACA will increase Illinois’s Medicaid spending by just 2.8% between 2014 and 2019. The Congressional Budget Office has estimated that the ACA would impose less than a 1% increase in state Medicaid costs.  Moreover, these high federal matching rates are highly likely to stay. In Medicaid’s close to 50-year history, Congress has never decreased FMAP levels in Medicaid other than to allow the expiration of temporary FMAP increases enacted as parts of stimulus packages in recessions. The more states that adopt the “newly eligibles” expansion, the more members of Congress who will resist any reduction below 90% down the line. In fact, with sufficient support, Congress could amend the matching rate, keeping it at 100% indefinitely.

3. Expanding Medicaid creates jobs. We know from our recent past that an increased federal matching rate in the Medicaid program has an enormously significant economic impact—called a multiplier effect—throughout the economy and positively impacts jobs. When Congress included an increase in the federal Medicaid matching rate in the American Recovery and Reinvestment Act from 50% to 61.88% from October 2008 through December 2010, $1.2 billion per year for that period flowed into Illinois. For FY 2009, one estimate places the value of the wages generated from the Medicaid program that included the enhanced match as high as $15.8 billion, supporting as many as 385,742 jobs. The job growth and wages generated are likely to be much more substantial under the ACA’s Medicaid expansion, since the federal matching rate under the ACA is 100% from 2014 through 2016 and an additional roughly 500,000 newly eligible Medicaid patients are expected to enroll. State and local revenue increases when Illinois residents pay income, sales, and other taxes generated by the federal funding for the Medicaid expansion; this revenue would offset much, perhaps all, of the additional costs.

4. Participating in the Medicaid expansion will help stabilize the state budget. The budget is critically dependent on federal Medicaid funding. The Illinois Medicaid program is by far the largest source of federal revenues to the state. Federal funds also support the Department of Human Services, Department on Aging, Department of Children and Family Services, local public health departments, Cook County Health and Hospitals Systems, Illinois’s state universities, and local school districts’ special education programs, among others. The Medicaid expansion will provide crucial federal funds across the state and local governments to support programs now being delivered to the expansion population with no federal funds, or being withheld from that population due to lack of funds.

5. We pay for the health care for the uninsured in any event, so let’s use federal dollars to pay for their current uncompensated care. A Kaiser and Urban Institute report on state spending under the expansion found that under the expansion, by 2019, Illinois would have reduced its number of uninsured adults in this newly eligible population by over 42% with the federal government paying for over 94% of the cost. This could translate into a decrease in Illinois’s uncompensated care spending of as much as $1.5 billion. And any cost to the state will be there, whether or not Illinois takes the money provided for the expansion. Working Illinoisans in low-wage jobs without insurance still get sick, still get injured. But without the federal dollars from the Medicaid expansion, other Illinoisans with insurance will still have to pick up the cost of their care, to the tune of $1,000 per year in increased annual premiums. And local property taxes are strained to support the township medical assistance programs and safety net health systems that provide care for low-income uninsured people now. In fact, currently over $400 million in services for uncompensated care is being provided annually by just one hospital: Cook County’s Stroger Hospital. 

6. Illinois hospitals need the Medicaid payments to offset reductions in federal funds in other areas. Targeted hospital subsidies, known as disproportionate share hospital (DSH) payments, will decline under the Affordable Care Act. The reduction was justified on the theory that the Medicaid expansion will eliminate the need for DSH subsidies by greatly reducing the burden of uncompensated care. If hospitals lose those payments, and the loss is not made up by the expansion of Medicaid, it will devastate not only hospitals, but entire communities. Many Illinois hospitals, especially in rural areas, simply are not viable if their DSH subsidies decline without being replaced by expanded Medicaid. Hospitals are among the largest employers in their communities. When a hospital closes, the community not only loses a major employer, but providers leave too, and then the community has great difficulty recruiting new industry. Additionally, expanding Medicaid will ensure that Illinois’s medical providers will have the financial support coming from the Medicaid expansion to offset the ACA’s Medicare payment reductions. Doctors and hospitals are counting on the Medicaid expansion (which will bring in revenue for services to the newly eligible and reduce the need for uncompensated care) to be in place as the Medicare payment changes are phased in.

7. Expanded coverage is the linchpin for the big picture reforms that will deliver both better health outcomes and lower costs. Coverage requires an investment (which the federal government virtually entirely funds under the ACA). But the investment will yield returns. Coverage makes possible a relationship with a regular medical provider. That, in turn, facilitates prevention, wellness advice, early detection of conditions, maintenance care (avoiding acute care), a platform for the full use of health information technology that avoids duplication and mistakes and spreads best practices, and care coordination. Coverage thus addresses the cost of health care by improving health outcomes across the system. This overall downward bending of the cost curve helps all of us, not just the newly insured. 

8. Federal Medicaid dollars will finally be paying for behavioral and mental health services for Medicaid enrollees. Under the ACA, the newly eligible population will have a benefit package that includes mental health and behavioral health services. These are costs now being borne by state and local funds, or else the services are simply not being provided—with impact on emergency rooms, state institutions and the criminal justice system. These state and local costs will be replaced with federally funded Medicaid.

9. Illinois’s veterans deserve health insurance. Not all veterans are able to get care at a Veterans Affairs hospital. And, in fact, roughly 43,000 Illinois veterans are uninsured (along with 25,000 of their family members). Illinois needs to take care of veterans, and the ACA’s Medicaid expansion will do just that. At implementation in 2014, nearly half of uninsured veterans will likely qualify for expanded Medicaid coverage. Illinois should serve these veterans, just like they served its citizens.

10. Does Illinois really want to subsidize health care in other states? As Justice Scalia stated in his dissent, “Those States that decline the Medicaid Expansion must subsidize, by the federal tax dollars taken from their citizens, vast grants to the States that accept the Medicaid Expansion.” So if Illinois does not take advantage of the federal 100%/90% funding for the Medicaid expansion, other states that chose to expand will get the benefit of Illinoisans’ federal tax dollars.

11. Expanding Medicaid coverage helps the financial viability of community clinics. Clinics are our best—really only—strategy for providing health care to the uninsured outside of emergency rooms. There will still be plenty of uninsured after the ACA is implemented, plus many of the newly insured Medicaid beneficiaries will get their care from clinics. The only way that clinics can serve the uninsured is by serving a critical percentage of patients who have coverage. The Medicaid reimbursement for covered patients allows the clinic to also serve the uninsured. With a high percentage of patients covered, the clinics will be able to expand capacity to serve the uninsured as well as those newly coverage by Medicaid.   

12. The Medicaid expansion is simply the right thing to do. We have a chance, through the incredible leveraging of federal funds, to provide health coverage—and the chance for better health and upward mobility—to hundreds of thousands of our state’s most vulnerable, needy residents. We can create a system that expands its circle of moral concern to include the uninsured, recognizing as Justice Ruth Bader Ginsburg wrote in N.F.I.B. v. Sebelius, that “[v]irtually everyone … consumes health care at some point in his or her life.”

People with insurance and people without insurance should be relieved that the process of reform can now move forward and make health care more secure. All of them have spent sleepless hours worried about the cost, lack of control, lack of choice, and absence of peace of mind associated with our current system. The Affordable Care Act (ACA) has tools to address all of these issues, although much still depends on decisions made at the state and local level, where officials must now continue implementing this important work.

The Court’s decision means that the benefits of the Affordable Care Act that are already in place will not have to be reversed.

• Health insurers will have to make their policies easier for customers to comprehend.  
• Insurance companies will have to spend a higher portion of your premiums actually providing health care.
• Young adults up to age 26 can now remain on their parents’ insurance policies.
• Over 60,000 “uninsurable” people have health insurance through the ACA’s Pre-Existing Condition Insurance Program.
• No child can be denied coverage by an insurance company due to a pre-existing health condition. Adults will win that protection in 2014.
• Every Medicare beneficiary who hits the prescription drug “donut hole” receives a 50% discount on their brand name and generic prescription drugs. As of March, Illinois Medicare beneficiaries who had triggered into this benefit were getting about $636 a month in savings.
• States receive significant federal grants to help them hold insurance companies accountable for unreasonable rate increases.
• Preventive services are free under all types of public or private health insurance. Thus, last year 18.9 million Medicare recipients received free annual checkups and preventative services.
• Women no longer need a referral from a primary care physician before seeing a gynecologist.
• Medicare premiums are lower than they would have been without the law.

Looking down the road a bit, the Court’s decision means that the full benefits of the law will be implemented on schedule:

• In 2014, 30 million Americans will gain coverage and no longer be uninsured.
• In consumer-friendly marketplaces, insurers will have to disclose all of their information in uniform and comprehensible language, so consumers can compare and make choices. 
• No one will be denied coverage or charged a discriminatory rate due to a preexisting condition.
• Starting in 2014, all health plans will have to include maternity care.
• Seniors will have even more help paying for their prescriptions, eventually closing the Medicare doughnut hole.

Starting in 2014, the Affordable Care Act expands Medicaid to cover all 16 million Americans with incomes under 138% of the federal poverty level who are not currently eligible for Medicaid. The Act provides 100% federal funding to cover the costs of this expansion for the first years, and then settles in at 90% funding after five years. The Supreme Court’s decision today upholds Congress’s power to enact this expansion, and we encourage all the states to take full advantage of this wonderful opportunity.  

The decision, however, also says that the federal government may not take away all of a state's existing Medicaid funding if it decides not to participate in the expansion. Medicaid law has always provided that, if states disobey the conditions Congress has imposed on the receipt of Medicaid funding, the federal government has several different remedies, one of which is to withdraw all federal funds. That remedy has never actually been used by the federal government, even though there have been many disputes involving state noncompliance with Medicaid conditions. So the threat that the federal government might deploy that remedy if a state failed to carry out the ACA's Medicaid expansion was highly theoretical. In today's decision, however, the Court ruled that a state's refusal to adopt the ACA's Medicaid expansion cannot trigger the removal from a state of all of its existing Medicaid funding. The ruling is unclear about exactly what the states' options are and what other remedies the federal government may have in those circumstances. As we study the decision further, we will address these Medicaid issues more in depth in future blogs. Of course, we urge all states to take advantage of the federally funded Medicaid expansion to bring coverage to their lowest income uninsured.

Tonight, people all over the country, men and women, of all ages, socioeconomic statuses, and political beliefs, can breathe a bit easier knowing that the reforms launched in March 2010 will continue and that America is moving toward quality, affordable, comprehensive health care for all.

This blog was coauthored by Caitlin Padula.

In early June, Illinois governor

Last week, we examined the three components of a good health care program:

1. Providing great outcomes and
   preventing bad ones.
2. Caring for the whole person.
3. Fiscal sustainability.

This is the second in an ongoing blog series in which we examine the Medicaid cuts from the SMART Act, recently signed by Governor Quinn, and measure them against the standard we have set for good health care. Some of the changes measure up, while others fall short. One of the cuts we think falls woefully short is the near elimination of dental care for adults on Medicaid. 

According to the federal Medicaid rule, adult dental services are in the “optional” service group; this means that states aren’t required to provide these services for their Medicaid-eligible populations. Under the SMART Act, Illinois’s Medicaid program will no longer pay for preventative services for adults on the program; emergency extractions will still be provided. 

These cuts mean that preventive services, like cleanings and even fillings, are not covered by the Medicaid program; sadly, this change means the cut obviously fails our first component—providing great outcomes and avoiding bad ones. Ideally, we would like all Illinois residents to be in good oral health, which is impossible to maintain without a regimen of regular visits and cleanings. These preventive visits are when we catch the little problems, like cavities, before they become big problems, such as completely unsalvageable teeth that need to be pulled, or dangerous infections. 

We also want to have a holistic approach to health care. It’s always been confusing to me why dental coverage is singled out as an optional piece. When any preschooler can tell you that your mouth is a part of your body, why can’t our Medicaid program accept this simple fact? Oral health is obviously a part of your overall physical health, and any distinctions we draw between the two are illusory. Poor oral health care is related to other adverse physical conditions, including low birthweights, coronary heart disease, strokes, and even cancer. That’s right—by refusing to cover one part of the body now, we could be setting up other parts of the body for (expensive) future problems. This is an obvious failure on our second component of providing holistic health care.

Our third component is fiscal sustainability. At first blush, it looks like eliminating adult dental will save the state around $35 million,  but let’s think about that number for a second. People with severe dental issues that cause pain or infections won’t all give up on relief—they will look for it. Emergency room treatment is a mandatory Medicaid category for states, so if individuals seeks dental care there, they cannot be turned away. A new report entitled “A Costly Dental Destination” from the Pew Center on the States estimates that preventable dental conditions were the primary reason for 830,590 ER visits by Americans in 2009, which is a 16% increase from 2006. The same report noted that from 2008-11, hospitals in the Chicago area alone saw nearly 77,000 visits for dental-related issues.

According to the Pew report, the average cost of a Medicaid enrollee's hospital treatment for dental issues is approximately 10 times more than the cost of preventive care from a dentist. Dr. Frank Catalanotto, professor of dentistry, noted that “Preventive dental care such as routine teeth cleaning can cost $50 to $100, versus $1,000 for emergency room treatment that may include painkillers for aching cavities and antibiotics from resulting infections.” That’s simply not cost-effective. These visits cost the Medicaid program millions of dollars each year, but they result in very little actual improvement for the patients. That’s because emergency rooms generally don’t have dentists on staff—so doctors can’t get to the root of the problem to fix it, but usually can prescribe nothing more than antibiotics and painkillers. Since the underlying problem continues, patients must return to the emergency room when their symptoms return. So, sadly, this change fails our third component of fiscal responsibility by a wide margin.

However, dental organizations are already speaking out against the cuts. Dave Marsh of the Illinois State Dental Society noted that these cuts are really just shifting the cost of the problem elsewhere: “You're going to see a lot of people waiting when they have tooth decay, toothaches, waiting until it gets to a point where they're going to go to the emergency rooms. And the cost of emergency care, as you're well aware, skyrockets over the cost of dental care."

Sorry, Illinois. This change to “save” the Medicaid program simply doesn’t measure up to the standard of good healthcare. Be sure to check back in with us as we examine other cuts in S.B. 2840 and measure them against our three-part standard.  

