The Illinois and Iowa commercial health insurance markets took hits through much of 2009 as rising unemployment resulted in fewer insured residents. The issue was more severe in Illinois where the manufacturing downturn caused enrollment losses for most major insurers. In Iowa, a more-stable economy left fewer losses, but carriers there are still feeling the pinch of employers seeking to hold down healthcare cost increases. As a result, high-deductible health plans are increasing in popularity as an option for mid-sized groups and as a sole solution for small groups. The average deductible for these plans is running at $2,500 with some preventive benefits covered before the deductible. Separately, BC/BS of Illinois – the state’s largest insurer – agreed to absorb the commercial members of UniCare, the WellPoint unit that is exiting the Illinois and Texas markets. The addition of these UniCare lives should benefit Illinois Blues at a time when the commercial market is stagnant and consolidation has removed some players from the field. Illinois Blue is also developing a patient-centered medical home pilot with physician groups in the Chicago suburbs that could expand to much of its PPO network. In Iowa, job losses are driving demand for Medicaid services, just as the state faces a budget crunch to pay for these services. With eligibility rules locked in, the state has already cut some reimbursement levels and could do so again, although hospitals are signaling support for a provider assessment program that would attract additional federal matching funds.