Those officials say the Patient Protection and Affordable Health Care Act will dramatically increase the number of those insured in Illinois and decrease the number of premature deaths by providing better preventive care and covering individuals with preexisting medical conditions.
A study released last year by Families USA, a national health advocacy group in Washington, D.C., shows that Illinois ranked sixth among all states in the number of uninsured people between the ages of 25 and 64 who died prematurely between 2005 and 2010. Nationwide, Families USA says, 134,120 people died during those five years because they lacked insurance of any kind, including Medicaid.
To estimate the number of deaths, Families USA used population data from the U.S. Census Bureau and mortality rates published by the National Center of Health Statistics, according to the Families USA website.
The website notes, in part: “The number of uninsured Americans reached an all-time high in 2010, as nearly 50 million Americans went without health insurance for the entire year. For many of these uninsured people, the consequences of going without coverage are dire. The uninsured frequently face medical debt or go without necessary care, and too many of them die prematurely.”
With a population of almost 12.8 million people, Illinois is the fifth-largest state in the country, according to the 2010 census.
Of Families USA’s findings, Mike Claffey, a spokesman for Gov. Pat Quinn who works with health care issues, says: “Generally we know that the economy has affected people’s abilities to get and hold onto health coverage. But this is an issue the ACA is designed to address. We know that thanks to the ACA, hundreds of thousands of people will be able to acquire health coverage in 2014 through either the Illinois Health Insurance Marketplace or Medicaid. This will make a major difference in people’s lives.”
Federal support under the act for Illinois health care between 2014 and 2020 is estimated to total $12 billion. The state’s share will total about $500 million, Claffey says. Signup for the program is scheduled to begin this month.
People who lack health insurance typically cannot afford and thereby skip regular physical checkups and medical tests that can detect cancer, heart disease, diabetes and other potentially life-threatening conditions in their early stages. When caught early, such conditions are often treatable — and less expensive to treat, say health care experts.
Dr. William McDade, president-elect of the Illinois State Medical Society, believes the Affordable Care Act will significantly reduce the number of uninsured Illinoisans and reduce premature deaths. Various factors, McDade says, have led to residents being uninsured, including loss of jobs that covered health care, insurance being denied to individuals because of preexisting conditions and residents not qualifying for Medicaid.
“The act represents a great step forward,” says McDade, an anesthesiologist and an associate professor in the Department of Anesthesia and Critical Care in the Pritzker School of Medicine at the University of Chicago.
About 1.2 million uninsured people in Illinois are expected to gain some form of health insurance coverage on January 1. About half of those people will be newly eligible for Medicaid, according to state and federal estimates.
While the new law is a great step, McDade says, it also presents challenges to Illinois, a state that has been beset by budget problems. “We’re going to continue to talk with lawmakers about [the importance of] planning now for the state funding of the expansion of Medicaid,” he says.
The law also lacks language regarding limits on medical malpractice insurance, which McDade says contributes to how much doctors charge for health care. He cites a doctor he knows as an example. About six months of the doctor’s salary, McDade says, goes toward malpractice premiums.
In addition, doctors are understandably concerned about when and how much they’ll be reimbursed for accepting patients on Medicaid, McDade says, noting the Affordable Care Act includes a two-year incentive that offers a higher reimbursement rate for primary care physicians.
Unless more physicians sign up to serve those on Medicaid, Illinois won’t have enough doctors to treat the surge of newly eligible residents, an April 2013 article in the Chicago Health Care Daily quoted Julie Hamos as saying. Hamos is the director of the Illinois Department of Healthcare and Family Services, which administers the state’s Medicaid program.
“To fill the gap, Hamos is encouraging doctors to take advantage of the higher reimbursements Medicaid is temporarily paying for primary care services,” the article says, noting that board-certified pediatricians, internists and family medicine practitioners are among those eligible for the higher fees. Physicians who aren’t certified in those specialties are also eligible, the article says, if at least 60 percent of their annual billings are to Medicaid.
About 47,000 physicians practice in Illinois. Thus far, Claffey says, about 10,200 doctors have signed up for this incentive. “We anticipate they will be paid $110 million in just the first six months of this fully federally funded incentive program,” he says.
About 30 percent of uninsured Americans are middle-income, according to Families USA, which notes in its report, “Although poverty and lack of insurance are linked, about one in three, or 32 percent of middle-income adults 18 to 64 years of age, went without health insurance during some part of 2009.
A 36-year-old married Evanston mother with a 5-year-old son is among the one in three middle-income individuals without health insurance. Depending on how much she works — she has two part-time jobs and her husband a full-time job — their annual household income ranges from $40,000 to $60,000, she says.
The woman, who didn’t want her first or last names used, lost health coverage when she was laid off from a full-time job that provided insurance and other benefits. While she could receive coverage under her husband’s workplace health care plan, the premium for her alone would be about $800 a month — money she says her family doesn’t have. The high premium, the woman believes, is due to her having a benign tumor in her pituitary gland that requires medication to keep the tumor from becoming too big.
The couple’s son is covered by the state-backed All Kids insurance program for children. “I hope both my son and I can have the same insurance under the Affordable Care Act,” the woman says.
Nationwide, 48 percent of the uninsured and 31 percent of those who buy their own coverage think they will be better off under the health reform law, a recent Kaiser Family Foundation poll found. About 78 percent of the uninsured don’t know they’ll be able to purchase insurance through the exchanges, according to Enroll America, a coalition of community organizations, health groups and businesses working with partners to educate the public.
In Illinois, Health and Disability Service Advocates, a Chicago-based organization, is among groups working to educate the state’s residents about the Affordable Care Act, according to Stephani Becker, a senior policy analyst on the organization’s Access to Health Care team. IllinoisHealthMatters.org, a website operated by Health and Disability Advocates, describes itself as a “statewide digital hub to raise awareness and provide clear, non-partisan information about how the new health care laws will affect Illinois.” Its mission, the online site says, is to “help Illinois individuals, small businesses, policymakers and community organizations understand and benefit from improvements and access to health care under national health care reform.”
Starting in 2014, all Americans must have insurance either through their employer or an individual plan. Otherwise, they initially will face annual penalties of $95 or 1 percent of family income, whichever is greater, with the penalties growing in subsequent years. Those who lack affordable insurance will be able to sign up beginning this month through state-based exchanges, with coverage kicking in in January. Premium subsidies from the federal government will be available to those eligible.
The Evanston woman says that when she had health insurance through her or her husband’s jobs, she didn’t realize the magnitude of what can happen without ongoing medical coverage.
“I never thought about it until I actually experienced it. I always had insurance, either through my insurance or my husband’s,” she says. “It is scary to be in this situation and thinking of the overwhelming medical debt that people can incur without health insurance.”
Debra Landis is a free-lance writer and the student publications adviser at the University of Illinois Springfield.
Illinois Issues, October 2013