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Clock ticking for Illinois to form state-run Obamacare exchange [Chicago Tribune](Chicago Tribune (IL) Via Acquire Media NewsEdge) Sept. 19--Unless Illinois acts quickly, it will leave hundreds of millions of federal dollars on the table that would go toward building its own health insurance marketplace, potentially upping the cost of coverage for nearly 170,000 Illinois residents. State lawmakers, unable to break a yearslong standoff, have not passed a law authorizing a state-based exchange, the marketplaces created under the Affordable Care Act that allow consumers to compare and buy health coverage, often with the help of federal tax credits. As a result, Illinois was one of 36 states that relied on the federal government to host its marketplace on HealthCare.gov, the website that survived a disastrous launch late last year to enroll about 217,000 Illinoisans, 77 percent of whom received federal help. Two of those states this fall are switching over to their own, state-run models. But so far, lawmakers in Illinois have balked, afraid of the risks associated with making the transition. Time is running out. Lawmakers have until the end of the year to act. If they don't get legislation through in the six-day veto session this fall, that federal money goes away. "It would be a missed opportunity, and I hope they don't miss it," said Margaret Stapleton, director of community justice for the Sargent Shriver National Center on Poverty Law in Chicago. "That's why we have to do everything we can, why we have to step forward now," before the availability of federal funds expires. It's unlikely that Illinois, with its deep budget woes, would be able to afford to build its own marketplace without federal help. Those states that have built their own exchanges received amounts between about $100 million to more than $1 billion from the federal government to do so. The absence of a state-based exchange also could hit some Illinois consumers in the pocketbook. This summer, two federal appellate courts issued conflicting rulings on whether the government can subsidize health insurance premiums for millions of Americans who live in states like Illinois that rely on the federal government's HealthCare.gov to enroll people in coverage. The issue, which centers on specific language in the Affordable Care Act referencing state-based exchanges, could make its way to the U.S. Supreme Court. At stake are millions of dollars in federal tax credits designed to help consumers offset the cost of buying coverage, a key pillar of the health law aimed at making coverage affordable. If the court decides subsidies for consumers who buy coverage through the federal portal aren't legal, inaction in Springfield this fall would translate to higher health insurance costs for up to 1 million Illinoisans estimated to be eligible for federal help. The average person who bought coverage on the exchange in Illinois received a $202 tax credit, lowering the monthly premium to $114, from $316, according to government data. To qualify for federal funds to build exchanges that would launch in 2015 or later, states must apply by Nov. 14. Though that deadline is five days before the state legislature is scheduled to convene for the fall veto session, the state intends to submit its application anyway, hoping lawmakers will push through a last-minute bill. Whether a bill stands a chance to pass, however, is a far more difficult question. Despite several attempts, including a 2013 bill that passed the state Senate, legislation in Illinois has never been able to reach the House floor. Gov. Pat Quinn, locked in a tight re-election campaign, supports a state-based exchange, but he hasn't made the issue a priority. A spokesman directed questions to Get Covered Illinois, the state's enrollment arm. Jennifer Koehler, the agency's executive director, said the state will be "in a position to apply for additional federal funding" if the legislature is able to move a bill. Get Covered Illinois, she said, "has been a tremendous success for Illinois, signing up almost 670,000 people for health coverage in its first year." Despite the first-year success in Illinois, proponents of a state-run exchange continue to push the idea of Illinois going on its own. They point to myriad potential benefits, including the opportunity to customize the site, integrate it with other systems like the state's Medicaid portal and make it easier for people to transition from private insurance to Medicaid and back, a churn that experts expect will be commonplace. Further, the state would be allowed real-time access to enrollment and website use data, giving it the ability to track the success of outreach events, advertising and other initiatives. Right now, for example, Illinois officials don't even know how many people in the state completed enrollment in exchange-based insurance for 2014 because the federal government hasn't updated its data since early May. With a state-run exchange, all of that data would be at the state's fingertips. But building an exchange also comes with a fair amount of risk. Though funded by the federal government, states still are on the hook for future operating costs, infrastructure updates and other changes. And there's no guarantee a state-run model would produce better results than the federal government's. GOP Rep. Patti Bellock, the deputy House minority leader, said Republicans have been right in withholding support for a state-run exchange because of questions about the recurring costs to support its operation. "There's a real need to be cautious on what the state would be responsible for, and we don't want to be responsible for" any costs beyond what the federal government would give the state, she said. Bellock said there's little appetite on her side of the aisle to take on the risk when what's in place works. "I don't think there would be enough support," Bellock said. "But I can't speak for the (Republican) caucus until we review it again." Legislation didn't stop governors of other states, like Kentucky, from setting up their own exchanges via executive action. But the Quinn administration has said such a move isn't possible in Illinois. Federal regulations require a state to prove that its exchange will be self-sustaining in order to receive funding. That means states must levy assessments, fees or taxes on insurers or find some other source of money to pay for the marketplace's continuing operations. In Illinois, the authority to assess such fees lies with the legislature. Dozens of interest groups, each with disparate desires and thoughts on a state-based exchange, have been trying to find common ground on the issue since the president signed the bill. "There's never been consensus. That's why we are where we are," said Steve Brown, a spokesman for state House Speaker Michael Madigan. "There's been a lot of discussion on this, and I'm sure there is a lot more that will continue," Brown said. "The current federal deadline could be an impetus for action, but I don't do predictions." Lawmakers and lobbyists have said Madigan will not move a bill to the floor unless it has bipartisan support. Republicans generally are loath to support any legislation related to the health law, also known as Obamacare, which has become a campaign issue in some districts. Even some Downstate Democrats are wary of supporting a bill linked to the law. Among the most vocal detractors are insurance companies, which are adamant that legislation would not allow the state or a governing board to manipulate the marketplace, whether by controlling rates, enacting more stringent requirements on plan benefits or design, or through limiting the number of plans they can offer. Blue Cross and Blue Shield of Illinois, the state's dominant insurer, said in a statement that it has "participated in good faith regarding that legislation, and will continue to do so. Should a proposed final piece of legislation emerge, we'll evaluate it at that time." Rep. Robyn Gabel, an Evanston Democrat, is among those leading the charge for a bill. "This is not the kind of bill we like to pass with just one side's votes," she said. "We are and will be working hard in these next few weeks to build some bipartisan support and support from the insurance industry. I think there's some potential to get this done." 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