By the end of June the U.S. Supreme Court will announce its decision in the King vs. Burwell case on the legality of tax subsidies for participants in federally facilitated Health Insurance Marketplaces, impacting 34 states including Illinois. The nation has been eagerly awaiting this ruling since the Supreme Court heard oral arguments in early March. A negative ruling will affect more than 230,000 Illinoisans and millions of people nationally.

IHA and the hospital community have been strong supporters of health insurance coverage for many years, and we have serious concerns about the potential loss of $600 million (annually) of Health Insurance Marketplace subsidies for Illinoisans.

As your trusted voice—the most influential voice for Illinois health care—IHA is ready and prepared to work with key stakeholders, including the Governor, his Administration and the General Assembly on making sure access to quality health care for Illinoisans is maintained, including making sure that these critical health insurance subsidies continue.

Not only have we developed and distributed a position paper on the King v. Burwell case, we have constructed a Key Considerations paper, outlining potential approaches and options for establishing a state-based exchange so subsidies can continue if the Supreme Court rules against them. We have outlined for stakeholders the key elements and options for a state-based exchange, to help facilitate the state moving efficiently to a state-based exchange, if the state needs or wants to move in that direction.

While establishing a state-based exchange is one option, we first must look to Congress to take action to continue the subsidies. Congress must find a reasonable solution – one that does not undermine the Affordable Care Act, e.g., by eliminating the individual and employer mandates – but a solution that ensures and maintains access to quality health care.

Over the past few months, IHA has been preparing for the Supreme Court ruling by having thoughtful conversations with the state’s Congressional Delegation, the Governor’s Administration, state legislative leaders and other key legislators. We have raised this issue with the media. We have knocked on doors and walked down hallways to make sure that key stakeholders know that we are ready to work with them on a moment’s notice to develop a viable solution.

The waiting is almost over, but our work is never done. IHA will continue to advocate for our members and the patients and communities they serve so that together we can continue on our transformation journey of providing affordable, high-quality care to all Illinoisans.

As we seek solutions to turn around the state’s economy, one answer is staring right in front of us. Hospitals and health systems drive economic growth in our neighborhoods, our towns and our cities.

Just look around. Surrounding our hospitals are local businesses, vibrant and recovering main streets, transportation routes, and “help wanted” signs. Our sign, the blue “H”, symbolizes access to health care and the health of our local economies.

Hospitals are a key economic asset, contributing to the vitality of our communities, and developing the life science industry in Illinois to support health and wellness for the future.

Businesses select locations where “must-have” health care is available and vibrant.

Just consider:

  • Hospitals are a leading sector for employment and new jobs:
    • 1 in 10 jobs in Illinois is in the health care sector
    • Illinois hospitals directly employ more than 250,000 workers
  • Hospitals are a key driver for the middle class and career development:
    • Hospitals provide professional level jobs and salaries, helping people move to and stay in the middle class
    • Hospitals develop the workforce of today and tomorrow from pre-K through higher education, including training physicians for the future
  • Hospitals help lower overall health costs by:
    • Keeping employees productive by preventing and managing chronic conditions
    • Engaging in population health activities to promote healthier conditions before they become complex and costly
  • Hospitals are hubs for innovation and economic growth by:
    • Fostering workforce development in life science jobs of tomorrow
    • Attracting private sector partners to grow and expand innovative businesses in life sciences
    • Serving as incubators for new medical technologies, life sciences research and biomedical engineering.

We can be proud of our hospitals and health systems – essential community organizations now and in the future and essential to the economy of Illinois.

Two years ago, the Illinois General Assembly had the foresight to create one of the most innovative Medicaid “accountable care” models in the country. What made it innovative? Two things: its aggressive timeline to full capitation in 36 months and it being provider sponsored or directly led by health care professionals. Policymakers for years have understood that linking the patient directly with the health care professional leads to better and more patient-focused decisions—care at the right time, in the right place with better outcomes and lower costs.

Already, more than 80 hospitals and health systems across the state are implementing new, innovative models to coordinate health care for nearly 450,000 Medicaid beneficiaries as part of accountable care entities (ACEs) and care coordination entities (CCEs). Illinois hospitals and health systems are leading the way to transform Medicaid and our health care delivery system.

The federal government realized the promise of these provider-led programs years ago when it established accountable care organizations (ACOs). Two weeks ago, the Centers for Medicare and Medicaid Services (CMS) issued a report showing early results that the ACO model saved roughly $385 million over two years. When comparing the experiences of people in Pioneer ACOs with those of a similar group in traditional Medicare, CMS found that total spending rose less for the 1.48 million people aligned with hospitals and medical groups than for the other group.

There is such promise to Medicaid accountable care models. As of March, eight states have launched Medicaid ACO programs, including Illinois. Another nine states are actively pursuing them. Colorado has reported more than $30 million in net savings and lower rates of emergency department visits, high cost imaging and hospital readmissions for those enrolled in the program for more than six months. Minnesota and Oregon have reported similar results.

With all this positive evidence, why is the accountable care model under attack in Illinois?

In the Governor’s proposed FY 2016 budget, fees paid to ACEs and CCEs to better coordinate care are slated for elimination. And, the state’s Medicaid agency appears arbitrary in its rationale for not staying the course as outlined in statute.

So, despite the foresight of the General Assembly, we run the risk of being shortsighted in 2015 and lose the one innovation that identifies Illinois as a national leader in health care.

We all lose if the ACEs and CCEs are not given the time to invest in the health care delivery systems of tomorrow.

This is an easy one – let’s not be shortsighted. Invest in the promise of Illinois’ provider-sponsored care coordination models, ACEs and CCEs.

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