Illinois General Assembly Extends Medicaid Coverage to Low-Income Residents

Time: 4:30 p.m Central, Tuesday, May 28, 2013. "Mr. Clerk, take the record." With those words the President of the Illinois Senate asked the clerk of the chamber to record the votes on Senate Bill 26, as amended, the bill which would  put Illinois in the column of states that will, come January 1, 2014, offer Medicaid coverage to all low-income state residents. The Senate passed the bill by a vote of 39 to 20, concurring with the House, which passed the same bill the previous day (63 to 55). Thus, pending Governor Quinn’s signature, which he has promised, President Obama's home state will extend Medicaid to all previously ineligible low-income adults under the Affordable Care Act.

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. 

Changes in Illinois's Medicaid Program--Smart Health Care Policy?

Today, Illinois Governor Pat Quinn signed into law S.B. 2840, which carves $1.6 billion out of the Medicaid program, claiming that it represents a bold plan to save Medicaid. Since the new law cuts the program so deeply and in so many different ways, it is legitimate to ask if these cuts really do improve the program, in terms of policy and long-term financial sustainability, or if they are actually merely expedient and short-sighted. To answer this question, we need to step back and really think about what makes effective and efficient health care policy. It’s a difficult question, and we’ve heard a lot of different answers, but I think we can boil it down to some broad categories. 

  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.   

Medicare Improving Fast

Helping Senior Citizen WalkThere is an intense debate over Rep. Paul Ryan’s (R. WI) proposal to scrap Medicare and turn it into a voucher program shifting costs to seniors, a debate that became even more intense when it was passed by the Republican-controlled House of Representatives. The Senate has not passed it, and the President has registered his opposition. The American people are also firmly opposed

But that debate has taken news focus away from the substantial improvements to the Medicare program that have been accomplished in just the last year under the Affordable Care Act, with more improvements soon to come. Costs are lower and care is better for seniors all over the country.

Here is what happened in 2010 and is about to happen in 2011 in Medicare under the Affordable Care Act. The numbers apply to Illinois, but the same impact is happening everywhere in America.

  1. Prescription drugs are more affordable. In 2010, 152,170 Illinois residents hit the Medicare prescription drug “donut hole” and received at $250 rebate check to defray their costs. Across the state, this came to $38 million in savings for seniors. In 2011, everyone in Illinois who hits the donut hole will receive 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 $800 a month in savings.
  2. Preventive services are free. In 2010, when this section of the new law had not yet taken effect, Medicare charged co-pays for preventive services like mammograms and other cancer screenings. In 2011 all of the 1.9 million Medicare beneficiaries in Illinois now get all recommended preventive services with no out-of-pocket costs.
  3. The annual checkup is free. In 2010, when this section of the new law had not yet taken effect, Medicare charged a co-payment for the annual checkup. Starting in 2011, Medicare beneficiaries can go to an annual wellness visit with no out-of-pocket cost. As of April 20, 17,508 Illinoisans have had a free wellness visit. 
  4. Premiums are lower. Under the new law, in 2010 Medicare Part B premiums were nearly $8 less per month than projected by the Medicare trustees. In 2011, the premiums are almost $5 less per month than projected by the Medicare trustees. The lower premium translates to $107 million in savings for Illinois Medicare beneficiaries in 2011.
  5. Medicare Advantage. In 2010 and 2011 all beneficiaries still retain the option of joining a Medicare Advantage plan if they so desire.

This is a story typical of many things in the Affordable Care Act. Improvements to the system are constantly rolling out, but the general public remains unaware of them. In part, this is because the subject matter is complex and hard to absorb unless you are directly affected. And in part it is a deliberate strategy of the opponents to keep the focus elsewhere and downplay the accomplishments of the law as they endeavor to repeal it and roll back its benefits. The intense reaction to Rep. Ryan’s proposal shows that at least the people directly affected – seniors who depend on Medicare – are well aware of the increasing quality of their program. 

An earlier version of this blog post inadvertently referred to Rep. Paul Ryan as "Jack" Ryan.  This has been corrected, and we apologize for the mistake.

 

Illinois Wins Millions in Federal Performance Bonus to Reward Cutting Red Tape in Connecting Children to Health Care

This week, Illinois received national recognition from the U.S. Department of Health and Human Services for the exceptional strides it has made in covering children. As part of this recognition, Illinois was rewarded a $15 million performance bonus. Illinois is one of the top 15 states in the country at cutting government waste and making taxpayer dollars go further to protect the health of Illinois children.

Research shows that the best results for children’s health and for the most efficient use of public funds are accomplished by quickly connecting children to preventive health care and then making sure that care is not interrupted. The Illinois performance bonus is a tribute to the public servants in our state who work every day to make the Illinois All Kids program function in this smart and effective way for Illinois children. In so doing, they make government work better and more efficiently for all Illinoisans.  

All Kids has had bi-partisan support from its beginning in Illinois, including the minimizing of bureaucratic red tape. Until now, leaders on both sides of the aisle have been committed to the effort to help families get the best kind of health care for their children, through coverage, quick connection to preventive care, and continuity of care. This is not only the best way to achieve good health outcomes for the children and to accomplish short- and long-term savings on their health care, but it has now also generated two years of federal performance bonuses (Illinois received $9 million last year). 

We urge Illinois leaders to continue this successful course for All Kids use these well-deserved performance bonus funds to maintain this commitment and sustain this progress in securing Illinois children’s health. This is especially important during challenging economic times as families need the security of knowing that programs like All Kids are there for their children.

Andrea Kovach coauthored this article.

 

 

Americans Want Health Care Reform to Go Forward

StethoscopeSome people are spinning hard about the outcome of the recent mid-term elections. They are trying to say that the changes in Congress were a “mandate” to repeal health care reform. As usual, most of those spinners have little to say about how to resolve health care issues--for them health care is an ideological or political issue, not an issue of importance in everyday lives. It is a tactical issue in the beltway game, a ploy in the never-ending struggle for power and for special interest money.

But out here, when the issue is reduced to kitchen-table reality, people don’t think ideologically or politically. They think about their own health care, their families’ health care, and their own financial circumstances. 

Here are some numbers about health coverage and the election. 

Even on the ideological level on which they choose to operate, the spinners are wrong. The election result was driven by concern about the economy and jobs, not health care. According to a CNN exit poll, only 19% of voters named health care reform as their top concern--a distant second to the 61% of voters most concerned with the economy.

On the big abstract ideological question about support for the health reform law, the voters split down the middle: 48% say they support repeal and 47% say they want the reform law to stay the same or be expanded. Some mandate. 

Polls consistently confirm that, when the public hears truthful facts (as opposed to the other kind of “facts”) about the health reform law, they want the benefits and support health reform. The specifics of health care reform already help people in ways that matter deeply to them. Undoing health care reform would mean:

  • People would continue to be denied coverage or charged more for it due to pre-existing conditions.
  • People diagnosed with the particular pre-existing condition of being female would continue to be discriminated against in the cost of their coverage. The spinners would continue that outrageous discrimination. 
  • People would continue to have coverage dropped when they get sick.
  • People would continue to have lifetime caps on their insurance coverage.
  • Small businesses would continue to have to pay higher rates for health insurance than big corporations.
  • There will be no smart investment in prevention as the focus of our healthcare system--clearly the way to get both lower cost and better patient outcomes.
  • People would lose the comfort of knowing that, no matter what happens to their job, their health, or their family, there will always be access to affordable, decent coverage.  
  • Entrepreneurs would continue to experience the drag on their creativity and chances for success caused by the health coverage problems. And health coverage issues would continue to prevent would-be entrepreneurs from even getting started, stuck in their current jobs in order to retain insurance.

The post-election spinners stay far away from these real problems. The new law leaves the private insurance sector in place (a single-payer system would have ended it), but imposes fair boundaries on it. The spinners, scrupulously avoiding anything specific about how to address health coverage issues, instead simply call the new law names: “takeover,” “socialism.” But calling something a name is not the same as talking about it honestly--indeed, it’s a time-honored way to stifle full discussion. The health reform law is in fact a very promising public-private effort to address a problem that plagues American households everywhere. The spinners are wrong about the importance to real people of health care reform. When the focus is on the actual health coverage problems that plague American households, most Americans want their federal and state officials to get on with implementation--and do a good job of it.

 

Women Will Benefit from Health Care Reform

Mother at the doctor's officeWomen are the most likely to have the greatest contact with the health care system, as they often coordinate health care for themselves and their families. Yet women face unique barriers to obtaining and paying for health care. Nearly half of all low-income women are uninsured, and those who are insured are less likely to visit the doctor because of unaffordable out-of-pocket costs. However, things are changing for the better. Thanks to health care reform, low-income women now will face dramatically fewer cost barriers to access health care. The newly passed health care reform law, the Patient Protection and Affordable Care Act of 2010, will make health care more affordable, easier to obtain and provide more comprehensive services, ensuring women receive the care they need. 

