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Illinois Needs to Protect Consumers in Wake of Land of Lincoln Debacle

The liquidation of Land of Lincoln Health is just the first of mounting hurdles for Illinois consumers and small-business owners shopping for health insurance coverage in the Affordable Care Act marketplace.

Not only do Illinois consumers wait longer than others across the country to see annual rate increases, but they also have fewer resources to help navigate the marketplace. The state's budget morass means the two state agencies charged with protecting consumer interests and helping consumers connect with coverage options—the Department of Insurance and Get Covered Illinois—are underfunded and ill-prepared to serve the public.

Who will protect consumers' interests in the demise of Land of Lincoln? We keep hearing that the state's insurance department doesn't have the staff to provide information on rate increases to the public until Aug. 1 (even though the department received them from insurers in April). If regulators can't meet the requirements of the ACA in a timely manner, how will they manage the liquidation details for Land of Lincoln? Can consumers count on them to answer critical questions about their now-defunct Land of Lincoln plans?

Questions like: Should I keep paying my premiums to Land of Lincoln? (Yes, you should if you want to be eligible for the special enrollment period plan holders will be offered.) Will I be able to find another plan with my providers in the network at the same price point? What happens if I already met my deductible with Land of Lincoln? Will that carry over to the new plan? And, who will help me find a new plan? Because Get Covered grant funding to help consumers is gone, and insurance carriers reduced or eliminated broker commission for working with clients, Illinois consumers are left with fewer resources when faced with complex health insurance decisions.

We should all be watching how the Department of Insurance addresses the needs of Land of Lincoln policyholders. When Blue Cross & Blue Shield narrowed its networks offered in the marketplace, thousands migrated to Land of Lincoln because of its broader networks with academic medical centers like the University of Chicago. The loss of Land of Lincoln leaves consumers and small-business owners worrying about continuity of care—for themselves and their employees.

This development ensures one thing for the upcoming open enrollment season: Illinois consumers and small businesses will have even less choice, and fewer affordable options that cover a broader network of health care providers.

How the Department of Insurance responds to this crisis is important for all Illinois consumers. We only hope the Rauner administration redirects resources to make sure the Department of Insurance can do its job and do it well.


Barbara Otto and Michelle Thornton Health & Disability Advocates

Reprinted with permission from Crain's Chicago Business

Small Employers: Take Another Look at Wellness Programs

Small employers want a healthy workforce but wonder how and if they should promote healthy
behaviors among their employees.  Trends show that larger employers, who typically self-fund their health insurance programs, find a direct link between the benefits of wellness programs and their health insurance bottom line.  This provides clear motivation for internal programming and incentives to keep employees fit, eating healthy and smoke-free.  For small employers who traditionally provide fully insured health insurance programs, the direct return on investment from implementing a wellness program may be less obvious.

The Return on Investment

Research has consistently shown that unhealthy employees are less productive and take more sick days. In 2010, The Harvard Business Review made a compelling argument in favor of worksite wellness programs. In the programs they highlighted, they found improved health status, fewer sick days and workers' compensation premiums declining by as much as 50%.  Even though small employers are faced with a highly regulated premium environment because of the Affordable Care Act (ACA), wellness programs might allow small businesses a solution for lowering workers' compensation costs.

Healthy Employees, Happy Employees

The Centers for Disease Control and Prevention (CDC) identifies several ways that both employers and employees can benefit from work-based health programs.  At the top of their list for employees: increased well-being, self-image and self esteem.   This kind of indirect impact on the employee psyche can boost morale, reduce turnover and ultimately improve productivity. Calculating the cost of employee turnover can be tricky for a small business, but some estimate it to be between 150 – 175% of the annual salary depending on the job level.

The question for small employers comes down to the bottom line.  The actual cost of employer wellness programs can vary greatly. Questions to consider as you begin exploring the feasibility include:

• Will the program be run in house or using an external vendor?
• How extensive will the health interventions be?
• Will you include health screenings?
• What type of employee incentives will be provided?

In addition, small businesses may not be aware that the ACA has created new tax-based incentives for qualified employer wellness programs.   There are rules to comply with, as plans must be reasonably designed to “promote health or prevent disease.”  Additionally they must be made available to all “similarly situated” employees.  For more details see this Department of Labor Fact Sheet.

Small Scale Ideas Make a Big Difference

Still unsure about incorporating a more comprehensive wellness initiative into your business model? Some small scale initiatives can make a big difference.  Even something as simple as extending lunch hours can give employees time to make lunchtime fitness practical and possible.   Rather than allowing employees 30 minutes to grab a burger and fries, 90 minute lunch slots offer employees time to hit the gym. Small changes like this can give a boost to employees and the small business as a whole.

Worth the Time to Investigate

Small employers have a lot to consider when it comes to how to allocate their health related workforce dollars.  Finding a little room in the budget now as well as spending some time re-thinking a few basic workplace rules could ultimately pay off.   Proven reductions in workers' compensation premiums, employee turnover rates and new ACA tax incentives make it the perfect time for small employers to give worksite wellness programs a closer look.

Michele Thornton MBA
Insurance and Benefits Consultant



Illinois Dodges Disaster on Supreme Court's Obamacare Ruling

The following originally appeared on Crain's Chicago Business.


Illinois just dodged a bullet with the outcome of King v. Burwell. If the Supreme Court had ruled against subsidies being challenged in the case, working people and families in the state collectively would have lost more than $49 million a month to help purchase health insurance.

In its decision, the court affirmed the legality of the provision of premium tax credits under the Patient Protection and Affordable Care Act in all states, whether they established their own health insurance marketplace or used the federal marketplace. On average, working poor and middle-class Illinoisans are getting $211 monthly to help pay their health insurance premiums. A different decision would have meant a 169 percent increase in out-of-pocket expense on the average premium.

Recent data by the Kaiser Family Foundation show nearly 73 percent of the remaining uninsured in Illinois eligible for Get Covered Illinois, the state's health insurance marketplace—roughly 597,473 people—live and work in metropolitan Chicago. In the Chicago area, more than 100,000 of the remaining uninsured reside in areas where English is not the predominant spoken language. While concise data are not available of how many of the uninsured are working, American Community Survey data indicate that as many as 62 percent of the uninsured in Illinois are working at least part time and more than likely work for small businesses.

The most recent year for which U.S. Census data on businesses are available, 2012, show 314,199 business establishments in Illinois. However, 94 percent of these companies employ fewer than 50 employees and thus are not required to provide health insurance via the ACA. Cook County alone accounts for 41 percent of the state's total small businesses.

NOW WHAT?

Now that the King v. Burwell decision has put the legality of subsidies to rest, Illinois needs to get busy enrolling the remaining 597,473 uninsured individuals eligible for a path to coverage in the Get Covered Illinois marketplace. Of these uninsured, 283,629 are eligible for a tax credit or subsidy.

It's a matter of economic security for our residents and for Illinois' economic environment. The math tells us that the business community—especially small businesses—needs to be at the heart of efforts to enroll the remaining uninsured. Crain's and Health & Disability Advocates surveyed small businesses last fall and learned that Chicago-area companies still face increasing health care costs; are confused by the requirements of the ACA; and are unlikely to enroll themselves and their employees online. In fact, more than 80 percent of those surveyed said they shop for health insurance for themselves and their employees using health insurance brokers and agents.

Now that federal funding for ACA assisters and navigators is ending, a public-private partnership for enrollment in Get Covered Illinois is critical. We need to double down on engaging health insurance brokers and agents. While the state did an amazing job in enrolling 633,757 adults in Medicaid as part of ACA, Illinois ranked well behind others in marketplace enrollment, coming in 20th out of 37 states that operate marketplaces using HealthCare.gov.

Get Covered Illinois is key to helping Illinois businesses thrive, enabling them to better attract and retain talent. The marketplace also encourages entrepreneurship by ending the reliance of individuals on larger employer-sponsored coverage.

A strong ACA marketplace is a win-win for the business community and the state. We urge Springfield, City Hall and county governments to make enrollment of the remaining uninsured a top priority and engage the business community, health insurance brokers and agents in the process.

Barbara Otto                                          
CEO                                                        
Health & Disability Advocates           

Erica Salem
Director of Strategic Health Initiatives
Health & Disability Advocates

Employer-Sponsored Health Insurance Staying Steady

Rates of employer-sponsored healthcare have not declined since the implementation of the ACA, according to Fredric Blavin, a Senior Research Associate at the Urban Institute’s Health Policy Center. These findings, published in the January 2015 issue of Health Affairs, are based on his analysis of the Health Reform Monitoring Survey. Researchers at the Urban Institute administered this survey to workers between June 2013 and September 2014, asking if they are/were employed and if they are/were offered employer-sponsored health coverage. Analysis of these national data, displayed in figure 1, suggests that rates have remained statistically constant. The pre-existing and new ACA economic incentives for workers to obtain coverage from employers remains strong; the feared erosion has not yet materialized.


Massachusetts An Early Example

Earlier studies on Massachusetts’ employer-sponsored insurance market support Blavin’s findings. Between fall 2006 and fall 2009, a period of time which included adoption of the state’s health reforms, the rate of employer-sponsored insurance increased by 3%.

ACA Provisions Prevented Downward Direction

Incentives in the healthcare law have restrained the predicted drop-off in employer coverage. Provisions, such as ongoing preferential tax treatment of premiums through payroll deductions and the mandate to provide coverage for businesses with 50 or more workers, have persuaded employers to continue offering plans.

But Small Firms Are Left Out

One notable result from this survey is the nagging imbalance between large firms and small firms offering coverage.  Although mechanisms like the small employer tax credit and the SHOP Marketplace are meant to close this gap, small businesses have not taken advantage. Outreach and education with small businesses represents a large opportunity for insurance coverage expansion.   Small employers need information to understand provisions of the ACA in order to provide health insurance options to this growing workforce.

Michele Thornton, MBA
Insurance and Benefits Consultant


Illinois Small Businesses Should SHOP for 2015 Health Coverage

Small business owners: are you considering all available options to find a health insurance plan that works best for your business and employees?

One resource for Illinois small business owners is the Small Business Health Insurance Options Program, or SHOP, where employers can compare group health insurance options. The SHOP is open year-round for small employers to browse, compare plans, and fill out applications online.

The Benefits of SHOPping Around


Buying health insurance through the SHOP can help small businesses save money. According to the Robert Wood Johnson Foundation, total spending on healthcare by small businesses will decrease by 8.7% because of provisions in the healthcare law. Small employers that offer coverage through the marketplace may be eligible for a tax credit that can cover up to 50% of their employees’ premiums. The Small Business Majority’s tax credit calculator shows if small businesses are eligible for the credit and how much money they could receive.

There are even more benefits to buying a SHOP plan, because small businesses will no longer be charged more for female workers, who had been paying up to 50% more for their premiums before the healthcare reform law. In addition, employers will no longer pay more for workers with pre-existing conditions and will benefit from new limits regulating health insurance costs for older workers.

Health & Disability Advocates, a non-profit with 16 full-time employees, is an example of a small organization that used the SHOP and found a better deal. Both HDA and its employees gained – the non-profit is now spending approximately $20,000 less on healthcare, while its workers have lower premiums and have access to a wider network.

The Downside of Sticking With Your Current Plan


As many as 80% of companies with up to 50 employees opted to renew their non-compliant plans for 2014, and a similar percentage will likely try to do so this year. Small business owners who decide to renew their old plan may not save money and may instead see a price increase for 2015. This is why investigating all health insurance options, including those offered through the SHOP, could benefit small businesses. Many could save money by purchasing a plan through the health insurance marketplace, or through selecting a plan with better coverage for about the same cost.

How to Start


In order to begin the enrollment process and explore options, Illinois small businesses can visit the SHOP online, or contact a certified health insurance broker to assist with the enrollment process. The more small business owners know, the easier it will be for them to get their employees more-affordable insurance coverage. Once owners have found a reasonable option for their small business, they can stop worrying about health insurance and do what they do best – run the companies that make up the backbone of our state and our nation.

Jesse Greenberg
Director, West and Midwest
Small Business Majority

Small Businesses in Illinois Lack Knowledge of What the ACA Has to Offer Them

With Illinois granted early access to the Small Business Health Options Program exchange, or SHOP, small businesses in the state already have the opportunity to familiarize themselves with a new online resource for purchasing health insurance for their employees.

For those that qualify, purchasing health insurance through the SHOP exchange can represent a smart business decision. They can receive tax credits covering up to 50% of their contribution to employee premiums, plus the SHOP allows small businesses to combine their purchasing with other small businesses to keep costs low.

The healthcare law does not require small businesses with fewer than 50 full-time equivalent employees to provide health insurance. Because 94% of businesses in Illinois employ fewer than 50 people, a large majority are exempt from offering health insurance.

The SHOP was meant to minimize the number of people left out of health reform by helping small businesses provide health insurance anyway, with tax credits and collaborative purchasing power incentivizing this option by keeping costs lower.

But to what extent are small businesses taking advantage of the SHOP? Health & Disability Advocates and Crain’s Chicago Business teamed up to find out and conducted a survey of small business owners. The results are documented in a recently released report from Health & Disability Advocates and an article in Crain's Chicago Business.

The survey found that small businesses are not using the SHOP to purchase health insurance and are largely uninformed about it:

  • Fewer than 18% of small business owners said they had learned “a lot” or a “a great deal” about the SHOP.
  • Only 11% took advantage of the small business healthcare tax credit.
  • And finally, 31% of small businesses surveyed said they did not know whether they were receiving the small business healthcare tax credit.

These findings mirror national trends. In a national survey by the National Small Business Association, 8% of small business owners reported they would use the SHOP to buy health insurance. Similar figures from the Kaiser Family Foundation were cited in a recent blog post at The New York Times.

Small businesses would gain from outreach and education on benefits of the SHOP and how to use this resource. Informing the business owners about the SHOP would equip them with information that they could use to enroll their employees in health insurance, an important benefit that helps in retaining and attracting workers.

Since small businesses overwhelmingly rely on brokers when purchasing insurance, the broker community could be a resource in outreach and education efforts. Indeed, brokers are increasingly viewed as vital partners in healthcare outreach and enrollment efforts. For example, during the first enrollment period they played a key role in the famously successful effort in Kentucky. Partnering with brokers to conduct outreach can help increase the numbers of small businesses that offer health insurance – and the number of individuals enrolled in healthcare.

The bottom line is that small businesses in Illinois are not aware of the Small Business Health Options Program, the tax credits available to them, or other ACA provisions that could benefit them. For us to effectively reach these important job creators and help them take advantage of these provisions, we must engage the broker community to provide this new outreach and education to their existing clients.

Bryce Marable, MSW
Policy Analyst
Health & Disability Advocates

Illinois Entrepreneurs and Small Business Need SHOP Employee Choice

Illinois is one of 18 states recently granted a delay by the Department of Health and Human Services for the employee choice feature of the small business health options program marketplace, or SHOP.

But what exactly is employee choice, and why is this important to small business owners? Below are some frequently asked questions and answers to help small employers learn more about this crucial provision of the SHOP.

Q: Just what is employee choice?
A: Employee choice is a feature of SHOP that allows small business workers to choose from a number of plans from different insurance carriers. The employer chooses a healthcare plan tier level (bronze, silver, gold and platinum), and the employee then chooses among a variety of health insurance carriers within that tier.

