WBEZ | Affordable Care Act

Limbo on Illinois health marketplace disappoints consumer and business advocates

Fri, 07 Jun 2013 07:55:00 -0500

Illinois’ new health insurance marketplace will be run jointly with the federal government for the foreseeable future, which has disappointed consumer advocates.

The marketplace, also known as the insurance exchange, is where people without health insurance will go to shop under the Affordable Care Act or Obamacare. States had the option to pass legislation establishing state-run marketplaces, or leave it to the feds.

Several such bills made their way through the Illinois General Assembly without passing by the end of the legislative session in May. As it stands, Illinois’ marketplace will be jointly run with the federal government for the foreseeable future.

“We’re not gonna have the ability to really have any oversight of the federal exchange,” said Jim Duffett, Executive Director of the Illinois Campaign for Better Healthcare. He says the bill would have established a regulatory board representing a broad swath of consumer interests including small businesses, communities of color and people with disabilities, calling the proposed body “a very broad-based independent pro-consumer board.” It would also have given the state the ability to regulate rates.

The bill, HB 3227, was passed in the Illinois state senate, but never came to a vote in the house. While it could still progress in the fall legislative veto session, the current limbo means the exchange will be run jointly with the federal government in 2014 based on previous legislation. The future of the exchange in 2015 remains unclear.

Healthcare and small business advocates had also hoped for a bill to pass this year.

Danny Chun, spokesperson for the Illinois Hospital Association (IHA), says hospitals supported HB 3227 because they, too, would have had representation on the regulatory board. And IHA supports requiring the insurance industry to cover the costs of managing the marketplace, another provision of the stymied bill. But he said he was not too worried.

“The marketplace is happening,” Chun said. “Just because they didn’t pass it in the spring session doesn’t mean the issue isn’t going to be called again.”

The Illinois Chamber of Commerce supported a different version of the bill, but had hoped another version would pass this session -- one without the same requirements for insurance companies to fund the exchange.

“Ultimately what ended up passing the Senate we were neutral on,” said Laura Minzer, head of the healthcare council for the ICC. “But it reflected a lot of the provisions and the principles we wanted to see captured.”

Other key legislation did pass the Illinois General Assembly, including a bill to expand Medicaid in Illinois to low-income adults and a bill to establish licensed Illinois Insurance Navigators. Navigators will help consumers make their way in the new marketplace.

Beginning January 1, 2014, all Americans will be required to get health insurance or pay a fine. At least 17 states have already opted to create their own insurance exchanges, while 26 states will likely leave it to the federal government. Illinois is among the seven that are currently planning a jointly-run exchange. The federal marketplace, including the one in Illinois, is set to open October 1.

Lewis Wallace is a WBEZ Pritzker Journalism Fellow. Follow him @lewispants.

Illinois businesses work to sort out the Affordable Care Act

Thu, 16 May 2013 05:00:00 -0500

Illinois businesses are preparing for the Affordable Care Act to go into full effect in 2014, and a leader from the Illinois Chamber of Commerce says some are considering limiting work hours to avoid future healthcare costs. But costs and logistics vary widely across different types of firms.

“It’s one giant puzzle within a puzzle within a puzzle,” said Laura Minzer, the Executive Director of the Health Care Council for the for the Illinois Chamber of Commerce.

She says employers, small and large, are scrambling to figure out which provisions of the federal law will apply to them and their employees. Businesses with under 25 employees may become eligible for tax credits for providing health care, while businesses with over 50 workers could face fines if they don’t provide affordable insurance for all employees working 30 hours or more.

The number of workers receiving employer-sponsored health care has declined steadily in recent years. Now, Minzer says limiting employee hours to under 30 is on the table for some bigger businesses worried about new health care costs.

“The cost of their benefits is not going down and it will not go down with this law,” said Minzer. Indeed, insurance premiums have been steadily rising, and experts expect to see a continued rise nationwide. But cuts to hours may be nothing new: the proportion of workers in part-time jobs has been on the rise since 2007.

One in five adults in Illinois is currently uninsured, and if they can’t get employer insurance, some will become eligible for government subsidies through the “marketplace” (formerly known as the exchange), which is a state and/or federally-run service intended to centralize and streamline shopping for private health insurance. Sliding scale subsidies in the form of tax credits will be available to those making up to four times the federal poverty level. Currently, Illinois has agreed to an insurance marketplace run jointly by Illinois and the federal government, but Minzer says the Chamber of Commerce supports opening a state-run marketplace by 2015.

“Even with all the concerns that we have about affordability, we see value in...the fact that you have a one-stop-shop for health insurance,” said Minzer. “The state is in a better position to administer that.”

States also have the option to expand Medicaid eligibility to adults making up to 138 percent of the federal poverty level, an option that’s already being piloted in Cook County. However, because of a controversial Supreme Court decision, states can opt out of the Medicaid expansion, and Illinois has yet to pass a bill that would expand Medicaid statewide in 2014.

Perhaps surprisingly, the Illinois Chamber of Commerce also supports the Medicaid expansion.

That’s because there’s a benefit for business: employees who receive Medicaid would do so without triggering penalties for their big employers (as opposed to seeking out insurance through the marketplace, which would trigger penalties). Recent reports have found that larger businesses have a financial incentive to support Medicaid expansion and avoid fees for not providing health insurance to low-income employees.

