Few want state to run Illinois’ health-care exchanges

By Benjamin Yount
Illinois Statehouse News

SPRINGFIELD, Ill. — Almost no one wants the state running Illinois’ new health-care exchanges.

Health-care advocates, unions, doctors’ groups and business people testified in unison this week before the Legislature’s rule-making body, the Commission on Government Forecasting and Accountability, that the state should have a limited role in running the health-care exchanges, but they were divided on their reasons.

Each state must create an exchange where people can shop for and purchase competitive health insurance plans, as required under the federal Patient Protection and Affordable Care Act. But each state can create its own exchange.

At its most basic, an exchange would be a marketplace, a one-stop shop. Some states are looking at online exchanges or physical, exchanges or both, but no single model has emerged.

Jim Duffett, executive director of Illinois Campaign for Better Health Care, which advocates for health care for everyone, said exchanges should be outside direct government control and, more importantly, governmental influence.

Political winds change,” said Duffett. “We need to keep this marketplace stable, no matter if it is a Democrat or Republican in the (governor’s) mansion.”

Duffett and other health-care advocates support a quasi-governmental exchange, where the state helps to create the exchange and enforces regulations regarding accessibility to and availability of insurance plans.

Duffett also said he wants the state to ensure anyone on Medicaid can “seamlessly transition” into the health-care exchanges.

Various advocates supported the state establishing regulations for the exchange but not running its day-to-day operations. The groups included AARP, which represent senior citizens; Planned Parenthood, which speaks for women’s health issues; and labor unions, including the Service Employees International Union and United Food and Commercial Workers.

Laura Minzer, executive director of the Healthcare Council for the Illinois Chamber of Commerce, one of the state’s largest business groups, said her organization was concerned about a proposal from the Illinois Department of Insurance that would give Gov. Pat Quinn (D) the power to appoint most of the people who would oversee the health-care exchanges.

We have some concerns in terms of the appointments (to the exchange) being largely from the governor,” Minzer said. “We believe this should be separate and apart from the politics” of the state.

But Minzer said politics is driving the decisions that will shape Illinois’ health-care exchanges. Lawmakers are trying to figure out whom they will pay to create an exchange and how it will be run. And they want a plan by the end of the fall veto session in early November.

We still don’t know what it is that we’re doing with the exchanges,” Minzer said Aug. 30. “We feel that this has to be tackled in a bigger way, and six days of sessions is not enough time to do that.”

State Rep. Greg Harris, D-Chicago, said Illinois has to have an exchange up and running for federal approval by January 2013. If not, the federal government will impose its own exchange on the state. The exchange would start selling insurance in 2014.

This is an immensely complex undertaking. It’s going to be expensive for somebody,” Harris said. “So, there is a real caution not to make promises to folks now that we can’t keep if the ground changes underneath us.”

The ground is changing as challenges to the requirement in the federal health-care law that would require everyone to buy health insurance make their way through the courts.

The U.S. Court of Appeals for the Sixth Circuit upheld the mandate last year. But the U.S. Court of Appeals for the 11th Circuit struck down the mandate earlier this month. The U.S. Supreme Court is expected to hear arguments once the cases move through the appellate process.

Bob Zirkelbach, spokesman for America’s Health Insurance Plans, a national trade association that represents the health insurance industry in Washington, D.C., said without a purchase mandate, health-care exchanges will be expensive because healthy people, who would lower the costs of insurance, might not buy into an exchange.

Nobody knows for sure what will happen if there is no guarantee,” Zirkelbach said.

Zirkelbach also is quick to say that health-care exchanges will be “much more expensive” in the states that involve their government in the exchanges’ day-to-day operations, as opposed to those that are essentially online marketplaces.

State Sen. Bill Brady, R-Bloomington, said that is why he does not want the state to take on too large of a role in the new health-care exchanges.

The federal health-care law “is traveling down that slippery slope of complete socialized medicine,” Brady said. “Reining it in from the framework to maintain a private-sector medical system with some government financial assistance is going to be the tricky part.”

Brady said he wants to slow down the health-exchange process until the U.S. Supreme Court makes it decision. But it could be months, or longer, before the nation’s highest court takes up any of the cases now in the courts.

Lawmakers are scheduled to return for the fall veto session Oct. 25-27 and again Nov. 8-10.

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