1. Good health care policy obviously needs to be focused on providing the best outcomes possible immediately and later. Preventive services are key for this kind of health care; for example, check out the U.S. Preventive Service Task Force’s recommendations of effective and recommended services for adults. But not all procedures are necessary; some may not have any effect or even be harmful. For example, this year the U.S. Preventative Service Task Force issued advice counseling healthy women to undergo Pap tests only every three years instead of yearly. A representative for the task force noted, “We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests […] It’s a win-win […].” We can prevent big problems from occurring tomorrow if we take some reasonable, manageable steps today. Preventing those big problems (obesity, heart disease, diabetes, etc.)  can also save big money, in addition to improving people’s quality of life.
2. Good health care policy also takes care of the whole person, from head to toe. The Medicaid program contains “optional” categories that states don’t have to cover, like prescription drug coverage and adult dental care, but are these categories really optional?  At first glance, dental care might seem like an oft-dreaded luxury, but it is critical to good overall health. Cavities and gum disease contribute to wide-ranging health issues including low birthweights,  coronary heart disease, strokes, and even cancer. As states cut dental coverage, more people are turning to emergency rooms to take care of dental issues (hospital coverage is a mandatory Medicaid category), but that’s a terribly inefficient way to deal with the problem. Emergency rooms usually don’t have a dentist on staff, so all they can do is prescribe pain medications or antibiotics, not treat the root of the problem. The problem is similar with prescription drugs—if people cannot afford their medications, they usually need other medical intervention. Treating people holistically, instead of with a narrow focus on certain aspects, is cost-effective and health-effective.  
3. Good health care policy needs to be fiscally sound not just now, but in the future, too.  We don’t want penny-wise cuts today that are pound-foolish down the line, since Illinois will pay for pieces of the Medicaid program that are mandatory, like emergency room visits and hospital coverage. While some services, like prescription drugs and adult dental care are technically optional, dropping this coverage may cause higher utilization of the mandatory categories, resulting in unforeseen high costs.

Senate Bill 2840 makes dramatic cuts to the Medicaid program.  Some of them are consistent with the above hallmarks of good policy, but more of them simply don’t make for good health care. 

So let’s start on a positive note—some of the bill’s provisions are solid choices that will save money and improve the health of our Medicaid system and our people. For example, one section of the bill deals with increasing the state’s ability to ferret out fraud in the program. There will be increased effort to make sure only eligible people receive Medicaid, including electronically examining residency and income to verify that they meet program requirements. It is estimated that this increased effort will save the state $350 million. We are strongly behind the effort to make sure that Illinois Medicaid uses its resources wisely by only enrolling those eligible for the program and reimbursing vendors fairly. However, it’s worth noting that the intent of the law appears to be that the state use a private company to provide computerized eligibility verifications. This bears close watching because, in the past, private companies have been guilty of inaccurate and profit-motivated caseload reduction. The determinations need to be accurate and procedurally fair. The law also contains welcome measures for finding and preventing fraud on the vendor side of the equation. 

Another provision we’re wholeheartedly behind ensures that Medicaid will no longer pay for medically unnecessary, or elective, cesarean births. A cesarean birth is a major abdominal surgery and comes with all of the risks associated with other common surgeries, including adverse reactions to medications and increased risk of infection. Babies born by c-section have, on average, more difficulty breathing after birth and have lower Apgar scores. Mothers have a longer recovery time and a higher risk of complications from c-sections than from vaginal births. Of course, some situations call for a cesarean section—medically necessary c-sections will still be covered under Medicaid, but elective c-sections will be covered only at the vaginal birth rate. This should cut down on the numbers of elective c-sections, saving money and improving health outcomes at the same time!   

However, there are other cuts in S.B. 2840 that are clearly not good policy and not fiscally sound, or that depend heavily on implementation decisions before they can be judged one way or the other. Among these, the law slashes the Illinois Cares Rx program, the FamilyCare program, and dental coverage for adults, and it applies utilization controls on many services, including especially prescriptions. We’ve already written a blog about the cuts to the Illinois Cares Rx program and you can find that here. Of course, S.B. 2840 wasn’t the only health care related bill this session. There were also changes in the laws regarding hospital charity care obligations and the expansion of Cook County’s Medicaid system. We’re planning blogs on these and other provisions of the law to explain them and examine how they fall short or could be implemented without measuring up to good policy, so please keep us bookmarked and return for an update.   

Last week, the Illinois General Assembly overwhelmingly voted to end Illinois Cares Rx, which is a state prescription assistance program that helps more than 150,000 Illinois citizens afford prescription drugs.

