Posted by on April 2, 2013 - 11:48am

Beginning in 2013, states will begin rolling out health care insurance exchanges as required by the Affordable Care Act (ACA). To this point most legislators, policymakers and health care experts have discussed the state-based and federal insurance exchange options at length. However, there is another form of insurance exchange that states are beginning to explore, and will soon be implemented in Illinois: the “partnership”.

In the state-federal partnership, states will divide obligations with the federal government. For this partnership model there is no requirement for a 50-50 split of labor, and the states are actually more of a facade whereby the consumers (individuals and employers) merely interact with the state. The federal government, on the other hand, will essentially perform all functions of exchange management except customer service and/or plan management. Moreover, states have the choice to run either one or both of those functions. According to former head of insurance exchange planning at HHS Joel Ario, “States that choose this option are ceding the more technical aspects of exchange activity to the federal government but can retain control
 of insurer oversight and consumer assistance.”

In the state-federal partnership model, the federal government will operate everything from consumer eligibility and enrollment to financial management and risk corridors. This essentially means that the federal government will take on most responsibility for the exchange, while granting states many of the perks they would receive if they had created a state-based exchange.

To date, only a few states have revealed that they intend to participate in a state-federal exchange. Here in Illinois, Governor Pat Quinn announced intention to run a partnership exchange in July of 2012. Since that announcement, the state has already received $39 million for the state, and this sum does not include monies issued for Medicaid expansion.

Currently, the Department of Health and Human Services (HHS) has written very little about this vague “partnership,” leaving many in Illinois wondering exactly what the collaboration will look like and how consumers will respond. The only known is that beginning in 2013, Illinois will embark down a new path for getting health care insurance to its citizens, and that will be facilitated through an exchange.

Posted by on February 25, 2013 - 7:36am

During a visit with Illinois Governor Pat Quinn on February 13,  Health and Human Services (HHS) Secretary Kathleen Sebelius announced that Illinois has been conditionally approved to operate a State Partnership Marketplace (Exchange), which will be ready for open enrollment in October 2013. This partnership will allow Illinois to make key decisions and tailor the marketplace to local needs and market conditions.

“I applaud efforts by Illinois to build a new health insurance marketplace,” Secretary Sebelius said.  “Working together, we will be ready in eight months when residents of Illinois will be able to use the new marketplace to easily purchase quality, affordable health insurance plans.”

“Here in the home state of President Barack Obama, we are forging ahead to make the promise of the Affordable Care Act a reality,” Governor Quinn said. “Access to decent health care is a fundamental right. Hundreds of thousands of people in Illinois will gain quality health coverage through the Health Insurance Marketplace. They will also gain the peace of mind that comes from knowing that the care will be there if they need it. We are going to be working very hard between now and October 1st to educate the people of our state about the health care coverage options they will have through the Marketplace, thanks to President Obama's leadership.”

With today’s conditional approval of Illinois, twenty states and the District of Columbia have been conditionally approved to partially or fully run a marketplace – with the remaining states having until Feb. 15, 2013, to apply for a State Partnership Marketplace.

Because of the Affordable Care Act, consumers and small businesses will, beginning next January, have access to a new marketplace, where they can access quality, affordable private health plans.  These comprehensive health plans will ensure consumers have the same kinds of insurance choices as members of Congress, and will not be able to be denied coverage because of a pre-existing condition.

Consumers in every state will be able to buy insurance from qualified health plans directly through these marketplaces and may be eligible for tax credits and cost sharing assistance to help pay for their health insurance and out of pocket costs.

For more information on the new health insurance marketplace, visit:

Posted by on September 13, 2012 - 7:56am

This week a public meeting will be held in Chicago to determine which Essential Health Benefits (EHB) Illinois will cover in future health insurance plans. The Affordable Care Act has tasked each state with creating a set of EHB, which are a comprehensive package of health benefits.

Beginning in 2014, all health plans are required to begin offering the EHB to beneficiaries in the individual and small group markets. These state-based benchmark decisions are due by September 30, 2012, and could eventually affect nearly 70 million Americans, many of whom are women. The law mandates that 10 basic categories must be covered. These inlcude:

1. Ambulatory Patient Services

2. Emergency Services

3. Hospitalization

4. Maternity and Newborn Care

5. Mental Health and Substance Use Disorder Services

6. Prescription Drugs

7. Rehabilitive and Habilitive Services

8. Laboratory Services

9. Preventative and Wellness Services and Chronic Disease Management

10. Pediatric Services

Governor Pat Quinn will choose a benchmark plan that will then serve as the mandatory minimum for insurance plans in the state. The greatest importance of these EHB decisions will be the amount of coverage required in each category and the costs of insurance due to those new requirements. At first glance, it might seem the package of services related to maternity and new born care will have the most impact on women, however, it is likely that the mental health and substance use disorders services may be most needed given that women are far more likely to suffer from a wide range of anxiety disorders and depression. Despite enthusiasm for more even coverage and plan equality, the minimum categories will require that almost all insurance plans offer more than they do at present, certainly impacting the cost of health insurance.