The Basics Healthy Illinois is a proposal for the state to: - - PDF document

www.healthyillinoisplan.com 1

Adequate Health Care Task Force March 29, 2006

Prepared by Citizen Action/Illinois

The Current System is not a System. To do nothing is not an option.

December 2005

Graham, Judith, “An Endless Wait for Health Care,” Chicago Tribune, Sunday Dec 25, 2005 Parsons, Christi, “Parents Roll Dice on I nsurance,” Chicago Tribune, Monday Dec 05, 2005

Prepared by Citizen Action/Illinois

The Basics

Healthy Illinois is a proposal for the state to: ▲ Working in partnership with private insurers, use the purchasing power of a massive risk pool to establish a statewide health insurance plan. ▲ Implement reasonable measures to control costs. ▲ Initiate new strategies for quality improvement.

HEALTHY ILLINOIS

Healthy Illinois, working alongside existing state programs like FamilyCare, KidCare, and All Kids, would make quality, affordable healthcare available to every man, woman, and child in Illinois.

Prepared by Citizen Action/Illinois

HEALTHY ILLINOIS:

An Integrated Approach

www.healthyillinoisplan.com 2

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Healthy Illinois Is Voluntary

▲ Individual and small business

participation is voluntary.

▲ Businesses and individuals can

keep their current coverage if they so choose.

Prepared by Citizen Action/Illinois

HEALTHY ILLINOIS

Prepared by Citizen Action/Illinois

HEALTHY ILLINOIS:

Individuals and Small Groups

▲ Small businesses, including not-for-profits ▲ Small municipalities ▲ Self-employed ▲ Individuals ▲ No pre-existing condition exclusion

Prepared by Citizen Action/Illinois

Affordability

▲Small businesses would be charged only 50%

• f the premium.

▲Discounts would enable individuals to join the Healthy Illinois Plan according to their ability to pay. ▲A single individual earning less than $27,930 and a family of four earning less than $56,500 would be eligible for discounts.

Prepared by Citizen Action/Illinois

Comprehensive coverage will include, at a minimum:

▲ Hospitalizations ▲ Mental Health ▲ Prescription drugs ▲ Preventive Care, including routine doctor’s

visits and disease screenings

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How much will it cost?

▲Revenue generated by assessment =

$400,000,000

▲Individual and Employer Discounts in year

• ne = $192,000,000 (50,000 enrollees @

$3,840 discount per year)

▲Administrative = $100,000,000 in year one ▲Reserve = $108,000,000

www.healthyillinoisplan.com 3

Prepared by Citizen Action/Illinois

Single mother earning $32,000/year (250% FPL)

• Total premium = $400 per month for employee
• nly
• Employer Discount (50%) = ($200 per month)
• Employer Pays (60%) = $120 per month
• Employee Discount (40%) = ($48 per month)
• Employee Pays = $72 per month

Prepared by Citizen Action/Illinois

HEALTHY ILLINOIS

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Key Cost Containment Measures

▲ Review of insurance rates. ▲ Ensure healthcare facilities’ major expansions are

consistent with state health goals.

▲ Reduce the unpaid cost of care for the uninsured,

thereby limiting the degree to which such costs are passed on to consumers with health insurance. In Illinois, over $1.8 billion passed on to consumers with health insurance in 2005.

▲ Public reporting of providers’ and insurance

companies’ cost increases and profits.

The Added Cost of Care for the Uninsured

(Families USA, June 2005)

$1,059

Total Family Premium: $11,762 Uncompensated Care: $1,059

HEALTHY ILLINOIS

Prepared by Citizen Action/Illinois Prepared by Citizen Action/Illinois

Illinois Quality Forum –

Quality Improvement Functions

▲

Promote nationally established best practices to eliminate some of the regional, economic, and racial disparities in the healthcare system.

▲

Establish incentives for consumers to adopt healthier lifestyles: health club discounts, 100% coverage of preventive care, smoking cessation programs.

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HEALTHY ILLINOIS: Financing

Prepared by Citizen Action/Illinois

Funding Sources

▲ Employer contributions ▲Individual contributions ▲Windfall Profit Assessment

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Windfall Profit Assessment

▲ Insurance companies pass on to consumers the unpaid cost

care for the uninsured (“uncompensated care”). In Illinois, insurance companies inflate premiums by 9-10% to reimburse themselves for uncompensated care.

▲ Under Healthy Illinois, the cost of uncompensated care

will be reduced because more people will have health insurance.

▲ Insurance companies will continue to charge the inflated

premium and thus will enjoy an unexpected profit (“a windfall”).

▲

A portion of the insurance companies’ windfall will be used to help fund discounts for lower income people. This assessment is known as the “Windfall Profit Assessment.”

Prepared by Citizen Action/Illinois

NEXT STEPS

▲ Meetings with stakeholders ongoing. ▲ SB 2561 is on second reading in the Senate.

Deadline extended to January 9, 2007.

▲ My contact info: 312-427-2114 xt. 114,

brent@citizenaction-il.org