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OPTIONS FOR A CONSUMER HEALTH CARE ACCESS STRATEGY IN ILLINOIS A Proposal to the Adequate Health Care Task Force by Campaign for Better Health Care and Health & Disability Advocates. With Technical Assistance Provided By Families USA and the National Academy for State Health Policy May 9, 2006.

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With Technical Assistance Provided By

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  1. OPTIONS FOR A CONSUMER HEALTH CARE ACCESSSTRATEGY IN ILLINOISA Proposal to the Adequate Health Care Task ForcebyCampaign for Better Health Care and Health & Disability Advocates With Technical Assistance Provided By Families USA and the National Academy for State Health Policy May 9, 2006

  2. Vision Goals To provide affordable, accessible, health care to all Illinoisans • Target vulnerable populations who are disproportionately uninsured. • Build on and improve the current private/public health care systems. • Present options that meet the HCJA’s main requirements. • Provide specific strategies for the Task Force Consultant to analyze. 2

  3. The Consumer Health Care Access Proposal Has Six Main Components • Expansions of Public Programs • Expansion of COBRA & ICHIP • Purchasing Pool for Individuals and Small Groups • Employer Responsibility for Health Care • Individual Responsibility with Consumer Protections • Establishment of Regional and Advisory Task Forces ------------------------------------------------------------------------------------------------

  4. Why Expand Public Programs? Provides comprehensive benefits for vulnerable populations Federal matching funds available ($5.53 billion in FY 2004) Offers portability Coordination with employer-based coverage Low administrative costs Provides crucial financial support to safety net providers 1. Public program expansions

  5. 2. Expansion of COBRA & ICHIP (High Risk Pool) How? • Sliding scale subsidies for ICHIP premiums • Sliding scale subsidies for COBRA premiums Why? • Cost of COBRA and ICHIP is often unaffordable • Promotes consumer choice to meet individual health care needs • Federal funding available for ICHIP expansion

  6. 3. Purchasing Pool for Individuals, Sole Proprietors & Small Groups (2-50 Employees) Why? To make comprehensive insurance affordable and accessible to individuals and groups who lack employer-based coverage. To meet the majority of the HCJA requirements. Key aspects of the pool: • Subsidies for individuals/tax credits for businesses • State-subsidized reinsurance • A standard range of benefit packages • Consumer protections • Crowd out provisions • Administrative overhead limit • Potential insurance market reforms

  7. 4. Employer Responsibility Why? • Preserves employer-based coverage • Ensures that lower-income workers have access to employer-base coverage • Generates revenue for health care expansions • Can be used for purpose of drawing down federal Medicaid dollars How?  “Pay or Play” • An employer would be required to pay a fee to the state for employees for whom the employer does not provide health insurance. • If the employer provides some health insurance, this fee would be reduced by the amount the employer spends on health insurance.

  8. Below 300% FPL - Employed - Below 300% FPL - Unemployed - Above 300% FPL - Employed - Above 300% FPL - Unemployed - 1.4 million Uninsured Adults, Ages 18-64 New Options for Coverage • Employer-based coverage • Purchasing Pool • Public Program Expansions • ICHIP Expansions • Purchasing Pool • Public Program Expansions • ICHIP & COBRA Expansions • Employer-based coverage • Purchasing Pool • ICHIP Expansions • Purchasing Pool • ICHIP & COBRA Expansions

  9. 5.Individual Responsibility -- With Consumer Protections Why? • Universal coverage vs. universal access. • Shared responsibility will help stabilize the cost of health insurance for everyone. Mandatory consumer protections • Individual responsibility component would be the final phase of the plan to be implemented, if necessary. • Must guarantee that affordable and comprehensive insurance options are available to low and moderate income populations. Must provide an exception if affordable coverage is not available for any reason.

  10. 6. Additional Provisions • Establishment of a Guaranteed Health Security Task Force • Establishment of Regional and Advisory Task Forces: Technology Development Capital and Network Infrastructure Health Professional Expansion Prevention and Health Education

  11. How the Consumer Plan meets the HCJA requirements

  12. Contacts Jim Duffett, Campaign for Better Health Care Phone: (217) 352-5600 ● E-mail: jduffett@cbhconline.org Stephani Becker, Health & Disability Advocates Phone: (312) 223-9600 ● E-mail sbecker@hdadvocates.org Stephanie Altman, Health & Disability Advocates Phone: (312) 223-9600 ● E-mail: saltman@hdadvocates.org

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