Skip to content

Illinois: Reforming the Insurers

After working at a bank for 30 years, Chicago resident Jacklyn Dale is unemployed and uninsured.

The 59-year-old took a buyout and used the money to pay off her debts. Dale continued with group health insurance through COBRA for the maximum 18 months, but as of May had no medical coverage and few alternatives. She had been taking money out of her 401(k) for living expenses, including $400 for her monthly insurance premium.

Dale’s rheumatoid arthritis medication costs $15,000 to $20,000 a year. With insurance, her copayments for an entire year’s supply totaled $320. When she runs out of the medicine and options to pay for it, she hopes either the manufacturer or the county will help her.

In a recent AARP Illinois survey of its members, one in five said they had delayed or not filled a prescription because of cost. More than half said they’ve had difficulty paying for basic needs like food, gas and medications.

More than 1.7 million state residents are living without health insurance, according to the U.S. Census Bureau. In the first three months of 2009, more than 200,000 people lost their jobs in Illinois. The uninsured number is certain to rise along with unemployment, and that could send more people to the government for help.

Here are two options:

Medicaid. This jointly funded state and federal program pays for medical services for low-income Illinois residents. Assistance is provided for children, parents or caretakers, some older people and the disabled.

Illinois Comprehensive Health Insurance Plan. Known as ICHIP, this state program is for people who have been rejected by health insurers because of a preexisting condition or any of 31 medical conditions that would lead to automatic rejection—or if their private insurance is similar to ICHIP coverage but is more expensive.

Many of the newly unemployed or those whose COBRA coverage has expired don’t qualify for government help. For them, their only option is private health insurance. Since insurance companies are allowed to consider an individual’s health status and demographics, they can deny coverage or charge premiums that are much higher than employer-paid plans.

A new law caps hospital charges to the uninsured at cost plus 35 percent. It was prompted by claims that charges to uninsured people sometimes doubled the actual cost. The law also caps what hospitals can collect each year from uninsured people at 25 percent of the patient’s annual income.

AARP Illinois is working on legislation to reform the insurance industry and help consumers. A bill, HB 3923, would require that insurers spend 75 cents of every dollar on patient care—not on administrative costs or profits; would allow the state to independently review rate increases and insurance claims that are denied; and would create a standard application process for individuals and small group insurance markets so more people can get coverage. If you support this bill, call your legislator at 1-800-664-9903.

“Unfair and inconsistent practices in the insurance industry are putting a wall up between people and the health care they need and deserve,” said Robert Gallo, AARP Illinois senior state director. “The insurance industry needs to put people before profits.”

Rebecca Sanchez is a freelance writer based in Chicago.

Join the Discussion

0 %{widget}% | Add Yours

You must be logged in to leave a comment.