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“Repeal and replace” bill could blow a $4 billion hole in Illinois budget

Friday, Mar 17, 2017

* A House committee took testimony yesterday about the impact of the US House’s Obamacare replacement bill on the state’s Medicaid fund

Illinois Health and Hospital Association spokesman David Gross testified that Illinois would lose at least $38 billion in federal Medicaid funding over the act’s 10-year lifespan. The association arrived at this figure by taking Illinois’ share of the nation’s Medicaid beneficiaries and multiplying it by the $880 billion in reductions estimated by the nonpartisan Congressional Budget Office under the Republican plan. Gross said the cuts would jeopardize patient care.

Democratic Rep. Greg Harris of Chicago, who chairs the appropriations committee for human services, said one in four Illinois citizens receives Medicaid benefits and could be affected.

Illinois currently devotes $10 billion in state funds each year to Medicaid, or about one-quarter of the general fund. The federal government matches that amount.

Harris said lawmakers would need to find ways to fill the $4 billion-a-year hole.

* Tribune

Officials pointed to two aspects of the GOP plan that would hurt the state’s Medicaid system. One provision would cap how much the federal government reimburses states, which is different from the current system. States that exceed the cap would be responsible for shouldering the additional costs, something that could prove challenging for cash-strapped Illinois.

The proposal also would freeze Medicaid expansion in 2020. People enrolled before then would be allowed to stay in the program but only if they never leave the program. Anyone who loses coverage starting in 2020 couldn’t re-enroll.

“We know from the data that this is really an end to the expansion, that people circulate off the Medicaid program. And this is not a gentle slope. This is a cliff for the Medicaid program,” said Roberta Rakove, senior vice president for government and public affairs at Sinai Health System.

Rep. Tom Demmer, R-Dixon, said Thursday that lawmakers also should focus on problems with the Affordable Care Act put in place under Barack Obama when he was president. He cited one portion of the congressional report that said the Republican health care proposal would reduce federal costs and lower the deficit.

Keep in mind, however, that at the moment this thing is “just a bill.” There’s a very long way to go.

- Posted by Rich Miller        

25 Comments
  1. - annonin' - Friday, Mar 17, 17 @ 9:55 am:

    Right. Pay no attention to those carin’ folks in DC we know they will do the right thing. Anyone askin’ what EmptySuitLaHood is doin’
    Could someone wake up Demmer and tell him Obama left office in January.


  2. - AC - Friday, Mar 17, 17 @ 9:57 am:

    If a grand bargain is worth about 4.5 billion, we’ll just need another one. So, with the 12 billion backlog it’ll only take about 4 grand bargains to make up the difference. Another 25-30 grand bargains would take care of the pension debt too. /s


  3. - Flynn's mom - Friday, Mar 17, 17 @ 10:00 am:

    No worries we don’t have a budget to blow a hole in…


  4. - Juice - Friday, Mar 17, 17 @ 10:03 am:

    The $4 billion number is wrong.

    The big savings from the Medicaid changes come after 2020, so the savings are backloaded. In 2026, the cut (assuming the IHAs overall assumptions are correct) would be closer to $6.5 billion.


  5. - @MisterJayEm - Friday, Mar 17, 17 @ 10:04 am:

    But can’t Bruce just bring it back into balance with another $4.6B line item labeled “working together on a second ‘grand bargain’”?

    – MrJM


  6. - PublicServant - Friday, Mar 17, 17 @ 10:05 am:

    How are our representatives in the house and senate positioning themselves on it?


  7. - Anon221 - Friday, Mar 17, 17 @ 10:10 am:

    Vox has a very good article from a few days ago on this…

    http://www.vox.com/policy-and-politics/2017/3/10/14847218/medicaid-ahca-republican-obamacare-replacement


  8. - Dome Gnome - Friday, Mar 17, 17 @ 10:16 am:

    This has literally caused me to lose sleep during the past few weeks. Serious stuff.


  9. - Nick Name - Friday, Mar 17, 17 @ 10:24 am:

    Blasting “boss Madigan” and his co-conspirator Susana Mendoza and passing term limits will magic the problem away.


  10. - 47th Ward - Friday, Mar 17, 17 @ 10:25 am:

    ===Keep in mind, however, that at the moment this thing is “just a bill.”===

    It’s more than a bill, it’s a perfect example of Republican’s governing philosophy. All they offer America are tax cuts and guns.


