Illinois: a new plan to insure all

An Illinois state task force on Thursday endorsed an ambitious plan to provide medical coverage to 1.5 million uninsured residents--at a cost to government and employers of more than $5 billion a year.

The groundbreaking proposal calls for a series of complicated, expensive reforms that would expand public medical programs, overhaul private insurance and guarantee the availability of medical coverage to all Illinois residents.

In turn, every state resident would be required to step up to the plate and obtain health insurance from their employers, from public programs or by buying it on their own. If not, they would pay a penalty.

Another requirement would force all employers to supply medical coverage to workers or pay an assessment?-yet to be determined?-to a state fund that would help pay for the new insurance initiative.

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But the daunting price tag?- $3.6 billion a year in extra state expenditures, and $1.5 billion a year in additional expenses for employers?-is raising serious doubts about the plan's political prospects in other quarters.

"That's one heck of a lot of money," said Rep. Rosemary Mulligan (R-Des Plaines), noting that Illinois is struggling to figure out how to pay for its current effort to provide medical coverage to all children. "There isn't that money in the budget."

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The task force plan assumes that everyone in the state has to take responsibility for reducing the ranks of people without medical coverage, estimated at 1.7 million. Among its major provisions:


All residents of the state, including undocumented immigrants and college students, would be required to obtain health insurance. Penalties would be assessed if proof of insurance can't be supplied.


Subsidies would help lowincome residents buy coverage or pay premiums for employerbased insurance. All residents who earn up to 400 percent of the federal poverty level?-currently $80,000 for a family of four?- would be eligible.


All insurers selling coverage in Illinois would be required to offer a policy with comprehensive benefits to individuals and small groups seeking coverage. Currently, individuals can be denied if they have various medical conditions, and some small groups find it difficult to find affordable policies.


All employers in the state would be required to provide health insurance to workers or pay an assessment to a state fund. Standards for employers would specify a minimum percentage of payroll that must be spent on medical coverage or a minimum percentage of employees that must be covered (60 percent in the current plan). Small employers will receive financial incentives to reduce the burden of meeting these requirements.


Medicaid would be expanded to cover adults with no children who earn up to 100 percent of the federal poverty level, currently $9,800 for an individual. A state program for low-income families and children will also be expanded to parents who earn up to 200 percent of poverty, currently $40,000 for a family of four.

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"If it's doable in other states, why not here?" asked Ruth Rothstein, former head of the Cook County Health System, referring to a fresh wave of state health reform efforts across the nation. Most notably, Massachusetts this year became the first state to promise all citizens access to health-care coverage. Like the plan proposed Thursday in Illinois, the Massachusetts plan requires all residents to buy insurance and all employers to provide it or pay an assessment.

Health reform is expected to become a major topic in the next legislative session. In addition to the task force's plan, the governor's office and Blue Cross and Blue Shield of Illinois are also said to be preparing their own proposals.

After being formed in 2005, the Illinois task force held extensive hearings on health reform in every legislative district in the state, soliciting testimony from hundreds of consumers, medical providers, businesses, political and religious leaders and others.

The group was charged with preparing a reform plan for the state under the Health Care Justice Act, a little-known piece of legislation passed in 2004. For the first time, the act affirmed that "it is a policy goal of the state of Illinois to insure that all residents have access to quality health care at costs that are affordable."

Now, the cost of that goal is becoming clear, and its political feasibility will be tested.