CHICAGO (AP) — Illinois lawmakers soon will face two critical decisions over how to fully carry out President Barack Obama's health care overhaul.
With attention turning in 2013 to how states will implement the health law, Gov. Pat Quinn is pushing legislation to establish a state-run health insurance exchange to help middle-class citizens and small businesses, along with a multi-billion-dollar expansion of Medicaid to cover the poor. While the state's Democratic leaders generally have supported the new health care law, neither proposal will be a slam dunk for passage.
Consumer groups and the insurance industry are warring over whether the state should be able to negotiate with insurers to get lower premiums for people participating in the health insurance exchange. It's not clear where the governor stands, but it would be difficult to pass a bill over the industry's objections.
Quinn is expected to get support from the hospital industry and major insurance companies for the Medicaid expansion, since it involves bringing billions of federal dollars to the state, but some legislators object in principle to such an expansion of government programs. States do not have to expand their Medicaid programs under a U.S. Supreme Court decision issued earlier this year.
The Medicaid issue could be addressed when the legislative session begins Jan. 2, before several dozen lame-duck lawmakers leave office.
With or without new legislation, the Quinn administration has signed up for an initial partnership with the federal government to run an insurance exchange — a sort of Travelocity for health insurance — for coverage starting in 2014. Illinois residents will be able to comparison shop for insurance plans starting Oct. 1.
Here's a look at the issues lawmakers will face as they consider their votes:
Q. Who would get insurance coverage under the Medicaid expansion?
A. Starting in 2014, an estimated 500,000 to 600,000 uninsured Illinois residents would be newly eligible for coverage by Medicaid, the government health program for the poor and disabled. Most of them would be low-income adults without children at home.
Hospitals and clinics would benefit, too, because they would get paid for care they now provide free or write off as bad debt.
Left out, however, would be illegal immigrants. People living in the United States without permission wouldn't be eligible for Medicaid or, for that matter, any other coverage offered in the new health insurance exchanges.
Health-care advocates hope to persuade Illinois lawmakers, district by district, of the personal impact of the Medicaid expansion. One group analyzed Census data to estimate the number of people who would benefit in each Illinois legislative district.
"What is clear is there are low-income, uninsured people in every district from Chicago to downstate Illinois," said Stephani Becker, of the Chicago-based Health and Disability Advocates.
Q. How much would the Medicaid expansion cost the state?
A. The federal government would pay the entire cost of expanding Medicaid to newly eligible Illinois residents for the first three years starting in 2014. The federal share falls to 90 percent by 2020, with the state paying the rest.
State costs would mount to more than $2 billion through 2022, according to a November report from the nonpartisan Kaiser Commission on Medicaid and the Uninsured, which estimates the expansion would bring another $22 billion in federal money to the state during that time.
The powerful Illinois Hospital Association says that extra money would create jobs.