250,000 children in Illinois without Health Insurance

Of the 250,000 children in Illinois without health insurance, half come from working and middle class families who earn too much to qualify for programs like KidCare, but not enough to afford private health insurance. The Governor’s program would make comprehensive health insurance available to children, including doctor’s visits, hospital stays, prescription drugs, vision care, dental care and medical devices like eye glasses and asthma inhalers. Parents will pay monthly premiums and co-payments for doctors’ visits and prescription drugs at affordable rates.

Unlike private insurance that is too expensive for so many families, the rates for All Kids coverage will be based on a family’s income. The state is able to offer All Kids insurance coverage at much lower than market rates for middle-income families by leveraging the significant negotiating and buying power it already has through Medicaid.

For example, a family with two children that earns between $40,000 and $59,999 a year will pay a $40 monthly premium per child, and a $10 co-pay per physician visit. A family with two children earning between $60,000 and $79,999 will pay a $70 monthly premium per child, and a $15 co-pay per physician visit. However, there will be no co-pays for preventative care visits, such as annual immunizations and regular check ups and screenings for vision, hearing, appropriate development or preventative dental. These premiums for middle-income families are significantly more affordable than typical private insurance premiums of $100 to $200 a month, or $2,400 per child annually.

The state will cover the difference between what parents contribute in monthly premiums and the actual cost of providing health care for each child, expected to be $45 million in the first year, with savings generated by implementing a primary care case management model (PCCM) for participants in the state’s FamilyCare and All Kids health care programs. Participants will choose a single primary physician who will manage their care by ensuring they get immunizations and other preventative health care services and avoid unnecessary emergency room visits and hospitalizations. Patients with chronic conditions like asthma or diabetes will have a single care manager to make sure they are getting the treatments and ongoing care they need to avoid acute care. Primary care physicians will make referrals to specialists for additional care or tests as needed.

By ensuring patients get adequate preventative care on the front end, fewer people will need expensive specialized care or emergency care for critical conditions. In children, preventative care is especially important. For example, infants with stomach flu (gastroenteritis) who receive appropriate primary care can avoid being hospitalized for dehydration. Providing a timely exam and appropriate antibiotic treatment for children with ear infections (otitis media) can prevent chronic ear problems, loss of hearing and the need for surgically placed tubes to relieve fluid build up. Treating children with bronchitis or minor lung infections in a primary care setting can help to avoid more expensive hospitalization treatment of pneumonia, including intravenous antibiotics and respiratory treatments. And early identification and appropriate treatment of children who have chronic illnesses, such as asthma, will result in fewer expensive emergency room and inpatient care visits.

Twenty-nine other states, including North Carolina, New York, Texas, Pennsylvania and Louisiana, have realized significant savings by using this model for their Medicaid programs. Based on independent analyses, the Department of Healthcare and Family Services estimates the state will save $56 million in the first year by implementing the PCCM model in all state health programs but those that serve seniors and the blind.

Research provides strong economic reasons for insuring all children. Delayed treatment can result in more complex, more threatening and more expensive care later. While the uninsured pay approximately 35% of their medical bills out of pocket, more than 40% ends up being absorbed by those who do have health insurance in the form of higher premiums. According to a recent Families USA report, the cost of paying for the uninsured added $1059 to the average family’s insurance premiums in Illinois in 2005.

In addition, investing in health care can have a positive impact on local economies. Over the past five years, the health care industry has created nearly 40,000 new jobs in Illinois. Health care is the second-fastest growing industry in the state, and one of the fastest in the nation. Families USA found that for every $1 million invested in health care for people who need coverage, an additional $2.4 million is generated in new business activity and $840,000 in new wages.

While All Kids coverage does not begin until July 1, 2006, pre-registration is now underway in order to expedite the application process so children can enjoy the benefits of the program as soon as All Kids takes effect. The forms are now available online at www.allkidscovered.com in 8 languages: English, Chinese, Hindi, Korean, Polish, Russian, Spanish, and Vietnamese, with more translations on the way. The forms can also be requested through 1-866-ALL-KIDS to receive them in the mail.

Once a pre-registration form is received, the Illinois Department of Healthcare and Family Services (HFS) will process the information and mail parents a letter to explain the next steps in the application process. When it is time for the family to apply, the Department will mail each family an All Kids application that will be partially filled out based on the information provided during pre-registration. Children who are determined to be eligible for KidCare can apply immediately to receive health coverage. Families not currently eligible for KidCare may apply early in 2006 for benefits that will begin July 1, 2006.

For more information on these plans, or to apply for Illinois health insurance visit us at www.medequote.com , www.medequote.net , or www.unicaresoundplans.com .