The move also appears to be Pritzker’s way of protecting a marketplace in Illinois even if a Republican becomes president and directs federal agencies to cut back on marketplace resources. Pritzker’s office points to the fact that under former President Donald Trump’s administration, funding for enrollment navigators was diminished.
“Our marketplace will also be insulated from changes in federal policy by those who seek to undermine access to affordable health care,” Pritzker spokeswoman Jordan Abudayyeh said in a statement to Crain’s. “Moving to a (state-based marketplace) insulates Illinois from changes in federal administrations who may seek to sabotage the marketplace.”
The bill amendment is working its way through the Illinois Legislature. New sponsors joined the bill on Tuesday and Pritzker’s office says he would “love to sign it this summer.” Building the exchange would incur a $10 million start-up cost that is already included in Pritzker’s introduced budget, Abudayyeh said.
“The adoption of a state-based insurance marketplace represents progress in creating a health care system in Illinois that ensures every person who is eligible can access the care and treatment they deserve,” Pritzker said.
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Under Illinois’ current system, the state uses a partnership exchange marketplace with the federal government in which residents enroll via HealthCare.gov. The number of Illinoisans enrolling in a marketplace plan this year hit a new record, with nearly 343,000 plans selected, up 6% from last year, according to the Illinois Department of Insurance.
Concern around federal health care policy and its impact on states was heightened last year after the Supreme Court overturned Roe v. Wade, which protected Americans’ right to an abortion. Since then, federal courts have moved to ban the use of a common abortion pill as well.
Additionally, big changes were made to the ACA in March when a federal judge in Texas ended a federal mandate requiring health insurance companies and employer-sponsored plans to pay for certain preventive health care services.
Other states, including Georgia and Pennsylvania, have set up their own marketplace exchanges in recent years. As of January, 18 states had created their own exchanges, according to the Centers for Medicare & Medicaid Services.
If the legislation in Illinois is approved, full transition to the state-based marketplace would take about three years, but an initial version would be up and running by the fall 2024 enrollment period. A state-based health plan marketplace would not change current coverage options in Illinois, Abudayyeh said. All ACA-approved plans currently offered to Illinois residents would appear on the state-based marketplace.
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In a statement, Pritzker’s office said a local exchange would also allow the state to better identify and target underinsured and uninsured people in Illinois. The Illinois exchange would be operated by the Department of Insurance and the Department of Healthcare & Family Services, which also administers Illinois’ Medicaid plans.
“The hope under (a state-based marketplace) is that the state can easily direct Illinoisans who are enrolling to the plan that works best for them,” Abudayyeh said. “For instance if you enroll in an ACA plan but would be better served on a Medicaid plan, we would easily be able to enroll you.”
If the legislation passes, Illinois would likely need to set up a new website and system to distribute plans and hire people to manage it, says Zarek Brot-Goldberg, an assistant professor at the Harris School of Public Policy at the University of Chicago.
“While I think bringing things in-house is probably somewhat costly, it does give Illinois a nice opportunity to not just protect itself against whims of what might be happening nationally, but also allow it to … maybe make these exchanges a little more functional,” he says.
This story first appeared in Crain's Chicago Business.