The healthcare plan tier level is based upon what percentage of healthcare costs a plan will cover. For bronze plans, insurers pay 60%. For silver plans, insurers pay 70% of healthcare expenses. Gold plans pay 80% and platinum plans pay 90%. The employee choice option is important to employers and their workers because it allows employees to pick a plan and carrier that works best for their needs, instead of the business owner choosing for them.

Q: Why is the employee choice feature important to small businesses?
A: By including employee choice in the SHOP, the Affordable Care Act reverses a longstanding market trend that left small employers on unequal footing. These kinds of benefits have historically been reserved for large businesses and public employees, while small businesses often have to offer a “one-size fits all” plan with added cost and fewer benefits.

Based on Small Business Majority’s opinion polling, it is clear small business owners want to offer this to their employees. The Small Business Majority found two-thirds of small employers believe allowing employees to choose from multiple carriers is an important element of the SHOP. And for small businesses, this component is fundamental in distinguishing the new SHOP marketplace from the outside health insurance market.

Q: What impact does the delay of employee choice have on Illinois’ small businesses?
A: The HHS final rule allowing states to opt out of employee choice for yet another year harms small businesses because it puts them at a competitive disadvantage to large firms that are able to offer a choice of plans to their employees. In states like Illinois, where the SHOP marketplace is run by the federal government, allowing further delay of employee choice puts small businesses at a competitive disadvantage to small employers in other states where marketplaces have employee choice.

Q: When will Illinois small businesses have access to employee choice through SHOP?
A: Barring any further delays, Illinois will implement employee choice in 2016. Employers will then be able to offer the additional benefit of allowing their employees to choose which insurance carrier they’d prefer to use for their health insurance.

While the Administration’s decision to allow states to delay employee choice for an additional year was a letdown for small business owners, the SHOP still helps small employers compare and evaluate health insurance options and get the small business tax credit to help with employee premiums.

Learn more about the SHOP, employee choice and enrollment by reading the Small Business Majority’s Health Coverage Guide which contains a wealth of information for small business owners regarding enrollment, the Affordable Care Act, and the healthcare system.

Jesse Greenberg
Director, Midwest and West
Small Business Majority


Illinois Granted Early Access to SHOP Marketplace

Yes, the Affordable Care Act offers individuals and families quality health insurance, but did you know small employers with less than 50 full-time equivalent employees can take full advantage of the Health Insurance Marketplace? Online functionality for the SHOP, aka the Small Business Health Options Program, is available starting later this October as part of SHOP early access, which is only available to 5 states. Illinois is one of the lucky few. Brokers and Small Businesses, check it out at HealthCare.gov!

This incremental launch will help identify issues early and assist brokers and businesses in building confidence in utilizing the SHOP online system.

During SHOP early access, Illinoisians can do the following to initiate enrollment:

  • Establish a Marketplace SHOP account
  • Establish an agent or broker to their account if they wish
  • Complete an employer application
  • Obtain an eligibility determination
  • Upload an employee roster when enrollment functionality is available
  • Starting in November, browse health plans with coverage starting in 2015

The SHOP Call Center can be reached at 1-800-706-7893 (TTY: 711) Monday through Friday, 9 a.m. to 7 p.m. EST.

While small businesses have always had group plan options, many even available online, there were challenges that got in the way of providing group coverage to their employees. Premiums were expensive and small businesses lacked the purchasing power of larger organizations. The SHOP makes some pretty substantial changes to the ways in which small businesses can buy plans.

Why SHOP?

First, financial assistance is now available in the form of a tax credit. This can substantially help employers by covering up to 50% of employer contributions towards employee premiums. This assistance provides the opportunity for businesses to offer employee coverage where it would have previously been unaffordable. Second, the SHOP helps small businesses harness the purchasing power of other small businesses, thus letting them play in the big leagues along with larger organizations.

Small businesses do not have to offer health benefits under the Affordable Care Act, but it is in their best interest to check out options and see what is possible, particularly if they are concerned with employee retention. Whether or not they decide to provide group health insurance coverage, small businesses are nonetheless required to inform employees of the Health Insurance Marketplace, so that individual coverage options can be explored.

Brokers and Small Businesses take note. The time is now to explore options, prepare, and get ready for a new system opening up possibilities for small businesses in Illinois.


Emily Gelber MSW, LSW
Health Policy Analyst
Health & Disability Advocates

TAKE OUR SURVEY HDA and Crain’s Chicago Business are teaming up to poll local small businesses about new health benefit options. Why participate? By taking this short survey about the changing healthcare landscape, you can inform policymakers, insurers and other small business owners. Results will run in a November 17 article in Crain’s. Take the survey now

Did Obamacare Destroy Competition in the Private Insurance Market?

One of the biggest criticisms of the Affordable Care Act was that it would be the death of the private insurance marketplace. Opponents of healthcare reform cautioned that the law change would crowd out private innovation in the market and make insurance carriers less interested in competing.

If we take a closer look back at the progression of insurance company involvement in Illinois, I think we’ll find that not only was this not the case – but in reality, the reverse was true.

