$5 million is just the beginning of Illinois’ health care exchange costs

August 24, 2011

By Benjamin Yount | Illinois Statehouse News

SPRINGFIELD — Illinois is touting a $5 million federal grant to set up health-care exchanges as part of the national health care law, but residents may not have access to an exchange for a couple years.

Illinois wants to have an exchange ready for federal review by 2013, said Kate Gross, assistant director for health planning at the Illinois Department of Insurance. If Illinois fails to set up its exchange by January 2014, it will be required to use an exchange chosen by federal officials.

The $5 million, Gross said, will be spent "on groups of consultants or firms to … begin to help (us) truly figure out all of the pieces that we're building."

These consultants or firms will write a report for lawmakers that details how the state should proceed to create a health-care exchange, Gross said.

A handful of full-time state employees in the Department of Insurance also are working on the exchange project, but Gross said more outside help is needed.

Illinois has spent $1 million on consultants to study Illinois' health insurance needs, but Gross said the state needed additional consultants to discern where to begin.

That report, provided by Wakely Consulting Group, a private consulting group from from Boston, suggests broad goals, such as using technology to identify under-insured populations and foster a competitive health-insurance marketplace.

But the report does not suggest how the state can accomplish these goals. Lawmakers are going to have to decide how to follow up on the report's vague goals.

The federal Patient Protection and Affordable Care Act’s health insurance exchanges are intended to help consumers shop for coverage in the same way airline travelers look for airfare bargains online.

"An exchange is a store to purchase health insurance," Gross said. "It will have a lot of encounters with people that will have to be addressed. It will have a policy shop, it has to have finance people, it has to have lawyers, and actuaries. But it doesn't have to have hundreds of those people."

Gross said the consultant or firm paid $5 million must address whether Illinois' health care exchange will be part of state government, quasi-public or nonprofit.

"How (the exchange) operates, its legal structure, its reporting structure, how it's governed, how it's permitted to make decisions, the amount of accountability to the people of Illinois — all of that is what the legislative study committee is charged with studying," Gross said.

The Legislative Commission on Government Forecasting and Accountability held its first study committee meeting Wednesday morning in Chicago. The lawmakers discussed a number of topics, but did not arrive at any solutions. The commission is expected to meet next week here.

Legislation signed by Gov. Pat Quinn in July started Illinois toward the health-care exchanges. SB 1555 requires businesses with less than 50 employees to spend at least $2,750 per employee on health insurance for their workers. The legislation also sets an October 2013 deadline, but does not specify how the exchanges will be governed.

Until a health-care exchange is finalized, and up and running, Jamie Lewis is not going to worry. Lewis and her husband, Troy, own Heritage Landscape and Design in Moline.

"You never know what's going to happen until it gets put through,” said Lewis.

Lewis said her firm, which employs about 26 people for landscape design and hardscape work, pays for about half of the health insurance bill for its workers, but she did not specify the actual amount.

If the health-care exchange doesn't deliver cheaper alternative, Lewis said, “we'll just hire less people," but she won’t be laying off any people.

Kim Clarke Maisch, the Illinois director for the National Federation of Independent Business, or NFIB, which lobbies and advocates for small- and medium-sized businesses, said those kinds of decisions are what she hopes lawmakers keep in mind, as they craft Illinois' health-care exchange.

"Who gets to be part of the exchange? Are employers going to have to pay for part-time workers?" Maisch said. "There's a lot of technical things, but very important aspects to the exchange that will make it or break it."

Maisch said she and her group are not opposed to health-care exchanges. But some private groups, including NFIB, and several states, not Illinois, have filed a lawsuit against the federal government over the requirement that people buy insurance. Opponents of the law say it's unconstitutional for the government to force someone to buy health insurance.

A federal court in Atlanta earlier this month ruled that the mandate went beyond Congress' power. The ruling is the second on the federal health care law. The first upheld the mandate.

Costs for the exchanges are likely to vary from state to state, depending on how they build their exchanges.