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Thursday, Aug. 28, 2014 12:01 am

Obamacare enrolls 622,000 in Illinois

 More than 622,000 previously uninsured people in Illinois now have health coverage, thanks to the federal reforms known as “Obamacare.” That accounts for about 51 percent of the estimated 1.2 million people in Illinois who didn’t have health insurance prior to the reforms.

The Patient Protection and Affordable Care Act, nicknamed “Obamacare,” was enacted in 2010. It attempted to control runaway health care costs by requiring most people to purchase health insurance and by further regulating the behavior of insurance companies.

Get Covered Illinois, an Illinois-based nonprofit working with the U.S. Department of Health and Human Services, released a report Aug. 12 on its first year of enrolling people for health insurance. The report says more than 217,000 people bought insurance through a mechanism set up by the reforms, while about 405,000 additional people enrolled in Medicaid.

The 217,000 people who purchased insurance used what’s known as the Health Insurance Marketplace. It’s a federally run clearinghouse for consumers to purchase private insurance that has been vetted to meet basic standards of coverage. Consumers can still purchase insurance outside the marketplace, but using the marketplace allows consumers to access a federal subsidy to offset the cost. While several states opted to create their own state-run exchange, Illinois lawmakers failed to pass legislation that would have created an exchange here, so the state instead partnered with the U.S. Department of Health and Human Services to use the federally run exchange.

Illinoisans who use the federal marketplace can choose from among 120 individual insurance plans and 45 small group plans from one of six insurance companies. Two-thirds of new enrollees for both private insurance and Medicaid were between ages 35 and 64.

About 10,300 Illinoisans who have signed up for coverage have yet to submit required citizenship or immigration documents, according to HHS, meaning their coverage could be revoked. HHS says applicants have until Sept. 5 to submit the documents, or their coverage will end on Sept. 30.

“A data inconsistency does not necessarily mean there is a problem with an individual’s eligibility for enrollment; it means that additional information is needed to verify the information provided in an application,” HHS said via press release on Aug. 13. “However, if these supporting documents are not received, health insurance plans will be terminated in order to ensure program integrity and protect taxpayer dollars.”

Under the federal reforms, individual states were instructed – but not required – to expand Medicaid eligibility to include     people earning up to 133 percent of the federal poverty line. For an individual with no children, the poverty line is an annual income of $11,670, meaning anyone making less than $15,521 annually qualifies for Medicaid. For a family of four, the poverty line is $23,850, so a family of four earning less than $31,720 qualifies for Medicaid. The median U.S. income is $56,853, according to the U.S. Census Bureau. Illinois expanded its eligibility in July 2013 and subsequently enrolled 405,000 people statewide in Medicaid.

Illinois’ enrollment of 217,000 people who purchased insurance through the marketplace far exceeded the goal of 143,000 set by the federal government, but it still left uninsured about 578,000 people of the 1.2 million who were uninsured previously.

The theory behind requiring most people to purchase insurance is that uninsured patients are more likely to rely on expensive emergency room visits for health care instead of seeing a primary care physician who may help prevent problems from arising in the first place. Hospitals typically charge uninsured patients significantly more than insured patients, and many emergency room visits are subsidized by taxpayers. That means – at least in theory – it’s cheaper for taxpayers to pay for insurance through Medicaid as a preventative than to pay for emergency room care as a last resort.

The marketplace was created as a way to ensure that people who otherwise might not have insurance have access to plans that meet basic standards. Insurers can no longer exclude people from coverage for pre-existing medical conditions or place lifetime caps on benefits, among other restrictions.

The reform package has been controversial, with Republican politicians at both the state and national level repeatedly calling for its repeal even four years after it passed. Republican pundits have labeled “Obamacare” a socialist redistribution of wealth, although Democrats counter that in negotiating the bill, Democratic members of Congress went out of their way to maintain private health insurance as the primary method of providing coverage to the uninsured. Most developed nations employ a universal health care system, in which the government – rather than private insurers – provides insurance for all patients.

Open enrollment in the marketplace begins on Nov. 15 and ends Feb. 15, 2015. For more information, visit www.getcoveredillinois.gov.

Contact Patrick Yeagle at pyeagle@illinoistimes.com.

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