Prior to the 2014 open enrollment period, the small business market in Illinois was extremely limited. If you had fewer than 50 employees, the options for group coverage were four to five carrier choices (depending on your county). These companies continued to churn business, and employers would change carriers every two to three years as their premium rate increases continued to increase. There were significant barriers to entry - and every time we saw a new carrier attempt to provide competitive options, the larger more traditional players quickly chased them out of the state.

For sole proprietors and the self-employed, the outlook was even bleaker. There were two or three competitive options, and the underwriting guidelines were so rigid that even those plans were unrealistic for many individuals hoping to gain private insurance coverage.

Reviewing the change to the market, we see that sole proprietors and the self-employed saw the biggest gain in options. The opening of the ACA Marketplaces in 2014 offered up to seven carrier choices for individuals in some regions of Illinois. Although many of the players were familiar faces, one – Land of Lincoln - was brand-new to Illinois consumers. Land of Lincoln is a co-op (oonsumer oriented and operated), a new type of insurance organization made allowable by the ACA.

The federal government has now awarded nearly $2 billion in loans to help create 24 new CO-OPs in 24 states. The CO-OP sponsors - consumer-run groups, membership associations, and other nonprofit organizations - are now moving forward to offer health coverage in competition with established commercial and nonprofit insurance companies. (Health Affairs Policy Briefs)

What about small employers? While the SHOP Marketplace faced many more struggles in Illinois, there were some indications of future hope in improving competitive choices for our state. First, Land of Lincoln did offer and enroll small employer options. This added a new type of plan for employers to consider – and because it was offered on the SHOP, employers that qualified and enrolled in their SHOP plans could take advantage of the Small Business Tax Credit.

Second, we began to see the creation and evolution of private marketplaces and partially self-funded programs being marketed to small employers. In the past, third party administrators had reserved these innovative solutions for larger clients. The need for financial solutions and minimum essential coverage has spurred creative thinking and new progressive options for forward-thinking small employers to test out. Although these solutions are in their early stages of development, they do reflect a market expansion - not contraction.

Finally, and perhaps most importantly, the existing small business market remained intact. All of the same original carriers that offered plans historically continued to do so in 2014. We didn’t see one single insurance company leave the state of Illinois - instead many of them continued to market aggressively to small businesses and create new plan offerings that would be both compliant with ACA rules and competitive.

As we begin to look forward to the 2015 open enrollment cycle, the question remains of whether this trend will continue or reverse. Early indications point to a growing market. Last month, the Department of Insurance in Illinois released a statement noting that 10 carriers have submitted applications to offer plans in the second year of the Marketplace. This representing a significant growth in choices in the insurance carriers and the numbers of plans they will offer from Year 1. (Get Covered Illinois). Here are the exact numbers:

Illinois Healthcare Marketplace Plan Options – Year 1 and 2
Year 1
Options		Year 2
Submitted Options
Individual Plans120306
Small Group Plans 45198
The Illinois Department of Insurance is not expected to announce which plans it has approved until early August. However, given the significant increase in possible options, we can expect that both the individual market and small group market will see growth for 2015. Although this is positive movement, my hope is that the department will focus its expansion of plan approvals on the small group marketplace, which was significantly under-represented in choices in 2014.

In any case, the numbers show promising evidence of expanded insurance plan competition under Obamacare – something that small employers and the self-employed desperately needed prior to its enactment. We can and should consider this component of the legislation a true economic win for Illinois business.


Michele Thornton, MBA
Insurance and Benefits Consultant

Supporting Chicago's Entrepreneurs: Marketplace Brings New Health Coverage Options


Finding the right healthcare plan can be stressful, and with all the noise surrounding the new healthcare law, it may seem downright overwhelming. But there’s good news coming out of Illinois. The state’s new health insurance marketplace is open for business, and it’s already providing small business owners and their employees with improved options for affordable coverage.

The new marketplace, Get Covered Illinois, is a partnership marketplace, which means the state and federal government run the marketplace together while Illinois prepares to run the marketplace on its own beginning in 2015. Get Covered Illinois has two branches – one for individuals, the other for small businesses. The individual marketplace is available to any self-employed individual or small business employee whose employer doesn’t offer insurance. Open enrollment for 2015 begins on November 15. In the meantime, employees and self-employed folks can use an online calculator to determine if they’re eligible for a subsidy to help cover the cost of insurance for coverage in 2015.

Many self-employed Chicagoans have already discovered the benefits of enrolling through the state’s marketplace, including Jade Phillips, a local children’s book author. After a brief stint with a precipitously high monthly premium and deductible from a private insurance company, Phillips says she spent the majority of her 20s uncovered. But this year, the self-employed entrepreneur was able to sign up for coverage through the individual market. For the first time in years, she’s enrolled in an affordable plan that allows her to continue doing what she loves while enjoying the peace of mind her new insurance brings.

There’s even more good news for small employers. The small business marketplace has year-round enrollment, so small business owners with fewer than 50 employees looking for a plan have plenty of time to determine if the new marketplace is the right choice. There are more than 230,000 small businesses in the Chicago metropolitan area, but in order for them to take advantage of this new option, entrepreneurs need to know what Get Covered Illinois’ small business marketplace can do for their businesses.

Here are some key facts about the marketplace to help get small employers up to speed.

