 Health care advocates, unions, doctors' groups and business people
testified in unison this week before the Legislature's rule-making
body, the Commission on Government Forecasting and Accountability,
that the state should have a limited role in running the health care
exchanges, but they were divided on their reasons.As required
under the federal Patient Protection and Affordable Care Act, each
state must create an exchange where people can shop for and purchase
competitive health insurance plans. But each state can create its
own exchange.
At its most basic, an exchange would be a marketplace, a one-stop
shop. Some states are looking at online exchanges or physical
exchanges or both, but no single model has emerged.
Jim Duffett, executive director of Illinois Campaign for Better
Health Care, which advocates for health care for everyone, said
exchanges should be outside of direct government control and, more
important, outside of governmental influence.
"Political winds change," said Duffett. "We need to keep this
marketplace stable, no matter if it is a Democrat or Republican in
the (governor's) mansion."
Duffett and other health care advocates support a
quasi-governmental exchange, where the state helps to create the
exchange and enforces regulations regarding accessibility to and
availability of insurance plans.
Duffett also said he wants the state to ensure that anyone on
Medicaid can "seamlessly transition" into the health care exchanges.
Various advocates supported the state establishing regulations
for the exchange but not running its day-to-day operations. The
groups included AARP, which represents senior citizens; Planned
Parenthood, which speaks for women's health issues, and labor
unions, including the Service Employees International Union and
United Food and Commercial Workers.
Laura Minzer, executive director of the Healthcare Council for
the Illinois Chamber of Commerce, one of the state's largest
business groups, said her organization was concerned about a
proposal from the Illinois Department of Insurance that would give
Gov. Pat Quinn the power to appoint most of the people who would
oversee the health care exchanges.
"We have some concerns in terms of the appointments (to the
exchange) being largely from the governor," Minzer said. "We believe
this should be separate and apart from the politics" of the state.
But Minzer said politics is driving the decisions that will shape
Illinois' health care exchanges. Lawmakers are trying to figure out
whom they will pay to create an exchange and how it will be run. And
they want a plan by the end of the fall veto session in early
November.
"We still don't know what it is that we're doing with the
exchanges," Minzer said Tuesday. "We feel that this has to be
tackled in a bigger way, and six days of sessions is not enough time
to do that."
State Rep. Greg Harris, D-Chicago, said Illinois has to have an
exchange up and running for federal approval by January 2013. If
not, the federal government will impose its own exchange on the
state. The exchange would start selling insurance in 2014.
"This is an immensely complex undertaking. It's going to be
expensive for somebody," Harris said. "So there is a real caution
not to make promises to folks now that we can't keep if the ground
changes underneath us."
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The ground is changing as challenges to the requirement in the
federal health care law that would require everyone to buy health
insurance make their way through the courts,
The U.S. Court of Appeals for the 6th Circuit upheld the mandate
last year. But the U.S. Court of Appeals for the 11th Circuit struck
down the mandate earlier this month. The U.S. Supreme Court is
expected to hear arguments once the cases move through the appellate
process.
Bob Zirkelbach, spokesman for America's Health Insurance Plans, a
national trade association that represents the health insurance
industry in Washington, D.C., said that without a purchase mandate,
health care exchanges will be expensive because healthy people, who
would lower the costs of insurance, might not buy into an exchange.
"Nobody knows for sure what will happen if there is no
guarantee," Zirkelbach said.
Zirkelbach also is quick to say that health care exchanges will
be "much more expensive" in the states that involve their government
in the day-to-day operations of the exchanges as opposed to those
that are essentially online marketplaces.
State Sen. Bill Brady, R-Bloomington, said that is why he does
not want to state to take on too large a role in the new health care
exchanges.
The federal health care law "is traveling down that slippery
slope of complete socialized medicine," Brady said. "Reining it in
from the framework to maintain a private-sector medical system with
some government financial assistance is going to be the tricky
part."
Brady said he wants to slow down the health exchange process
until the U.S. Supreme Court makes its decision. But it could be
months, or longer, before the nation's highest court takes up any of
the cases now in the courts.
Lawmakers are scheduled to return for the fall veto session Oct.
25-27 and again Nov. 8-10.
[Illinois
Statehouse News; By BENJAMIN YOUNT]
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