Starting January 1, 2014, 8.2 million women whose incomes are at or below 133% of the federal poverty level will now be eligible for health coverage through the expansion of the Medicaid program. According to the National Women’s Law Center, up to 154,300 uninsured, low-income women in Illinois will gain health care coverage through the Medicaid expansion.  Another benefit, this coverage will be more comprehensive and include family planning and contraceptive services that are, without a doubt, a plus for women.

Moderate-income women and their families will also reap the benefits from health care reform with the creation of health insurance exchanges. Women with incomes up to 400% of federal poverty level can receive tax-credits that effectively lower out-of-pocket costs and help pay for health insurance coverage. Up to 7 million uninsured women nationwide and 471,000 women in Illinois will benefit from health insurance exchanges and tax-credits.

All women will benefit from the provision that requires all new individual and small business health plans to carry an “essential benefits package”, which provides coverage for essential services such as maternity care, prescription drug coverage, and mental health services.  Because of the difficulty women have finding these services in the individual market, this coverage marks a vital improvement in providing fundamental services women need.

Women stand to gain greatly from health care reform. In fact, women across socioeconomic levels have already started benefiting from health care reform. The National Women’s Law Center and the Commonwealth Fund have done extensive work to make clear what health care reform means for women. For more information on how health care reform benefits all women, read or subscribe to the latest issue of WomanView, entitled “30 Million Women Will Benefit from Health Care Reform.”

Heidy Robertson coauthored this article.

 

Questions About the Illinois Auditor General's Program Audit of the Covering All Kids Health Insurance Program

Kid and DoctorThis May, the Illinois Auditor General released an audit of the Covering All Kids Insurance Act expansion population of the All Kids program, Illinois’ comprehensive and affordable health insurance program for all uninsured children, which benefited over 1.67 million kids in 2009 and has garnered bi-partisan support in the state General Assembly over the last several years. The Sargent Shriver National Center on Poverty Law recently released a brief examining the scope of the audit and the conclusions made by the Auditor General. Instead of providing helpful information to Illinois legislators and citizens on the program’s expenditures of money and awards of contracts, as directed by the law authorizing the audit, it overreaches into policy issues beyond its legislative authority and unwisely recommends changes to the All Kids program that, if implemented, would contradict health policy experts and jeopardize billions of federal Medicaid match dollars. 

The legislative purpose of the audit was to monitor expenditures of money and awards of contracts under the program, not to evaluate public policy. However, the Auditor General chose to focus the overwhelming majority of his attention on the public policy behind the Covering All Kids Insurance Act (to cover all children) and the carefully researched administrative policies regarding enrollment and retention in the program that have been adopted by the Department of Healthcare and Family Services (DHFS). It is unclear why the Auditor General assumes that the General Assembly was inviting an audit of its own public policy choices, and by doing so, second guesses the implementation choices made by DHFS experts on these matters. Moreover, the requirement of an annual audit for a subset of a state Medicaid program is unusual, administratively costly, and not supported by any data or legislative finding. The Covering All Kids Insurance Act—which provides coverage to less than 6% of the total All Kids population—was unjustifiably singled out for this scrutiny.

The Auditor General’s critique of Illinois’ use of passive renewal and 12-month continuous eligibility, and his other recommended changes to the enrollment procedures contradict national health policy experts and federal health leaders. If implemented, these recommendations could result in eligible kids being dropped from coverage, leaving them less likely to receive treatment for chronic conditions such as diabetes and asthma, and more likely to have poorer health, greater rates of avoidable hospitalizations, higher mortality rates, delays in necessary care, and unfilled prescriptions. At the same time, many of these recommendations, if implemented, could jeopardize federal Medicaid match money under the maintenance of efforts requirements of the stimulus law and federal health reform--at a loss of billions of dollars for Illinois.

