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More than One Million Eligible for Health Care Coverage. Is Illinois Ready for the Barrage?
Posted on: 10/4/2013
Eldon A. Trame, MD
ISMS President

Eldon A. Trame, MD

It's here. And there remain more questions than answers now that health insurance enrollment under the Affordable Care Act (ACA), otherwise known as Obamacare, has begun.

Despite three years of buildup, Illinoisans are only now getting their first glimpse at the insurance rates and product information offered through the Illinois Health Insurance Marketplace. In case you missed it, the policy wonks have renamed "exchanges" as "marketplaces." To further add to the confusion, the marketplace will be promoted here as "Get Covered Illinois." Going forward you'll probably hear all three of these titles used interchangeably to mean the same thing. I'll stick with marketplace for the sake of this column.

Illinois' marketplace offers various health plan options in every county through eight insurers.

In addition to the commercial options, some patients will gain coverage through Illinois' Medicaid expansion (which can also be accessed via the insurance marketplace). A separate marketplace available to small businesses known as the Small Business Health Options Program  (SHOP) is in the process of getting up and running.

Interestingly, despite all the attention given the ACA, one study  suggests 78 percent of the uninsured aren't even aware of the coverage options that will be available to them. A recent poll here found 6 in 10 Illinoisans are unaware of the marketplace. For anyone seeking more eligibility information, a good site to start with is www.healthcare.gov.

While some of the nuts and bolts about the marketplaces' "infrastructure" are becoming clearer, there remains a need for further information on how the practical elements of this phase of the ACA will impact Illinois physicians. A menu of more than 100 plan options offered through the marketplace sounds good for patients, but is it really? Will every one of these plans have network adequacy to ensure the patient is really able to access convenient care? In some of the cheaper plans, corners may be cut. Will those cuts interfere with our patient-physician relationships?

There will also be an interesting hitch in terms of eligibility verification. The ACA allows enrollees who have paid one month's premium and received an advance tax credit to incur up to three months of unpaid premiums before policy cancellation. Cancellation will be retroactive to 60 days and could expose a practice to insurer recoupments if patient coverage eligibility isn't continuously checked.

And here's the big question: Is Illinois prepared to treat the newly covered patients coming through the marketplaces and Medicaid expansion? Roughly 1.3 million uninsureds in Illinois will be eligible for coverage. ISMS has long been on record questioning such a hefty expansion of Medicaid, as those patients already wait longer or are unable to access care compared to commercially insured patients. Will it get worse? 

ISMS will be working to assist with these and other questions as the ACA rollout proceeds. Please be in touch with me about any of your concerns as implementation moves forward.

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