The Medicaid spenddown is still an option for many of the Illinois seniors who will be forced off Illinois Cares Rx. Medicaid spenddown can help individuals afford health care that would otherwise be unobtainable due to cost. The spenddown program is designed to help people who are ineligible for regular Medicaid because their incomes are too high or they have too many assets, as long as those people have significant monthly health costs. 

Who is eligible for spenddown and how can you estimate the spenddown amount? Almost anyone who is eligible for Medicare is eligible for spenddown, as long as they have medical expenses that are high enough to meet their “spenddown amount.” Spenddown is a little bit like having a health insurance deductible. Based on your income and your assets, you are assigned a monthly spenddown amount. For an individual, the income dividing line between regular Medicare eligibility and Medicaid spenddown eligibility is $956 per month (not counting SSI income), or $11,472 a year. That means that an individual whose income is over that amount must spend down to that amount in order to receive a monthly Medicaid medical card. In other words, if your income is $1,000 per month, the spenddown amount is $44, and if monthly income is $1,500, the spenddown amount is $544. An individual will also have a spenddown if their assets are over $2,000 (although some assets, like one’s home, are exempt from this limit).      

Once you are assigned a spenddown amount, you are responsible for showing that you have either paid or unpaid medical bills; once the bills equal the spenddown amount, you are eligible for a Medicaid card and assistance paying for your health care expenses for a month. So, if your spenddown amount is $100, you are eligible for Medicaid assistance after you show that you have monthly medical bills equal to that amount. You can submit expenses monthly or, if you have large bills for something like a hospitalization or expensive testing, you can use those bills to satisfy several months of your spenddown amount.

Paid or unpaid bills for the following can count towards meeting your spenddown limits:

• doctor services;
• hospital services;
• nursing home services;
• clinic services;
• dentist services;
• podiatrist services;
• chiropractor services;
• medicines, medical supplies and equipment that are prescribed by your doctor;
• eyeglasses;
• medical or personal care in your home;
• health insurance premiums, including Medicare premiums;
• speech, occupational and physical therapy;
• transportation to and from medical care; and
• co-payments or deductibles you pay for medical care.

To apply for the Medicaid spenddown program, contact your local Department of Human Services (DHS). Use this locator to find the office closest to you. The Department of Human Services will decide if you are eligible for Medicaid without a spenddown, or, if you are ineligible, will assign you a spenddown amount.

There may also be another option for seniors losing their prescription coverage. It appears there will be an open enrollment period for individuals to change their plan choice in Medicare Part D after Illinois Cares Rx ends. (We’ll keep you updated when we get more facts on this). Medicare Part D is available to anyone who is eligible for regular Medicare, but it is offered through private insurance companies that contract with Medicare to offer this additional coverage. Typically, you pay a monthly premium, deductible and co-pays, depending on which plan you choose. After you satisfy your deductible, you will be responsible for a co-pay for each prescription up until you reach the “donut hole,” when you will pay the full cost of the prescription until you have spent about $3,600, after which the insurance kicks in again. (The Affordable Care Act is working to close this “donut hole” over several years.) All Part D plans will include their own formulary, or list of covered drugs, so you should confirm which ones cover your particular prescriptions. Because of the existence of Illinois Cares Rx, many people chose cheaper and less comprehensive plans, or perhaps did not enroll in Part D at all. However, it appears that they will be allowed to enroll in a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan that will replace some of the coverage lost with the ending of Illinois Cares Rx. This chance to join lasts for two full months after the month in which coverage is lost.  

Additionally, some Illinois Cares Rx enrollees are AIDS patients. AIDS treatments are notoriously expensive, with some treatments topping over $25,000 a year. Those individuals may be eligible for the AIDS Drug Assistance Program (ADAP). Individuals whose incomes are less than 300% of the federal poverty level (about $33,500) are eligible for the program. ADAP provides 81 different drugs on its formulary, including all anti-retroviral therapies approved by the U.S. Food and Drug Administration. Clients do have a benefit cap of $2,000 per month (except for a few Category V drugs), which is sufficient to support triple and quadruple combination therapies. You can apply for ADAP online.

The elimination of Illinois Cares RX is effective on July 1, if the Governor signs the bill as is. As you can tell from this blog, that leaves precious little time for seniors to make the complicated choices and actions necessary to rearrange their drug purchasing and transition to the new system. Advocates have asked that Governor Quinn amendatorily veto the bill to keep Illinois Cares Rx on the books, or, at a minimum, to delay the effective date to January 1, 2013, to allow for a smoother transition—let’s keep our fingers crossed. Of course, we will keep you updated on any developments.   

In 2010, over 22 million men and women who have served our country in the Armed Forces were still alive. That’s a sizeable chunk of the population and those veterans have served in every conflict from World War II through the ongoing War on Terror. Veterans are a vital part of America and this weekend is a special time to think about their contributions and thank them for their service. 

