State Rep. David Welter, R-Morris, spoke out about the likely changes to the Affordable Care Act (ACA) at the state level heading into fiscal year 2019.
In its fiscal year 2019 budget request, the Illinois Department of Human Services projected ACA-related Medicaid costs to total $2.5 billion gross.
Welter said the net cost to the state for fiscal year 2019 was projected to be $160 million.
The final fiscal year 2019 and projected fiscal year 2020 figures will be released in February 2019.
Under the ACA, adults ages 19-64 who were not previously eligible for coverage under Medicaid can now receive medical coverage. That means individuals with income up to 138 percent of the federal poverty level—or monthly income of $1,366 per individual, $1,845 per couple—are covered.
Illinois law states that if the Illinois Federal Medical Assistance Percentage (FMAP), or match, rate is reduced below 90% than ACA adults are no longer eligible.
The federal government paid 100% of costs of newly eligible adults through Dec. 31, 2016.
Welter said the match rate on newly eligible adults reduces to 93%, effective Jan. 1, 2019.
Projections show the match rate decreases to a floor of 90% on Jan. 1, 2020.
When asked whether the state is in a position to make healthcare a legislative priority heading into 2019, Welter did not negate the idea.
“The state is facing serious fiscal difficulties, but that does not prevent us from making healthcare a priority,” he said. “The legislature can focus on streamlining health care processes, improving market transparency, and increasing implementation of new technologies.”
This year, the General Assembly passed a bill requiring the implementation and use of standard electronic forms for the prior authorization of prescription drugs.
The prior authorization requirements can be a significant source of administrative hassle for doctors and their patients, Welter said. By standardizing the forms and making them electronic, we can reduce the burden, hassle and cost for all involved.
The bill is still awaiting the governor’s signature.
Another recent example is the use of telehealth services, which the General Assembly passed requiring that insurers cover telehealth services for diabetes treatments, Welter said. This allows diabetes patients, who are often seniors or have mobility issues, to meet with their diabetes health care providers from their own homes.
As changes to the Affordable Care Act loom for many, a recent ruling in the federal district court in the Northern District of Texas struck down popular key provisions of the legislation.
In a statement, the American Medical Association gave its input on the matter.
It reads, the “decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections and other policies that have extended health insurance coverage to millions of Americans,” said AMA president Barbara L. McAneny, M.D. “It will destabilize health insurance coverage by rolling back federal policy to 2009. No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction.”
The AMA intends to work with patient and other health stakeholder groups in pursuing an appeal and reversal of this decision at the district court level.
Welter told the Morris Herald-News the new developments present nothing for people currently enrolled on ACA plans to worry over in the short term.
“The exchanges are still operating in Illinois and throughout the country and the judge in Texas did not order the Federal government to stop enforcing the ACA,” he said. “However, if the Texas judge’s ruling is upheld in its entirety, it does invalidate the entire ACA. This would include subsidized plans on the exchange, and coverage requirements for pre-existing conditions, which would create quite the disruption in the health care market that is hard to quantify right now.”
Welter said the impact of the ruling to the ACA and its future is unclear.
“The judge’s decision relies on a novel use of what is known as the severability doctrine that most commentators believe will not survive review,” Welter said. “Therefore, we will need to see what happens at the Fifth Circuit in New Orleans before we will know what will happen.”
While the ACA and its 2019 open enrollment period passed, Welter said residents can still get covered in a few ways.
“That would be if a resident had an event in their life that would allow them to enroll outside the open enrollment period,” he said.
These events generally include changes in household, residence or a loss of insurance.
“Another option would be to see if the resident qualifies for either Medicaid or the Children’s Health Insurance Program,” Welter said.
If anyone needs 2019 healthcare coverage, visit healthcare.gov to view the requirements.