CHICAGO (AP) — An Illinois Democrat who has led work on implementing a key part of President Barack Obama's health care overhaul now says the state will need to partner with the federal government for its insurance exchange.
Rep. Frank Mautino told The Associated Press this week that Illinois won't meet be able to meet a Nov. 16 deadline for the online insurance marketplace and must consider a new option — a federal-state partnership — to get ready for its first year if the U.S. Supreme Court upholds the law.
That would put Obama's home state among a majority of states limping unsteadily toward implementing the law. The court is expected to rule on the reforms Thursday, and could overturn or dismantle the law, leaving states to determine how to proceed from there.
A spokeswoman for Gov. Pat Quinn said Illinois is prepared for the court's decision.
"We are prepared for the numerous scenarios," said Quinn spokeswoman Brooke Anderson. "We are making progress, and have since the law was passed, to implement the (Affordable Care Act) in Illinois."
Insurance exchanges, a cornerstone of Obama's health law, would allow people and small businesses to comparison shop online for insurance starting in 2014. The concept has been described as Travelocity for health insurance.
Before new federal rules issued in May, there were two choices for states: run your own exchange, or see the federal government step in and take over.
But as states lagged behind and asked for more flexibility, the federal government developed a third choice — a state-federal partnership — that will make it easier for slower states to catch up and provide political cover to state officials who don't want to be seen doing anything to hasten what critics have called "Obamacare."
Most people buying insurance through the exchanges will likely be eligible for taxpayer-financed subsidies, and the exchanges will help people who qualify enroll in Medicaid. Participating insurance plans would have to take all applicants, regardless of prior health problems, unless the Supreme Court strikes down that portion of the law along with a requirement that most people buy health insurance.
Illinois has received three federal grants totaling $39 million to study and start building an exchange, but the Legislature has failed to pass a law establishing it, a necessity. The Quinn administration has considered an executive order to establish one, but Mautino said it's too late now.
"Because of the timeline, the first year of the exchange is going to be a joint state-federal exchange," Mautino said.
If the law is overturned or altered substantially by the Supreme Court, Mautino said there will be questions, including what happens to the nearly 2,000 Illinois residents covered by a federally funded insurance plan for people denied insurance because of pre-existing conditions.
"On Thursday, I'll read the decision," Mautino said. On Friday, "I'll start making some phone calls."
The twin health care problems of rising insurance costs and people losing health coverage won't disappear if the court overturns Obama's health law. That scenario could leave Illinois Democrats and Republicans floating their own ideas for health care.
Sen. Heather Steans, a Chicago Democrat and sponsor of recent Medicaid legislation in Illinois, said the state "can still pursue universal coverage" if the law is overturned, using Massachusetts as a model.
"A Republican governor and Democratic Legislature in Massachusetts were able to accomplish an insurance exchange with generally favorable results," Steans said referring to former Massachusetts Gov. Mitt Romney, the presumptive GOP presidential nominee. "I believe we can learn from and improve on this model to get more people covered — an important policy objective."
Sen. Bill Brady, a Bloomington Republican who co-chaired a legislative study committee on the health insurance exchange, said he'd like to see the court overturn the law. "Then we in Illinois could craft the delivery of health care services without the forced hand of the federal government and the Obama administration," Brady said.
Brady said he wouldn't rule out a health exchange in Illinois, even if the law is overturned. He said first he would revisit the issue with insurance carriers. "If the idea of one central exchange works for them, then how do we afford it?" he asked. The federal money would dry up without the law, he acknowledged.
Only 10 states and the District of Columbia have passed laws establishing exchanges since Obama signed the law. New York and Rhode Island established exchanges with executive orders. Massachusetts also has a state-run exchange.
One insurance carrier lobbyist confirmed Illinois has fallen so far behind that it's "almost impossible" for the state to run its own exchange in the first year. The state hasn't given insurers the information needed to get their health plans ready to sell on an exchange, said Elena Butkus of Aetna Inc. "Once you put out the specifications, it's going to take a minimum of 16 months (for health insurers to be ready). I don't have those specs from Illinois," Butkus said.
Illinois was not among the 26 states challenging the law in court and Quinn, a Chicago Democrat, has been an enthusiastic supporter of the law. But progress on implementing it slowed as doubts about "Obamacare" grew.
Obama's signature legislation focuses on covering most of the uninsured and requires nearly every U.S. resident to have coverage. In Illinois, nearly 17 percent of residents under age 65 are uninsured, up from about 14 percent in 2008, according to an analysis of government data released Friday by the Metropolitan Chicago Healthcare Council.
Illinois officials estimate about 800,000 uninsured residents would get health insurance in 2014 because of the national law, climbing to more than 1 million by 2020.
AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson
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