By law, the exchanges have to be operating by January 1, 2014, with prototypes for inspection ready six months from now. But Illinois is way behind in creating them.
At the new Lurie Children's Hospital, supporters of the president's health care law celebrated the Supreme Court's affirmation of the individual mandate, the call for everyone to carry insurance to lower the overall cost of health care.
"This is a special day for Illinois and for America," said Gov. Pat Quinn. "This is a great victory day for health care in our state and in our country."
Now the governor must pass a law creating health insurance exchanges where those without health care will be able to buy policies to cover them and their families through their employers. They are entities that would eventually resemble travel and car insurance websites. Unlike such states as New York and California, Illinois has done little to create them.
"We have already been working on this issue," said Quinn. "It will be 100 percent funded by Washington with respect to anyone on Medicaid who is covered, and that will be true for some years."
Indeed, many who now cannot afford insurance and do not qualify for Medicare and Medicaid will get subsidies from Washington to help them buy insurance on the exchanges. The "premium subsidy" will come in part from the Medicaid and Medicare budgets, and new government debt.
State Comptroller Judy Baar Topinka has the job of making the transaction work and worries that the implementation will cost Illinois.
"It is going to cost us roughly about $2.4 billion," she said. "This will bring in 600-900,000 people that are not currently on the Medicaid rolls ... It is either they do this or they pay a tax."
But U.S. Senator Dick Durbin says Topinka is wrong.
"The entire cost for the first four years is paid by the federal government and it continues to make the majority payment for those who are newly covered under Medicaid, so when she reads that, I think she will understand her statement was inaccurate," said Durbin.
The U.S. Department of Health and Human Services says in the first two years of the law, nearly 2,000 Illinoisans have gotten coverage even though they had pre-existing conditions. Over 100,000 young adults have been able to stay on their parents' coverage and in the first five months of this year 26,000 people in our state on Medicare saved an average of $636 per person on prescription drugs because the law is closing the coverage gap known as the "doughnut hole."