Bills to expand Medicaid and to establish a state-run insurance marketplace are creeping through the Illinois General Assembly, and the federal/state insurance marketplace is slated to open October 1, 2014.

Lewis Wallace is a Pritzker Journalism Fellow at WBEZ. Follow him @lewispants.

Fewer Illinoisans get health insurance at work

Thu, 11 Apr 2013 09:40:00 -0500

A new report says the percentage of Illinoisans who get health insurance through work has declined.

The report, released Thursday, finds the portion of non-elderly Illinois residents with insurance through their jobs dropped from 74 percent in 2000 to 62 percent in 2011.

It's a national trend. Overall, the report finds that 11.5 million fewer Americans received health insurance through an employer or a family member's job in 2011 than in 2000.

Fewer employers are offering insurance and fewer workers are accepting it, possibly because of rising costs.

In contrast, more young adults are covered through employer-sponsored insurance. The researchers attribute that to a provision of the Affordable Care Act, passed in 2010.

The report is from the Robert Wood Johnson Foundation and the State Health Access Data Assistance Center.

Adjunct professors demand inclusion in health care reforms

Mon, 11 Mar 2013 16:44:00 -0500

Starting in January 2014, large employers will be required to give health benefits to people who work at least 30 hours a week. The provision of the federal Affordable Care Act applies to anyone with more than 50 full-time employees – including all of Illinois' community colleges.

Now some adjunct professors are worried they’ll have their hours cut by colleges who don’t want to shell out the cash come January.

Dennis Polkow joined a group of protesters Friday outside the Westin Hotel, where Illinois community college leaders were holding a weekend gathering. After working at Oakton Community College for 13 years, he’s teaching 3 classes this semester and making less than 12 thousand dollars, he says, with no benefits. Like many other adjuncts, Polkow often juggles jobs at several colleges to make ends meet.

He said when he heard about the health care bill, “I thought, hallelujah, affordable health care act. I’ll be able to get affordable health care. Instead it’s like...cut, cut, cut, cut, cut.”

Polkow’s one of the people who’d be covered under Obamacare. But this February he found out Oakton may limit adjunct course loads in preparation for the health care law to kick in.

The college caught flack from faculty over memos that circulated about limiting adjunct course hours, and now Oakton Community College President Peg Lee says nothing’s been decided.

“We don’t even know how to define the number of hours,” she said Friday.

Adjuncts are paid by the course hour rather than by hours worked, and federal guidelines for calculating who will get coverage are still under review. Lee says whatever the calculations, community colleges are already strapped for cash. Governor Quinn’s 2014 budget slashes higher education by five percent, and Lee says Oakton’s still waiting on state reimbursement checks from last year. Sequestration cuts could also limit the numbers of students bringing federal aid into the community college system.

“As much as I believe in universal health care and a single payer, we can’t be that universal health care and single payer provider,” Lee said. “We just don’t have the money.”

It’s unclear whether most community colleges will adopt the practice of cutting adjunct hours to avoid Obamacare costs.

“We’re learning what the rules are and how they impact employees and employers, and the decisions that need to be made,” said Mike Monaghan, director of the Illinois Community College Trustees Association. “We have lots more work to do.”

Still, he said the adjuncts’ concerns are legitimate.

“Everybody has reason to be concerned, whether you’re an employee or an employer,” Monaghan said. “Any additional expense puts pressure on declining budgets.”

Cuts are already in place at Joliet Junior College (JJC). In anticipation of the health care reforms, the administration has placed a cap of six course hours per semester on all adjuncts’ schedules beginning this summer. At the protest Friday, JJC adjuncts’ union president Al Kennedy spoke quietly but urgently about the effect of the cuts on some union members.

“Are they going to be able to pay their rent for their apartment? Are they gonna be able to put food on the table for the kids? They’re just beside themselves,” he said.

JJC stands by the decision, saying that planning for a law they still have so little information about is a balancing act.

“I think this is just one of the sort of byproducts of this law,” said JJC spokesperson Kelly Rohder.

But to protester Steven Brody, also an Oakton adjunct, this is about more than a fight over health care.

“This is simply the first reaction of every one of these colleges to having to finally come to grips with the fact that they overutilize and underpay their adjunct faculty,” he said.

A recent study found that three quarters of college classes nationwide are taught by part-time or adjunct instructors, a dramatic shift from the 1970s when the majority of classes were taught by tenured faculty. Average pay for adjunct professors adds up to just over $20,000 a year for eight courses total, and most of the positions don’t come with health insurance.

Follow Lewis Wallace on Twitter.

Cook County begins enrolling 250,000 new Medicaid recipients

Mon, 19 Nov 2012 00:00:00 -0600

This week Cook County will start sending letters to about 115,000 of its low-income residents inviting them to enroll in the county’s new Medicaid program.

Adults under 65 with an income of up to 133% of the federal poverty level will be eligible for Medicaid beginning in 2014 in states that choose to participate in the Affordable Care Act Medicaid expansion.

In Cook County, the expanded eligibility will begin even sooner, in January 2013. Cook County applied for and received a federal waiver to let the law kick in a year early.

“We are excited not only because we got the waiver, we also get an opportunity to transform our healthcare system into the way it should be,” said Dr. Ram Raju, CEO of Cook County Health Services.

The new Medicaid program, called County Care, will operate on a “medical home” model - which means the county’s patients would have a doctor, a nurse, a social worker, and a medical assistant assigned to manage their health care.

“What we do in the old model is, if you come through the door, you are my problem, I’ll treat you well, I’ll give you prescriptions. Then, you are not my problem until you come back next time six months later,” said Dr. Raju. “In the medical home model, even when you go home, you are still my responsibility.”

To begin enrollment County Care, the county plans to reach out to every single eligible person currently on its books.

“It’s a massive task, because it is a lot of people we need to reach within a short period of time,” said Dr. Raju. “But one good advantage is that most of the people are already in our system.”

A total of about 250,000 people in Cook County are probably eligible for County Care, but the county first plans to make contact with those who have already come through the Cook County system or one of its community health centers. After Nov. 26, low-income adults who are not already on the books will be able to call to find out whether they are eligible.

County Care to provide mental health and substance abuse services

Medicaid is generally administered by states, but the federal waiver offered under Obamacare allowed counties to apply to create Medicaid programs jointly operated by the county and the federal government. The costs of the expanded coverage under County Care bypass the Illinois’ fiscally rocky Medicaid system – they’re split between the county and the federal government.

Come 2014, eligible people will be able to leave County Care and enroll in Medicaid through the state of Illinois. County Care patients are required to go to a provider within the county’s network of hospitals and affiliated Federally Qualified Health Centers, whereas recipients of state Medicaid can go to any doctor that accepts Medicaid.

But Dr. Raju said he hopes that by then, they will want to choose County Care. In addition to setting up patients in a “medical home”, County Care will provide mental health and substance abuse services, which Illinois Medicaid currently does not cover. The lack of mental health services in the region has been a topic of ongoing controversy.

“If there are substance abuse issues, we do not want them to get lost in the system,” he said. And he thinks the medical home model should be in use around the country. “We believe that is the future of the healthcare delivery model in this country.”

Community health centers prepare for influx of new patients under Obamacare

Fri, 16 Nov 2012 12:00:00 -0600

Medical providers are preparing for an avalanche of new patients as the federal health-care overhaul becomes a reality in Cook County.

One in five adults in Cook County is currently without health insurance, and the Affordable Care Act (ACA) mandates that all Americans access health insurance of some kind beginning in 2014.

“The population that’s coming into coverage hasn’t been consumers of the service,” said Warren Brodine, CEO of Chicago Family Health Centers (CFHC). “So I’d submit that none of us really knows how to care for that population completely. We don’t know what their preferences are. Are we gonna need to be providing primary care at 10 o’clock at night? That very well may be the case.”

Illinois has already turned in its blueprint for an exchange, a state-run marketplace for private insurance that will also help connect low-income people to federal aid. And Cook County is planning to expand Medicaid coverage to 115,000 new patients beginning in January 2013.

What remains unclear to many – including providers themselves – is just how many new patients will start flooding the health system as soon as six weeks from now, when Cook County begins its Medicaid expansion.

“Even without the Affordable Care Act people are really struggling to get appointments in a timely manner,” said Kimberley Tester Smathers of Heartland Health Centers. Medicaid patients are subject to long waits because their options are limited; Illinois’ Medicaid reimbursements are notoriously slow.

In Cook County alone, over 800,000 currently uninsured people will be required to get insurance or pay a fee in 2014; many will be eligible for subsidies. But whether it’s Medicaid or private insurance that covers their visits to the doctor, the newly insured will still need a place to get care.

Community health centers prepare to fill the gap

Hundreds of community health centers across the country have received ACA funding since 2010 to build new facilities and expand capacity. Two years after the ACA funds first started to flow, new health centers are popping up with regularity across the city and suburbs.

CFHC is currently building a new health center in Pullman funded by a $6.2 million grant under the ACA. It takes up an entire city block, and will replace an outdated facility nearby. The facility, expected to open in summer of 2013, will have the capacity to serve 10,000 new patients per year.

But Brodine has no idea just how many newly insured people will flock to his organization’s five South Side locations - or precisely what their needs will be.

“We’re pretty sure there’s quite a bit of pent-up demand in underserved communities, people who today drop in at an emergency department when they have some urgent need that really should have been taken care of in the context of a primary care relationship,” he said.

CFHC serves 28,000 low-income Chicagoans at five South Side locations; more than half of their patients are on Medicaid, and only 4 percent have private insurance.

The federal government's long-term goal is to help expand the capacity of community health centers by 20 million – double what they serve now. Nearly $80 million in federal funds has already been doled out in I llinois, and in 2012 alone, the Department of Health and Human Services made grants for the creation of 219 new sites nationwide.

Community health centers, also known as Federally Qualified Health Centers (FQHCs), are non-profits tasked with providing primary care at sliding scale rates. These health centers were first created nationwide in 1965 and they are required to accept Medicaid and Medicare; most also receive federal grant funding. Many of Chicago’s FQHCs have been providing care for low-income people for thirty or forty years.

FQHCs are used to taking on the uninsured. But now, they also need to plan ahead to be able to help patients get on insurance under the ACA, even though it is not entirely clear yet how the insurance exchange will work.

“Some of those questions are just starting to be answered on the logistics level,” said Smathers. “But this is all really confusing. It’s confusing for me, and I can’t imagine how confusing the insurance options might be for our patients.”

A shift from response to prevention

Brodine said the state of Illinois has dragged its feet more than some states on setting up its insurance exchange and making it clear how healthcare providers will be involved in enrollment.

But to him, implementing Affordable Care is not just about increasing the number of health centers and doctors.

“An insurance card is not enough; it’s only half the equation.” The other half of the equation is a transition to a system in which nearly everyone has primary care – and knows how to use it. As Mitt Romney reminded us during the 2012 presidential campaign, the emergency room has long been the fall-back of the uninsured. Community health clinics will be tasked with convincing people to come to them for preventive care, rather than waiting until they already have severe health conditions.

CFHC has already brought in 1,500 new patients through a program focused on hypertension. Hypertension, or high blood pressure, has a disproportionate impact on youth of color, particularly young men. Hypertension can be easily treated if a doctor catches the signs early. And it affects a group that is unlikely to be going to the doctor preventively right now.

“We very purposefully targeted this program toward individuals who we know would be covered in 2014, so that when they have coverage...they already know us,” said Brodine. The project should help young people get used to preventive care and treatment, and in the process, help them get used to the idea of having a primary care physician before they become eligible for insurance.

Brodine also predicted the new healthcare model will lead to an increased focus on the quality and outcomes of preventive care.

"We need to flip it around to a preventive approach, where people are exercising, people are eating right, people can get fresh fruits and vegetables in their local communities,” he said. “And you can’t take away the issues of things like housing adequacy and violence as real contributors to health. Those things are going to have to be addressed in a coordinated way.”

All of which means it’s an exciting time to be in the business of running community health clinics, whose mandate since their creation has been to provide community-centered care in low-income areas. If Affordable Care works out the way he hopes, Brodine said he’ll finally see some of his own dreams for community healthcare realized.

“We want the ‘health center’ to take that name,” said Brodine, “and mean more than a beefed up doctor’s office, but your center of health in the community.”

Risky Business: What happens when only the sick buy insurance

Fri, 29 Jun 2012 08:20:00 -0500

On Thursday, WBEZ talked to lawmakers, strategists, doctors, lawyers and economists over five hours of live health care coverage. We heard from moms with sick kids who were overjoyed by the news of the upheld mandate, and we heard from conservatives so convinced that the law is flawed that they vowed to repeal it in Congress. Friday morning on Eight Forty-Eight we return to the story after a day of reflection to explore how the legislation, now that it is confirmed, will affect the insurance market going forward.

Many believe that Illinois legislators were lackadaisical about creating a health care exchange because they thought the mandate would be struck down. Now that they’re sure it will stand, it’s time to figure out what the exchange will mean and how we’ll manage to comply before the federal deadline.

One thing both of Friday morning’s guests agree on is that the exchange will almost certainly decrease the breadth of provider networks. Health Alliance Medical Plans CEO Jeff Ingrum says the penalty — or what we’ll now call a tax — "is not high enough to compel someone to buy insurance.” Healthy consumers will opt out of the exchange, flooding the exchange pool with high-risk buyers. “If you ask an insurance company to exist in a system where they can’t control their risk or plan design,” says Marcus Newman, “the only variable left for them to use is network, so I imagine they will have very thin provider networks, similar to HMOs or even more anemic.”

Newman is the small businesses director for GCG Financial, a 38-state operation that provides health care communications and consulting for over 500 independently owned companies. It’s very rare, Newman says, that after conferring, an employer will choose to buy an insurance plan through an exchange. Newman reminds us that the health insurance an employer buys for his employees is often de facto his own insurance, and that many employers would prefer to retain their current doctors and networks.

Ingrum says that while Health Alliance has not yet settled on a final strategy, they are prepared for the transition. He does expect “narrower networks” as well as a “less rich product design,” and further, that Illinois will end up with a federally facilitated exchange, not a locally managed one. Many opponents to the ACA predict a decrease in the efficiency of the markets if they are no longer locally managed. A press release from the National Federation of Independent Businesses said, “the ruling guarantees that Illinois residents will have their most personal health care decisions made by politicians and bureaucrats in Washington and in other states whom they’ve never met and whom they’ll have a hard time influencing in the future.”

One major question small business owners will have in the coming days, Newman predicted, is what the cost of the exchange will be -- a question says nobody will have an answer to for a long time. Newman will be offering what advice he does have for employers as he chats with Richard Steele Friday morning, and we’ll ask Jeff Ingrum for specifics on how insurance companies plan to proceed now that the mandate is here to stay.

Politicians respond to Supreme Court ruling of President Obama's health care law

Thu, 28 Jun 2012 11:27:00 -0500

As the Supreme Court ruling on the Affordable Care Act came down Thursday morning, politicians in Illinois and across America began to release their responses. Below are some of their statements, culled from Twitter, email and phone interviews conducted by WBEZ.

"I gave (President Barack Obama) my advice. I told him many times, I said the political cost of doing this, and thank God, for the rest of the country, he didn't listen to me." -- Chicago Mayor Rahm Emanuel

"We're going to do whatever we can to do to repeal this law, because as Governor Romney said, this law is terrible for America."

“I want to start over. I want to get rid of the whole thing. And then I want Republicans and Democrats to sit down and work on the things we all agree on, which are tort reform, expanding health savings accounts, letting Americans cross state lines to buy insurance. Look, Obamacare goes in the exact opposite direction.” -- Representative Joe Walsh (R-IL-8th)

“Today is a historic day when the Supreme Court declared that the Affordable Care Act and the health security it brings is the law of the land. With President Obama’s leadership, Congress enacted the most significant law in half a century. The law ends insurance industry abuses in the health system, improves Medicare and Medicaid for seniors and the disabled, and covers millions of uninsured Americans. Today, Republicans need to finally put to rest the relentless, partisan attacks against a landmark law that is already working to provide affordable, high-quality care....Today is a day for celebration. Tomorrow we will get back to work ensuring that every American can take advantage of the benefits of Obamacare and have access to affordable, comprehensive and high quality health care. ” -- Representative Jan Schakowsky (D-IL)

"While I respect the Court’s decision, the health care law threatens our economic recovery by raising taxes, imposing new regulations and creating a drag on the economy. Congress should repeal the health care law and replace it with common sense, centrist reforms that give Americans the right to buy insurance across state lines and expand coverage without raising taxes, while blocking the government from coming between patients and their doctors." -- Senator Mark Kirk (R-IL)

"I am pleased to see that the Supreme Court has validated the important benefits of this law and look forward to its full implementation #hcr" (Twitter)

“Today the United States Supreme Court told the American People that they do indeed have a right to quality health care. I am pleased that the most important part of the Affordable Care Act, the individual mandate that makes the entire program possible, has been ruled constitutional.

Now the fight begins to make sure that these benefits are not taken away. Please know that I will continue to fight in behalf of the residents of the First Congressional District and our nation." -- Representative Bobby Rush (D-IL)

“Unfortunately, the court’s ruling will have tragic consequences that will spread well beyond the issue of mandatory insurance and health care services. It will drive up health care costs and put yet another financial burden on our already struggling small businesses. We in Illinois will be exploring avenues available for implementing this sweeping law and still providing the greatest options and lowest cost for our families and businesses.” -- State Senator Bill Brady (R-IL)

“This decision means that we can move forward to address the unsustainable increase in health care costs and expand the protection of health insurance coverage to over 30 million Americans – including millions in Illinois.”

“Those who opposed any change in the law and dismissed the constitutionality of this measure were rejected by the actions of Congress and the opinion of the Chief Justice.”

“It is also noteworthy that after two controversial, activist decisions in Bush v. Gore and Citizens United, the Chief Justice, in both the Arizona immigration law and the Affordable Care Act cases, appears to be working to reestablish the political neutrality of this court. That is a positive development.” -- Senator Dick Durbin (D-IL)

"Constitutionality should not be mistaken for good public policy. Although the Supreme Court today ruled that ObamaCare is constitutional, that does not change the fact that it will drive up the cost of health care, add to our already exploding debt and hurt job creation, including within our vibrant medical device manufacturing sector.

"Standing outside the Supreme Court in our Nation's Capitol today as the ruling was handed down I was reminded of the passion this legislation has ignited among an overwhelming and consistent majority of Hoosiers who have rejected ObamaCare from the very start.

"The stakes are too high. Our economy, our future, depends on us electing Mitt Romney this November." -- Indiana Republican Party State Chairman Eric Holcomb

“While this ruling speaks to the constitutionality of the ACA, the real question is whether the 2010 law makes for good public policy. The American people missed a golden opportunity with health care reform when Congress rushed it through on a partisan basis. I believe that properly confronting the big issues and challenges in this country requires input from both sides and bipartisan support. There are positive provisions in the ACA that should remain as law, but there is more we can do to increase quality and access to care, while reining in skyrocketing costs to the health care system. As health care reform continues to take shape, I am committed to working in a bipartisan way to find positive solutions to the rising costs of health care.” -- Representative Robert Dold (R-IL)

“I applaud today’s decision by the United States Supreme Court upholding the Affordable Care Act.

“In accordance with this historic ruling, the Cook County Health and Hospitals System will continue to seek a 1115 Medicaid Waiver from the work Centers for Medicare and Medicaid Services. This waiver, if approved by the federal government, would permit CCHHS to receive federal reimbursement for the costs of treatment provided to the tens of thousands of our patients who currently have no medical coverage but will gain access to Medicaid on January 1, 2014.

“CCHHS is the foundation of the safety-net health network in northeastern Illinois. Today’s decision by the Supreme Court will allow our system to proactively prepare for Affordable Care Act implementation in 2014.” -- Cook County Board President Toni Preckwinkle

"There's still so much more that needs to be done but for most families this insures that them the rug is not going to be pulled out from underneath them." -- Representative Mike Quigley (D-IL)

“With or without the unpopular health mandate, the cost of care continues to rise, and it’s up to Republicans and Democrats alike to work across the aisle on solutions. I’m disappointed that the Court did not put a stop to the government overreach. But Washington still has a responsibility to fix polices that are raising costs, hurting job creation, siphoning millions from Medicare, and placing an added layer of bureaucracy between patients and their doctors.

“Under the Administration’s law, too many families will lose the plans they have, and small businesses are afraid to hire new employees. We should go back to work on effective, bipartisan reforms that Democrat leaders ignored, like Association Health Plans for small businesses, allowing consumers to buy insurance across state lines, and medical malpractice reform. At the same time, we can and should maintain coverage for pre-existing conditions and young adults under 26.” -- Representative Judy Biggert (R-IL)

Supreme Court upholds requirement that most Americans have health insurance

Thu, 28 Jun 2012 08:27:00 -0500

Update Thursday June 28 10:05 a.m.

Read the full text of the decision.

The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.

The decision means the huge overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also hands Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.

The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.

The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

"The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding," the dissenters said in a joint statement.

Republican campaign strategists said presidential candidate Mitt Romney will use the court'sruling to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.

"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Illinois reacts: Quinn "thrilled" with health care ruiling

Illinois officials must decide how to implement key provisions of President Barack Obama's health care overhaul now that the U.S. Supreme Court upheld the law's individual insurance requirement.

That includes developing an online insurance marketplace where people and small businesses can comparison shop for insurance beginning in 2014.

Gov. Pat Quinn's administration wouldn't answer questions about Illinois' plans, but aides say he's "thrilled" by the ruling.

A lawmaker who led work on implementing the state's insurance exchange has said Illinoiswon't be able to meet a Nov. 16 deadline to get it set up.

Democratic Rep. Frank Mautino told The Associated Press this week that Illinois must consider a federal-state partnership to meet the requirement.

Illinois officials estimate about 800,000 now-uninsured residents would get public or private health insurance.

Republicans plan to continue campaigning against health care law

Republican campaign strategists say Mitt Romney will use today's Supreme Court ruling to continue campaigning against "Obamacare." They say he will be attacking the president's signature health care program as a tax increase.

Veteran Republican campaign adviser Terry Holt says, "Obama might have his law, but the GOP has a cause." He says the decision will rally Republican support for an appeal of what Holt says "could well be called the largest tax increase in American history."

Romney has said this week that if the law were to be upheld, Americans would need to elect a president who would repeal it.

House Speaker John Boehner says the Supreme Court ruling shows the need to repeal the law. The Ohio Republican says in a statement that the law is hurting the economy by increasing health care costs and making it difficult for small businesses to hire.

He says the court's ruling demands repeal of the entire law.

Boehner say Americans want a common-sense approach to health care. He says Republicans are ready to work with a president who's willing to listen to the people and "will not repeat the mistakes that gave our country 'Obamacare.'"

What's next?

The 2010 health care law will continue phasing in as planned. It's expected to bring coverage to about 30 million uninsured people, so that more than nine in ten eligible Americans will be covered.

Some parts are already in effect: Young adults can stay on their parents' insurance up to age 26. Insurers can't deny coverage to children with health problems. Limits on how much policies will pay out to each person over a lifetime are eliminated. Hundreds of older people already are saving money through improved Medicare prescription benefits. And co-payments for preventive care for all ages have been eliminated.

Starting in 2014, almost everyone will be required to be insured or pay a fine. There are subsidies to help people who can't afford coverage. Most employers will face fines if they don't offer coverage for their workers. Newly created insurance markets will make it easier for individuals and small businesses to buy affordable coverage. And Medicaid will be expanded to cover more low-income people.

Insurers will be prohibited from denying coverage to people with medical problems or charging those people more. They won't be able to charge women more, either. During the transition to 2014, a special program for people with pre-existing health problems helps these people get coverage.

An assortment of tax increases, health industry fees and Medicare cuts will help pay for the changes.

Is the issue settled?

Not necessarily. Although the court found it constitutional, the health care law still could be changed by Congress. Romney and Republican congressional candidates are campaigning on promises to repeal it if elected in November.

Some parts of the law are popular, but others — especially the mandate that virtually everyone have insurance coverage — are not.

Also, an estimated 26 million people will remain without health coverage once the law is fully implemented, including illegal immigrants, people who don't sign up and elect to face the fine instead, and those who can't afford it even with the subsidies.

* * * *

Update June 28 8:31 a.m.

Political uncertainty weighed heavy before ruiling

"My guess is they're not sleeping real well at the White House tonight," presumptive Republican presidential nominee Mitt Romney told supporters Wednesday in northern Virginia.

Anticipation of Thursday's decision could be equally unnerving for Romney, whose opposition to the law has become a central pillar of his campaign.

Neither candidate has any direct influence over the ruling. The court could uphold the health care law, strike it down or deem the requirement that most Americans carry health insurance unconstitutional while retaining other aspects of the law.

The announcement is expected to be followed almost immediately by a barrage of advertisements and fundraising appeals from Democrats and Republicans, all trying to cast the decision in the most advantageous light for their candidates.

The Obama campaign began trying to raise money off the ruling even before it was announced. In a Thursday morning fundraising email with the subject line "Today's Decision," Obama campaign manager Jim Messina told supporters "no matter what, today is an important day to have Barack Obama's back."

The Democratic Congressional Campaign Committee also issued a fundraising appeal for a "health care rapid response fund," telling supporters by email Wednesday that, however the court rules, "Democrats are in for a tough fight."

Secrecy has marked each campaign's planning for the critical moment.

Obama is scheduled to be in the Oval Office with Vice President Joe Biden when the ruling is announced. The president is certain to respond to the decision, but his specific plans to do so were unclear. Romney's campaign has refused to disclose the location of a Capitol Hill venue where he will face reporters shortly after the announcement.

It is clear, however, that the Supreme Court's ruling on Obama's sweeping federal health care law will shape the contours of the presidential campaign through the summer and fall. Both Obama and his Republican rival are primed to use the outcome — whatever it is — for political gain.

Obama has expressed confidence the court will uphold his signature legislative initiative. But he won't be shocked if a conservative majority overturns the most controversial provision, those familiar with his thinking say. Romney aides say the Republican candidate will get a political boost if the court strikes down the measure. But they don't want celebrations that could alienate voters who could lose health care benefits as a result of the decision.

The court's ruling could have a far-reaching impact on the nation's health care system. If thelaw is upheld, about 30 million of the 50 million uninsured Americans would get coverage in 2014 when a big expansion begins.

Overturning all or part of the law could leave as uninsured the more than 3 million young adults who gained coverage through a provision allowing them to stay on their parents' insurance up to age 26, according to the Health and Human Services Department. Another 60,000 people who gained coverage through a plan for those with pre-existing conditions may not be able to get coverage elsewhere if the entire law is struck down.

Obama recently has avoided mentioning the impending court ruling directly, but during campaign events this week he has vigorously defended the health care overhaul as critical to the public's health and well-being.

"I think it was the right thing to do. I know it was the right thing to do," he told supporters in Boston.

Romney, who as Massachusetts governor signed a health care law on which the Obama's federal law was modeled, has focused more than usual on the Supreme Court ruling this week. In campaign appearances in Virginia, New Jersey and New York, he offered supporters and donors a preview of his likely response to the decision and said Obama's first term would be essentially wasted if the law is overturned.

If the court upholds the law, Romney told supporters at a northern Virginia electronics manufacturer Wednesday, it's still bad policy. "And that'll mean if I'm elected president we're going to repeal it and replace it," he said.

And if the court strikes down the law, Romney said, "They're going to be doing some of my work for me."

Obama advisers say the Supreme Court showed reasonableness earlier this week in a ruling on an Arizona immigration case, and they see it as a hopeful sign for how the court might rule on health care.

If the court upholds the law, Obama could get an election-year gust of wind at his back, with his vision and leadership validated. If the court strikes down the overhaul, the White House would seek to cast the decision as detrimental to millions of Americans by highlighting popular elements of the law that would disappear, such as preventive care and coverage for young adults on parents' plans.

The Romney campaign has coordinated its response directly with the Republican National Committee and House Republicans, who have agreed not to "spike the ball" — as one Republican put it — should the law be struck down. His campaign worries that an over-celebratory tone may turn off voters affected by the decision.

Indeed, the stakes are high for both candidates. Polling suggests that most Americans oppose the law, but an overwhelming majority want Congress and the president to find a new remedy if it's struck down.

Romney so far has spent little time crafting a comprehensive plan to replace the overhaul. And the Obama campaign already has seized on Romney's opposition to the most popular provisions in the law. For example, Romney would not prevent health care companies from denying coverage to new customers with medical conditions. Nor would he force them to cover young adults on their parents' plans through age 26.

Still, both sides will use it to raise money and motivate supporters. And outside groups are ready to unleash a flood of advertisements following the ruling, including a 16-state, $7 million ad buy from the conservative political action group Americans for Prosperity.

___

AP White House Correspondent Ben Feller contributed to this report.

ACA Ruling

Live Affordable Care Act updates from Eight Forty-Eight

Thu, 28 Jun 2012 08:14:00 -0500

By 10 a.m. CT/11 a.m. ET Thursday morning, we’ll know what fate President Obama’s Affordable Care Act met with in the Supreme Court. The one thing everybody knows is that anything could happen — the justices could strike down all of it, none of it, or some of it. Eight Forty-Eight will be live throughout the hour, previewing the announcement and responding to the decision. Scroll down to read live updates as the ruling develops.

Prof. Anup Malani is a legal expert who specializes in health law. He’ll be on hand to turn the legalese into plain English as the opinions are released. Malani is a professor at both the University of Chicago Law School and the Pritzker School of Medicine, as well as an editor of the Forum for Health Economics and Policy. For his part, Malani predicts that the court will strike down the mandate but retain the rest of the law, although he did warn that if the court strikes the entire law, the government will have lost between $14 and $20 billion in preparation for the bill. Tune in to hear Malani explain the legal reasoning behind the court’s decision.

Brian Imus, State Director of the Public Interest Research Group, will also be in studio for this live conversation. Imus contributed to, “At Stake: What’s On the Line for Health Care Consumers in the Pending Supreme Court Case,” a PIRG report aimed at uncovering what Thursday’s decision will mean for Illinois taxpayers.

Since the Affordable Care Act was introduced, Imus found, 102,600 young adults in Illinois gained health insurance, over 2 million Illinoisans added high-value preventive services, and a law was put in place mandating that 80 percent of consumer premiums be put toward services rather than profit. When the decision is announced, Imus will be on hand to explain exactly what it means for Illinoisans, including who might lose coverage -- and when.

And finally, Prof. David Dranove will be our on-hand economist throughout the hour. In addition to being a professor of economics at the Kellogg School of Management, Dranove is the author of Code Red: An Economist Explains How to Revive the Healthcare System without Destroying It. He’s been keeping his eye on Intrade.com, a website where individuals can bet money on outcomes of a variety of public decisions. Dranove, who predicts an assenting vote of 5-4, will keep monitor the share prices, which rose two cents as of 8:30 Thursday morning.

Dranove, who calls the Affordable Care Act the “most important legislation of the last forty years,” already wrote a reaction to his own projection of the Supreme Court’s decision. He suggests that the mandate will be upheld, and fingers Justice Scalia for predicted undue snark. As we await the decision on Eight Forty-Eight, Dranove will not only lay out the numbers for us, but he’ll also explain why he believes that, constitutionally, a punitive tax for those who don’t buy health insurance is no different than a tax rebate.

WBEZ will continue its live coverage of developing health care news throughout the midday hours and into Friday morning, so stay tuned to hear from doctors, lawmakers, an insurance company CEO and small business consultants. To react to the news, or ask questions of our experts, call 312.923.9239. We’ll also be tweeting live at @WBEZ; follow us for updates from the conversation.

LIVE BLOG

9:03 am Tony Sarabia points out that if President Obama speaks during the hour, we’ll be cutting to that on air.

9:08 am The SCOTUS blog reports that the individual mandate survives as a tax. "The mandate is constitutional; Chief Justice Roberts joins the left of the Court.

9:11 am "The medicaid provision is limited but not invalidated."

Malani: "The mandate may not stand under the commerce power...but it does stand under the tax power, which is very surprising to legal scholars."

"I'm really looking forward to reading the opinion."

9:14 am Dranove: "This isn't a constitutional issue; it's kind of an economics and market issue."

"The universal mandate will help make sure individuals who are young and healthy stay in the insurance pool."

Imus: "That's really the whole purpose of the individual mandate: to make healthcare more secure."

9:19 am Malani: "I'm not surprised about the Chief Justice siding with majority...I think he wanted to control the opinion."

"This interesting compromise; the commerce clause is not unlimited."

"The biggest challenge to freedom -- according to the challengers-- is the federal government exercising its power through the commerce clause."

9:21 am Malani: "On the individual mandate, SCOTUS is saying, 'You will get to pay lower taxes if you purchase insurance, and you'll pay higher taxes if you don't.'"

9:26 am Dranove: For the economy, "this is good, but the expansion of tax revenues might be bad. It makes economic sense to have people covered and to do this in exchange with the mandate is a way to make sure we have risk pools."

9:28 am Dranove: "What I think is unfortunate is that we had an opportunity through health care to allow more creativity on the part of the states than we're going to see...instead I think we're tied to the mast of this law, and I think it's going to be very difficult to overturn large parts of this law."

9:30 am Tony Sarabia reads Justice Kennedy's dissent: "In our view, the entire Act before us is invalid in its entirety."

Malani: "It's clear that Justice Roberts was the swing vote here. I would have guessed that it would have been 6-3. I think we've seen the first chapter of the Roberts legacy being written, in that he found a compromise."

9:32 am: From the SCOTUS blog "The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding."

9:37 am Dranove: "This is really news to Wall Street...people betting online were betting that this would fail. If you look at the stock market reaction, it's not surprise to see the magnitude of reaction. Hospital stocks are up around 5 percent. Companies that provide medicaid managed care...are up five to ten percent."

"This is what we saw during the debate -- once different sectors got the part of the act they wanted, they turned to favor the Act."

9:43 am Imus: Governor Quinn could take action, today even, to create a [health] exchange here in Illinois.

9:44 am Here's the full PDF of the SCOTUS decision.

9:45 am Malani: "If a state says 'No, I do not want to expand medicaid'...the federal government can [take the money away for medicaid expansion already given.] I would be surprised if a state said no. The only time a state would think about that is if they were under extreme financial pressure."

Tony Sarabia: "Well that's Illinois."

9:49 am Dranove: "Insurance companies sell very similar products. But in many ways, the market is not particularly competitive."

"What the exchanges will do is kind of level the playing field. It'll give individuals more information about their options and give them more choices."

"Blue Cross is going to continue to enjoy some benefits in the market due to it's sheer size."

9:52 pm Surprising news: Dranove: "Insurance stocks are down."

"We should be careful about interpreting the stock market until the end of the day."

Imus: Health exchanges could become "an Expedia" for health care.

9:55 am To wrap-up, Tony Sarabia asks, what are the mistinterpretations surrounding this ruling?

Dranove: Justice Roberts says the court shouldn't be activist. "The court is going to start looking less activist whether you're on the left or the right."

Imus: Today is a great opportunity for Governor Quinn to call for an executive order for health exchanges.

Malani: I don't think anybody thinks the health care system we had was working.