However, we could be doing more to help our veterans. According to a new report by the Urban Institute and the Robert Wood Johnson Foundation, there are an estimated 1.3 million uninsured veterans between ages 19 and 64 nationwide – more than 10% of all veterans. These uninsured veterans make up about 5% of the total uninsured population.    Veterans as a group are more likely to be insured than the rest of the population, but these numbers are still shocking. The report also finds that 41 percent of uninsured veterans report unmet medical needs, while 34 percent report having delayed care due to cost. That’s right—2 out of every 5 veterans need medical attention and are not getting it.  

But wait a second—can’t veterans all get care at their local Veterans Affairs (V.A.) Hospital? Not necessarily. The pool of money provided by Congress to the V.A. hospitals is a set amount and can provide care for a set number of veterans; priority groups have been established make sure that certain veterans, such as those with a significant injury, Medal of Honor or Purple Heart, definitely receive healthcare. Thankfully, not everyone in the armed services is injured in combat, but that does mean that some veterans fall lower on the priority list. Other veterans have to pay co-pays to be seen at the VA Hospitals, which may be financially difficult.   So who are these uninsured veterans? They are more likely to be younger, have served recently, overall have less education, and are more often unmarried and unemployed.   In Illinois, 43,000 veterans don’t have health insurance and 25,000 of their family members are similarly uninsured.  

Americans need to take care of veterans and the Affordable Care Act will do just that. When the ACA is implemented, nearly nine in 10 uninsured veterans will have improved access to affordable coverage. At implementation in 2014, nearly half of the uninsured veterans will likely qualify for expanded Medicaid coverage. This provision will expand Medicaid coverage to adults with incomes under about $15,000 a year. Another 40 percent of uninsured veterans have incomes that would allow them to qualify for subsidized coverage through state health insurance exchanges, in which they will receive subsidies to help pay for private health insurance coverage.

The Affordable Care Act is around to serve these veterans, just like they served their country. Take a few minutes this holiday weekend to think about veterans and their service. Don’t they deserve affordable healthcare for themselves and their families?   

If you or someone you know is a veteran, check out this benefits calculator and this financial calculator to see if you are eligible for VA health benefits!

On Memorial Day at 3 p.m., local time around the nation, Americans will pause for the annual Moment of Remembrance to pause and reflect on the sacrifice of America’s fallen warriors and the freedoms that unite Americans. 

Last week, the  Centers for Disease Control (CDC) released their

For example, the CDC noted the following:

We don’t have enough primary care doctors.  The report notes that the South and Rocky Mountain areas of the country have about 85% of the doctors that the rest of the country has. The ACA is addressing this crucial problem through providing training and financial support to thousands of new primary care  doctors, nurses, nurse practitioners, and physician’s assistants. Primary care providers paid by Medicare will also get 10% “bonus” payments and the number of community health centers will grow, increasing access to affordable primary care. In 2013, primary care providers paid by Medicaid will see an increase to the higher Medicare rates, making it fiscally easier for doctors to see Medicaid patients.

Obesity is still a major problem.  Although childhood obesity rates are leveling off, they are still troublingly high. The CDC report also shows that childhood obesity is strongly correlated to the level of parental education. Luckily, the ACA has allocated funds to fight childhood obesity through teaching kids to improve their nutrition choices and encouraging more physical activity. 

We’re getting better at keeping ourselves well. In 2010, almost 60% of the recommended adults had a colorectal screening, compared to 34% in 2000. The ACA is seriously working to change the culture of health care from caring for people after they’re sick to prevention and screenings. The ACA requires that health insurers, including Medicare, offer certain preventative care and screenings free of charge. Check out the list here!

Racial health disparities are narrowing. The difference between life expectancy for Caucasians and African-Americans is closing, although Hispanics still have the longest lifespans. Other health disparities include higher rates of obesity, asthma, flu, infant mortality, cancer, and heart disease in minority communities. The Affordable Care Act recognizes these disparities and is working to close the gap and make all Americans healthier through numerous advances, including increasing cultural competency among providers, adding more health care providers to underserved communities, and coordinated care organizations that will help manage chronic diseases.

The percentage of uninsured people has grown from 13% in 2000 to 16% in 2010. Nearly 1 in 6 Americans lacks health coverage—an indication of how badly this country needs the ACA. The Affordable Care Act is designed to hugely increase the number of people who are covered, both through tax subsidies for Americans under 400% of the federal poverty level to purchase private insurance and through expanding Medicaid to cover all individuals under 133% of the federal poverty level.

The CDC report contains many more charts and data on Americans’ health. Overall, the report is an excellent reminder of how far we’ve come and how far we still have to go in our work to improve the health of our people.  I encourage everyone to page through the list and take a look at the reality of health in America today.  The Affordable Care Act is vital to improving that reality and is already at work doing so!

