CHAMPAIGN — Patient advocates are celebrating the U.S. Supreme Court's decision to uphold the basic provisions of the Affordable Care Act, but a local insurance executive warns it will likely result in higher coverage costs for those under 45.
Jim Duffett, executive director of Illinois-based Campaign for Better Healthcare, said when he heard the ruling, he also heard a "collective sigh of relief" among Illinois residents that means they'll have some peace of mind about their health care.
"We are definitely elated that the Supreme Court upheld Obamacare," Duffett said. "Their decision today helps to strengthen our nation's social fabric and does provide hope that constitutional law and democracy do matter."
Now, he said, it's time for Illinois Gov. Pat Quinn and the General Assembly to get to work moving ahead on the state's insurance exchange.
"They've done nothing to move it forward at all," Duffett said. "They have not had the guts to do it."
The state exchanges being established under the health care reform law are intended to create a more organized and affordable market for one person or family and small employers to purchase health insurance.
State Sen. Mike Frerichs, D-Champaign, declined to comment on the court's decision, but said Illinois' health exchange "is something the General Assembly will have to address for the next year or so."
Meanwhile, Urbana-based Health Alliance Medical Plans CEO Jeff Ingrum said Health Alliance has been working with a consultant and is prepared to implement the new law.
That's meant getting ready to respond to a new marketplace, selling coverage to individuals instead of large groups, he said.
Health Alliance currently has about 20,000 individual members, and projections call for the individual coverage market to triple in a short time after the exchanges are up and running on Jan. 1, 2014, Ingrum said.
"We do expect a significant number of uninsured people will come into the exchange," he added.
Ingrum also said he and his company will continue to seek changes to fix problems they see in this massive law.
"We do think this ruling today does not solve the problems for people who want to buy affordable insurance, because the act still has problems related to the cost of insurance," Ingrum said.
For example, he said, health insurers will be prohibited from denying anyone coverage based on pre-existing conditions starting Jan. 1, 2014. And for healthy people, Ingrum predicts, it will be much cheaper to pay the tax to opt out of mandated coverage and simply buy coverage when they get sick and need it.
The penalty tax is $95 in 2014, $325 in 2015, and $695 in 2016.
Ingrum also said the law narrows the gap between what younger and older people can be charged for coverage.
"So, insurance rates for the younger people between 18 and 44 are going to go up dramatically, while rates for people over 44 are going to go down," he said.
Ingrum said he also anticipates an increase in the federal deficit if many states opt out of participating in the expansion of the Medicaid program and more people enter health exchanges through federal subsidies.
The Medicaid expansion is intended to expand health coverage for lower income people, but the court declined to force states to participate in the law's large Medicaid program expansion under threat of losing their existing federal Medicaid funding.
Champaign County Health Care Consumers Executive Director Claudia Lennhoff says she thinks Illinois would be foolish to turn down a chance to participate in the Medicaid expansion.
It will be funded at a much higher rate than existing Medicaid, she said, "so even though Illinois has made cuts in is current Medicaid program, that doesn't mean the state will not take the expansion, because most of it will be funded by the federal government."
In all, Lennhoff said, the court's ruling was good news.
"We're very excited and very happy with this news, and I think what it means is, we get to move forward with implementing health reform."
Just some of the reforms already in place, she said: Young adults can already remain on their parents' insurance until they're age 26; the "doughnut hole" in Medicare drug coverage has been shrinking, and Medicare recipients have been getting preventive health services without copayments. Many health insurance reforms, such as making it illegal to cancel insurance coverage when someone gets a serious illness, have already been put into place, she said.
"It would be terrible to go back to the days without protections," she added.
Lennhoff said there are about 50,000 people without health insurance in Champaign County.
"I think most people will welcome the opportunity to become insured," she said.
Along with Duffett, Lennhoff says there's work that needs to be done in Illinois at the technical level.
"Not there's no excuse for not moving forward," she added.
Local hospital officials had mixed reactions about the ruling.
Deb Schimerowski, chief financial officer for the Provena hospitals in Urbana and Danville, said Provena hospital officials are pleased with the outcome.
Many benefits have already been provided under the law, she said, and now more patients will have access to coverage — an issue that stands to have a large financial impact on the two hospitals.
Last year, Provena Covenant Medical Center provided $6.1 million in charity care to needy patients and Provena United Samaritans provided $4.1 million, she said.
Covenant absorbed another $8.7 million in bad debts last year, and United Samaritans covered $10.8 million.
"So it's a real issue for us for patients to not have health insurance available to them," Schimerowski said.
Carle Foundation Hospital released a written statement, saying it will take some time to determine how the court's decision will unfold and acknowledging that it sees challenges ahead.
"While many will debate the Supreme Court decision to uphold the Affordable Care Act, it cannot be denied that improving the quality of care while also controlling the cost of care must continue to be priorities," the statement says.
Carle says it delivered care at discounted charges to 14,000 patients last year.
The Illinois State Medical Society called the ruling "good news," but said much work remains before the nation's health care system can be truly considered "reformed."
The doctors organization said it sees significant challenges remaining in Illinois' struggling Medicaid program, upcoming Medicare reimbursement cuts for physicians and a need for medical liability reform.