Illinois is ahead of some states but behind others on the path toward creating a health insurance exchange, a cornerstone of President Barack Obama's health care law.
Obama's home state plans to partner with the federal government to run a health insurance exchange beginning in 2014, the first year for coverage. State officials submitted their blueprint for that partnership Friday.
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That puts Illinois among a group of seven states planning to join with Washington to run an exchange where consumers and small businesses can shop online for the best deals on health insurance. Sixteen other states, including California and New York, want to build their own exchanges, and many other states haven't decided what to do or are deferring to the federal government to run their exchanges. States now have until Dec. 14 to tell the federal government their plans.
So far, Gov. Pat Quinn has been unable to get Illinois lawmakers to pass legislation needed to build its own exchange. But Quinn adviser Michael Gelder said he's confident state lawmakers will pass the legislation now that Obama has been re-elected and the health law survived a Supreme Court challenge. The state-based exchange would replace the partnership.
"The president has won. The Affordable Care Act itself has ... survived two near-death experiences," said Gelder, the governor's senior health policy adviser. "We're now confident there will be the energy -- hopefully from both Democrats and Republicans -- to pass an exchange bill next spring and we'll have our exchange ready to function for 2015."
Quinn, a Democrat, has made access to health care a high priority throughout his career, Gelder said. Quinn supports Obama's health care legislation, which focuses on covering most of the uninsured and requires nearly every U.S. resident to have coverage. Illinois officials estimate about 800,000 uninsured residents would have coverage in 2014 because of the law, and that the figure will have eclipsed the 1 million mark by 2020.
The exchange will be like Travelocity for health insurance, a website where consumers will be able to find out whether they're eligible for new federal subsidies to help pay premiums, or whether they qualify for Medicaid. A call center would help consumers who don't have access to computers, or who have questions.
Looking ahead, Quinn and Illinois lawmakers must resolve disagreements on operating a state-based exchange. Consumer advocates want a governing board free of insurance industry members and insurers want a voice in oversight. There's also disagreement over whether the state should be able to actively negotiate with insurers on behalf of consumers, and be able to exclude health plans that don't offer a good deal.
Brian Imus of the nonpartisan Illinois Public Interest Research Group wants consumers and small business owners to have a big role in how the exchange will operate in Illinois, and he supports Illinois playing an active role in negotiating with insurers.
"I hope lawmakers remember the exchange is created to create more competition and make it easier for consumers to shop for the best health insurance," Imus said. "If the insurance companies are running the exchange it's going to be harder for that to happen."
Insurers may not be willing to compromise on the state's role and whether Illinois will be able to actively negotiate with insurers, said one insurance lobbyist.
"We absolutely believe that insurance is a state-based, state-regulated product and the people who know it best are our state regulators. What we will not compromise on is if the legislation allows the state to become an active purchaser of insurance," said Elena Butkus of Aetna Inc. Real competition would come only if the state plays a less active role, she said.