Gov. Pat Quinn has less than a month to choose which benefits will be required in basic health insurance plans sold to individuals and small businesses in Illinois under the federal health care law, an important decision that will determine the cost of future premiums and how broad coverage will be for many patients.
As the presidential election focuses on President Barack Obama's national health care overhaul, Illinois has been inching toward implementing the law. Although the governor hasn't been able to push through some needed legislation, he doesn't need the Legislature to OK his choice of a benchmark to assure that Illinoisans receive "essential health benefits."
Illinois is behind only nine other states that have already chosen a benchmark plan or have a preliminary recommendation, according to a nonpartisan group tracking state progress on the law. The deadline for states to select those basic plans is Sept. 30.
"Illinois is pretty much on track with a lot of other states" on essential health benefits, said Sonya Schwartz of the National Academy for State Health Policy. "For the most part, this is a temporary decision and is about keeping the market stable."
The federal health law set 10 basic categories that must be covered by health plans, such as emergency services, prescription drugs and maternity care. But within those categories, states have flexibility to determine a basic level of covered services and costs.
For instance, should acupuncture be covered? Weight loss surgery? Hearing aids? Routine eye exams?
Choosing a benchmark plan that covers acupuncture doesn't mean that all plans in Illinois would have to cover it. But the health plans would have to provide benefits of equal actuarial value, so they could trade coverage of another service of equal value for acupuncture.
States will select one existing health plan to serve as a benchmark or guide. If states don't choose a benchmark, the federal government steps in to name an existing popular small group plan in the state as the default benchmark.