Updates on health care reform in Illinois

November 2017

As we continue to fight for healthcare access and equity, we are grateful to all our partners and to each of you. Thank you for your support.

 A tense OE5 - and a short one
An anonymous but timely flier seen on Chicago storefront and lamp posts
Drama and anxiety attended the start of open enrollment period, which began with decimated funding for outreach and assistance and a ban on HHS staff participating in state enrollment event s

So far, though, the numbers have been surprising. HealthCare.gov enrollment is 47% higher than for the same period last year, and average daily signups by new consumers are up 53% over last year. T he trend in Illinois is similar. Awareness of the ACA may, in fact, have had an unintended boost from all the dramatic attempts to repeal it.

But despite this good news, the absense of TV ads and a concerted publicity campaign is having its effect. In a recent Kaiser survey, 3 in 10 respondents said they hadn't heard anything about open enrollment. Almost half said they've heard less about it than last year.

Less than a month now remains before the December 15th cutoff, so anything you can do to raise awareness in your county or your neighborhood - by all means, do it ASAP. ICHA has free materials you can request ( http://www.ilcha.org) - or make your own, like these enterprising Chicago leafletters did. Bless their hearts.

For updates follow @2018ACASignup and @GetUSCovered 

 Tax reform
This complex and rapidly moving initiative by congressional Republicans threatens to produce budget shortfalls that could imperil Medicaid and other health programs.  

The House passed their tax plan earlier this week. The Senate has their version through committee and a vote is expected after Thanksgiving. This attempt to repeal a key ACA provision in a tax bill is not without risks. Some Senators expressed concern about the tax bill because of the mandate repeal. Obviously, those concerns have worked their way to the White House. Just yesterday, administration officials signaled that they would consider dropping the provision in order to smooth the tax bill's passage through Congress. Yet even without this provision, serious concerns remain on how the administration would address the budget deficits created by the tax plan. If past actions are any indication, public program funding could be threatened.

 Elsewhere in health care access
CMS rule
A 365-page rule proposed by CMS late last month would give states and insurers great latitude on the essential health benefits provision of the ACA. The rule also proposes to let states relax the ACA requirement that at least 80% of premium revenue be spent on members' medical care.

CSR Payments
Judge Vince Chhabria of Federal District Court in San Francisco refused to issue a preliminary injunction requested by 18 states that sued to compel HHS to continue making the Cost Sharing Reduction payments, which the While House announced on October 13 would be stopped. Although a loss for the plaintiffs, the payment stoppage will have little immediate effect on purchasers of ACA plans, as the premiums they pay will not change. The underlying issue of whether Congress had appropriated fund for the CSR payments - raised in the the House v. Price lawsuit - has not yet been revisited.

In the wake of failure to repeal and replace the ACA, several legislative moves have taken shape. A bipartisan market stabilization effort by Sens. Lamar Alexander (R-Tenn.) and Patty Murray D-Wash.), halted by the repeal effort, resumed. (They are the chairman and and ranking member of the Senate Health, Education, Labor, and Pensions Committee). The CBO found that the package would reduce the deficit by $3.8 billion without taking away consumers' coverage options, and at last report, the bill had the support of a majority of the Senate. Meanwhile House Ways and Means Chairman Kevin Brady (R-Texas) and Senate Finance Chairman Orrin Hatch (R-Utah) offered a package that ties CSR payments to restrictions on abortion funding and would split coverage into an afforable "healthy" pool and a costly "sick" pool. Despite apparent progress of the Lamar-Murray stabilization package, there is concern that some of the ACA-undermining Brady-Hatch provisions could make it into an end-of-year that would woud be difficult counter due to including other, must-pass items.

 Medicaid in the crosshairs

HCBS. During the recent fights to save the Medicaid program from devastating cuts and fundamental restructuring, threats to critical home and community-based services kept looming over people with disabilities and seniors. Money Follows the Person was one such program, providing critical support for individuals looking to move from institutions to community settings.

Senators Rob Portman (R-OH) and Maria Cantwell (D-WA) plan to introduce a bill after the Thanksgiving break that would: (1) extend the Money Follows the Person program for five years at current levels; (2) reduce the 90-day period of required stay in an institution before qualifying for the program; (3) align qualified residence with the definition of HCBS setting; (4) enhance reporting; and (5) provide for accountability of MFP funds and best practices reporting.

DIA. The Disability Integration Act  (S910/HR2472) would require states and managed care organizations to provide the community-based services to prevent people with disabilities from being forced into unwanted institutionalization. Work is ongoing to clear up misconceptions such as the idea that unions and lawyers oppose the bill.  The Coalition for Community Integration has set up a website to collect stories to that make the case for DIA.

 News from our team

Last month, Health & Disability Advocates, which powers Illinois Health Matters, celebrated its 25th anniversary as a change agent and advocate for health access and health security. And with that milestone, came the launch of our new identity, Smart Policy Works. Read more

John Jansa
Health & Disability Advocates

Please forward this newsletter to friends or colleagues who are interested in how the ACA and other developments are impacting health care in Illinois with. If you have questions or suggestions, email us at info@illinoishealthmatters.org .
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