Given the landscape of health insurance and health care costs in Illinois, the Health Care Affordability Act, effective July 7, 2020, mandated that the Illinois Department of Health and Family Services (HFS) and the Department of Insurance (DOI) conduct a Healthcare Affordability Feasibility Study. This study will research how the state can make insurance more affordable and accessible in Illinois by researching what other states do and considering options based on Illinois-specific data. The study will provide a report with an array of options to the Illinois General Assembly and the Governor by February 28, 2021, which can be used by legislators to guide decision-making regarding insurance policies in Illinois. 

Affordable and accessible health care has been a priority for Illinoisans for decades. Even with the financial assistance provided by the Affordable Care Act, premiums, deductibles and cost-sharing are still too high for many families. A recent survey reveals that uninsured Illinoisans cite high costs as the main reason for not having insurance. The burden of cost affects families of all income levels, but especially those with incomes below 200% of the federal poverty line. In fact, nearly 15% of people with incomes below 200% of the federal poverty line are uninsured in Illinois. Even for those with insurance, the cost of health care remains prohibitive for many people. In a 2020 survey of Illinoisans, 49% of respondents reported delaying going to the doctor, skipping the dentist, or choosing to not fill a needed prescription to help curb out of pocket costs. Additionally, the COVID-19 pandemic has resulted in the largest loss of employer-sponsored health insurance in American history. 186,000 workers in Illinois lost their insurance coverage when they lost their jobs in Spring 2020. 

Despite the advances in insurance coverage for many people as a result of the Affordable Care Act, problems persist in Illinois, including prohibitively high costs, insurance and service provider systems that are often narrow, confusing, and time-consuming to navigate, and increasing rates of uninsured children. Additionally, clear disparities exist in insurance coverage. In 2018, 5.8% of white people were uninsured, compared to 6.9% of Asian people, 8.3% Black people, 12.5 % of American Indian and Alaskan Native people, 13.5% of Native Hawaiian and Pacific Islander people, and 15.4% of Hispanic people. Immigrant communities often face an additional burden of lack of citizenship status as a barrier to accessing coverage. In 2018, 23% of documented immigrants and 45% of undocumented immigrants reported being uninsured, compared to 9% of U.S. citizens. Disparities also exist for people with disabilities, who are 4 times more likely to report their health to be fair or poor than people with no disabilities (40.3% vs 9.9%). Additionally, LGBTQQIA+ people are disproportionately affected but more research is needed to understand the gaps in coverage. Studies show that more LGB people became insured as a result of the ACA, but in 2016 about 10% of LGB people were still uninsured. Disparities persist for the transgender population as well. Transgender people are more likely to be uninsured than the general population, and more likely to have trouble using their insurance to access care. 

The Affordability Study provides a chance to learn about potential solutions. Member Organizations of Protect Our Care Illinois provided feedback to HFS and DOI about the study, both in the form of submitting written recommended guiding principles, as well as through hosting two listening sessions between community members and HFS and DOI. The feedback from participants of the listening sessions made it clear: dental and vision care should be included in any health care plan, the cost of prescription drugs are too high, provider networks for Medicaid are too small, and barriers to full coverage for immigrant communities are insurmountable. We need solutions. Meaningful access to comprehensive health care is paramount for Illinoisans across the state. Protect Our Care Illinois believes that everyone deserves access to equitable, affordable, comprehensive healthcare no matter their race, ethnicity, gender identity, sexual orientation, income, ability, or immigration status. We also believe that health care coverage is a right – not a privilege – and will continue to push for new health care policies that move the state toward universal coverage.  We look forward to the results of the Affordability Study which will add to the conversation about health care in Illinois and lead us towards more affordable and accessible care.

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