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Illinois health insurance

ACA enrollment, public health improve in Land of Lincoln

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 expanded Medicaid eligibility.

Have these improvements impacted public health? The Land of Lincoln has improved a few spots in recent national health rankings.

This brief summary looks at Illinois’ standing in several rankings of healthcare measures and its decisions related to the Affordable Care Act, including Medicare expansion and a partnership exchange.

Illinois health ratings

In the 2015 edition of America’s Health Rankings, Illinois placed 28th – an improvement from 30th in the past two years. The state earned high marks for good access to primary care doctors and dentists, and below-average uninsured rates.

Illinois saw its ranking hold steady in the 2015 Scorecard on State Health System Performance, at 26th. 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.

In theme with America’s Health Rankings, Illinois performed well in health indicators related to access on its Scorecard. The percentage of uninsured adults and children and individuals who went without care were lower than national averages. 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

The Affordable Care Act has greatly reduced the number of uninsured Illinoisans. According to the Kaiser Family Foundation, about 1.8 million Illinois residents were uninsured at the beginning of 2014. The uninsured rate in Illinois decreased from 15.5 percent in 2013 to 8.7 percent by the late in 2015, much lower than the 11.7 percent national average.

About 67 percent of the uninsured, nonelderly people in the state qualified for financial assistance to help them gain coverage through either Medicaid or Illinois’ health insurance exchange.

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

2017 rates and carriers for the Illinois exchange

Seven carriers will sell health plans through the Illinois exchange for 2017; there were nine in 2016.

  • Celtic Insurance Co. (Ambetter)
  • Coventry (including Coventry Health & Life Insurance Co. and Coventry Health Care of Illinois, Inc., which are two separate legal etnities)
  • Harken Health Insurance Company (Midwest Security Life, a UnitedHealthcare subsidiary)
  • Health Alliance Medical Plans, Inc.
  • Health Care Service Corporation (Blue Cross Blue Shield)
  • Humana Health Plan, Inc.
  • Cigna (new to the exchange for 2017)

These carriers have requested rate increases ranging from 10.3 percent to 50.2 percent. BCBS requested the 50.2 percent increase, which heavily skews the average proposed rate increase since the carrier has more than three-quarters of the individual market share in Illinois. Rates have not yet been finalized and made public.

Absent from Illinois’ exchange in 2017 will be Aetna and the ACA-created CO-OP, Land of Lincoln Health, which will cease to provide coverage on September 30, 2016.

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 has 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.

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 was appointed to the Senate by then-Gov. Rod Blagojevich to fill the seat vacated by Barack Obama. Burris was surrounded by controversy as Blagojevich was later convicted of corruption charges and sentenced to 14 years in prison, in part for soliciting bribes to fill the Senate seat. Burris was not charged with wrongdoing.

Burris, a Democrat, was replaced by Republican Mark Kirk. Kirk opposes the Affordable Care Act and has repeatedly voted to repeal the law.

Illinois’ delegation to the U.S. House of Representatives voted 11-8 in favor of the ACA.

At the state level, the governor’s office and both legislative houses are under Democratic control. Gov. Pat Quinn considered establishing a state-run health insurance exchange by executive order, but the state ultimately implemented partnership exchange.

Quinn lost his 2014 re-election bid to Republican Bruce Rauner. Medicaid expansion was a campaign issue, with Rauner saying he would not have authorized Medicaid expansion, but will 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.

Medicaid and CHIP in Illinois

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

Illinois Medicaid enrollment grew 18 percent from 2013, before expansion, to June 2016, when average monthly enrollment reached over 3 million.

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 closure in 2016 and plans to cease operations September 30. As of September 2, 2016, only seven ACA-created CO-OPs remained.

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 have emailed 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 18 percent of Illinois Medicare recipients have selected a Medicare Advantage plan, much lower than the 31 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 2015. Nationwide, 45 percent of Medicare enrollees selected Rx plans.

Health reform legislation in Illinois

Here’s what’s happening legislatively with healthcare reform in Illinois at the state level: