Illinois’ Health Care Reform Implementation Council released a report on March 1 which reflects its analysis of key questions facing Illinois (and other states) in the implementation of the Affordable Care Act (ACA); valuable testimony that the Council obtained through public meetings in Chicago, Springfield, Peoria, and Carbondale; additional comments and position papers submitted to the Council; and the Council’s carefully considered recommendations for Illinois’ next steps to implement the ACA. Governor Pat Quinn’s July 29, 2010 Executive Order established the Council, chaired by the Governor’s senior health advisor, and co-chaired by the Directors of the Department of Healthcare and Family Services (DHFS) and the Department of Insurance. The Council conducted extensive public meetings across the State of Illinois from September 22 to February 9, eliciting the perspectives of over 150 organizations and stakeholders. The Council’s March 1 report includes recommendations that Illinois develop a state-based health insurance exchange as a quasi-governmental entity, one of various options under the ACA. It recommends that this entity serve both individual and small-business health insurance purchasers, and that the funding of the exchange be independent of state general revenue appropriations. It recommends changes in state law consistent with ACA standards governing coverage appeals and external review processes, to avoid federal preemption of state law, as well as other changes in state law to help implement other health insurance marketplace reforms in the ACA (such as the protections for consumers with pre-existing health conditions, prohibitions against arbitrary rescissions of insurance coverage, and medical loss thresholds). It recommends changes in state law that would give the Illinois Department of Insurance new authority to deny unreasonable increases in private health insurance premiums, and changes in state law that would reduce barriers to the formation of nonprofit, member-run, health insurance plans, to spur appropriate competition based on price, quality, and value to consumers. It also examines the need for major upgrades in state-based health information technology that will be critical in order for Illinois (and other states) to meet the eligibility verification, premium determination, and enrollment challenges under the ACA.
About Tom Entrikin
A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.
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