Federal officials could end up overseeing the new Illinois health insurance marketplace for years to come after lawmakers in Springfield balked again at a full embrace of President Barack Obama's health care law.
The Legislature adjourned Friday without sending Gov. Pat Quinn's a bill on a state-run marketplace -- a consumer-friendly online shopping site for insurance. Quinn has pushed such a plan for three years without success.
Although the state will partner with Washington the first year, the Democratic governor had hoped Illinois could take the reins in 2014 for coverage starting in 2015. That timetable now seems highly unlikely unless lawmakers pass legislation when they convene for the abbreviated veto session this fall.
Jim Duffett of the Campaign for Better Health Care, an Illinois group that supports the health care law, predicts that if lawmakers don't approve a state-run marketplace then, there won't be one in Illinois for at least five years.
State senators approved the bill along party lines, but the full House never voted on it before last Friday's adjournment. A spokesman for House Speaker Mike Madigan noted the bill "didn't have much bipartisan support" in the Senate and would have had "tough sledding" in the House.
It was one more case of Obama's home state lagging behind some other Democrat-controlled states in implementing the president's signature domestic achievement.
The marketplace, as envisioned in the Affordable Care Act, is intended to be an online site where people can comparison shop for health insurance plans, just as they now shop for airline tickets on the Web. Most people buying insurance through the marketplace will get financial assistance to help them pay for insurance.
In Illinois, that will be true whether the marketplace is run by the federal government, as it will be this year, or by an Illinois governing board as Quinn wants for next year. Supporters of an Illinois-run marketplace say the benefit would be keeping state officials -- not Washington -- clearly overseeing the system and the insurance industry.
The marketplace will open for business Oct. 1 in Illinois, as scheduled. Illinois officials expect 165 health policies to be offered by six different insurance carriers. The marketplace will be run substantially by the federal government.
Sonya Schwartz of the National Academy for State Health Policy, which has been tracking states' progress on Obama's health law, said legislative approval in the fall is essential for Quinn to achieve his timetable. There's a Dec. 16, 2013, federal deadline for states to submit their plans to Washington if they hope to run a state-based marketplace for insurance coverage in 2015.
Even so, Schwartz said, the timeline would be demanding, but "you never know."
The bill's main Senate sponsor was Sen. Dave Koehler, a Peoria Democrat. Koehler said he's working with others to convince more House members to pass a state-run marketplace, also known as a health insurance exchange, in the fall.
"If we want to control the destiny for Illinois we need to have a state-based exchange," Koehler said.
Quinn spokesman Mike Claffey said the governor's office will work with Koehler and others "to craft legislation that can pass both houses of the General Assembly later this year. The fall veto session is Oct. 22-24 and Nov. 5-7, so there is an opportunity to pass legislation in the fall."
Consumer advocates, who want a state-run marketplace, are pessimistic.
"The picture looks really bleak for a state-based exchange in 2015," said Brian Imus of Illinois Public Interest Research Group. "There's going to have be leadership from Speaker Madigan to make it happen and a willingness from legislators to stand up to the insurance industry."
Madigan spokesman Steve Brown said it's not a question of the speaker's leadership.
"People, when they fail to accomplish something, tend to blame someone like Mike Madigan," Brown said. "I don't recall the bill's sponsors pushing for a vote" in the House, he added. The bill didn't have bipartisan support in the Senate, Brown said, and "it probably would have been tough sledding if it had been called" in the House.
The Illinois Legislature did pass another key element of the law: an expansion of Medicaid to cover most low-income adults without children at home. A U.S. Supreme Court decision last year made the Medicaid expansion optional for states. In Illinois, the Senate voted along strict partisan lines to expand Medicaid. In the House, some Democrats voted "no" on Medicaid expansion, although the measure passed.
"Medicaid expansion was the first big thing that needed to happen," Duffett said. "I can only speculate that Madigan did not want House members to take a second vote on Obamacare."
The Affordable Care Act calls for almost all Americans to have health insurance beginning in 2014 or pay a penalty. Starting in 2014, insurance companies will no longer be able to turn away people with a history of medical problems, or charge them more.
Nearly 1.8 million Illinois residents are uninsured. An estimated 486,000 Illinois residents will get coverage from commercial insurers through the marketplace in 2014. That figure is expected to reach 1 million customers by 2016.