  • The new health insurance marketplace is one of the most important components of the Affordable Care Act for Chicago small employers. The small business marketplace allows small businesses with fewer than 50 employees to band together when buying coverage – giving them the kind of purchasing clout large businesses enjoy.
  • The marketplace offers businesses more competitive choices, which can help lower premium costs, thus improving their bottom lines.
  • Small employers that do offer coverage through the marketplace may also be eligible for a tax credit of up to 50 percent of your premiums. Check out our tax credit calculator to see if you’re eligible and to receive a tax credit estimate. 
  • Illinois’ small business marketplace will offer employee choice in the future, which means small business workers will be able to choose from a number of plans from different carriers.

In order to begin the enrollment process, Chicago entrepreneurs can visit Get Covered Illinois’ site or Healthcare.gov and begin filling out a paper application, or visit contact a certified health insurance broker who can assist with the enrollment process.

What’s more, Small Business Majority’s certified educators can help answer questions regarding the enrollment process. Check out our state outreach calendar or the Small Business Health Care Consortium’s events page to find an event in your area.

To learn more about the small business marketplace, enrollment dates and coverage plans, visit our Health Coverage Guide (healthcoverageguide.org), which contains a wealth of information for small business owners regarding enrollment, the Affordable Care Act and the healthcare system in general.

The more small business owners know about the new marketplace, the easier it will be for them to get their employees and businesses more affordable insurance coverage. And then, instead of worrying about health insurance, they can do what they do best: run the companies that make up the backbone of our state and our nation. 


Mary Timmel
Midwest Outreach Manager
Small Business Majority

On COBRA? New Announcement from HHS Could Save you Thousands of Dollars


In mid-April, I received a call from a 62-year-old woman named Alice who had been laid off from her job quite a while back. She was paying around $650 each month to maintain her COBRA coverage. Turns out she got my number from her brother, Carl, whom I had helped enroll into a Marketplace plan. He, too, was paying a lot of money each month for COBRA coverage after his employer had cut his hours in half, making him ineligible for employer-offered coverage. By enrolling into a subsidized Marketplace plan, Carl saved more than $400 a month in premium costs. He hoped I could also help his sister. Unfortunately, she called me just a few weeks after open enrollment had ended.

Normally, this would mean that she would have to wait until the next open enrollment period or until she exhausted her COBRA coverage before she could qualify for a Special Enrollment Period which would allow her to enroll into a much more affordable Marketplace plan. It seemed she had missed this window of opportunity – that is until HHS announced new Special Enrollment Periods for folks currently enrolled into COBRA coverage.

As I mentioned, normally a consumer has four options regarding COBRA coverage:
  • Decline an initial offer of COBRA coverage
  • Get a Special Enrollment Period and enroll in marketplace coverage
  • Switch from COBRA coverage to marketplace coverage during open enrollment
  • Wait until the exhaustion of COBRA coverage to get an Special Enrollment Period

Well, HHS recognized that folks just like Alice were confused about their options. So they decided to offer COBRA enrollees a Special Enrollment Period. If you or someone you know is on COBRA, he or she can qualify for a Special Enrollment Period to shop for a plan on the Marketplace until July 1 of this year.

Simply call the Marketplace call center at 1-800-318-2596 and tell them you are currently on COBRA and that you would like to explore your options in the Marketplace. Then fill out an application at healthcare.gov to see if you’re eligible for financial help. This could very well save you hundreds of dollars each month in premium costs. You have nothing to lose. I’ve already called Alice.

Jillian Phillipsr
Chicagoland Organizer
Campaign for Better Health Care

For more info on qualifying events:
http://illinoishealthmatters.org/wp-content/uploads/2014/04/Special-Enrollment-Periods-Explained.pdf

Can Non-Profits leverage the ACA to bring down health insurance costs?

The non-profit sector is a leading source of job growth in the United States and currently employs just under 11 million people nationally.[1]  Locally here in Illinois, we see  direct growth in this sector – now holding 10.6% of the private employment, up from 9% in 2005.[2]   However, in a recent survey of 600 national non-profit organizations, recent increases in employee turnover are indicated to be an ongoing concern.[3]  One of the greatest tools that organizations have available to them to attract and retain high quality employees is the compensation and benefits package.  Providing high value, yet affordable benefits is part of the ethos of most non-profit organizations.  However, as the cost curve of health insurance continues to rise, this proposition has become increasingly more challenging.  The Affordable Care Act created a small employer tax credit to help offset some of these costs – but many non-profits are left wondering how this might benefit them.

The ACA includes a provision that gives small employers, including nonprofits with fewer than 25 employees (with average salaries below $50,000), the right to access a tax credit for insurance premiums paid by the employer for their employees' health insurance.  For tax-exempt nonprofits the credit is treated as a refund on quarterly payments that the nonprofit has made to the IRS for income tax withholdings or Medicare withholdings from employee wages. For 2010-2013 the refund is 25% of the expenses paid by the employer towards employees' health insurance premiums; the refund increases to 35% after January 1, 2014.[4]  Non-profits should know that they are still able to retroactively apply for previous year’s tax credit if they meet all of the eligibility guidelines.
            To better understand the tax credit and available provisions under the ACA, you may want to explore the new small business page of Illinois Health Matters.  Here you can find additional information about the small employer tax credit and other key resources.
            Beginning in 2014, to obtain the tax credit – employers must enroll in a qualified health plan through the SHOP Marketplace.  These plans are competitively priced and cover all of the EssentialHealth Benefits that are important to you and the employees you are trying to retain. The Illinois SHOP Marketplace can be found at GetCoveredIllinois.gov.  Here you can find additional information about the plans available – but more importantly through their Get Help feature you can search for registered brokers in your neighborhood.  Brokers can assist you in applying for the small employer tax credit, evaluate your health insurance and employee benefit package, and assist you in enrolling in a plan that qualifies for the tax credit reduction.
The ACA offers two important tools to assist small employers – the SHOP marketplace, and the small business tax credits. Together, these two strategies can help non-profits begin or continue to offer quality benefit programs at an affordable price. As nonprofit organizations continue to play an integral role in the workforce and in the communities they serve – finding business partners that can assist in helping to leverage these resources will continue to be paramount for long term workforce and budgetary planning. Creating stability and financial sustainability in these areas will ultimately allow non-profits more freedom to focus on what’s important – fulfilling the mission of their organization and continuing to serve the community around them.


Michele Thornton, MBA
Insurance & Benefits Consultant
[1] Salamon, LM, SW Sokolowski and SL Geller. Holding the Fort: Nonprofit employment during a decade of turmoil. Nonprofit Employment Bulletin 39, Johns Hopkins University. January 2012.

[2] Salamon, LM, SW Sokolowski and SL Geller. Illinois Nonprofit Employment: An Update.  Nonprofit Employment Bulletin 21, Johns Hopkins University. January 2005.

[3] 2013 Nonprofit Employment Trends Survey Report. Nonprofit HR Solutions. Accessed at: http://www.nonprofithr.com/wp-content/uploads/2013/03/2013-Employment-Trends-Survey-Report.pdf

[4] Small Business Healthcare Tax Credit for Small Employers. IRS (2014).  Accessed at: http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers

CBO on ACA: Devil is in the Details

On Tuesday, while driving between meetings, my favorite talk radio host shared shocking details from a new report – Obamacare, or the Affordable Care Act, is going to result in a loss of 2 million jobs in the United States over the next 10 years. Well, I thought, it's going to be a long day.

Later I learned that this reporter was sharing details from the latest Budget and Economic Outlook Report from the Congressional Budget Office. The CBO is an independent agency tasked with providing fiscal analysis for Congress with the intent of informing the budget-making process. Periodically, they release these reports which provide a 10 year forecast demonstrating the economic impact of many policies. Since 2010, they have included analysis on the impact of the ACA.

Needless to say, I was anxious to dig into this nearly 200 page behemoth and figure out what was going on. What I read in this report turned out to be great news. The report does not say that the economy will lose 2 million jobs. It says that, by making it easier to access affordable, high quality health insurance, more than 2 million people can make the choice to leave their job and pursue their passions, spend time with their families, start businesses, or find better jobs.

For those of us that have been following and championing the ACA, this isn't actually new information. Last year, the Robert Wood Johnson Foundation released a report, entitled The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment, which estimated that we could see as many as 1.5 million entrepreneurial spirits leave their jobs to become their own boss in 2014 alone!

Both reports highlight the same important fact: Because of the promise made by the ACA, that we can all access good health care, people will have the freedom to do what they want without fear of medical emergency and financial ruin.

My father, sister, and brother-in-law are all self-employed. Even my grandmother owned a small craft shop for the better part of my 26 years. While they were all brave (and maybe a little stubborn) enough to pursue these passions before the ACA, it has not been without sacrifice. After my self-employed and uninsured father had emergency eye surgery in 1992, my family filed bankruptcy as a result of unpaid medical bills. If the ACA had been around then, things would have been much easier for us and my dad certainly would have avoided a lot of sleepless nights worrying about keeping his business or providing for my sister and I.

I was shocked when I heard that radio report, but – as always – the devil was in the details. Except the devil isn't really a devil at all. The bottom line is that the ACA presents a new opportunity: an opportunity for people like my dad, to become their own boss; for someone who has put in their years and saved their pennies to retire early; or for a new parent to work part time so they can spend more time watching their child learn and grow. The CBO report means that what happened in my family, and millions like us, doesn't have to happen anymore – and that is why I will continue to be a proud champion of the ACA.

– By Kathy Waligora

Kathy Waligora is the Manager of Health Reform Initiatives at EverThrive Illinois (formerly the Illinois Maternal and Child Health Coalition).

See the 2013 ACA Self-Employment Infographic in PDF.


ACA: More Than Just Healthcare for People With Disabilities

For people with disabilities finding a job has always been a one-two punch. It's not just the salary and financial independence they're looking for; they also are in greater need of health benefits than say, a nondisabled 30-year old.

October 1 marks the first day that people with disabilities can finally get both needs met. Under the provisions of the Affordable Care Act, many of the barriers to private health care for persons with disabilities will disappear. Americans can now shop for benefits in the new health insurance marketplace, for coverage beginning January 1, 2014.

For the first time ever, people with disabilities cannot be denied coverage due to a pre-existing condition, denied particular services or charged more for coverage based on their health status. Many health plans have to cover certain preventive services like routine vaccinations. And the ACA limits the ability of insurers to cap annual services on patients.

The ACA undeniably changes the paradigm for working-age people with disabilities, who now do not need to choose between healthcare and a job. If an employer doesn't offer insurance, the Marketplace will, with plans starting at less than $100 a month. No longer does a person with a disability need to rely on Medicaid, the free state healthcare program for low-income people where the income requirement is so stringent that not even a full-time McJob would be allowed.

The new law also takes some of the burden off employers, too. Employers hiring people with disabilities can be assured that rates will not rise. All health insurance plans will be required to offer a standard set of benefits like hospital care and doctors' visits, as well as cover services like medication, therapy and rehabilitation services, which people with disabilities need throughout their lifetime. There will be limits on rate increases and co-pays. Small employers with fewer than 50 full-time workers can also purchase coverage through the Marketplace.

What's more, 25 states and the District of Columbia have kicked in with their own programs to provide extra coverage to workers if the benefits a company offers are too "basic" for a person's unique disability needs. These special plans wrap around private employer-based coverage.

And an optional program known as Medicaid Buy-In allows workers with a disability in 42 states and the District of Columbia to retain Medicaid coverage and pay health premiums on a sliding fee scale based on their income. Medicaid buy-in programs are geared toward higher-paid workers, for whom a salary truly trumps federal assistance.

As always, our mission at Think Beyond the Label is to increase the percentage of working-age Americas with disabilities in the workforce. The ACA will help us to be more successful at connecting qualified workers to the employers that want to hire them. No longer will a job seeker need to ask: Does my employer offer insurance? Is the plan comprehensive enough to take care of my disability? Will my health needs be better met through federal and state programs that discourage work?

The ACA makes business and economic sense, too. Less reliance on federal disability insurance programs that limit work (and cost billions of dollars a year to run). Less concerns from employers -- especially small employers -- about how to pay for coverage for a person with a disability. More opportunity for all Americans to achieve financial independence and make a significant economic contribution -- to pay for important life goals like starting a family, buying a house and sending kids to college.

Though the law may have passed under President Obama, it was Ronald Reagan who asked, "How can we love our country and not...reach out a hand when they fall, heal them when they're sick, and provide opportunity to make them self-sufficient so they will be equal in fact and not just in theory?" The ACA does just this, providing an innovative approach that will give millions of people with disabilities a chance to live the American dream, without sacrificing their critical healthcare needs.

Barbara Otto

Principal, Think Beyond the Label
 Follow Barbara Otto on Twitter: www.twitter.com/@beyondthelabel 

This post was published first on the Huffington Post blog

Strong Interest in Illinois: State is Meeting Demand



 
Chicago – A stronger than expected showing for the Get Covered Illinois website, GetCoveredIllinois.gov, dominated the State’s storyline on the opening day of the Illinois Health Insurance Marketplace.  The following is an operational update:

WEBSITE:

The Get Covered Illinois website opened on time at 12:00 a.m. Monday, October 1.  As of 3:30 p.m. CST, more than 69,840 visitors had come to the online marketplace. 65,043 of them were unique visitors; and the page views totaled more than 412,580, with visitors viewing an average of six page views per visit.

“With a project of this magnitude, there was no accurate way to predict what our web traffic would be,” offered Jennifer Koehler, Executive Director of Get Covered Illinois. “But with that said, today’s numbers certainly validate the strong interest in healthcare in Illinois, and we’re glad to be able to service it. It also validates our strategy of education, since all this has come with basically no advertising. So we are overall very, very pleased.” 

Only a handful of early and minor glitches were reported, impacting a very limited number of consumers. All minor glitches were reported and fixed by early afternoon. “The site has performed incredibly well, the way we designed it to,” added Koehler. 

Additionally, the State received more than 1,100 online applications submitted on the ABE (Application Benefits Exchange) portion of the Get Covered Illinois site. 

HELP DESK:

The Help Desk received more than 350 calls as of 3:30 p.m.  Calls were answered in an average speed of six seconds, and callers were on line with Help Desk specialist an average of six minutes.

FIELD OPERATIONS:

There is steady interest, as judged by customers at our grantee community organizations today.  Most consumers are reportedly doing exactly as State officials hoped – coming in to be introduced to the process, the website, the Navigators and making appointments over the next few weeks as they become educated themselves on the site, and come back with prepared questions, and more ready to enroll.

“We know this is not nearly the same as buying a gallon of milk, a new pair of shoes, or anything in daily life,” said Director of Outreach Brian Gorman.  “Shopping for health insurance is brand new for more than a million Illinois residents, and it will take education and time to get comfortable with this new process.  But we are thrilled to see, today that process of understanding the right plan for them and their families started in earnest in locations all across Illinois. Consumers responded to our ask – which was to meet their community partners, understand the resources available and get an appointment when they are ready to get covered.” 

SOCIAL MEDIA:

Follow us on >>

Facebook: www.facebook.com/coveredillinois
Twitter: @CoveredIllinois
Hashtag: #GetCoveredIllinois

Posted with permission from GetCoveredIllinois.gov

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