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Making Health the Best Policy

Making Health the Best Policy
Since the day health care reform was voted into law at the federal level, Illinois policymakers have been at work to implement provisions of the law.  Key legislators and other Illinois officials have a vision of how reform will impact west and south siders’ ability to gain health insurance and health care.

Moreover, they’re working hard to make that vision a reality.  But as they do, they’re fighting another battle on a different front as well.  Those who back the Affordable Care Act are attempting to impart positive messages, to counter Act opponents working daily to ensure its provisions never go into effect.

Arriving at the bold new era in which individuals and families will enjoy access to affordable health insurance and a new level of integrated care will require the efforts of not just policymakers, but community organizations, faith-based groups business organizations, and everyday people across the city.

A long-time advocate for affordable health care for low income families, Senator Donne Trotter has been instrumental in including programs such as FamilyCare in a shrinking Illinois budget.

Video and gallery by Jay Dunn

In this article, we will first look at what steps policymakers have taken so far, then focus on what’s ahead and how everyone can get involved.

Illinois policymakers’ efforts in health care reform began in July of 2010, when Governor Pat Quinn established by executive order the Illinois Health Reform Implementation Council.  The chair of the council is Quinn‘s senior policy advisor Michael Gelder, while the two vice-chairs are Julie Hamos, director of the Illinois Department of Healthcare and Family Services, and the (now former) director of Illinois Department of Insurance Mike McRaith.

The next step was the convening of four public hearings across the state.  One concerned expansion of Medicaid, another centered on workforce issues, and still others zeroed in on health information technology infrastructure.  “There were a number of issues about who should govern the exchange, who should be eligible for the exchange, how it should operate and should it be an active purchaser,” says Laura Minzer, Executive Director of the Illinois Chamber of Commerce Health Care Council.

Being an active purchaser means a government board would select the insurance plans that would participate in the exchange.  By contrast, were the exchange to be an aggregator or facilitator, insurance plans would be able to sell on the exchange if they met all criteria established by the federal government, allowing consumers to use the exchange to choose among participating plans.

Examples have been established by two of the first states to create exchanges, Massachusetts and Utah.  The former is the more regulated active purchaser, the latter an aggregator.  “Utah is regarded as a kind of Travelocity of insurance exchanges,” Minzer says.  “A few other states are in the early stages of following the Massachusetts example. Each state’s insurance market is very different, Minzer says.  Market needs, demographics, who is uninsured and why they are uninsured are very different in each state.

“Utah can’t work here, Massachusetts can’t work here,” she says.  “It’s really a matter of taking the best features of other exchanges, and making sure they do work with what Illinois has, and that there are no coverage gaps.” The Health Care Reform Implementation Council’s set of recommendations was issued in February and is available here.

Better Health Care for West, South Siders

From his vantage point as council chair, Gelder says health reform’s mission is to bring more people under the umbrella of health insurance.  “That’s beneficial to providers, and people who currently have no health insurance,” he says.  “They’ll have access to better care.  Not just access to the emergency room care they have now, but access to preventive and primary care.”

Health care reform should also result in more coordinated care, an objective about which Hamos is enthusiastic. By providing for an integrated health delivery system, the era of reform will make for improved health care, and ultimately better health, for traditionally underserved west and south side Chicagoans, Hamos says.  “For people who have chronic health conditions, and other concerns like mental health, integrating care will provide for better health care and keep healthier those people already in Medicaid and those who will come into Medicaid,” Hamos observes.

Under the new health care law, more individuals will qualify for Medicaid or for health insurance, and if they’re low income, they will receive some subsidized support to buy their insurance, she adds.  “We believe there will be one million more people who will have access to private health insurance through the exchange, or public insurance through Medicaid,” she says. “These are people who have not had a doctor, or a health checkup, in many years.”

Everyone Can Help

Getting to this new paradigm will require a number of entities crucial to health care reform to come together.  That includes not just policymakers and other leaders in areas like Chicago’s west and south sides, but the general public itself.  “People on the west and south sides should see this as an opportunity to get health insurance,” Gelder says.  “They should also see it as an opportunity to make their elected representatives, both federal and state, hear that they’re enthusiastic about [reform], and that they expect us to deliver on that.”

The Illinois General Assembly created the Illinois Health Benefits Exchange Legislative Study Committee to develop legislation that will establish the Illinois health insurance exchange, Gelder says.

The committee, which includes as one of its prominent and influential members Illinois State Rep. Monique Davis (D-Chicago) from the 27th District including Chicago’s south side, is expected to issue a report by September 30, after hearing testimony from stakeholders and interested parties that include the insurance industry. “It’s very important that legislators know about this,” Gelder adds.  “They already know the health insurance industry cares, and wants to narrow the number of people benefiting from the exchange, which would increase the cost to those who would be eligible.”

West and south siders who would benefit from an exchange making it easy to access health insurance and choose among options have every reason to pay heed to the progress of the study committee.  “They should come to those meetings, and let their elected representatives know they want an exchange that’s broad, affordable and easy to access,” Gelder says.

Other entities will also play a role.  Employer groups and organizations such as chambers of commerce will be essential on the employer side, says Illinois State Rep. Frank Mautino (D-Spring Valley), Co-Chair of the committee.  In health care, the Illinois Hospital Association and the Illinois Medical Society will be active participants, Mautino believes.

But local leaders in west and south side communities will also have to play a role in helping educate constituents about reform, says Mike Koetting, deputy director for planning and reform implementation at the Illlinois Department of Healthcare and Family Services.  “At the point all this goes live in 2013, it will be important to turn out those who are newly eligible for the exchange or for Medicaid, and get them to apply,” he says.

“They may not have a lot of experience in buying insurance, so it’s important that community organizations are involved in helping educate them.”

Of crucial importance in assisting people in all communities, including the west and south sides, will be “navigators,” Hamos says.  “These are people who will help individuals get onto the website that will give them their options.  “With the help of the navigators, they will be able to sort through their options, which will be in very consumer friendly terms, allowing them to compare apples to apples and understand how it applies to them specifically.”

What West and South Side Leaders Can Do Now

Leaders in West and South Side communities, whether they are church leaders, community organizers, aldermen or other elected officials, can greatly contribute now to health care reform’s eventual success, according to Hamos.

“They can put the law in a positive light,” she says.  “Right now, it has a lot of negative energy around it.  Every day we’re hearing about repealing it, that it’s not going to work.  It’s hard to make the changes we hope to make without building some positives around it.”

One thing is certain.  Health care reform will “change how we’ve done business,” Illinois State Sen. Donne Trotter says.  Senator Trotter has been an advocate for affordable health care for low income families and has served Chicago’s 17th District for over 20 years. “Let’s make it simple for people, and they’re more likely to buy into it.  We have to simplify the language of insurance.”

Story by Jeffrey Steele,

Jeffrey Steele is an independent writer in Chicago who has researched and written more than 2,500 articles appearing in such publications as the Baltimore Sun, Barron’s, Boston Globe, Chicago Sun-Times, Chicago Tribune, Los Angeles Times, New York Newsday and others.

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Illinois Health Matters presented accessible, personal stories about how health care reform is impacting underserved communities on the South and West sides of Chicago. These stories were part of the Local Reporting Initiative, supported in part by The Chicago Community Trust.