It’s no secret that many Illinois Democrats have been reluctant to throw their full support behind President Barack Obama’s signature health care law. And Republicans at the state level are not going to get behind a law that their party counterparts in the U.S. House have voted dozens of times to repeal. As a result, those seeking insurance in the state have been handed a mixed bag of policy.
Illinois lawmakers did approve a massive Medicaid expansion that was a key part of the Patient Protection and Affordable Care Act. The law expanded coverage to individuals who earn up to 138 percent of the federal poverty line, which is $15,860 for single adults and $21,408 for couples. It also makes Medicaid benefits available to childless adults in Illinois. So far, more than 400,000 residents have signed up for Medicaid under the expansion.
“In the home state of President Obama, we believe access to quality health care is a fundamental right, and we proudly embrace the Affordable Care Act,” Gov. Pat Quinn said when he signed the Medicaid expansion. However, Illinois politicians did not embrace another important component of Obamacare: the online insurance marketplace.
Legislative hearings were held to address how the state might establish its own exchange. Insurance companies wanted to have a say in the governance of the marketplace, and they wanted customers to foot the bill after initial federal funding had been spent. Advocates thought that the insurance industry should be a silent partner in the exchange — by allowing a representative on the governance board but not giving him or her voting power — and dip into profits to cover the costs. Health care reformers said that allowing insurance industry reps on the governing board was a clear conflict of interest because they would also be making money off of the exchange. They likened it to letting the fox guard the henhouse. Industry lobbyists argued that the exchange would need the oversight and technical knowledge that only insurance experts could provide. They compared it to banning an aerospace engineer from serving on the board of Boeing.
Instead of addressing these competing opinions and finding a solution, Democrats in the House opted not to vote on a bill. It’s hard to ignore the fact that leaders — from both parties — of the House committee negotiating the issue were also receiving substantial campaign cash from the insurance and health care industries. The fact that the law was facing a U.S. Supreme Court challenge, which many had wrongly predicted would not go in its favor, did not help matters, either.
House Speaker Michael Madigan’s spokesman, Steve Brown, told Illinois Issues earlier this year that there had not been enough support to pass a bill. Brown noted that the issue is a political minefield in part because of real problems with the law and its execution and in part because of the zero-sum game political climate surrounding the topic. “Obviously the issue is fraught with controversy for sometimes informed reasons and sometimes uniformed reasons.”
Quinn pushed the issue of the exchange a few times, but he did not use his bully pulpit to advocate for it in the way he has with other issues, such as a pension overhaul and gun control measures. There was a time when it was difficult to get his staff to go on the record about the topic, or to get some lawmakers on the House Insurance Committee to return phone calls.
So Illinois went with a state/federal partnership for its exchange. The state created a website, getcoveredillinois.com, that it could market. But visitors are ultimately directed to the federal website, healthcare.gov, to buy insurance. Unless you have been willfully ignoring current events, you know how the launch of the federal website went. Illinoisans who visited the state’s webpage to insurance shop were greeted with error messages, often after they had already entered much of their information. They were unable to look up rates or see if they were eligible for federal subsidies. All this made it nearly impossible, in the early days of the exchange, for online consumers to assess whether the exchange was the right option for them — an experience that is beyond frustrating when trying to ensure that you and your family will have coverage if you get sick.
Some states, including Kentucky, were able to build exchanges that worked. Their websites did not function perfectly, but they could add servers and make tweaks to address bugs. States that had not created their own marketplaces had to sit and wait for the feds to sort it out, and then push hard to get people signed up before deadlines once the website was functional. To their credit, those spearheading efforts in Illinois were able to do that. Given how bad things were with the website in the early days, the state’s enrollment number of 622,000 is a good start.
That’s not to say that all the state marketplaces were success stories. Hardly. Many websites were just as bad as the federal exchange. Some, such as Massachusetts, are still trying to figure it out. But by passing on creating its own exchange, Illinois is completely at the mercy of the federal website’s performance. After some recent court rulings, it could also mean that Illinois consumers will not have access to subsidies to help cover their costs.
In late July, the U.S. Court of Appeals for the District of Columbia Circuit ruled that under the wording of the Affordable Care Act, federal subsidies should only be available to residents of states that operate their own online insurance exchanges. Under the decisions, Illinois and 35 other states would lose the subsidies.
That same day, the Fourth Circuit Court of Appeals in Virginia issued a diverging opinion on a similar case. That panel of judges said that the wording of the law was unclear, but the majority agreed that the law allows for the subsidies to be dispersed through the federal exchange.
President Obama’s administration says it plans to ask the full panel of judges at the D.C. appeals court to consider the issue. In the end, the case may end up before the U.S. Supreme Court. For now, the approximately 168,000 Illinoisans who rely on subsidies to make their insurance affordable will be able to keep the help. But if things don’t go the president’s way in court, they could find themselves in a tight spot. And if Illinois opts to build its own exchange at that point, it will likely be too late to take advantage of some federal grants that were available to help cover the costs, making the debate over who pays for the website even thornier.
Please welcome Brian Mackey to our staff. He has been covering state government and politics off and on for almost a decade. Most recently, Mackey covered the Statehouse beat for WUIS-FM and a dozen other NPR stations across Illinois. He has also contributed to Illinois Issues as a free-lance writer.
A graduate of the Public Affairs Reporting program at the University of Illinois Springfield, Mackey started his journalism career in earnest as the Springfield bureau chief for the Chicago Daily Law Bulletin in 2005. From those early days, Mackey recalls once waiting near a Capitol dumpster to ask then-Gov. Rod Blagojevich about a new campaign finance plan. Blagojevich had already built a sizable war chest, and reaction from lawmakers suggested the proposal was dead on arrival. After more than an hour, the governor appeared with his entourage. He responded to his critics in what would become a signature quirk for the now-imprisoned governor — reciting verse, often with a general disregard to context. “Ah, but a man's reach should exceed his grasp, / Or what's a heaven for?” he asked, borrowing from the poet Robert Browning.
From 2008 to 2012, Mackey was A&E editor at the State Journal-Register. He will continue contributing to public radio as he writes full-time for the magazine.
Illinois Issues, September 2014