The audit spends much time complaining about the lack of documentation in case files differentiating the types of immigrant children covered by the program, because, according to the audit, the correct documentation would entitle the state to federal matching funds that Illinois would otherwise forego. However, the difference in documentation among immigrant children did not become relevant to federal financing until Congress passed CHIPRA in January 2009 allowing federal matching funds for certain immigrant children for the first time. The Auditor General paid insufficient attention to the fact that DHFS can retroactively obtain the documentation needed to maximize and claim these federal funds for the time period in question. Similarly, the Auditor General failed to mention that the expansion population of the Covering All Kids Insurance Act has been entirely paid for by offsetting spending reductions elsewhere in the state’s medical assistance programs, as intended by the General Assembly when it passed the law.

Hard working Illinois families know far too well today’s economic reality and the importance of their children’s health insurance. We owe Illinois families a complete, accurate picture of the All Kids program, including a thoughtful real-world analysis of how over 1.6 million Illinois children and their families would be affected by implementation of the auditor’s recommendations. The full brief on the All Kids program is available on the Shriver Center's website.

 

How Does Health Care Reform Help Older Americans?

Senior CitizensThroughout the debate on health care reform, the focus on changes for older Americans was largely prescription drugs and closing the drug coverage "doughnut hole." These changes are extremely important for many senior citizens who hit their drug coverage limit and are forced to pay high out-of-pocket costs. In fact, there is a $250 payment to seniors who reach the doughnut hole--a down payment until the eventual full elimination of the doughnut hole that will happen later this year.

However, the new law also includes several other provisions that will greatly assist older Americans, particularly low-income senior citizens, which the National Senior Citizens Law Center details in several recent reports.

  • For older Americans who rely on long-term services, the new law will create financial incentives for states to shift Medicaid spending toward community-based services, including a six-percentage point increase in federal Medicaid reimbursement for community-based care initiatives.
  • The law establishes several pilot programs to study and improve coordination of care for Americans who receive coverage through both Medicare and Medicaid, otherwise known as "dual eligibles."
  • The law strengthens medical assistance programs to ensure beneficiaries promptly receive covered services.
  • The law eliminated co-payments for prescription drugs for individuals receiving long-term care services in the home and in an institutional setting. Under current law, individuals living in an institutional setting do not have co-payments, while those receiving services in the home do have co-payments.
  • For Americans who are too young to qualify for Medicare but who retire early, a temporary "reinsurance" program will reduce the cost burden on employers.

According to the National Senior Citizen Law Center, the most significant new provision in the new law is the extension of coverage for 32 million Americans, which includes millions of people aged 50-64, through a Medicaid expansion, new state-based Exchanges with subsidies for low- and middle-income Americans, and regulation of the worst practices of insurance companies. Finally, millions of low-income older Americans will have access to the care that they need, and important improvements will be made to programs that contribute to the health and well-being of older Americans.

Check out the NSCLC reports for details on how reform benefits older Americans!

Carrie Gilbert co-authored this post.

 

Historic Social Change

I'm not a health care expert, just a spectator like most of America. It's been said that watching legislation being made is like watching sausage being made. Thanks to the 24-hour news cycle, blogs, etc., we've all just been treated to 14 months of the stomach-turning process of watching legislation being made. This may account for the less-than-jubilant reaction to the enactment of health care reform into law.

Make no mistake, however. This is real, lasting, fundamental, historic social change, on a par with the creation of Social Security in the 1930s and Medicare in the 1960s. It ends the national shame of more than 40 million people without health insurance. It creates a system where everyone must play and everyone has a stake.

Health care reform is not a traditional safety net program. You don't get a card. But we live in a much more complicated world than we did in the 1930s or the 1960s. This reform had to be a accomplished within the confines and constraints of two of the most powerful industries in America--the pharmaceutical industry and the insurance industry. Health care reform succeeded because it builds on the existing health care structure to accomplish at least nine extraordinary goals:

  1. First and foremost, it creates a system of subsidies that will allow all people--adults, children, working, not working--to access affordable health insurance.
     
  2. It will protect people from financial ruin if they contract a disabling disease.
     
  3. It will prevent insurance companies from canceling insurance policies when the policyholder gets sick.
     
  4. It will provide workers with job mobility since insurance companies will no longer be permitted to deny coverage based on a preexisting condition.
     
  5. It will make insurance affordable for middle-income people through a system of subsidies.
     
  6. It will provide very low-income single adults with access to Medicaid.
     
  7. It will make it affordable for small businesses to provide health insurance to their workers.
     
  8. The doughnut hole will be eliminated and seniors will be able to afford their prescriptions.
     
  9. Young adults--an age group that is particularly likely to be uninsured--will be able to remain on their parents' insurance policies until they turn 26.