At first glance, the new Pre-existing Condition Insurance Plan, commonly known as I.P.X.P., sounds like welcome relief for jobless Illinoisans who have serious medical issues and are struggling with the loss of employer-financed health care.
The federally financed $5 billion plan — $196 million of which is earmarked for Illinois — provides an affordable health insurance option to people who previously were limited to the far more expensive, state-run Illinois Comprehensive Health Insurance Plan. Under the federal plan, which is administered in Illinois by Health Alliance Medical, enrollees pay about $200 a month, compared with $600 for comparable I.C.H.I.P. coverage.
Applicants for the federal program must be American citizens, and they must have a medically documented pre-existing condition that has disqualified them from private coverage. But the I.P.X.P. is available only to individuals who have not had “creditable” health insurance coverage for the past six months.
“Creditable coverage” includes almost any type of health insurance, including continuation of coverage under the federal Consolidated Omnibus Budget Reconciliation Act, or Cobra.
So those who have lost their jobs and health insurance, have a pre-existing condition and have been making $500 monthly Cobra payments will be faced with having to pay the $600 monthly I.C.H.I.P. premiums when the Cobra coverage runs out after 18 months. If they let their insurance lapse for six months in order to qualify for the $200-a-month federal program, they risk running up medical bills that could bankrupt them or turn up on the state’s balance sheet.
Michael T. McRaith, director of the Illinois Department of Insurance, said his staff “shares the concern” about the discrepancies between the premiums. “We want people to have access to affordable, meaningful coverage,” he said.
As far as enacting change, Mr. McRaith added, his hands are effectively tied.
“I.C.H.I.P. premiums are established by state law,” he said, “and I.P.X.P. is a creature of federal law. And the Department of Insurance does not have the opportunity or the ability to change those statues.”
Jessica Santillo, a spokeswoman for the federal Department of Health and Human Services, said in an e-mail: “The statutory language is specific. It’s written by Congress.”
It is a shame, because the ICHIP premiums are so high that people really do struggle to pay them. But the federal language is very clear, and makes some sense when you remember that the goal was to get insurance to more individuals. Pricey as it is, at least people on ICHIP do have insurance.
The real solution, of course, would have been to reduce ICHIP premiums to IXPX levels. But, unlike every other states’ high risk pools, in Illinois much of our funding comes from the legislature and, as you can imagine, an increase isn’t likely to come from that direction in this climate. In other states (and partially in Illinois), funding comes from insurance companies, who, after all, are the ones benefiting from the fact that we get to let them pick and choose who they’re willing to insure. The logical thing to do would be to raise the assessment on Illinois insurers enough to reduce the ICHIP premiums to IXPX levels. With their record profits and the small number of ICHIP participants, the increase would be scarcely noticeable. But in Illinois nothing, I repeat nothing, happens to insurance companies without their permission. So it’s a non-starter. But put the blame there, not on ICHIP or the feds.
I agree with Ann; it is not simple enough to say that the language of the bill limits access – it is the lack of money that is limiting access and the cost of care. There is a lot of back story and questions to be answered regarding both.
$196 million dollars is not a lot of money to cover all of those with pre-existing conditions in Illinois. Until there is a new source of revenue allocated towards this effort, or until the costs of state plans is lowered, the state does have to figure out how to go about selecting the 4,000 – 6,000 citizens they will accept on to the IXPX plan.
While it is horrible to have to narrow down this group, I do see some sense in their criteria. If people who are ill have gone for 6 months without care, their illnesses may be compounding and could end up causing the system even more money. However, if people with pre-existing conditions have already been receiving care during the last six months, we hope there is a higher chance that they might be able to find a way to continue to scrounging together the high cost for ICHIP.
Also: “If they let their insurance lapse for six months in order to qualify for the $200-a-month federal program, they risk running up medical bills that could bankrupt them or turn up on the state’s balance sheet.” The state is monitoring closely to prevent people from trying to take this approach. And it is important to note that Illinois law prevents someone who voluntarily disenrolls from ICHIP from re-enrolling for 12 months following disenrollment.
I am one of the many uninsured that have applied for the IXPX coverage. As of now, I am not sure that I will be accepted. The amount that I will pay for premiums is in the area of $500 per month. I work part-time, I am nearly 62, and I have a pre-existing condition. I have waivered between COBRA, ICHIP, and indemnity programs. At one time, I was paying close to $750 per month until I went through most of my savings. I am divorced and have not had a decent paying job in a few years. It’s impossible to come up with $500 a month, much less $750 (though I’ve noticed ICHIP has come down in price). I have basically worked my entire life and desperately need insurance, less I go to Stroger’s. Not a feasible choice as I live 40 miles from the Hospital and am my mom’s caretaker and cannot leave for 15 hours a day. I need help soon.
This article has some erroneous information. IPXP is not $200 a month. Here is a premium table:
http://www.insurance.illinois.gov/ipxp/IPXPratetablev4.pdf