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Showing posts sorted by date for query essential health. Sort by relevance Show all posts

Monday, December 23, 2013

Obamacare deadline extended another day

By Jamey Dunn

While today is the official deadline to sign up for insurance coverage, which would kick in on January 1, under the Affordable Care Act, consumers have been given a little extra time.

President Barack Obama’s administration already delayed the cut off for purchasing insurance through online marketplaces, known as exchanges. The original deadline for coverage that starts with the new year was December 15. But after the federal exchange and many state exchanges experienced chronic technical problems, that deadline was bumped to December 23. However, the feds quietly pushed that deadline back as well. The federal exchange will now allow consumers to purchase policies, with coverage that begins on January 1, by midnight December 24.

The move was made without an official announcement, but the Washington Post broke the news earlier today. “Anticipating high demand and the fact that consumers may be enrolling from multiple time zones, we have taken steps to make sure that those who select a plan through tomorrow will get coverage for January 1,” Julie Bataille communications director for the U.S. Centers for Medicare and Medicaid Services, said in a written statement after word got out.

Those turning to the Illinois exchange, Getcoveredillinois.gov, to purchase insurance coverage will also get another day to buy plans that kick in on January 1. Mike Claffey, a health care spokesman for Gov. Pat Quinn, said Illinois residents will get the same options offered on the federal site because the state’s jointly run exchange links to the federal exchange. But he said Illinois officials are advising those in need of coverage not to wait until the last minute. “We are urging people not to wait and to go ahead and try to get it done today if you can.” Claffey said that technically, the deadline has been extended for people who have already started the process and created an account on the site. So he said at the very least, those interested in getting coverage by January 1 should start the process today. “If you haven’t started yet, it’s getting pretty late in the game.”

This is just one of many recent tweaks to the law, known as Obamacare. The president faced loud criticism from Republicans and some in his own party after insurance companies began canceling plans that did not meet the basic requirements set out in the law. Obama said on several occasion before the law went into effect that if Americans liked the insurance they had, they could keep it. But Obamacare requires insurance plans to offer a set base level of coverage in 10 “essential health” categories, such as prescription coverage, ambulatory care and preventative care.

Instead of upgrading their more bare-bones offerings, many companies opted to cancel the plans, resulting in millions of consumers receiving letters informing them that their policies would not be renewed. Last month, the Obama administration announced that these companies could renew such policies for one more year in states that would allow it. Illinois officials decided to let providers continue to offer such plans. Those who were covered by insurance providers that opted not to extend their plans could be eligible for a “temporary hardship” exemption, which would allow them the buy the catastrophic plan available through the exchange. That plan offers a low level of coverage for a cheaper price, but was originally only available to consumers under 30. To qualify for the exemption, consumers must be able to prove that their previous coverage was terminated.

They may also be eligible for federal subsides to help them purchase a plan that does meet the coverage requirements under the new law. People who pick a plan by tomorrow at midnight will be scheduled to have their coverage start in January. However, those who miss the cut off can still get insurance through the exchange. Open enrollment will continue through March 31.

Monday, December 02, 2013

Politics swirl around pension vote

By Jamey Dunn

The political fallout has begun over a deal reached by legislative leaders to make changes to the state’s public employee pension systems.

The proposal, which is yet another version of Senate Bill 1, is projected to save $160 billion over 30 years and fully fund the pension system by 2043.

The legislation would reduce annual cost of living adjustments (COLAs) for current and future retirees. While previous plans have cut COLAs in a more straightforward way, this bill would apply differently to employees and retirees, depending on how long they worked and which retirement system they are a member. The current COLAs are 3 percent compounding interest. Under the new SB1, the COLA would be determined by 3 percent of salary or 3 percent of the product of years served multiplied by $800 for state employees or $1,000 for teachers and university employees. The COLA would be based on whichever number is smaller. The number for teachers and university employees is larger because workers in both systems generally do not get Social Security benefits. Some annual COLAs would be deferred for current employees upon retirement. The number is contingent of years of service.

Employees younger than 46 would also have to retire later. For each year an employee is younger than 46, an additional four months would be tacked onto the time he or she would have to work to receive full benefits. The proposal would also cap pensionable salary at $109,971, but that number would increase annually based on inflation. The plan would reduce the employee contribution toward retirement benefits by one percentage point and allow the systems to sue the state if it does not make its required payment. However, lawmakers could vote to change the payment schedule and reduce the annual payment. Since the details of the plan were released last week, candidates running in the 2014 elections have been weighing in.

Only one Republican gubernatorial candidate, Bloomington Sen. Bill Brady, came out strongly in favor of the proposal. “I will be voting in support of this legislation, which has been crafted through months of discussion, exhaustive analysis and legislative debate. It will not be an easy vote by any means; in fact it will be one of the most difficult votes I have ever cast,” Brady said in a written statement. Brady served on the conference committee that helped to craft the legislation. “It’s not fair to ask state employees and teachers who have paid every dime they owed to the system to make a sacrifice. It’s necessary, however, because governors and legislators who voted for budgets over the last decade did nothing more than delay the resolution we now have before us.”

Illinois Treasurer Dan Rutherford, who is running for the Republican nomination for governor, said the plan goes too far by not offering employees legitimate consideration for the benefits they would lose. “I have taken due consideration over the long Thanksgiving weekend to evaluate the proposal for State Public Pension Reform. Having examined the information available, I do not support the current legislation. I do not believe it will withstand judicial review should it pass the Illinois General Assembly,” Rutherford said in a written statement. “Strong beliefs are held in this debate, but fundamental to our rule of law is our Constitution. Our government’s obligation can be changed through a process involving adequate consideration to the employees. In my opinion, the legislation before us fails to address this relationship and offer adequate consideration in exchange for altering the pension benefits.”

Union leaders agree with Rutherford that the plan is unconstitutional. “It’s an unfair, unconstitutional scheme that undermines retirement security,” said a statement issued by the We are One Coalition last week.

University of Illinois leaders also oppose the bill. Previous versions of pension reform were based on proposals from the U of I’s Institute of Government and Public Affairs. “The University of Illinois called for a pension system that would be reasonable, responsible, sustainable and competitive with those offered by our peer institutions,” said an email to employees from U of I President Robert Easter; Phyllis Wise, chancellor of the U of I at Urbana-Champaign; Paula Allen-Meares, chancellor of U of I at Chicago; and Susan Koch, chancellor of the U of I at Springfield. “In our view, the legislation under consideration fails to meet those basic principles. The likely changes arguably lessen the retirement commitments made to employees and retirees, and their net effect also will harm the public higher education sector in Illinois.”

Hinsdale Republican Sen. Kirk Dillard, who also is running for governor, has yet to take a stance on the bill. He has instead called for multiple hearings and time before a vote to ensure that lawmakers understand the legislation. “Addressing pension reform is an essential first step in working our way out of a deep fiscal hole,” Dillard said. “But we must know what's in the bill and not rush a vote merely because we've been assured by the leaders and Gov. [Pat] Quinn that this is the best deal for the people of Illinois.” Dillard is not alone. Other Republican lawmakers have complained that they are being pushed to vote too quickly on the more-than-300-page bill.

 Supporters of the plan say the changes in the bill are nothing new to lawmakers who have been debating the issue for years. “We’ve been working on this issue for two years. There’s [been] plenty of time to take a look at every single aspect. It’s been debated, discussed, looked over, analyzed scrutinized — you name it,” Quinn said in Chicago today. “The time for review is fast eclipsing. It’s time now to vote. That’s what the people want. They want their legislators to take this bill that’s been discussed in many different ways and vote on it, and I think a vote ‘yes’ is the best way for our state to go.” Quinn said that the vote would be the “most important” fiscal vote taken by lawmakers during their legislative careers. But he said that anytime there is an important vote, opponents look for ways to block it. “There’s always going to be a do-nothing caucus, and they will say anything in order to continue to do nothing.” The governor added: “I think everyone who is interested in the future of Illinois, the common good, what’s good for taxpayers, should join us in urging a ‘yes’ vote tomorrow for the pension reform.”

Quinn’s own Lt. Gov. Sheila Simon issued a statement today opposing the plan. She says it should do more to protect low-income employees and retirees. “While I congratulate the legislative leaders who came together in a bipartisan way to produce a pension compromise, the proposed legislation puts too much of the burden on lower income workers and retirees,” she said. Simon is also in candidate mode. She is challenging Comptroller Judy Baar Topinka, and the statement was issued by her campaign staff.

Meanwhile, Republican venture capitalist and gubernatorial hopeful Bruce Rauner slammed the proposal, saying it would “guarantee a future of higher taxes.” He said the cuts to benefits do not go far enough and proposes moving workers into a 401(k)-style plan. Rauner and others argue that employee benefits earned to date are protected by the Constitution, but future benefits are not. “Government workers and retirees deserve to be treated fairly. But let’s not forget who pays for this — it’s the hard working taxpayers of our state, who themselves are struggling to make ends meet in an economy that is weighed down by the fiscal blunders in Springfield,” he said in a prepared statement. “We can have a pension system that is fair to both sides of this transaction, the government workers and the taxpayers who pay for it. True reform would cap the current system and fully put in place a 401(k)-style program that is similar to the retirement plans of most Illinoisans. That’s fair to workers and taxpayers, and it ensures we will never face a pension crisis again.”

While Rauner dismissed SB 1, many other business leaders in the state have voiced their support. “The pension crisis is by far the most pressing economic issue facing the state of Illinois today. Despite rapidly escalating pension contributions that are consuming the state’s budget and crowding out funding for critical state services, the fiscal health of the pension funds themselves continues to deteriorate. The bill is a good bill and deserves your support. It incorporates a number of benefit reforms that have been widely discussed and that we have supported in the past,” said a letter sent to lawmakers and signed by several prominent representatives of Illinois business. Those signed on include Tyrone Fahner, president of the Civic Committee of the Commercial Club of Chicago, a group that led the charge for pension reform in the state; Gregory Baise, president of the Illinois Manufacturers' Association; David Vite, president of the Illinois Retail Merchants Association; and Doug Whitley, president of the Illinois Chamber of Commerce. “While not a solution to all of the state’s fiscal problems, this bill is a significant step forward. It will stabilize the pension systems and help put Illinois on the path to fiscal stability.”

Northbrook Democratic Rep. Elaine Nekritz, who served on the pension conference committee, said of the letter: “I think that that will be very significant in giving people the security that they need that the business interests in the state line up in support.” Nekritz said that while others might have different ideas about how to tackle the problem, they don’t have the votes needed to pass their plans. “We’ve always been trying to achieve a balance with this legislation, and I think that this is a balanced approach, a moderate approach, a compromise approach that actually can pass. It’s one thing to talk about all the things that you’d like to see, but if you can’t put votes on it, then it isn’t any good.”

Those who would rather not see the bill pass tomorrow say that the opposition coming at the issue from two different sides — some arguing that it does not cut benefits enough and others that it cuts too much — could manage to kill the bill through their combined lobbying efforts. “What happens tomorrow, I don’t know?” said Rep. Raymond Poe, a Springfield Republican. Poe represents many state workers and says he does not support the bill. “If both of those forces get together, we may be back to start over again. So who knows where we’re at for sure. ... It’s going to be funny tomorrow to see how that all shakes out.”

Evanston Democratic Sen. Daniel Biss, who also served on the conference committee, said that the opposition on both sides of the spectrum is to be expected. “It’s a compromise. There are those on the right who oppose compromise, who are hard-line dead-enders and don’t want to see us accomplish something. And so we have those opposing it. And of course there are those in [organized] labor who are very concerned that it gives too much, and I understand where they are coming from. But the bottom line is, this is a reasonable sound compromise that saves a lot of money, shelters the people in greatest need and puts us on a path to sustainability.”

Both the House and Senate plan to hold session tomorrow. A hearing on SB 1 is scheduled for 8:30 a.m.  It's difficult to deny the politics of the issue when they may have even had a hand in the timing of a potential vote. The deadline for candidates — including potential challengers to legislators — to file paperwork to appear on the spring primary election ballot passed at 5 p.m. on Monday.

Friday, November 22, 2013

Some Illinoisans may get to renew canceled insurance plans

By Jamey Dunn

After the rollout of Obamacare got off to a rocky start, some Illinoisans may be able to keep their insurance polices that do not meet the minimum requirements of the law.

The Illinois Department of Insurance announced today that it will allow insurance providers to renew for one year plans sold on the individual marketplace that do not meet the coverage levels required by the Patient Protection and Affordable Care Act. The new law requires that insurance plans offer a set base level of coverage in 10 “essential health” categories, such as prescription coverage, ambulatory care and preventative care.

President Barack Obama’s administration also announced today that it was extending one of the deadlines to purchase insurance through the online marketplace. Under the original plan, consumers who wanted their insurance to kick in by January 1 were required to make their purchase by December 15. The administration has moved that cutoff back to December 23. The change does not apply to other deadlines. The end of the enrollment period for 2014 is still set for March 2014, and those who are still uninsured at that point would potentially face penalty fees under the individual mandate.

Obama’s previous statements that Americans who like their insurance coverage could keep it after the law went into effect has come under harsh criticism after insurance companies began canceling polices that did not offer the basic coverage required. The Illinois Department of Insurance estimates that 185,340 Illinois residents have been notified that their coverage has been canceled.
In the face of the backlash, the administration has decided to allow companies to renew those plans. State insurance officials in each state must also approve the renewal of such plans. “DOI came to this decision based on the concerns raised by Illinois consumers and the guidance from the U.S. Department of Health and Human Services,” Andrew Boron, director of the Illinois Department of Insurance, said in a prepared statement. “Allowing companies to renew current plans gives consumers more time to evaluate their options and will provide a smoother transition into the health care coverage system envisioned by the ACA.

While Illinois, Florida, North Carolina, Ohio, Kentucky, Kansas, Oregon, South Carolina, Colorado, Hawaii and Texas have approved the president's  proposal, officials in some states, such as New York, said they do not plan to.

Insurance providers will be able to renew plans, but it is up to the companies to decide whether they will offer renewals. They will also be required to notify customers that they are waiving protections afforded by the new law. The companies must also let customers know they can shop for alternative plans on the online health insurance exchange and may be eligible for federal subsidies to purchase insurance that does meet the coverage requirements.

The online exchange has been plagued with technical problems, and many consumers have been unable to create accounts, let alone find out what plans would cost or what subsidies they might be able to get. Officials from the U.S. Department of Health and Human Services say they plan to have the website fully operational for most users by the end of this month.

Check out this Stateline story for a good Q&A on the policy change and a breakdown of how other states are handling it.

Tuesday, October 01, 2013

Insurance marketplace goes online despite federal shutdown

By Jamey Dunn

After the federal government shut down at midnight in a battle over Obamacare, the online health insurance marketplaces that are a cornerstone of the law rolled out across the country today.

Federal Government Shutdown
Some Republicans in Congress had been pushing to defund the Patient Protection and Affordable Care as a condition for their votes to approve a federal budget. Last night House Republicans approved a one-year delay in the Affordable Care Act’s requirement that all Americans have health insurance. The Senate rejected it, and the House refused to take up an extension of the federal budget previously approved by the Senate.

With no budget in place, all but what has been deemed “essential services” of the federal government have shut down. National parks and monuments are closed. Research labs have stopped their work. Many regulatory bodies will only maintain a bare bones staff. For instance, only 5 percent of the staff at the Environmental Protection Agency will work through the shutdown.

Social Security and federal entitlement programs, such as Medicare will continue to pay benefits. Mail service will also continue. So will services deemed necessary for safety or national security, such as the work done by the Federal Aviation Administration. However, most federal employees who report to work today will not be paid as long as there is no budget in place. Notably, members of Congress will continue to receive their checks, though some have vowed to forgo pay until the government is running again. The U.S. Constitution has a provision similar to the Illinois Constitution that prohibits any change in lawmakers’ pay during their terms. The 27th Amendment was intended to keep federal lawmakers from voting to increase their pay, but it will also keep their $174,000 annual salaries coming during the shutdown. Gov. Pat Quinn is currently trying to challenge that notion in Illinois after he vetoed the money for lawmaker’s salaries. Quinn says they should not be paid until the approve changes to the states troubled pension system. But a judge ruled last week that the move violated the state Constitution. Quinn is appealing to the Illinois Supreme Court.

Illinois officials say the federal shutdown would not halt state services in the short term.  State employees who are paid with federal funds will face temporary layoffs as soon as tomorrow. The timing of the layoffs could vary across agencies because some may have enough cash on hand to keep employees working longer. According to Quinn’s office, the agencies that could see layoffs include the Departments of Labor, Veterans’ Affairs, Military Affairs, Illinois Emergency Management Agency, Office of Health Information Technology and the Department of Human Services’ Bureau of Disability Determination, which evaluates applicants for disability benefits. When the federal government last shut down in 1995, the state laid off 1,200 employees.

If the shutdown drags on, federally funded programs could be in danger. Some states are already looking to tap into rainy day funds if Congress does not pass a budget soon. But Illinois, which cannot pay its bills on time under normal conditions, does not have that option. The biggest immediate impact on states will likely be an economic one as thousands of their residents are laid off. About 800,000 federal workers nationwide will be laid off until a federal budget is approved. According to the Pew Charitable Trust’s news service, Stateline, Illinois has 45,801 civilian federal employees, but some of them will continue to work. Retired federal employees will continue to receive their benefits. “Unfortunately, the possible consequences to state economies of a federal shutdown or not increasing the national debt limit are severe. States are partners with the federal government in implementing most federal programs. A lack of certainty at the federal level from a shutdown therefore translates directly into uncertainty and instability at the state level,” said a letter that the National Governor’s Association sent to President Barack Obama and congressional leadership. “That uncertainty can lead to the suspension of programs and services, increased borrowing costs or even layoffs — all actions that will weaken our economies and potentially stall the national recovery.”

Affordable Care Act Questions and Answers
While the political battle that held up approval of a federal budget was essentially over a push to defund the new health care law, the implementation of Obamacare will continue largely unscathed by the shutdown. The Affordable Care Act falls into a category of mandatory spending along with other federal programs such as Medicare. This spending actually makes up the majority — 57 percent — of the federal budget.

Do I have to buy insurance right away? No. The exchange is open for business. Any coverage you buy now will not kick in until January 2014. But you must buy your insurance before December 15 to ensure that your coverage will begin in January. If you wait longer, your coverage would begin later. The open enrollment period for 2014 ends on March 31, 2014. After that date, you can only sign up if you have a life event, such as a marriage or career change.

What kind of insurance coverage is available on the exchange? The plans offer a base level of coverage for 10 service categories, including ambulatory care and prescriptions. The plans have a metal ranking, with bronze being the lowest cost plans. Under such bronze plans, consumers would likely pay lower premiums but would have more out-of-pocket costs, such as copayments. Under the higher-premium gold and platinum plans, patients would likely pay less out of pocket. The rates in Illinois will vary across the state.

Does my employer have to help pay for my insurance? Starting in 2015, businesses with more than 50 employees will be required to offer coverage to full-time employees or face penalty fines. Small businesses can opt to use the exchange to buy coverage for their employees starting today, but they are not required to.

I already have insurance. Will I have to buy a different kind? Most likely no, especially if you get your coverage through your employer. Those with bare bones plans or catastrophic plans would have to get more coverage to meet the insurance mandate that is part of the Affordable Care Act.

Can I keep seeing my doctor? Yes, if you do a little research. Some plans sold on the exchange will only cover care within the provider network for that plan. You should check to see if your doctor is in the provider network of a plan before you buy. You should be able to find provider information for each plan on the exchange’s website. Here is more info from the federal website. 

I smoke or chew tobacco. Do I have to pay more for coverage on the exchange? Yes. Tobacco users will pay higher premiums for insurance. For instance a 40-year-old smoker in Cook County will pay $44 more per month for a basic bronze plan. The law allows insurance companies to charge smokers twice as much, but states can opt to keep the rates lower. Insurance plans offered on the exchange are also required to cover programs to help smokers quit. Here is more info.

I’m young, healthy and broke. Do I have to buy insurance? If your parents have insurance and are willing to let you stay on their plan, you can until you turn 26. If you are younger than 30, you may be eligible for catastrophic plans offered through the exchange. You also may be eligible for insurance subsidies or Medicaid.

How do I find out if I am eligible for subsidies or Medicaid? If you make between 138 percent and 400 percent of the federal poverty level — $15,856 to $45,960 for individuals — you will be eligible for federal subsidies that will cut your monthly premiums. If you make less than 138 percent of the poverty level, you could be eligible for Medicaid. You can use this subsidy calculator from the Henry J. Kaiser Family Foundation to assess your personal situation.

What happens if I am not covered? If you do not get coverage in 2014, you will likely face a penalty on your tax bill in 2015. The fee would be 1 percent of your household income, or $95 a person, whichever is more. Fees for having uninsured children would be $47.50 per child. That penalty is capped at $285. If insurance premiums are more than 8 percent of your household income, or you do not make enough to file federal income taxes, you are exempted from the individual insurance mandate. There are some other exemptions to the individual mandate, including a religious exemption. For more info on exemptions to the mandate, see this story in the Washington Post

How do I access the exchange? Go to www.healthcare.gov click the “apply now” button and then choose Illinois as your state. You can also go directly to the Illinois exchange, called Get Covered IllinoisHere is a checklist of the personal information you will need to purchase a plan. Note: As of this morning the federal site has a very slow load time, so you may be waiting a while. When I attempted to access the federal site, the system was down. It is likely overloaded by curious browsers and reporters like me trying to check it out on the first day. You may want to give it a little time before you try to use it to buy insurance. Or try out the direct state site. In the meantime, you can check out some of the information provided in this blog to do a little research.

I don’t have regular access to the Internet. How do I get signed up? I do have Internet access, but I find the marketplace confusing and could use a little help. Where can I find it? There is help available both in person and over the phone. You can find the numbers for a federal toll-free help line here. There are also local groups working to help people navigate the marketplace and get insurance. You can find one of these groups in your area by entering your ZIP code here. 

Here is more info from the state of Illinois, including a short video that explains some of the key components of the law.

Tuesday, September 24, 2013

Illinois' Obamacare rates to be lower than expected

By Jamey Dunn

A week before consumers can begin to purchase insurance through an online exchange, Gov. Pat Quinn’s administration released some information on the rates they will pay.

The rates are 25 percent lower than previous estimates from the U.S. Department of Health and Human Services and generally equal to or less than rates released by other states. “All health insurance plans offered through the Illinois Health Insurance Marketplace are designed to meet the needs of individuals, families and small business owners across the state,” Quinn said in a prepared statement. “I am happy to say that starting in October, Illinois residents will be able to select a plan that is affordable and meets the health care needs of their families. The number and quality of affordable health plans that will be offered through the Illinois Marketplace is impressive.”

The state’s online insurance marketplace is scheduled to become active on October 1. Residents and small business have until December 15 to purchase coverage that will kick in on January 1. The plans offer a base level of coverage for 10 service categories, including ambulatory care and prescriptions. The plans that will be offered are then giving a metal ranking, with bronze being the lowest cost plans. Under such bronze plans, consumers would likely pay lower premiums but would have more out-of-pocket costs, such as copayments. Under the higher-premium gold and platinum plans, patients would likely pay less out of pocket. The rates in Illinois will vary across the state. A 25-year-old non-smoker in Peoria would pay $128 a month for the basic bronze plan. That some plan would cost $120 in Chicago, $109 in Rock Island, $147 in Springfield and $173 in Carbondale. A Quinn spokesman said that population density plays a role in the rates. The same coverage would cost $146 in Denver and $167 in Seattle. Costs go up with age, and tobacco users will pay more. A 55-year-old smoker living in Carbondale that springs for silver level coverage could pay up to $652.

Americans who make between 138 percent and 400 percent of the federal poverty level — $15,856 to $45,960 for individuals — will be eligible for federal subsidies that will cut their monthly premiums. Illinois residents who fall below that income level for subsides will be eligible for Medicaid. Those residents can begin to enroll in Medicaid on October 1, and coverage will begin on January 1. “Today’s announcement by the State of Illinois confirms what many have been saying for years: Obamacare will lower health care costs for millions of families,” U.S. Sen. Dick Durbin said in a prepared statement. “Beginning on October 1, families across the state will be able to pick a health care plan that suits their needs. Dozens of plans will be available. Low-income and working families will be eligible for subsidies to help them cover the costs.” Durbin called on Illinois House Republicans to oppose efforts by their party to defund the Affordable Care Act.

While the rates are lower than expected, opponents argue that if consumers want less costly plans with more limited benefits than what will be offered in the exchange, they should be able to buy them. “The level of choice for the patient and for the consumer is really limited,” said Naomi Lopez-Bauman, director of health policy for the Illinois Policy Institute. She said that young people, who tend to need less medical care, especially should be able to stick with bare bones coverage that can currently cost them about $60 a month. She said that instead of using a “clunky” system such as Obamacare, the government could encourage citizens to purchase coverage by offering a tax subsidy. “You have a young man who could be spending $60 because that’s what he wants and that’s very affordable to him,” said Lopez-Bauman. “Why not just give him the money to go out and pick what best suits him? If you truly want to provide access and affordable health care for Americans, there are much better ways than what is being done right now.” People younger than 30 would still have the option of buying a so-called catastrophic plan under Obamacare, but Illinois has not released rate information on such plans.

Jim Duffett, executive director of the Campaign for Better Health Care, said that the basic plan offered in the exchange has coverage that people truly need, such as preventative care. “I think the essential health benefit package that’s out there isn’t whistles and bells.” He said that while there are few who will need care in all 10 categories, most people would need many of the services that fall under required coverage areas at some point in their lives. “Will a 32-year-old male that’s uninsured, will he need maternity care? No. Will he need something else? Yes.” Duffett’s group is one of many organizations being paid to get the word out about the insurance exchange and help consumers use it when it comes online.

Duffett added that a large portion of young people would be eligible for subsidies that would help to drive down their insurance costs. He said most young adults would probably find that they are paying less for their coverage than they pay for their current cell phone plan. He said that while there are still more details that consumers will need to know when they make their purchases on the exchange, the rates released today are far from the “rate shock” predicted by opponents a few months ago. “It definitely does show that the folks that will be eligible for the marketplace are going to be able to select a plan that is affordable and is going to meet their needs and their family’s needs.”

Thursday, June 20, 2013

Committee likely to mine old ground for pension compromise

By Jamey Dunn

On Wednesday, the Illinois Senate and House voted to hand over pension reform to a group of 10 legislators who will try to produce a compromise that can pass in both chambers. Several pension ideas have been floated in recent years, and components of those proposals will likely make their way into the committee’s recommendations.

“I think the healthy way to do this is to walk into the room and say, ‘We’ve got a lot of different things that have been Frankensteined together, and let us now examine all of them and see what we can assemble that can get 30 votes in the Senate, 60 votes in the House and achieve adequate savings to put the state on a manageable fiscal course,’” said Sen. Daniel Biss, an Evanston Democrat. Biss was chosen by Senate President John Cullerton to serve on the conference committee. He has been a key player in the efforts to pass changes to the state’s pension systems. However, Biss has been in favor of Senate Bill 1, a measure opposed by Cullerton but backed by House Speaker Michael Madigan. Supporters of SB 1 say that it creates enough savings, by reducing employee benefits, to ensure that the public employee pension systems would be stabilized for the foreseeable future. They argue that the state’s shaky fiscal situation and the nearly $100 billion unfunded liability would justify the Illinois Supreme Court granting lawmakers special powers to fix the problem, despite a constitutional protection for pension benefits.

SB 1 would:
  • Increase the retirement age for employees younger than 46. Employees from 40 to 45 would see a one-year increase, employees 35 to 39 would see a three-year increase and employees 34 and younger would see a five-year increase. 
  •  Require employees to contribute 2 percent more of their salaries. The increased contribution would be phased in over two years. 
  • Cap pensionable salary at $109,000, the limit that is currently used for Tier Two employees. The cap would increase at the rate of one half of the Consumer Price Index that is set for urban consumers. Base the amount of pension benefits that would be eligible for cost-of-living adjustments (COLAs) on the amount of time employees worked. For each year of employment, $1,000 (or $800 for employees who receive Social Security benefits) of pension income would be eligible for a cost-of-living adjustment. For example, if an employee worked for 30 years, then $30,000 of his or her retirement benefit would see an annual COLA. Before employees reached their cap, they would receive a compounding COLA. After they reached the cap, they would get a flat annual increase. 

SB1 passed the House in early May with 62 “yes” votes, but it fell short of the 30 votes needed in the Senate. Only 16 senators voted in favor of the bill when it was called for a vote on the floor on May 30. Senate President Cullerton believes that SB 1 is unconstitutional because it does not offer employees anything in return for cutting their benefits. He worked out a compromise with the unions that would offer employees a variety of choices.

Under Cullerton's preferred bill, SB 2404:
  • Option 1 Employees would give up their current 3 percent compounded cost of living adjustment for a flat 3 percent COLA that would be delayed for three years after retirement. In exchange, the employees would receive access to retiree health care plans, and future raises would count toward their pensions. They would also have the option of enrolling in a 401(k)-like plan to supplement their pensions. 
  • Option 2 Under this option, employees would keep their compounded COLAs but would lose access to retiree health care, which is currently subsidized by the state. Their future raises would not count toward pension benefits 
  •  Option 3 Employees would keep their COLAs and access to retiree health care, but they would pay 2 percent more of their salaries to their retirement benefits. Their COLAs would be delayed for three years after retirement. 
 Employees who are retired or who had given notice of their retirement by Jan. 1, 2013, would have two options:
  • Option 1 Workers would keep the 3 percent compounded COLA but give up access to retiree health care. 
  • Option 2 They could still have access to retiree health care and a 3 percent compounded COLA, but the COLA would be frozen for two years. 
Cullerton’s other appointees to the conference committee, Aurora Democrat Linda Holmes and Chicago Democrat Kwame Raoul, seem committed to the Senate president's focus on constitutionality. “You can’t just say: ‘Oh, screw the Constitution. Let’s just proceed without it,’” Raoul during Senate floor debate of SB 2404. He said of SB 1: “It’s not constitutional just because you declare it's constitutional. You’ve got to make an argument based on the law.”

But Cullerton’s plan apparently would save far less than SB1. There is also a level of uncertainty because they savings would hinge on which choices employees made. Madigan refused to call Cullerton’s plan for a floor vote in the House despite Cullerton’s insistence that the bill had the support needed to pass in that chamber. Cullerton argues that Madigan's SB1 will save nothing if it is tossed out by the Illinois Supreme Court.

“There needs to be some consensus around what makes it constitutional and a consensus around an adequate level of savings,” says Northbrook Democratic Rep. Elaine Nekritz, who is one of the members Madigan chose to serve on the conference committee. Like Biss, Nekritz has been a point person on the issue for some time and a strong supporter of SB 1. Nekritz said the House will likely never vote on Cullerton’s proposal, but she said, “That doesn’t change the fact that we all recognize that ‘just say no’ is not going to be an active response right now.” So the key for the committee will be finding something that satisfies Cullerton’s demand that employees be offered some kind of consideration for cuts to benefits, while still saving enough money to gain the backing of those who supported SB 1 — most important of all, Madigan.

The presumption is that to reach this compromise, the committee will pull largely from legislation and concepts that have already been debated. “You can cook the soup a number of different ways, but the ingredients are pretty limited at this point,” said Kent Redfield, an emeritus professor of political science at the University of Illinois Springfield.

Biss said he knows that the final product will likely not save the $187 billion that SB 1 is expected to cut. “My view is that there’s room to give on both sides. I think that we’ll need to land in the triple digits. I think if we land in the $125[billion] to $150 billion range, that’s likely to provide the level of fiscal relief that the state needs.” Cullerton this week indicated that he might be open to a model of consideration that does not involve a choice.

A proposal from the Institute of Government and Public Affairs at the University of Illinois would swap the current 3 percent compounded annual COLA, which is the largest cost driver in the pension systems, for a COLA that is tied to inflation. Under SB 2591, which a Senate committee took testimony on this week, the COLA would be one-half of the adjusted Consumer Price Index from the previous year. That means that in times such as recent years, when inflation has been low, retirees would receive small COLAs or sometimes no COLA at all. But in years when inflation is high, retirees would get larger COLAs.

The framers of this proposal say that other factors would help to negate the cost for COLAs in high-inflation years. “Linking COLA to inflation will also reduce the cost of providing the increases during periods of low inflation. Costs would increase when inflation is high; but the impact of this higher cost is mitigated by the fact that the state’s tax base, and thus the state’s tax revenue, rises more quickly when inflation is high,” said a report on the plan from the IGPA. The authors of the report say that this change to COLAs would constitute consideration and would make their plan constitutional. “The truth is that the current COLA provision offers no protection against high inflation — which is an essential feature of any good pension system. It is for this reason that we believe that annuity increases should be linked to some measure correlated with inflation,” the report says. “In our view, it would be constitutionally permissible to reduce the expected average future increase in exchange for the valuable insurance protection that individuals would receive during periods of high inflation.”

Cullerton did not indicate he was in favor of the idea this week, but did say that the plan is something to be considered. The proposal would also require employees to contribute an additional 2 percent of their pay toward retirement benefits. The legislation has the support of the public university presidents and is intended to be coupled with a bill that would gradually shift the future costs of employee retirement benefits to the universities. SB 2591 would apply only to the State University Retirement System, but concepts from the plan could be applied to the other systems for state workers, teachers and lawmakers. Cullerton also said this week that it is possible that different changes would be made to the different systems.

Other pieces may end up in a final plan, such as a funding guarantee that would allow the systems to sue if the state does not make its required annual contribution. Both SB 1 and SB 2404 had some version of a guarantee. Some who back SB 1 have even floated the idea of the guarantee being the thing that is given as consideration in exchange for benefit reductions. However, Cullerton has not warmed to this idea in the past. Recent proposals have also called for money that is currently being used to pay off borrowing that was made to make past pension payments to be redirected to pay down the unfunded liability once the bonds are retired. That could mean an additional $1 billion annually for pensions costs.

Redfield said that even though pension changes are now in the hands of the committee, in the end it will be legislative leaders who are still calling the shots. “Certainly, in terms of the Democrats, I don’t think Cullerton and Madigan have delegated their power to negotiate to those people. They can’t cut a deal independently of their leader. I don’t think that’s going to happen,” he said. “It still comes down to the leaders, and to a certain extent it comes down to one of the [Democratic] leaders backing down from where they were a week ago.”

Monday, June 17, 2013

Quinn signs fracking bill

By Jamey Dunn

Gov. Pat Quinn today signed legislation to regulate hydraulic fracturing in the state.

Hydraulic fracturing, also known as fracking, is a process used to extract oil and gas by pumping water, chemicals and sand into the ground. The water fractures a source rock, allowing gas or oil to escape and be collected. Sand is used to hold the cracks in the rock open. Chemicals are added to the water for a variety of reasons, such as disinfection, lubrication and making the water thicker to keep the sand from sinking. Large-scale fracking operations can pump hundreds of thousands, or even millions, of gallons of water into the ground. (For a detailed description of fracking and its history, see Illinois Issues May 2012.)

Senate Bill 1715 sets ground rules for the controversial practice in Illinois. The bill creates standards for drilling wells and requires water testing before and after fracking begins. If chemicals used in the process are found in water, it will be assumed that it was the fracking well operator's fault, and the operator would be required to prove otherwise. Fracking fluids will have to be stored in closed tanks instead of open pits.

Fees for permits will be $13,500 per well. Oil or gas extracted from fracking wells would be taxed at 3 percent for the first two years of the life of a well and then on a sliding scale based on production. The law offers a reduction in tax rates for operators who hire local workers.

Proponents are calling the new law, which goes into effect immediately, the strictest regulation of fracking in the nation. “This new law will unlock the potential for thousands of jobs in southern Illinois and ensure that our environment is protected,” Quinn said in a written statement. “As I said in my budget address, hydraulic fracturing is coming to Illinois with the strongest environmental regulations in the nation. It’s about jobs, and it’s about ensuring that our natural resources are protected for future generations. I applaud the many environmental advocates and representatives from government, labor and industry who worked with us to make Illinois a national model for transparency, environmental safety and economic development.”

Environmental groups were part of the negotiations that produced the bill, and many supported it, including the Illinois Sierra Club and the Illinois Environmental Council. “While our community still has concerns about the environmental impacts of this new technology, it is essential for these tough restrictions to become law to protect our communities. The environmental community looks forward to working with the governor and agencies to make sure that this bill is strongly enforced,” Jen Walling, executive director of the Illinois Environmental Council, said in a written statement. Environmental groups that backed the legislation said they would have preferred a ban on fracking. But they believed it was not politically possible, and said they wanted to ensure that strong regulations were enacted.

Environmental and community groups that opposed the bill say those that worked on it were too quick to dismiss legislation that would have banned fracking until further study about its effects on health and the environment could be conducted. They say they were shut out of the process, while lawmakers used the environmental groups that supported the bill as political cover to ignore opponents. “It’s a very sad time for Illinois. We have to fight our own government to keep our children and grandchildren safe from harm,” said Tabitha Tripp, a Union County resident and volunteer with Southern Illinoisans Against Fracturing Our Environment (SAFE).

Annette McMichael, communications director for SAFE — an all-volunteer group that sprang up to oppose fracking — says that the organization will continue its work. “We will never never never stop.” She says that the group is planning to hold a workshop this week to plan its next moves. “We also already have a legal time in place comprised of attorneys all around the country who have offered to help us pro bono.” She said SAFE will work to help residents and local governments push back against fracking in any way they can.

“It’s still a very sad day. I’m just terribly ashamed of our state government,” she said of Quinn signing the bill today. For more on the rifts that fracking negotiations caused among environmental groups and community organizers, see the upcoming environmental issue of Illinois Issues, which comes out July 1.

Tuesday, May 21, 2013

Fracking deal moves ahead in the House

By Jamey Dunn

Supporters of fracking regulation have reached an agreement in the House that is likely to sail past the vocal opposition from some community groups and environmentalists and reach the governor’s desk.

Senate Bill 1715 is the product of months of negotiations between lawmakers, industry representatives, unions, environmental groups and regulators. Backers call it the strictest regulations of horizontal hydraulic fracturing in the country.

Hydraulic fracturing, also known as fracking, is a process used to extract oil and gas by pumping water, chemicals and sand into the ground. The water fractures a source rock, allowing gas or oil to escape and be collected. Sand is used to hold the cracks in the rock open. Chemicals are added to the water for a variety of reasons, such as disinfection, lubrication and making the water thicker to keep the sand from sinking.

A House committee approved the legislation unanimously this morning. “I live in southern Illinois. I drink the water in southern Illinois. My children drink the water in southern Illinois. My neighbors drink the water in southern Illinois,” said sponsor Rep. John Bradley, a Marion Democrat. “Our first and foremost presumption, effort, intent in everything we did in every negotiation we had, was first and foremost, we’re going to protect the ground water in southern Illinois. Secondly, if we can do that, we are going to give this industry an opportunity to develop in a responsible matter and create jobs and economic development in the area.”

The bill would create standards for drilling wells and requires water testing before and after fracking begins. If fracking chemicals are found in water, it would assumed that it was the well operator's fault, and the operator would be required to prove otherwise. It also would assess fees to be paid by operators that would be used to fund oversight efforts.

Environmental groups who were in talks over the legislation said they would prefer a ban on fracking, but they say it is coming to the state, and it needs to be regulated. “The environmental community is not endorsing high-volume horizontal hydraulic fracturing, nor are we encouraging it in the state. This legislation does not open the gates for fracking to come into Illinois; the gates are already open. This new controversial technology is already permitted and may already be in use,” said Jennifer Walling, executive director of the Illinois Environmental Council. She said current mining and drilling regulations are not enough. “These protections are important, but they do not mean that we are confident that fracking can be done safely. Our support for these safeguards does not represent an endorsement of fracking. However, we believe that operators are seeking permits for fracking today, and it is essential for the legislature to pass tough restrictions before the end of session to protect our communities.”

But opponents accused such groups of being “complicit” in allowing fracking into the state. “When you look under fracking’s hood, you find terrifying problems because behind the hard sell and the soothing promise that you’ve heard here this morning. This contraption is unsafe at any speed,” Sandra Steingraber, a scholar in residence at Ithaca College in Ithaca, N.Y., told the committee. She urged lawmakers to follow New York’s lead and adopt a moratorium on fracking until the potential environmental and health impacts are studied. Steingraber lives on the East Coast now, but she grew up in Pekin, Ill. New York lawmakers have been weighing the issue for about four years. Gov. Andrew Cuomo has still not made a public decision on fracking but has instead called for further study.

 Business groups that support fracking say that it will bring much-needed jobs to southern Illinois “While this is not a perfect bill, this is a bill unique to the challenges of the state of Illinois and has some of the strongest environmental regulations in the nation,” said Mark Denzler, vice president and chief operating officer of the Illinois Manufacturers Association. “We cannot let perfect get in the way of possible when we’re talking about creating tens of thousands of jobs and hundreds of millions of dollars in new revenue for state coffers.” But Steingraber said that without considering the potential costs of fracking to the health of residents and the environment, projections about the boost it might give to the economy or the state revenues are incomplete. “Shale gas extraction by fracking is an accident-prone, carcinogen-dependent enterprise. It turns communities into industrial zones, and until and unless you understand and quantify those costs, you cannot claim that fracking Illinois will provide economic benefits.”

The bill passed with no debate or questions from members of the committee. The vote was met with calls of “for shame” from opponents in attendance. Several community organizations from southern Illinois and throughout the state were in Springfield today to protest and lobby against the bill. But at this point, their efforts appear to be in vain. Barring any major developments, the bill is expected to pass in the House. Gov. Pat Quinn and Attorney General Lisa Madigan support the measure. House Speaker Michael Madigan said he supports a ban, but he also said he expects a regulation bill to pass before the spring legislative session is scheduled to adjourn at the end of the month.  Last year, the Senate passed less restrictive fracking legislation with no votes in opposition. 

For more on fracking, see Illinois Issues May 2012.

Thursday, April 18, 2013

Another concealed carry plan fails in the House

By Jamey Dunn

For the second time in two days, the Illinois House voted down a concealed carry bill.

A federal court struck down the state’s ban on concealed carry of firearms and gave the state a June 9 deadline to pass legislation to regulate carry. If there is no law regulating carry when that deadline hits, the court could opt to allow what many are calling constitutional carry, which would let anyone with a Firearm Owners Identification Card carry a gun anywhere in the state.

House Bill 997 (Amendment 9) needed 71 votes to pass because it would supersede the control of local home rule governments. It received only 64 “yes” votes.

The measure is a “shall-issue” bill that would require the Illinois State Police to issue concealed carry licenses to all qualified applicants. However, the legislation would allow local law enforcement to contest an application if they can demonstrate that applicants are a danger to themselves or others.

“A lot of people probably don’t want to hear this, but this is probably the strictest shall-issue bill in the country,” said Rep. Brandon Phelps, who sponsors the legislation. Phelps, a Harrisburg Democrat, said he tried to compromise with those who are concerned about concealed carry by increasing the amount of time that permit applicants would have to spend in training and upping the fees of the permits. Under his proposal, $30 out of every $100 permit fee would be dedicated to fix the state’s troubled Firearm Owner Identification (FOID) system, which does not receive most mental health records from county officials. Phelps called the current system a “travesty.” The measure also would increase penalties for violating the restrictions in the legislation.

But those tweaks could not bridge the deep divides on gun issues, which many lawmakers acknowledge are driven by regional differences.

“Clearly, we do simply come at this from different perspectives,” said Chicago Democratic Rep. Kelly Cassidy. On Wednesday, the House soundly rejected Cassidy’s more restrictive “may issue” bill, which would have required applicants for permits to demonstrate a need to carry a firearm. It also would have let sheriffs, who would issue the permits under her proposal, use their discretion when deciding who could and could not carry. Opponents of such a model say it allows for unequal treatment and could let some counties essential opt out of concealed carry by denying the bulk of applications received.

Cassidy said she respects the desires of people in more rural communities who view guns as tools for hunting and protection. But she said lawmakers must also consider gun violence in some parts of Chicago, where young people are shooting each other in the streets. “The only hunting that’s happen in my neighborhood is of young men. More guns are not the answer to our gun problem in Chicago. Please. Let’s get to the table. Let’s get a solution that respects the differences between our communities. There is a solution, and there is time. This isn’t soup yet.”

Proponents of Phelps' bill said concealed carry could help protect residents of high crime areas, where criminals already have guns. “Wouldn’t it be nice for them to wonder if everybody had a gun? That’s the real deterrent,” said Rep. David Reis. He said of criminals who already illegally use guns: “You’re never going to control them. You control them by having an armed society.” Reis, a Willow Hill Republican, said people in other parts of the state need to carry guns to ensure their safety when the police cannot come quickly enough. “For us in rural areas, [it is] 20 or 30 minutes before a sheriff can get to our house or to our fields where we’re working.”

When the bill failed Rep. Will Davis, a Chicago Democrat who voted against it, called out a similar sentiment to Cassidy’s remarks. “It’s not soup yet; not yet,” he said, and was met by calls of “it’s close” from supporters.

But Phelps was not so optimistic. “It might be the last chance. I don’t know what else we can give on.” His bill would preempt local control, which would bar local governments from putting their own carry laws in place. He said he does not plan to compromise on that issue. “There should be one uniform law that everybody knows about,” he said. Phelps said it would be too much to ask traveling gun owners to keep track of different laws across counties and cities throughout the state. “We think that you could make law abiding gun owners criminals.”

Phelps said lawmakers need to wake up to the reality of the court ordered deadline. “It better get real here soon because that's June 9th,” he said. If he and others on his side decide to leave the negotiations, he said, there would not be enough votes to pass legislation in the House. “If we walk, there’s not going to be a bill.

Monday, October 08, 2012

Advocates concerned about lack of direction from feds on health care reform

By Jamey Dunn

Health care advocates are generally pleased with the benchmark benefits for individual and small group health plans that Gov. Pat Quinn’s administration chose to comply with the Affordable Care and Patient Protection Act. However, they worry about the lack of details coming from the federal government on how states should carry out those and other changes that came with federal health care reform.

The United States Department of Health and Human Services (HHS) gave states the task of choosing the basic level of benefits that plans for individuals and many small businesses will offer under the new law. “HHS decided to punt the ball to the states at least for 2014 and 2015,” said Lydia Mitts, a health policy analyst for Families USA, a health consumer advocate group based in Washington, D.C. In 2016, the federal government plans to revisit the benchmarks set by states. “But for now, it’s the states’ responsibility,” Mitts said. States picked existing plans to base the so-called essential benefits on.

Illinois had the option to choose among existing plans for federal and state workers, as well as several private options. Quinn’s advisory council opted for the Blue Cross Blue Shield's Blue Advantage plan. The council focused on finding a plan that included all of the state’s numerous insurance mandates. The one they chose does cover them all, but if they had picked one that did not, the state would have had to pay for any mandates that weren't included. Members also tried to find a balance between benefits and price. “One the big issues for the work group [was] balancing the cost of the coverage with the actual comprehensiveness of the care,” said Coleen Burns, special counsel for health policy for the Illinois Department of Insurance.

The plan will set the level of care covered in 10 benefits categories, such as emergency services and prescription drugs. Small group insurance providers will not have to offer plans with identical benefits to the Blue Cross Blue Shield plan, but they will have to offer benefits under those 10 categories that are equal to the benefits offered in the benchmark plan. “It will set a minimum that consumers will be guaranteed,” Mitts said.

But deciding which benefits are equal to those offered in the benchmark plan is a complicated task. Advocates say they need to be vigilant to ensure that other plans offer truly equal benefits. Burns said that the Department of Insurance will provide oversight and the federal government will provide actuarial analysis to ensure that benefits offered live up to the minimum requirements.

HHS still has to approve Illinois' choice of the Blue Cross Blue Shield plan. The department will accept  public comments, and Burns said HHS has not yet issued a deadline for when it will sign off on states’ choices. HHS is still working on many of the regulations for the plan, as well as on other areas of the Affordable Care Act, which states must implement by 2014. The uncertainty leaves many of those working to put the law into action on the state level unable to answer key questions until guidance comes down from the federal government. It also makes many advocates nervous.

“They didn’t really outline the clear chain of command and accountability,” Mitts said. “HHS is in the process of working on proposed regulation for this. Things might slip through the cracks, and people might find themselves in plans with coverage that doesn’t really meet their needs.”

Sara Moscato Howe, chief executive officer of the Illinois Alcoholism and Drug Dependence Association, agreed that things are uncertain. “Nothing is very clear in terms of how comprehensive or how robust the mental health or substance abuse coverage is.” She said that definitions of basic services, such as residential care for addiction or mental illness, differ across different plans, which could result in disparities in benefits. “Key definitions and terms need to be the same across the board.”

Brigid Leahy, director of legislative affairs for Illinois Planned Parenthood, said many advocates would have preferred the option to build a benchmark from the ground up instead of choosing from existing plans, but that wasn’t an alternative. “We feel given the parameters that were set under the Affordable Care Act ... given what we had to choose from, we were satisfied with the choice.”

Burns said most consumers who have small group or individual plans probably won’t notice much difference in their coverage “Most of the plans in the small group market covered all the 10 essential benefits. They just covered them at different levels,” she said. “It’ s unlikely that they are going to see a great difference in their benefits.” However, she noted that there are plans that do not cover some of the essential benefits, such as maternity care, and in 2014 they will be required to.

Wednesday, September 12, 2012

State council considers required insurance benefits

By Jamey Dunn 

Illinois officials are weighing choices that could determine the future of the insurance market in the state for the near future.

As part of the Affordable Care and Patient Protection Act, Gov. Pat Quinn’s Health Care Reform Implementation Council is working to determine a benchmark for benefits that insurance companies must offer to individuals and small businesses in Illinois. “The benchmark will have an impact on insurance that’s sold both on and off the [online insurance] exchange,” Coleen Burns, special council for health policy for the Illinois Department of Insurance, said at a meeting of the council today.

The council will recommend one plan that will set the standard for benefits offered in 10 service categories, such as prescription drugs, maternity care and laboratory services. These basic required offerings are known as essential health benefits.

The council can choose between several existing plans, such as the three largest state employee health plans or the three largest group plans in the state. Once the council picks one plan to use as a model, other insurers must offer benefits under the 10 categories that are equal to the value of benefits offered in the plan. Illinois must pick a plan as is and cannot add on or subtract benefits. The standards set by the council will kick in in 2014 and last until 2016, when the federal government plans to reassess the required essential benefits.

 Burns said the choice will set a floor for required benefits, but insurance companies can offer more generous plans. “A[n insurance] carrier is at liberty to sell a bronze plan, a silver plan and a platinum plan, but all three plans must meet the benchmark.”

The council is taking public comment and suggestions through September 19, and Quinn must make a recommendation to the federal government by September 30. If the state does not choose a benchmark plan, the feds will choose one for it.

Council members have to weigh several areas of interest when considering what essential benefit requirement to recommend. Members of the committee said they hope to ensure that there are strong benefit levels for mental health and substance abuse treatment, which are two areas they say are often inadequately covered by insurance. “It truly signals that there is greater acceptance and understanding that the treatment of mental health disorders and substance abuse must be a priority,” said Lorrie Rickman Jones, director of the Department of Human Services' Division of Mental Health.

Russell Welcherd from Quincy asked that the council pay close attention to the benefits related to treating chronic disease. Welcherd has a genetic disorder that causes emphysema. He receives weekly treatments for his illness. “If a health insurance policy that discourages the proper treatment is imposed, people like me will ultimately suffer.” Welcherd said that without his treatment he would have to make frequent emergency room visits and be placed on oxygen therapy.

Larry Barry, president of the Illinois life Insurance Council, warned Quinn's council members that requiring plans to have overly generous benefits could make the insurance too pricey for many individuals and small businesses. “Now you’ve got a wonderful product, but it’s one that no one can afford.” He also asked state officials to make their decisions in a timely manner and let insurers know what is expected of them, so they can change their offerings accordingly. “We, as the sellers of this product, aren’t going to be able to wait until the last minute.”

For more on the state’s implementation of the Affordable Care Act, see the current Illinois Issues.

To submit a comment to the implementation council, go to http://www2.illinois.gov/gov/healthcarereform/Pages/default.aspx

Tuesday, May 08, 2012

Chicago mayor jumps into Statehouse pension debate

By Jamey Dunn

As lawmakers look to scale back retirement benefits for state employees, Chicago Mayor Rahm Emanuel asked them to also consider cutting benefits for workers in his city.

Emanuel presented the broad strokes of his proposal to change the city’s six pension systems to an Illinois House committee today. He proposed:
  • A freeze on cost of living increases for 10 years. After 10 years, the COLAs would not be figured on a compounded basis. 
  • A phased in contribution increase for employees. Employees currently contribute between 8 percent and 9 percent of their pay depending on which system they are in. Under Emanuel’s plan, that would increase by a percentage point each year for five years. After five years, the average cost employees pay would be 14 percent. 
  • A five year increase in retirement age that Emanuel said would be phased in over time. This change would increase the age to 67 for most city workers and 60 for police officers and firefighters. 

The mayor’s proposal would have to be approved by the General Assembly, and it would apply to Chicago’s pension systems for laborers, municipal employees, teachers, police officers, firefighters and park employees.

Emanuel estimated that his plan would eliminate about 40 percent of the city’s $20 billion unfunded pension liability. He said that growing pension costs are crowding out other vital services. “Our taxpayers cannot afford to chose between pensions and police officers or pensions and paved streets or pensions and public health,” he said. “Our pension payment will eventually squeeze out every essential that residents require and a city must provide.”

Emanuel projected that if nothing is done to scale back benefits for city employees, property taxes would have to be increased by 150 percent to keep up with the cost. “I do not believe that property taxes should go up 150 percent. No business will come to the city of Chicago or Chicago land area, and no family will relocate [there].”

He praised Gov. Pat Quinn’s plan to reform the state’s pension system and acknowledged similarities in the underfunding that Chicago pensions and state pensions are facing. He said taxpayers and workers are not to blame. The mayor said that politicians have not been honest with the public in the past about the magnitude of the problem and have made promises to workers that they cannot keep. While his plan shares some components with Quinn’s, he said Chicago has different needs. “We are facing problems that a one-size fits all framework will not fit.”

House Speaker Michael Madigan agreed that Chicago and the state face similar problems when it comes to pensions. “Well, I think he delivered his message that the city pension systems need to be reviewed. They need to be examined. They’re not financially sustainable as they’re currently constituted. It’s very similar to what we’re doing here at the state level with the state pension systems. I’ve been very much involved in that. Same issues,” Madigan told reporters today.

The mayor came out strongly in favor of Quinn’s proposal to have school districts outside of Chicago take on some of the cost for teachers’ retirement. He said it is unfair that Chicago covers most of the cost for its teachers while school districts outside of the city do not. “Only taxpayers in Chicago pay for the pensions of their own teachers and those teachers statewide. If taxpayers in Northbrook or Springfield or Marion were faced with that kind of double duty, their mayors would not tolerate it. And as mayor of Chicago, neither will I.”

House Minority Leader Tom Cross said there are other funding inequities between Chicago and downstate that benefit the city, and any potential unfairness should be considered in the context of all state spending. Cross and other Republicans have been less than enthusiastic about the possibility of shifting costs to local school districts. Cross said it would do nothing to address the problem of the unfunded liability. Republicans who have been more vocally opposed have said that it would decimate school budgets. Besides the call for a cost shift, Cross was supportive of Emanuel’s plan. “I like his concept. I like the governor’s concept. I like our concept,” Cross said. “We’re ready to go. We need to do this now.”

Unions decried Emanuel’s plan, saying that he is blowing the situation out of proportion. “What he’s trying to do is alarm the tax payer and pit them against the Chicago Police officers and the fireman that protect our city every single day,” said Michael Shields, president of the Fraternal Order of Police Chicago Lodge 7. “A guy does 30 years, 27 years down the road you can’t just change the rules of the game for the employee. It’s an individual contract between the employee and the employer and you cannot reduce those benefits. It’s against the constitution in Illinois.”

Union officials say Emanuel sprung the proposal on them during today’s hearing and voiced frustration about not being asked for input in the mayor’s plan. “The unions representing city employees have repeatedly conveyed to the mayor our willingness to work constructively to solve the pension funding problem. Yet he has never once met with us to hear our views or put forward the suggestions he unveiled today,” Henry Bayer, executive director of the American Federation of State, County and Municipal Employees Council 31, said in a prepared statement. “No one has a bigger interest in assuring the fiscal stability of city pension funds than the retirees and employees who depend upon them. Our union remains committed to working toward a solution that is fair and constitutional, but we need an administration that shares our commitment to a collaborative process and a genuine solution.”

Emanuel said his “framework” is just the start of a discussion over pension reform for Chicago. He said he would use all the political capital he may have with the legislature to help back reforms to both the state’s pensions systems and the city’s pensions systems through the legislative process this session. But, Emanuel said, getting something passed this spring is not a given. “I never underestimate — given that you’re about to make change — the difficulties surrounding it,’ he said. “Because details matter.”

Thursday, March 22, 2012

Medicaid expert sees few options for cuts

By Jamey Dunn

As lawmakers look to cut billions from the state’s Medicaid budget, one expert told them today that the task will be difficult and their options are limited.

Joy Johnson Wilson, health policy director for the National Conference of State Legislatures, addressed the Illinois Senate today about Medicaid trends across the country. She indicated that Gov. Pat Quinn’s demand that lawmakers find a way to curb Medicaid growth by $2.7 billion next fiscal year is an ambitious goal. She said she was not aware of another state that was trying to cut costs as much as Illinois, and that states that had successfully trimmed Medicaid expenses had done it through multi-year plans. “It is very hard to get savings in the Medicaid program in real time. It just is.”

Wilson emphasized that under the Affordable Care Act, states cannot make changes to who is eligible for Medicaid until 2014. At that time, residents above a certain earning level may be deferred to an online insurance exchange, where they could buy low cost insurance with the help of government subsidies. States can seek permission from the federal government to more rigorously check residents' eligibility status. After some delay, Illinois was granted permission to verify through state records whether applicants are residents. However, federal officials have not signed off on another piece of Medicaid reform passed in the state that would require applicants to provide multiple paychecks to prove their income level under eligibility requirements.

Wilson pointed out that the federal law leaves only a few areas to look for substantial savings. Lawmakers can reduce the rates paid to health care providers, limit how often patients can access some services, go after fraud and reduce services offered that are not required by the federal government.

“Optional programs in Medicaid are not like options on a car.” She said that options on a car are often considered luxury items, such as seat warmers or nice stereos, but they are not essential to making the car run. Wilson said many so-called optional Medicaid offerings, such as prescription drug coverage, are essential to the success of the program. She cautioned lawmakers to look at the “downstream financial, legal and political impacts” of cuts and reductions to services. “It’s very important that you make sure that you don’t make cuts that actually cost money,’ she said. Wilson said many states that eliminated adult dental services, something that is under consideration in Illinois, put the services back in place after they found that hospitalizations were going up. “So it actually cost them more when they eliminated them than what they were actually paying for them.”

She said some cuts can go too far and be met by public backlash. Arizona eliminated transplantation services but then put some back in place after a public outcry. “They have since restored some but not all of the transplantation services. She noted that Illinois is considering cuts to in-home services and said such reductions could run counter to Quinn’s stated desire to move people out of  institutional settings whenever possible. She said such cuts might also put the state in violation of court agreements, known as consent decrees. “If you are going to do something on the institutional side, then you’ve got to make sure that there’s some support for home and community based services.”

Wilson indicated that Quinn’s plans to transition people with developmental disabilities and mental health issues from institutional care to community care could be a crucial factor in the state’s efforts to find savings. “The critical piece is the assessment piece. Who belongs in an institution and who doesn’t? If you get that wrong, you will lose money. So that’s critical,” she said. “Who can actually be taken care of and function in a community, and who needs institutional care?”

According to Wilson, states that were early adopters of HMO-style managed care systems saw savings of up to 20 percent, but she said Illinois would likely not see such savings from a managed care program now. Instead, the state might see upfront costs. “We’re not seeing that now. … I think that you’re not going to get those big savings up front. In fact, it may actually cost something to expand Medicaid [managed care] to get savings later on because you have to make sure that your [health care provider] networks are adequate and that you do all the education outreach activities that are necessary to get people in the system and teach them how to utilize managed care.” She also said that managed care programs in the state’s rural areas would likely face challenges, but as the trend grows, more providers have become familiar with managed care.

Wilson also warned that ferreting out fraud involves upfront costs, such as hiring investigators. She said that eliminating fraud would not produce the desired savings on its own.

Sen. Heather Steans, who is a member of the working group looking to find the cuts Quinn has called for, said she found Wilson's presentation ‘a little disheartening.” “There’s a lot of restriction being put on by the feds in terms of the flexibility the states have, so there’s only certain things we can really look at, and that makes it, I think, more challenging to achieve the kind of reductions in the short period of time in which we’re talking about.”

But she said the presentation reassured her that her group is looking at all possible options. “Everything she talked about we’re actually already looking at and considering here. So I do think we’re on the right track in terms of making sure we are looking across the breadth of things that are possible,” said Steans, a Chicago Democrat. She said the Medicaid working group is meeting weekly to work on a plan to reduce the state’s Medicaid liability.

For more on the legislature’s efforts to cut billions from Medicaid, see the upcoming April edition of Illinois Issues.

Thursday, January 19, 2012

Quinn plans to close Jacksonville and Tinley Park facilities

By Jamey Dunn

Gov. Pat Quinn today announced plans to close the Tinley Park Mental Health Center and the Jacksonville Developmental Center as part of a larger proposal to close several state institutions.

Quinn previously proposed the closure of seven state facilities because he said there was not enough money in the Fiscal Year 2012 budget to keep them open. Lawmakers worked out a budget deal in November to keep the institutions open through the end of FY 2012, but Quinn said he planned to move ahead with closures after the end of the fiscal year.

Under the plan, 600 of the about 2,000 people with developmental disabilities currently in state institutions would be moved into community care settings over the next two and a half years, up to four state centers for the developmentally disabled would be closed and two state mental health centers would also be shuttered.

“My administration is committed to increasing community care options and improving the quality of life for people with developmental disabilities and mental health conditions,” Gov. Pat Quinn said in a prepared statement. “The approach we are taking will allow for the safe transition of care for some of our most vulnerable citizens to community care settings. I want to thank the members of the public, the General Assembly and advocates who worked with my administration to meet this challenge and help our state move forward.”

