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Lawmakers eye final attempt at state-run exchange

CHICAGO (AP) – Illinois lawmakers may have one more chance to approve a state-run health insurance marketplace during the fall legislative session that starts today, and they are under pressure from an end-of-the-year deadline and a pending court decision.

Supporters of creating a state-run website say the impending deadline to receive up to $300 million in federal funding plus a U.S. Supreme Court decision on tax credits due in the spring create urgency. Currently, Illinois residents purchase insurance on the national website.

Gov. Pat Quinn, who’s set to leave office in January, supports the idea, and the Illinois Senate passed a bill last year. Sponsors are now readying a House version. “I’d like to see the House take it up and pass it,” the Democrat said at a wellness fair Saturday.

But disagreement remains over who should pay for the estimated $50 million annual operating cost of a state marketplace, also known as an insurance exchange. Democratic House Speaker Michael Madigan has pushed for bipartisan support because the system would require a new government agency to run it, said state Rep. Frank Mautino, a Spring Valley Democrat.

“It has to have a financing mechanism and, for a new agency, it should have bipartisan support,” Mautino said. Madigan has said Republican buy-in is important for this idea, Mautino said, but that very GOP support may be hard to find.

Republican Gov.-elect Bruce Rauner told The Associated Press earlier this year that if elected he would “take a hard look at how things are being run” and the best way to improve value for taxpayers. A spokesman for Rauner said Tuesday he didn’t have any additional comment.

At the end of the year, the federal government will stop awarding grants – in Illinois’ case, that could amount to $300 million, said Rep. Robyn Gabel, an Evanston Democrat, who plans to introduce legislation during the 2-week fall session.

Bipartisan support may be impossible, Gabel said, and shouldn’t be a deal-breaker.

“It’s really critical for Illinois to act now,” said Gabel, who also brought up the pending U.S. Supreme Court decision expected in the spring.

The high court is to decide whether the wording of the Affordable Care Act limits insurance tax credits only to people who live in states that have set up their own insurance markets, which could cost thousands of middle-class Illinois residents valuable insurance subsidies.

“If we wait until the Supreme Court decision, it will be too late to get federal funding to establish the exchange and the cost is too great for Illinois to take it on without that federal support,” Gabel said.

Jillian Phillips of the Campaign for Better Health Care, an Illinois coalition supporting health care access, sounded a warning: “This is the last chance we have to draw down the federal funding to build a state-based marketplace.”

And Sonya Schwartz of the Georgetown University Health Policy Institute, which has been tracking states’ implementation of the health law, believes Illinois residents will not “be quiet if they lose their subsidies.”

The insurance industry has qualms. Last year’s Senate bill required Illinois insurance carriers to finance the operating cost through an assessment based on the dollar amount of premiums each carrier collects from customers.

“When a bill is written correctly, we absolutely believe Illinois should pass that bill,” said Elena Butkus, a lobbyist for insurer Aetna Inc. “To date, I haven’t seen language that has been worked out by both sides.”

Madigan spokesman Steve Brown referred questions to Mautino, but Brown said he was “not sure whether the state would act in advance of a court ruling.” Mautino said he would be reviewing proposed legislation.

“The reality is that it remains unclear whether the decision of the Supreme Court to take the case will impact the decisions made by the General Assembly on the matter,” said Lauren Perlstein, a spokeswoman for Illinois’ largest health insurance carrier, Health Care Service Corporation, which operates Blue Cross Blue Shield of Illinois.


Associated Press medical writer Carla K. Johnson can be reached at

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