The Illinois General Assembly is currently debating where to cut $2.7 billion dollars (roughly 18 percent of spending) from the state’s health insurance program for certain

And while this might prevent some problems, it is much more likely to cause larger, more serious ones. Of course we need to manage Medicaid spending so that the program is working efficiently. But cutting almost 18 percent of the program in just one year is not the way to do it.

Why should you care that these low-income folks may be cut from the Medicaid program or have severely reduced access to medical services? Because every dollar Illinois cuts means a little more than a dollar in federal funding is lost from Illinois’s economy, creating a negative ripple effect of economic harm. The proposed 18-percent cut to Medicaid would put 25,600 Illinois jobs at risk and reduce business activity by roughly $3.3 billion. 

And you should care because medical needs and costs don’t disappear when Medicaid is cut. The people who lose coverage or vital services like dental care still get sick, and then forgo or delay necessary medical care, and eventually end up in the emergency room. And by that time, they are often more expensive to treat. For those who lose coverage, manageable health conditions, such as high blood pressure and diabetes, may deteriorate and lead to hospitalizations. And a portion of these costs go unpaid and are eventually passed on to all of us--consumers, employers, and businesses--in the form of higher insurance premiums.

Rather than imposing such drastic cuts on the Medicaid program, let’s instead look at thoughtful alternatives to closing the budget gap. First, the state needs to raise revenue. The cigarette tax is an important and necessary step in that direction. Second, there are already processes in the works that promise to produce sustainable savings and improve care in the Medicaid program. For instance, let’s allow the state’s new Medicaid reform plan, which includes increased care innovation for high-cost enrollees, to take effect. And new care coordination entities, such as the Medical Home Network, show great promise for increased efficiencies for Medicaid enrollees.

Let’s remember that quick fixes sound good but often have long-term negative impacts. And like an amputation, they can be both irreversible and regrettable.

If your mom is anything like mine, she’s part doctor, part cheerleader, part chef, part justice of the peace, and all-knowing. Being a mother is a tough job (and one we can’t outsource).  However, things are starting to get a little better for mothers across the country. The United States just moved up six places in the annual Save the Children State of the World’s Mothers

Luckily for mothers, the Affordable Care Act is at work to improve maternal health! The Affordable Care Act cares for moms many ways, with more improvements on the way. 

Some provisions of the law are already helping mothers.

• Right now, the ACA mandates that most companies provide nursing mothers time and a private place to express milk, allowing mothers to return to work and still ensure their children enjoy the benefits of breast milk. While the benefits to the baby are numerous, mothers also benefit from breastfeeding, with decreased sick days and lower incidences of postpartum depression, obesity, and breast and ovarian cancers.        
• Children up to age 26 can now be covered on their parents’ insurance plans, creating peace of mind for parents of young adults. 
• Currently, free preventative services, like mammograms and cervical cancer screenings, help moms stay healthy for their families. Pregnant women can now also receive a screening for gestational diabetes.  

And there will be major improvements in August of this year!

• Beginning August 1 of this year, most women will have access to the full-range of FDA-approved contraceptives without co-pays or deductibles.  Contraception obviously allows women to choose when to become mothers, resulting in healthier parents, children and communities. Other benefits include a reduced risk of ovarian cancer, endometrial cancer, and osteoporosis. 
• Also beginning this August, nursing mothers will also receive nursing support, supplies, and counseling from their insurance companies when they give birth.

And looking to the future, 2014 will also bring great things for mothers!

• When the health insurance exchanges begin functioning in 2014, maternity coverage will be a mandatory component of insurance sold on those exchanges.

Mothers do so much work that goes unrecognized and un-thanked, so let’s make sure we do right by our 85.4 million mothers. The Affordable Care Act recognizes that healthy mothers are essential to raising the next generation of healthy Americans and works hard at providing them with the resources they need to do so.    

Watch out Norway—with the Affordable Care Act, we are coming for your title!

Happy Mother’s Day, Mom!

Illinois Governor Pat Quinn recently offered a proposal to increase the cigarette tax by one dollar. This proposal is a triple win for the state−the tax would be a budget win, a health win, and a political win.

Illinois’s Medicaid program is facing deep and painful cuts, and raising the cigarette tax to help pay for Medicaid seems like a no-brainer. The U.S. Centers for Disease Control and Prevention estimate that smoking-caused health costs total $10.47 per pack sold and consumed in the U.S.  $10.47 a pack! For a pack-a-day smoker, that adds up fast. In fact, it adds up to $3,811 in yearly health costs for that smoker. Illinois spends nearly $5 billion treating smoking-related illness, and $1.8 billion of that is paid for by the Medicaid program. 