Under the governor’s proposal, the Tinley Park Mental Health Center would shut down in July, and the Jacksonville Developmental Center would close in October.

The Tinley Park Center primarily serves so-called acute care patients, who typically stay between 24 hours to 21 days. The administration plans to halt admissions at Tinley in time for all patients to complete treatment before the closure, but no date has been chosen yet. “The [Department of Mental Health], however, is actively securing additional beds at community providers and hospitals in the area surrounding Tinley Park [Mental Health Center] to ensure that services in the area are not interrupted,” said a summary of the plan issued by Quinn’s office.

According to the governor’s office, several factors were weighed when considering which facilities to close, including the age of the facility, the amount of deferred maintenance and repairs, the level and quality of care and the economic impact.

But Rep. Jim Watson, a Republican from Jacksonville, said that he thinks administration officials knew what facilities they wanted to close and created the rubric to fit those institutions. “It was pretty obvious that they developed criteria to get the outcome they wanted.” Watson was part of a working group that took up the issue of which facilities should be on the chopping block. “I think that they picked facilities that were largely downstate geographically where he did not fare well and then picked them in mainly Republican districts.”

Watson noted that Tinley Park us in northern Illinois, but he said it made the list because Quinn has been considering closing it for a while. Both of the facilities announced today were also on the list for closure under the governor’s previous plan.

Unions representing the workers and families of residents at the state’s developmental center say Quinn has not included them in talks over closure decisions. Watson said he thinks that Quinn is listening to advocates on just one side of the issue. “As a governor, don’t you have to be responsive to both sides of the issue and the entire state?” he asked. Watson was critical of Quinn for being in Washington, D.C., when the word came down about planned facility closures today. “I think it’s reflective [of his mindset on the issue] that the governor today is in [Washington,] D.C., when he makes an announcement that affects the lives of thousands of Illinoisans.”

Union officials complained earlier this week about working group meetings that were held outside of the public view and said Quinn was moving forward without their input. “Mental health and developmental centers provide essential health care services in communities across Illinois. When these facilities are threatened, what’s at stake is life or death for men and women who need intensive developmental services or treatment in mental health crisis and have nowhere else to go. The closure push appears based on politics and budget considerations, not what’s best for individuals, families and communities. It’s grossly irresponsible to plot to close these facilities behind closed doors,” Henry Bayer, executive director of AFSCME Council 31, said in a written statement.

“The governor’s office has not reached out to us at all,” said Rita Burke, president of the Illinois League of Advocates for the Developmentally Disabled, which represents parent organizations from the state facilities. “My concern about these particular people making decisions that are monumental in meaning in scope for families is that I don’t believe that they are intimately knowledgeable about the facilities or about the residents.” She said that the quota-driven nature of the plan could force people into the community against their will or into situations that do not provide an appropriate level of care.

Advocates for delivering care in smaller settings argue that receiving services in one’s home or a home-like setting with fewer residents allows developmentally disabled adults more freedom, flexibility and the ability to be a part of their community through activities, such as holding a job or volunteering. “Community-based care is about quality of life,” Kevin Casey, director of the Division of Developmental Disabilities, said in a prepared statement. “Through this careful, deliberate process, Illinois will improve quality of life for hundreds of people with developmental disabilities, while realizing significant savings through the closure of a costly state facility.” The Department of Human Services said it would conduct thorough assessments, so residents of facilities would be matched with the services they need when they are outside of institutions. The plan is to move 20 residents per month out of institutional care.

Supporters also highlight the potential cost savings that could come from closing facilities and serving those with developmental disabilities and mental health needs in community settings. According to the Department of Human Services, operations at the Jacksonville Developmental Center cost about $29.7 million annually. Under Quinn’s plan, the state would invest about $16.2 million in community care and save about $11.7 million. Tinley Park Mental Health Center has an annual operating cost of about $20.6 million. The state would invest $9.8 million in community mental health programs and save about $8.1 million.

But Watson said that losing the economic stimulus that the facilities provide to the local communities is not worth savings that seem somewhat meager when compared with the overall state budget. “Is this financial or is this philosophical?” he asked.

“If the Department of Commerce and Economic Opportunity could make an investment of $12 million and get an economic impact of $47 million, they would do it in a heartbeat,” Watson said of the plan to close the facility in Jacksonville.

For more on the state's shift away from institutional care, see the upcoming February issue of Illinois Issues. 

Tuesday, December 13, 2011

Report finds Illinois juvenile justice system is "failing"

By Jamey Dunn 

A new study has found that more than half of youth imprisoned by the Illinois Department of Juvenile Justice ended up back behind bars.

The report, released by the Juvenile Justice Commission today, said: “While precise data is difficult to come by — itself an indication of our current reentry shortcomings — it is clear that well over 50 percent of youth leaving Department of Juvenile Justice (DOJJ) facilities will be reincarcerated in juvenile facilities; many others will be incarcerated in the adult Department of Corrections (DOC) in the future.”

For seven of the last eight years, more than half of the incarcerated juveniles had been locked up over parole violations, such as truancy or curfew offenses. The report said, “On any given day, approximately 40 percent of incarcerated youth are technical parole violators.” The study found that 2 percent of all the incarcerated population was made up of offenders who committed a new crime while on parole. George Timberlake, chair of the commission and a former judge, said that many youth are going back to jail for “typical teenage” behavior.” The report said: "An essential measurement of any juvenile “reentry” system is whether youth returning from incarceration remain safely and successfully within their communities. By this fundamental measure, Illinois is failing." 

A 2009 law called for the commission to conduct the study and make recommendations on how DOJJ could do a better job of helping youth offenders become productive members of society. The state commission, which advises the DOJJ, looked into 230 prisoner review board hearings on juvenile cases and the cases of 400 juveniles whose parole had been revoked.

The report said a major problem is that the DOJJ, which was split off from the DOC, continues to use an adult parole system through the DOC. The commission said this one-size-fits all system is only geared toward policing youths’ behavior after release and does nothing to address their needs or help them make connections to schools, services, employment and their communities. “Responding appropriately to the differences between youth and adults does not require absolving youth of accountability for harmful behavior. Instead, it requires skilled professionals charged with moving a youth toward successful and safe return to the community,” the study said. Commissioners said that this failure of the DOJJ parole system to address the needs of youth and its focus on “surveillance” rather than rehabilitation contribute to the high rate of juvenile recidivism.

Timberlake said that parole hearings for youth, conducted by the Illinois Prisoner Review Board, are brief — sometimes lasting only minutes — and the board gave many of parolees the same terms for release. “We found them rushed, to say the least,’ he said. “Often they were the same conditions time after time after time.” He said many children were not aware of their rights, did not have legal representation and did not understand the proceedings. The report found that the proceedings were improperly recorded, and there was no system to review or reassess the board’s decisions. The commission recommended that if a juvenile faces losing parole and going back to a detention center, a court and not the review board should make that decision. Timberlake said that moving such cases in the court system would mean about one more case a day in Cook County, which would have the most cases. He said as time goes on and fewer youth are in the system, because parole changes would help more stay out of detention centers, the number of cases gets even smaller. “When you look at the numbers, it’s very doable now. And when you look at the future, it’s not even a blip on the screen.” The report said that the review board should document its hearings more thoroughly, and a legal advocate should be on hand for youth that do not have a lawyer.

The report also recommended that parole conditions be tailored to each offender and offenders have individual plans to help them get back on their feet. Case plans might include access to mental health treatment, addiction services or family counseling after release. The report said that holding a youth behind bars for one year costs $86,861. Timberlake said that community-based services, such as counseling, cost between $4,000 to $7,000 a year. “The economic ripple effect of incarceration inflates taxpayer costs even more. In human terms, we must do better for our young people and our communities. In fiscal terms, we simply cannot afford to continue business as usual,” the report said.

Arthur Bishop, director of the DOJJ, said that his department is moving in the direction of many of the commission’s recommendations. “This report and these findings are definitely in line with the mission of the Department of Juvenile Justice under this administration, which is a change the culture.” He said that the department is working to move from a “punitive model” to “therapeutic, rehabilitative” process. Bishop said that linking incarcerated youth to community programs before they are released is key to trying to keep them from coming back to prison. “Those youth tend not to commit new crimes. Those youth then can become tax-paying citizens.”

Commissioners and Bishop acknowledge that it may be difficult to find the money needed to execute the commission’s recommendation during the current budget crisis. Bishop said a previous plan from Gov. Pat Quinn to merge DOJJ with the Department of Child and Family Services has been abandoned. But he said DOJJ is working with DCFS and other agencies to provide wrap-around services to youth offenders and their families and to try to recoup federal Medicaid dollars whenever possible. “I think in some ways, we’re not just having to add new money to accomplish this, but use some services more wisely," he said.

“Certain things will cost money up front,” said Julie Biehl, a commission member and director of the Children and Family Justice Center at Northwestern University Law School.

However, she said: “It’s predicted it’s going to be saving money by not reincarcerating kids at the same rate. … Over time, I think you are going to see a tremendous cost savings to the state.”

The commission plans to release a fiscal analysis of its recommendations sometime in the next few months.