Illinois lawmakers should create a state-based health insurance exchange and consider renting certain functions of HealthCare.gov if the U.S. Supreme Court rules against federal subsidies in states that haven't set up their own marketplaces.
The Illinois Hospital Association, an influential Naperville, Ill.-based lobbying group, floated the ideas in a June 11 memo obtained by Crain's. The Supreme Court is expected to rule within the next two weeks whether consumers in Illinois and other states where the federal government operates the exchanges via HealthCare.gov are eligible for subsidies to help buy coverage.
“If the Court rules that subsidies are not available . . . approximately 250,000 Illinoisans are likely to lose tax credits, jeopardizing their ability to obtain health insurance,” the association wrote in its memo.
The better fix would be for Congress to extend the subsidies if the Supreme Court rules against them, spokesman Danny Chun said in an interview. But if federal lawmakers don't—and Republican majorities have made undoing Obamacare a priority—the hospital group would support Gov. Bruce Rauner and the General Assembly creating a state-based exchange and finding money to pay for it.
The healthcare exchanges debuted in 2014. More than 11 million people have enrolled, including nearly 350,000 in Illinois, according to the most recent enrollment figures.
Establishing an Illinois marketplace could be less expensive than in 2012, when a consulting group estimated it would cost $57.4 million to $88.6 million. That's because the state already has created several functions of the exchange. They include making sure Illinois plans sold at HealthCare.gov meet certain requirements, such as covering hospital stays and prescription drugs.
But Illinois would need to pay for key pieces that the federal government now performs, such as determining if consumers are eligible for subsidies. Given the state's deep budget deficit, funding any expanded program would be difficult.
It's anticipated that the federal government will develop a leasing fee for states that use certain parts of the federal exchange process, the hospital association's memo said. States that instead decide to rent functions from other state exchanges likely would have to pay similar fees, the memo said.
A spokeswoman for the CMS, which oversees HealthCare.gov, declined to comment. A spokesman for Get Covered Illinois, the state exchange, did not respond to a message to comment.
"Illinois could rent pieces of HealthCare.gov if states lose subsidies, hospital group says" originally appeared on the Crain's Chicago Business website.