This tax will incentivize people to quit smoking or not to start at all, but the decrease in consumer numbers will be more than offset by the dollar tax increase. From 2002-09, twelve states increased their cigarette taxes by one dollar or more. Every single one of these states saw both a decline in sales (indicating fewer consumers were smoking) but also a spike in revenue ranging from 36% to 193%. There will certainly be people on the margins who can evade the tax by purchasing outside of Illinois, but most smokers will either quit or pay the increased costs of smoking. Currently, Illinois’s cigarette tax rate is only 98 cents a pack—the 18^th lowest state cigarette tax, with Massachusetts being the highest at $2.51 per pack. Professor Frank Chaloupka of the University of Illinois estimates that a $1 per pack cigarette tax increase in Illinois would raise $377 million.  

Although opponents of the law claim that it will decrease overall revenue as people decrease their purchases, Illinois has enjoyed substantial revenue increases every time it has raised the tax on cigarettes. Nor will Illinoisans simply leave the state in droves to purchase their cigarettes.  Professor Chaloupka notes that when Illinois last increased its cigarette tax rates, the state’s cigarette revenues increased over 38%, while increases in neighboring low-tax state of Missouri were only 6.4%.  

But the benefits of the tax include more than just the money. Tobacco’s burden on statewide health and budget concerns is widespread: in addition to costs for ailments directly attributable to tobacco use, like lung cancer or emphysema, tobacco use also increases state expenditures via decreased productivity and premature deaths. 

A $1 per pack tax increase would actually increase the health of Illinoisans by changing people’s smoking habits. The tax is expected to prevent 78,000 young Illinoisans from taking up the habit, encourage almost 60,000 Illinoisans to quit, and prevent up to 59,000 deaths caused by smoking. Young people in particular are very price sensitive; an extra dollar is expected to prevent thousands of young people from paying the price to get hooked in the first place.

Plus, this tax has amazingly high support from Illinoisans. Seventy-four percent of Illinois voters support a $1 increase per pack to pay for the associated health costs and to reduce the budget deficit. Without the revenue raised from the cigarette tax, the State of Illinois would have to look to other areas in the budget to make up the shortfall. Governor Quinn stated "[I]f we don't succeed in the area of raising the price of cigarettes, then there will be pressure on cutting reimbursements or, perish the thought, trying to reduce education. I think that would be a very bad way to go."   

I agree with the Governor and I bet you do, too. Taxing cigarettes to help pay for the health consequences they cause or cutting important services? This triple-win seems like a clear-cut choice to me.  

There’s no debating that Illinois could use some healthcare help. The state is

These problems are not insurmountable. However, we all know the state is in a budget crisis.  Governor Quinn has announced a plan to drastically reduce spending and raise revenues for Medicaid. We understand the state budget crisis, but obviously, people in Illinois need medical services, and the state is currently struggling to provide them.  

Luckily, the Affordable Care Act is there to throw a lifeline out to health service providers and state agencies and especially to the real people who need healthcare. Thanks to the ACA, the states will spend about $90 billion less on healthcare with the implementation of the law than they would have spent without it. Thousands of people will still be getting the increased services mandated by the Act, but much of the funding will be federal rather than state. 

It’s important to note that these benefits are not in the distant future; Illinoisans from birth to retirement are already benefitting from the Affordable Care Act.  

Assistance from the ACA starts when kids are young; the ACA has already provided:

• $10.3 million for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals into individual homes to connect families to the services they need to raise happy and healthy kids. These services include prenatal care, pediatric care, education, and parenting skills.   
• $191,000 for Family-to-Family Health Information Centers, organizations run by and for families with children with special health care needs.
• $4.9 million for expanding and improving school-based health centers. Illinois funds 38 school-based clinics that provide screenings, physicals, exams, and more to students.
• $555,000 to support the Personal Responsibility Education Program, which educates youth on abstinence and contraception to prevent teen pregnancy and sexually transmitted infections, including HIV/AIDS.

The ACA is also spending money putting people to work at improving healthcare! Illinois has received:

• $400,000 to support the National Health Service Corps, by assisting Illinois in repaying educational loans of health care professionals in return for their practice in health professional shortage areas. This program is designed to help medical, dental, and mental health providers who choose to work in needy communities to repay their student loans. This is a particularly critical program because these professionals provide medical and dental care that individuals desperately need; the program allows professionals to provide care to needy individuals without worrying about their reimbursement rates or their ability to pay back debt.
• $5.1 million for health professions workforce demonstration projects. This program is designed to supplement the workforce in areas that are either already short-staffed or expected to be in the future. The Illinois Workforce Investment Board’s report noted  shortages of both registered nurses and licensed practical nurses in Illinois. 

And the ACA helps elderly Illinoisans, too!

• $457,000 to support Aging and Disability Resource Centers (ADRCs). ADRCs help seniors and people with disabilities understand long-term care options including community care. 

So far, Illinois has received $170.7 million in grants due to the Affordable Care Act.  These grants are creating tangible improvements to the physical and fiscal health of our state.  Thanks, Affordable Care Act!