Health Care Reform

Illinois Health Care Reform Implementation Panel Releases Initial Recommendations

CHICAGO–(ENEWSPF)–March 2, 2011. A state panel convened by Governor Pat Quinn to guide Illinois’ implementation of national health care reform released its initial recommendations today. The Health Care Reform Implementation Council urged the creation of a health benefit exchange — called for in the federal Affordable Care Act (ACA) — through which individuals and small businesses would be able to purchase health coverage at competitive prices. The panel also recommended that state regulators be given the authority to approve or deny health insurance rate increases, and that insurance companies be required to spend at least 80 percent of premium dollars on health care for policy holders.

“I would like to thank the members of the Council for the thoughtful and thorough analysis and outreach effort that they have conducted across our state,” Governor Quinn said. “The unifying theme heard at the Council’s meetings was that the ACA must be implemented quickly, efficiently and fairly in order to make comprehensive health insurance affordable and accessible to all Illinoisans. The council will continue leading the state’s implementation efforts and reporting periodically on their progress to ensure we meet our goals.”

Governor Quinn created the Health Care Reform Implementation Council by Executive Order in July 2010. The group was tasked with providing recommendations for implementation of the ACA, many provisions of which take effect in 2014.The panel held a series of five hearings around the state to gather input from health-care stakeholders, including providers, insurers, and consumer advocates.

“Governor Quinn has directed the state agencies that will play a role in implementing health care reform to work together to deliver on the promise of the Affordable Care Act,” said Michael Gelder, chair of the council and Governor Quinn’s senior health policy advisor. “As we implement the federal reforms, this council will continue to meet with the goal of improving the health of Illinois residents by increasing access to health care, reduce treatment disparities, control costs, and improve the affordability, quality and effectiveness of health care.”

The report estimates that by 2014, more than 1 million uninsured Illinois residents will obtain health coverage. Between 500,000 and 800,000 individuals will be covered under the state’s Medicaid program with full federal funding. An additional 200,000 to 300,000 people will purchase their insurance through the health benefit exchange, with premiums subsidized by the federal government.

The Council’s report recommends that legislative action should begin this year on many of the steps that will be needed to implement the ACA. The report recommends passage of state legislation to give the Department of Insurance the power to approve or deny health insurance rate increases; the ACA gives state exchanges the authority to regulate rates.

The panel also called for legislation to meet a requirement in the federal law that insurance companies spend a minimum percentage of premium dollars on health care. For individuals and groups of 50 employees or less, 80 percent would have to be spent on health care; for large groups, the minimum would be 85 percent.

In the initial report delivered to Governor Quinn, the panel also recommends:

  • Passage of state legislation to bring Illinois in compliance with the ACA’s requirement for internal review and external appeal for health insurance claims that are denied.
  • Amendment to state law that would make it easier to create non-profit, member-run health insurance cooperatives that will be eligible for funding under the ACA.
  • Passage of state legislation to bring Illinois in compliance with federal law that requires parity for mental health coverage in group health insurance policies and HMOs.
  • Seeking the maximum available federal funds to upgrade the state’s data system so to accurately verify eligibility and keep track of individuals that shift between Medicaid, the Children’s Health Insurance Program and private insurance purchased through the Exchange.

The report notes that further study and input will be needed from the U.S. Department of Health and Human Services before decisions can be made on a variety of issues, including the exact nature of the Exchange and whether the state should adopt a Basic Health Plan that would specify the health benefits offered by the Exchange.

In addition to Mr. Gelder, the chairman, the members of the Council include: vice chairs Julie Hamos, director of the Department of Healthcare and Family Services and Michael McRaith, director of the Department of Insurance; Dr. Damon Arnold, director of the Department of Public Health; Charles Johnson, director, Department on Aging; Michelle Saddler, secretary, Department of Human Services; James Sledge, director, Central Management Services and David Vaught, director of the Office of Management and Budget.

To view the full report, go to: