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Illinois health insurance

Four insurers offer coverage in the exchange; Medicaid expansion enrollment hovers above 630,000

Enrollment update

Illinois insurance overview

The Land of Lincoln has had relative success under the Affordable Care Act. Its uninsured rates have been nearly cut in half as more residents access coverage via subsidized private plans on the state’s exchange, and more than 600,000 people are covered under expanded Medicaid. 12.7 percent of the population was uninsured in 2013, according to US Census data, and that had fallen to 6.5 percent by 2016, due primarily to the ACA.

Open enrollment for 2018 coverage in the individual market was much shorter than it had been in prior years. It began on November 1, 2017, and ended just over six weeks later, on December 15, 2017. This schedule will continue to be used in future years.

Although ACA repeal was a significant portion of GOP legislative efforts in 2017, the only legislative change that was made to the ACA was repeal of the individual mandate penalty (as part of the GOP tax bill that was enacted in late 2017), but that won’t take effect until 2019. People who are uninsured in 2018 will still be subject to a penalty unless they’re eligible for an exemption. Premium subsidies and cost-sharing reductions continue to be available through the state’s exchange and the ACA’s expanded Medicaid is still available to residents with income up to 138 percent of the poverty level.

Illinois health ratings

In the 2015 edition of America’s Health Rankings, Illinois placed 28th – an improvement from 30th in the past two years. And in the 2017 ranking, Illinois climbed one more place, to 27th. The state earned high marks for good access to primary care doctors and dentists, and below-average uninsured rates. But Illinois performed poorly on rankings for air pollution and excessive alcohol use (although Illinois is ranked 45th for excessive drinking, their rate of excessive drinking is down 12 percent from where it was five years ago).

Illinois saw its ranking hold steady in the 2015 Scorecard on State Health System Performance, at 26th, but they dropped one position, to 27th, in the 2017 scorecard. The scorecard ranks the 50 states, and the District of Columbia, on more than 40 individual health measures to come up with an overall score.
Similar to the results from America’s Health Rankings, Illinois performed well in health indicators related to access to care. The percentage of uninsured adults and children and individuals who went without care were lower than national averages. Illinois ranked third in the nation in terms of the percentage of children with health insurance, and 8th for the percentage of children who had preventive medical and dental care in the past year. See Illinois’ scorecard to learn more about how the state scored on each measure.

The 2016 edition of Trust for America’s Health also tracks numerous public health measures. See Key Health Data About Illinois to see how the state fared with health indicators related to diet, disease, activity level and more.

For a county-by-county assessment of health in Illinois, see health variations by county with data from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

How Obamacare is helping Illinois residents

Illinois operates a state-partnership exchange called Get Covered Illinois and uses the federal platform to enroll residents in Obamacare plans. Illinois has also adopted Medicaid expansion under the ACA.

The Affordable Care Act has greatly reduced the number of uninsured Illinoisans. According to US Census data, 12.7 percent of Illinois residents were uninsured in 2013. Due mainly to the ACA, the uninsured rate fell to 6.5 percent by 2016. At that point, the national average uninsured rate was 8.6 percent.

According to a 2014 Kaiser Family Foundation analysis, about 67 percent of the uninsured, nonelderly people in the state were projected to be eligible for financial assistance to help them gain coverage through either Medicaid, CHIP, or Illinois’ health insurance exchange. By 2017, expanded Medicaid was covering more than 630,000 people in Illinois, and more than 250,000 people were receiving premium subsidies in the Illinois exchange. The number of people receiving financial assistance with premiums in the exchange was lower than the original projections, but still substantial (exchange enrollment all across the country has been lower than projected), and expanded Medicaid enrollment is just slightly lower than the Kaiser Family Foundation analysis had projected.

2018 rates and carriers for the Illinois exchange

There were five companies selling individual plans through the Illinois exchange in 2017. All but Humana returned for 2018 (Humana ceased all of their remaining individual market participation at the end of 2017). The following insurers are offering plans for 2018 in the Illinois exchange:

  • Celtic Insurance Co. (Ambetter)
  • Health Alliance Medical Plans, Inc.
  • Health Care Service Corporation (Blue Cross Blue Shield)
  • Cigna

Illinois enrollment in qualified health plans

About 23 percent of the estimated Illinois market – about 217,500 people – signed up for a qualified health plans (QHPs) during the 2014 open enrollment period. Seventy-seven percent of those enrolled in a QHP qualified for premium subsidies.

Enrollment continued a steady increase in the two open enrollment periods that followed. During the 2016 open enrollment period a total of 388,179 people enrolled in private plans through the Illinois exchange, an 11 percent increase over 2015 enrollment. The average premium subsidy amount was $237 per month, and 77.5 percent of Illinois exchange enrollees received premium subsidies as of March 31, 2016.

But for 2017 and again for 2018, enrollment in the Illinois exchange declined. 334,979 people enrolled during the open enrollment period for 2018 coverage, which was down 13.7 percent from the state’s peak enrollment in 2016. Enrollment decline was the norm in states that use the federally-run exchange ( in 2017 and 2018. This was due in part to the Trump Administration’s decision to reduce funding for advertising, outreach, and enrollment assistance at the end of the 2017 open enrollment period, and throughout the 2018 open enrollment period. It was also due to misperceptions that the individual mandate had been repealed (it has, but that won’t take effect until 2019; people are still required to have coverage in 2018).

Illinois and the Affordable Care Act

In the 2010 vote on the Affordable Care Act, Sen. Roland Burris and Sen. Dick Durbin both voted “yes.”

Durbin remains in office. Burris, a Democrat, was replaced by Republican Mark Kirk in 2010. Kirk opposed the Affordable Care Act and repeatedly voted to repeal the law, but he was defeated in the 2016 election by Tammy Duckworth, a Democrat. So the Illinois Senate delegation once again has two Democrats, both of whom support the ACA.

Illinois’ delegation to the U.S. House of Representatives voted 11-8 in favor of the ACA. The current House delegation from Illinois has 11 Democrats and seven Republicans.

At the state level, Governor Bruce Rauner is a Republican, but both chambers of the legislature are under Democratic control. Former Gov. Pat Quinn (a Democrat) considered establishing a state-run health insurance exchange by executive order, but the state ultimately implemented partnership exchange.

Quinn ran for re-election in 2014, but lost to Republican, Bruce Rauner. Medicaid expansion was a campaign issue, with Rauner saying he would not have authorized Medicaid expansion, but that he would not try to reverse the state’s position. The overall ACA was not frequently mentioned during the campaign. However, in one debate, Rauner called the ACA a “financial disaster” for Illinois and said “We’ve got to step back key elements of” the law. But Rauner expressed concerns about GOP efforts to repeal the ACA in 2017. He didn’t go as far as some other Republican governors, however, in rejecting the Party’s efforts to repeal the law.

Illinois strongly favored its own Hillary Clinton in the 2016 presidential election.

Medicaid and CHIP in Illinois

With the state’s decision to expand its Medicaid program, an estimated 46 percent of uninsured Illinois residents qualified for either Medicaid or the Children’s Health Insurance Program (CHIP) in 2014.

Illinois Medicaid and CHIP enrollment grew 15 percent from 2013, before expansion, to November 2017, with average monthly enrollment exceeding 3 million (this includes people who were already enrolled in Medicaid and CHIP before the ACA, as well as the 630,000 people who have enrolled under the expanded eligibility guidelines).

Learn about low or no-cost Illinois’ Medical Assistance Programs at the Illinois Department of Healthcare and Family Services.

Other ACA reform provisions

The Affordable Care Act established a federal loan program, called the Consumer Operated and Oriented Plan (CO-OP) Program. The program is designed to increased consumer choice and expand competition by enabling new nonprofit health insurers to enter the market.

In Illinois, Land of Lincoln Health received more than $160 million in grant funds. It struggled in its first year and enrollment was only 4,000 in 2014. However, participation grew significantly in 2015, when premiums were cut 20 to 30 percent, and reached 50,000.

Nonetheless, after losing $7.1 million in the first quarter of 2016, Land of Lincoln Health announced its impending closure in 2016 and ceased operations September 30, 2016. As of early 2018, only four ACA-created CO-OPs remained operational, out of 23 that began offering coverage in the fall of 2013.

Does Illinois have a high-risk pool?

Prior to the reforms the ACA brought to the individual health insurance market, coverage was underwritten in nearly every state, including Illinois. People with pre-existing conditions often found themselves ineligible to purchase private plans, or only able to get coverage that excluded pre-existing conditions.

The Illinois Comprehensive Health Insurance Plan (ICHIP) was created in 1989 to provide a coverage option for people unable to obtain private plans because of their medical history.  Due to budget shortfalls, the plan stopped enrolling new members in September 2000, and applicants were placed on a waiting list.  The program was able to reopen to new enrollment in the spring of 2001. The pool also briefly suspended new enrollment in the summer of 2009.

In 2001, the risk pool had about 5,700 members, but that number had grown to more than 18,000 by the end of 2010.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This reform measure has largely eliminated the need for high-risk pools, since medical history is no longer a barrier to obtaining coverage in the individual market.

ICHIP was still enrolling eligible HIPAA pool applicants, but stopped renewing traditional risk pool members’ coverage after April 30, 2014. They notified members and posted extensive data on their website explaining how to transition to an exchange plan.

Illinois Medicare enrollment

In 2015, there were more than 2 million people enrolled in Illinois Medicare – about 16 percent of the state’s population, compared with 17 percent enrolled in Medicare nationwide. As of 2013, Medicare beneficiary eligibility was 85 percent based on age and 15 percent due to disability.

Medicare pays about $9,259 annually per Illinois enrollee, and the state ranks 7th in overall spending with $19.2 billion per year.

Illinois Medicare beneficiaries may choose a Medicare Advantage plan instead of original Medicare, a decision some make to gain additional benefits beyond what the traditional Medicare coverage offers. About 21 percent of Illinois Medicare recipients have selected a Medicare Advantage plan, much lower than the 33 percent who choose one nationwide.

Illinois Medicare beneficiaries can also select Medicare Part D plans for stand-alone prescription drug coverage, and 51 percent did so in 2017. Nationwide, 44 percent of Medicare enrollees selected stand-alone prescription plans. It makes sense that a higher percentage of Illinois residents would select stand-alone prescription plans versus the national average, since a smaller percentage of Medicare beneficiaries in Illinois select Medicare Advantage plans. Stand-alone Part D plans are for use with traditional Medicare rather than Medicare Advantage.

Health reform legislation in Illinois

Scroll to the bottom of the page to see what’s happening legislatively with healthcare reform in Illinois at the state level:

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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