  11. - Captain Illini - Friday, Mar 17, 17 @ 10:30 am:

    The fact of the matter is the ACA was temporarily supporting Medicaid to states that expanded, and at some point would have had to carry all the freight, So what’s the difference? The carrot extended - with a hidden lead pipe - to state to “encourage” their medicaid expansion was the federal subsidy…and that was the rub from the beginning, since many states determined that their budgets would be smashed when the subsidy went away. Regardless of how potential federal funds go away or not, Illinois has its own chance to craft a program which tries to assist as many in need as it can moving forward.


  12. - @MisterJayEm - Friday, Mar 17, 17 @ 10:34 am:

    “Illinois has its own chance to craft a program which tries to assist as many in need as it can moving forward”

    Illinois also has a chance to craft their own space program, but that too seems unlikely.

    – MrJM


  13. - Norseman - Friday, Mar 17, 17 @ 10:46 am:

    Dear Rep. Demmer, I understand that with Rauner’s impasse you’re not used that silly thing we call a budget. However, you ARE a STATE legislator who needs to care about the ILLINOIS budget. Coming up with a state budget is important to your constituents and the rest of us in Illinois. You are NOT a federal legislator. You may want to become one, but at the moment, please DO YOUR JOB as a STATE legislator. Passing Trumpcare to lower the federal deficit and be a tax boon for the wealthy, it will really, really make balance a budget in Illinois even harder than it is now. Yes, a budget. We use to do that here in Illinois. If you’ve got a plan to balance the Illinois budget with the additional cuts planned by Cong. GOP, let’s see it.

    P.S. If you got suggestions about ACA changes that we in IL can make, we would love to see them.


  14. - Irish1 - Friday, Mar 17, 17 @ 10:50 am:

    @Captain Illini, Medicaid Expansion states received 100% match 2014-2016, then 90% match thereafter, Illinois’s match for all non expansion is right around 51%.


  15. - Dome Gnome - Friday, Mar 17, 17 @ 10:50 am:

    Thank you, Norseman, I may just sleep a little better tonight.


  16. - A guy - Friday, Mar 17, 17 @ 11:03 am:

    Just the thought of it ought to inspire a balanced budget and a bill.

    It would anywhere else.


  17. - Sue - Friday, Mar 17, 17 @ 12:07 pm:

    Perhaps the expansion of Medicaid was always going to be like the Quinn tax hike- temporary


  18. - Captainillini - Friday, Mar 17, 17 @ 12:33 pm:

    Mr. MJM - classic, with respect!
    Irish - thanks for the info. My point in this is that perpetual expectation of federal monies to cover state expenses should not be the norm, rather it should be our task to craft programs for our neediest that are sustainable…but alas, that would actually take a functional legislature and executive. Uh…never mind…


  19. - Anonymous - Friday, Mar 17, 17 @ 12:50 pm:

    I tremble to think of how much Federal funding Chicago stands to lose if Rahm Emanuel insists upon maintaining “sanctuary city” policies and continues to refuse to comply with ICE.


  20. - Mod Dem - Friday, Mar 17, 17 @ 1:51 pm:

    I am disappointed that Gov Rauner was not one of the four governor’s to come out against the Health Care Act today. You would think that this would be a no brainer for the Gov, he has air cover from four other Governors, and clearly the bill hurts Illinois. Unless he is truly for the bill, which he should then make his position known.


  21. - Mama - Friday, Mar 17, 17 @ 1:52 pm:

    Does anyone know if Medicaid is used for people with Disabilities for health insurance who can not otherwise get insurance coverage?


  22. - Truth - Friday, Mar 17, 17 @ 2:01 pm:

    Illinois the welfare state .


  23. - Dome Gnome - Friday, Mar 17, 17 @ 2:03 pm:

    Mama, there are two main types of Medicaid — traditional Medicaid and ACA Expansion Medicaid. Both types are for people in poverty, including persons with disabilities. The coverage includes healthcare and often pays for attendants for personal care, so that people with disabilites can work and/or live in their own homes instead of relying on more expensive institutional care. The AHCA cuts take a swipe at both types of Medicaid.


  24. - Norseman - Friday, Mar 17, 17 @ 2:40 pm:

    Mod Dem, Rauner is not exactly a portrait of courage. Also, being concerned about Trumpcare’s impact on Illinois only matters if you want to govern. We’ve not seen any indications that he wants to do that.


  25. - RNUG - Friday, Mar 17, 17 @ 4:24 pm:

    == Does anyone know if Medicaid is used for people with Disabilities for health insurance who can not otherwise get insurance coverage? ==

    I.don’t know about that, but it is definitely used by the working poor who can’t afford either traditional health insurance or even ACA coverage.


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