The Illinois insurance market is poised to be hit by rising unemployment that is hitting the factory towns of Peoria, Rockford and Bradley-Kankakee. These markets are typically led by Blue Cross Blue Shield of Illinois, which is already forecasting an enrollment decline this year, the first such drop in a quarter century. Health insurers are responding with narrow-network products from Aetna and UniCare, while Aetna is rolling out a high-deductible plan that charges no copay for preventive care. Because of these issues, the placidity that has defined insurer-provider relations over the last couple of years will be strained. Providers face increasing bad debt thanks to the rising number of uninsured and have traditionally pushed to make up for this through larger reimbursements from commercial carriers. Through the first three quarters of last year, HMOs in Illinois saw a medical cost trend of around 10 percent with both hospital/medical and drug costs rising by an equal amount. Facing their own problems – namely enrollment declines – insurers won't be able to stomach large reimbursement demands from major providers.