It’s summer at last. Time to read a good book, and catch up on some podcasts. Here’s one we like – it’s about the cost of healthcare. How much does healthcare cost in the U.S.? An Arm and a Leg, started in November by former WBEZ reporter Dan Weissmann, explores that. “Entertaining, empowering, and even useful” – rather than political – it’s about “the way that healthcare runs our lives.”
It’s hard to believe, but true – the omnibus Medicaid reform bill headed to Gov. Pritzker was passed without a single dissenting vote in either of Illinois’ famously disputatious legislative chambers.
It might be because the need for change was so unambiguously clear: the difficulty people had enrolling and in the program, the vast backlog of applications, the likelihood of losing your coverage in the course of the renewal – or “redetermination” – process, and growing frequency of claims denials. It also represents many months of negotiation and compromise by all parties. Continue reading “A Medicaid Reform that Passed Unanimously”
On April 11, the Freedom from Aggressive Insurance Increases Review Act passed the Illinois House on a bipartisan 73-41 vote. The bill ( HB 471 ), known as the FAIIR Act, would give the Department of Insurance the authority to approve or deny unreasonable health insurance rates. This kind of meaningful rate review is practiced in 37 states and has been shown to curb outrageous rate hikes.
In terms of health insurance, Illinois is what is known as a “file and use” state, which means that insurance companies must file their intended premium rates, which then go into effect without having to be approved by the Department of Insurance. In “prior approval” states, the insurance commissioner can approve, reject, or reduce rates, often actively negotiating with the insurer. Continue reading “Rate Review – What a Difference!”
The long fought-for $15 minimum wage bill was signed into law by Governor Pritzker on February 19. It raises the state’s minimum hourly wage from $8.25 to $9.25 next year, and then phases it in to $15 by 2025.
Although the federal minimum wage is still $7.25, much of the country has moved on. More than 60% of the working age population is estimated to live in areas with a higher-than-federal minimum. Chicago and Cook County have raised theirs, currently at $12 and $11, respectively. California, Massachusetts, and New Jersey will beat us to $15. As of January 2017, 29 states and a couple dozen cities had set their own minimum wage, and a dozen states automatically raise it every year to keep pace with inflation. Continue reading “Will Benefits Updates Follow Wage Increase?”
Do you remember when the ACA Marketplace opened in 2013, and the whole thing was so complicated that special roles like “navigators” and in-person counselors, aka IPCs, had to be created to help people enroll? Even though few assisters remain due to significant funding cuts from the federal government, people still need help with healthcare choices, especially in our Medicaid program.
Most people have access to expert help figuring out their healthcare choices. With an employer, you have an HR person or representative to help you sort through your healthcare choices. On the private market, you have brokers and agents. In Medicare, you have Senior Health Insurance Program counselors and brokers. Granted, all those systems have their shortfalls, but the common thread is that there is a person you can reach for help.
As people age, they typically need more help doing everyday things, whether it’s getting the groceries or taking a shower or remembering to take their meds. In many cases, even limited assistance can allow a senior to remain in their home for many years, even decades.
The logical program to provide in-home services is Medicare, which pays for most of seniors’ medical care. But Medicare does not cover them. Medicare does cover skilled medical services like physical therapy or nursing care when you’re ill or recovering from an illness or surgery, but you must be certified by a doctor as homebound, and even then it will not cover non-medical home services such as help bathing or dressing or preventive aids such as grab bars. The result is that many seniors end up spending down their resources to be eligible for Medicaid to get the non-medical care they need in order to live at home. Our system makes middle class people become poor to get the care they need – and, ultimately, states pick up the tab. Medicaid has been covering a growing portion of long-term care in the U.S. – 53% in 2018.
But 2019 ushers in help at home services for Medicare – and the change may be the catalyst for a more dramatic transformation in healthcare delivery and effectiveness.
When Governor-elect JB Pritzker and incoming legislators take office a few days from now, we hope among the top-of-mind issues for them will be healthcare – and the possibility of creating a public option that would allow Illinois residents to purchase a premium to participate in the state’s Medicaid program. Candidate JB Pritzker talked about his vision for such an initiative, which he called “IllinoisCares,” and his platform included a public health insurance option that would be available to all residents.
IllinoisCares would allow Illinois residents to purchase health insurance from the state, rather than a commercial plan. Forty-two states – including Illinois – already have Medicaid buy-in programs, but they are limited to working people with disabilities who have not been able to purchase affordable health insurance coverage that meets their health needs in the private market. Continue reading “Will 2019 Bring a Medicaid Buy-in to Illinois?”
Recent guidance from the Centers for Medicare and Medicaid Services encourages states to take new steps to circumvent the ACA. Specifically, it invites them to apply for Medicaid Section 1332 waivers in order to use ACA subsidies for short-term insurance and association health plans. These plans, originally intended only to tide people over between periods of more-permanent coverage, are little more than flimsy stop-gaps that scarcely merit the name of real health insurance. Continue reading “Feds Will Subsidize Junk Health Coverage”