Despite a decreasing percentage of uninsured Illinois residents, one in eight Illinoisans still do not have health insurance. With the implementation of the Health Insurance Marketplace in 2014, Americans will have a new way to obtain health insurance. 

While the number of Illinois residents without insurance has dropped from 16 percent in 2006 to 14.7 percent in 2011, problems with the current health care system still exist. 

James Shawn, 29, is one of 25,000 uninsured residents of Champaign County. Shawn, who works at a local gas station, says it is difficult for him to afford health insurance.

“My employer does not provide health benefits. It is difficult to manage in case of emergency,” Shawn said. “In some cases, the only option is to go to the emergency rooms or community health clinics.”

The Illinois Department of Insurance has reported that cost is the most common reason people do not have health insurance. Although 52 percent of Illinois residents obtain health insurance through their employers, employers who don’t offer insurance are the second most common reason Illinois residents report not having insurance.  

“The lower your income, the more likely you are to be uninsured. In the wake of the Great Recession many people lost their jobs, and with it their health insurance coverage,” explains Jennifer Clary, research associate at Heartland Alliance. She says even those who are employed are not necessarily covered as many low-wage jobs do not offer benefits.

Inappropriate use of ER

Prominent use of the emergency room by the uninsured is another concern for the state insurance department. Since many uninsured residents know it is possible to receive treatment in the emergency wards without paying immediately — if at all — they use ERs regardless of how small the need. 

Kimberly Parker, communications manager at the Illinois Department of Insurance, says the federal and the state governments are working on the problem together. 

“With the establishment of the Marketplace, consumers with household incomes between 100 percent and 400 percent of the Federal Poverty Level (currently up to $45,960 for an individual and $94,200 for a family of four) will be eligible for federal financial assistance to help make premiums and cost-sharing more affordable,” Parker said.

According to a report released by the Center for Disease Control and Prevention, in 2011, uninsured adults were more likely to visit the emergency room than those with private health insurance.

Sasha Pryer-Gibbons, supervisor of outreach at Regional Presence Health, says that efforts are made to understand the complex reasons for multiple emergency room visits. She says the Community Resource Center has been established to improve health care outcomes in the community by mobilizing internal and community resources. 

“We focus on serving individuals who come to the emergency department for multiple visits, yet persist with ongoing care needs that might be more appropriately addressed by other service providers,” Gibbons said.

Affordable health insurance a problem for retirees

One of the biggest obstacles of retiring before the age of 65 is finding affordable health insurance, as most employers don’t provide retiree health benefits to their former employees.

Over the past two decades, the percentage of big companies offering retiree health benefits has shrunk from 66 percent to about 35 percent.

Richard Van Hook, 55, has been working as an assistant program administrator for the computer science department at the University for the past 20 years. Van Hook is planning to retire within the next five years, but he doesn’t trust the state retiree health policy. 

He says the state health policies are not transparent. 

“It’s like Ponzi scheme where you don’t know where your money goes. After I retire, I plan to get myself private health insurance rather than relying on the state policies,” Van Hook said.

Van Hook is not the only one who has been hit hard by the health policies. Petsy Howell is a social activist and has been working in the health field for 25 years. She is diabetic and was once uninsured herself. 

“People who are retiring, and yet are not entitled to retiree health benefits, have to bear the brunt of expensive medical cover. Most of the companies do not offer them benefits. They think it is too expensive,” says Howell. 

More uninsured in rural areas

Rural counties have the highest rate of uninsured people in the state. The Illinois Health Insurance Survey estimates 19 percent of the population of rural counties to be uninsured.

Rachel Licata, senior policy analyst at Kaiser Family Foundation, says that the newly created Marketplaces can provide people with the ability to purchase health insurance.

“Many individuals and families will be able to get help with the cost of premiums through tax credits and low income families will get additional help with cost-sharing subsidies,” Licata said.  

Undocumented immigrants not eligible for ACA

Illinois is home to a huge number of undocumented immigrants who are not eligible for the Affordable Care Act. Ineligibility makes things worse for the insurance system. According to a report published by the Illinois Department of Insurance, Hispanics have the highest uninsured rate at 27 percent.

Awais Vaid, data analyst at Champaign-Urbana Public Health District, says immigration reforms can benefit the uninsured. 

“There are 11 million undocumented immigrants in the U.S. who are not eligible for ACA. I think the reforms will play an important role in reducing the number of uninsured,” Vaid said.

Recent analysis done by Kaiser Family Foundation reveals around 57 percent of non-elderly uninsured Hispanics in Illinois have incomes below 139 percent of the FPL, which is the Medicaid expansion limit, and 39 percent of uninsured Hispanics have incomes between 139-399 percent FPL. 

Licata says that the ACA can potentially have an impact on increasing health insurance coverage for Hispanics in Illinois.

Number of uninsured youth drops

Recent statistics show a drop of 40 percent in the number of uninsured people between 19 and 25. Heartland Alliance states the government is increasingly picking up the tab as individuals and families find themselves without coverage due to job loss and are unable to purchase the coverage they need.

Vaid suggests the decrease in number of uninsured young adults is due to the expansion of health coverage for them under their parents’ plans, made possible by the ACA.

The U.S. Census report shows that across the nation, 539,000 fewer Americans between 19 and 25 were uninsured in 2011 than in 2010. The state government is expecting a decline in the number of uninsured in the coming years.

According to the Illinois Department of Insurance, prevention and increasing access to affordable and quality health care will greatly improve people’s overall health in coming years. 

Full implementation of the ACA, including passing SB26, the bill expanding the Illinois Medicaid Program, can help provide health care access to around 342,000 poor and near poor uninsured Illinoisans. 

ACA was intended to improve affordability for lower income people. With the provisions like the exchange and premium subsidies, it will substantially impact affordability, if implemented in the future.

The Illinois Department of Insurance said with the establishment of the Health Insurance Marketplace, consumers will no longer be charged higher rates or denied coverage because of health status. It will ensure that consumers have the coverage they need when they are sick, which is often the case for uninsured older adults who do not (yet) qualify for Medicare.  

The State Department suggests that nearly one million people in Illinois will be eligible for new health coverage when open enrollment begins on October 1, 2013 and coverage begins on January 1, 2014.

Zara can be reached at [email protected].