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Illinois health insurance

Land of Lincoln's uninsured rate falls 43 percent under ACA

What’s your impression of the quality of life enjoyed in the “Land of Lincoln”? Chances are, the health status of residents and the state’s approach to healthcare reform factor into your opinion.

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 2014 edition of America’s Health Rankings, Illinois placed 30th – the same position it held in 2013. The state earned high marks for good access to primary care doctors and dentists, and a low rate of occupational fatalities. However, Illinois is challenged by high rated of preventable hospitalizations and binge drinking as well as high levels of air pollution.

Illinois saw its ranking hold steady in the 2015 Scorecard on State Health System Performance, at 26th (which is significant improved from its 35th in 2009). 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. See Illinois’ scorecard to see how the state scored on each measure.

The 2015 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.

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.

How Obamacare is helping Illinois residents

According to the Kaiser Family Foundation, about 1.8 million Illinois residents were uninsured at the beginning of 2014. Through the ACA, 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.

The uninsured rate in Illinois decreased from 15.5 percent in 2013 to 11 percent by the end of 2014, the first year in which the ACA’s individual mandate was in effect.

By mid-2015, the state’s uninsured rate had dropped to 8.8 percent, just a fraction lower than the national average. In other states with Medicaid expansion and state-run exchanges, including partnership exchanges, the uninsured rate was 8.9 percent.

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.

During the 2015 open enrollment period, 349,487 individuals selected a QHP from the Illinois exchange. As happens nationwide, some people failed to make their initial premium payments or dropped coverage, and effectuated enrollment was 297,406 as of June 30, 2015. Of those enrollees, 77.8 percent were receiving advanced premium tax credits and 46.6 percent were receiving cost-sharing subsidies.

Illinois’ individual health insurance market has 10 carriers, including three that were not on the exchange in 2015:

  • Aetna Health Inc. – was on the exchange in 2014, but dropped in 2015 and is back
  • Celtic Insurance Company – new for 2016
  • Coventry Health Care of Illinois, Inc.
  • Coventry Health & Life Insurance Company
  • Health Alliance Medical Plans, Inc. (HAMP)
  • Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC, aka Blue Cross Blue Shield)
  • Midwestern Security Life Insurance Company – new for 2016
  • Land of Lincoln Mutual Health Insurance Company
  • UnitedHealthCare of the Midwest, Inc.

Illinois exchange plans saw an average 2016 rate increase of 5.3 percent for its lowest cost silver plan and 11.3 percent for its lowest cost bronze plan. Illinois has 480 individual plan offerings and residents in all counties have a minimum of 37 plans to choose from—there were 56 in 2015. The state no longer has individual marketplace platinum plans.

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 19 percent from 2013, before expansion, to August 2015, when average monthly enrollment reached 3.1 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.

While other ACA CO-OPs announced their closure in 2015, Land of Lincoln Health remains in operation and is selling coverage for 2016.

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 15.5 percent of the state’s population, compared with 17 percent enrolled in Medicare nationwide. Historically, 83 percent of Illinois Medicare recipients qualify based on their age alone, while 17 percent qualify as the result of a disability.

Medicare pays about $10,615 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 23.6 percent of Illinois Medicare recipients have selected a Medicare Advantage plan, much lower than the 32 percent who choose one nationwide.

Illinois Medicare beneficiaries can also select Medicare Part D plans for stand-alone prescription drug coverage, and 52.5 percent did so in 2015. Nationwide, 43 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: