The U.S. House Energy and Commerce Committee released its recommendations for budget reconciliation early last week. A preliminary review by the Congressional Budget Office projected that, if implemented, at least 8.6 million Americans would lose their Medicaid coverage during the coming decade.
That translates to well over 300,000 Illinoisans.
In addition, the CBO projected that 5.1 million more people would lose their health insurance because of the federal Centers for Medicare & Medicaid Services’ new rules regarding Affordable Care Act tax credits and restrictions on obtaining and retaining eligibility, including work requirements.
That would be about 190,000 more Illinoisans, for a total of about half a million people losing coverage here.
Another part of the U.S. House’s budget reconciliation proposal would reduce the federal Medicaid expansion match under the Affordable Care Act from 90% down to 80% for any state that used its Medicaid “infrastructure” to provide health insurance to undocumented residents.
Illinois’ All Kids program and its health insurance for undocumented older adults, as well as the adult insurance programs that Gov. JB Pritzker wants to cut off, all use the state’s Medicaid infrastructure to provide state funding for undocumented residents.
If that ultimately passes, the reduction to 80% would trigger a state law which halts all state funding for Medicaid expansion under the Affordable Care Act if the federal match falls below 90%.
So, either the state would have to give up funding health care for undocumented residents or continue to fund them with state dollars and then pay perhaps a billion dollars a year to make up for the 10-point reduction in the federal match.
No way the state could afford to step in and spend billions upon billions to cover all those folks.
The CBO also released cost estimates last week for the House Republican budget reconciliation plan, and it included even more eye-popping numbers about state Medicaid cuts and increased state costs.
The estimates cover the federal budget years of 2026 up to and including 2034 (apparently nine fiscal years). According to the nonpartisan budget office estimates, changes to the Medicaid program would result in “$698 billion less in federal subsidies.”
A back of the envelope calculation shows that would work out to about $24.4 billion in federal Medicaid cuts for Illinois, or about $2.7 billion a year on average, although the cuts are backloaded. A Kaiser Family Foundation report earlier this month showed Illinois received $21.1 billion in annual federal Medicaid funding out of $606.3 billion in total federal Medicaid funding, or 3.5%.
The CBO also estimates “$78 billion in additional state spending, on net, accounting for changes in state contributions to SNAP and Medicaid and for state tax and spending policies necessary to finance additional spending,” during the same time period.
That would be about $2.73 billion in additional expenses for Illinois, or about $303 million per year on average.
Later in the week, congressional Republican honchos proposed a “manager’s amendment” to their massive reconciliation bill.
One new item would prohibit private insurance companies in the Affordable Care Act exchange to pay for abortions unless “necessary to save the life of the mother or if the pregnancy is a result of an act of rape or incest.”
Illinois requires companies in the ACA health insurance marketplace to cover abortion if they offer pregnancy-related benefits, according to the Department of Insurance.
So, if the congressional provision is enacted, Illinois would have to decide whether to pick up the tab itself or find another workaround.
The same could happen with the amendment’s language banning Medicaid coverage of gender-affirming care for adults. The proposed ban earlier applied only to children.
The amendment would also move up Medicaid work requirements from the original 2029 start date to 2026, which will undoubtedly result in more Illinoisans being kicked off, if Arkansas’ disastrous experience is repeated here.
The budget office claimed that household resources for those in the bottom 10% of earners would “decrease by an amount equal to about 2 percent of income” in 2027 and 4% in future years, due to Medicaid and Supplemental Nutrition Assistance Program cuts.
Household resources for those in the top 10% would “increase by an amount equal to 4 percent for households in the highest [ten percent] in 2027 and 2 percent in 2033, mainly because of reductions in the taxes they owe,” the CBO reported.
We’ll just have to wait and see what the U.S. Senate does now that the ball is in its court.
About 70% of all the days a person spends in a nursing facility in Illinois are covered by Medicaid, and in fiscal year 2024 that amounted to $3.8 billion in federal dollars for long-term care facilities, according to the Illinois Department of Healthcare and Family Services.
“Federal cuts to Medicaid will leave state and local governments with vast budget shortfalls that cannot be made up, and the direct result would not only mean an economic impact for communities but also one directly felt by Medicaid customers currently residing in nursing facilities – and those served throughout the Medicaid program,” the department said in a statement.
The bill will place a moratorium on an effort to increase staffing levels at nursing homes, said Gelila Selassie, an attorney with Justice in Aging. Staffing levels at nursing homes are important because they prevent deaths at facilities, she said. The rule would have required an around-the-clock registered nurse and a minimum of 3.48 total nurse staffing hours per resident per day, according to a KFF analysis. […]
Another provision in the bill limits retroactive coverage from three months to one month, said Selassie. Applying for Medicaid requires a lot of paperwork and Selassie said now families will have a shorter window of time to gather the necessary documents. […]
People with disabilities who do not live in facilities will also be affected. Less Medicaid funding for things like personal attendants, wheelchairs and home modifications will mean they won’t be able to live at home, said Bridget Hayman, director of communications for Access Living.
- Career politician - Tuesday, May 27, 25 @ 9:24 am:
These cuts will be deadly to many in Illinois, particularly rural residents. Rural hospitals will be overrun by patients needing treatment but who no longer have access to a primary care doctor to treat common health issues. The eastern bloc makes a point to stand on the floor and praise the big beautiful bill, but do their constituents realize that they will bear the brunt of the pain it causes? I will never understand how we let politicians get away with robbing from the poor to enrich those who already have too much. They keep us divided and pointing fingers at each other while they rob our country of its wealth. What does America first even mean to these people?
- very old soil - Tuesday, May 27, 25 @ 9:37 am:
Number of people hurt in each congressional district
https://www.kff.org/medicaid/issue-brief/congressional-district-interactive-map-people-with-medicare-and-medicaid-dual-eligible-individuals/
https://www.jec.senate.gov/public/_cache/files/c398b0e7-5b57-4fc7-aa63-4c8b4c815bce/jec-fact-sheet-on-district-level-impacts-of-health-care-cuts.pdf
- Perrid - Tuesday, May 27, 25 @ 9:41 am:
All of this chaos and harm to PARTIALLY offset a tax break, mostly for the rich and well off. If they let the tax cuts lapse while making spending cuts, you could argue they care about the deficit. As it is it is obvious they do not care about the deficit, because they’re plan makes the deficit larger. They’re just using it to push their culture war BS.
- Demoralized - Tuesday, May 27, 25 @ 9:55 am:
=What does America first even mean to these people?==
In this case it means I’ve got mine and I don’t care about you. It’s more of a “me first” attitude.
- Grandson of Man - Tuesday, May 27, 25 @ 10:00 am:
The Founding Fathers envisioned free people solving their own problems, not welfare dependency and massive debt. Spending cuts are not tragedy but opportunity. Time for the people to take back healthcare. They can do their own research and teach each other medical procedures that can be done inexpensively with innovative new products like an all in one surgery kit. Bleach kills 99.9% of viruses and bacteria on surfaces, imagine what it will do in the body. These can be bought in the new medical section of hardware stores, next to the ivermectin. /s
- very old soil - Tuesday, May 27, 25 @ 10:03 am:
People who might be hurt by SNAP cuts
https://www.fns.usda.gov/data-research/data-visualization/snap-community-characteristics-congressional-district-dashboard
- JS Mill - Tuesday, May 27, 25 @ 10:15 am:
=In Matthew 25:40, Jesus says, “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.”=
I guess they didn’t get that far in Sunday school.
I would venture to guess that a lot of the ilgop/gop constituents will be hurt by these cuts along with cuts to rural internet. But hey, you get what you voted for.
- ChicagoBars - Tuesday, May 27, 25 @ 11:06 am:
Seems like there is a good Chicagoland media story waiting here on what these impacts will be to the safety net hospitals and Cook County Health system. Cannot be good. Maybe catastrophic?
- Leap Day WIlliam - Tuesday, May 27, 25 @ 11:16 am:
== The Founding Fathers envisioned free people solving their own problems, not welfare dependency and massive debt. Spending cuts are not tragedy but opportunity. Time for the people to take back healthcare. They can do their own research and teach each other medical procedures that can be done inexpensively with innovative new products like an all in one surgery kit. Bleach kills 99.9% of viruses and bacteria on surfaces, imagine what it will do in the body. These can be bought in the new medical section of hardware stores, next to the ivermectin. /s ==
Insert “NotGonnaLieHadMeInTheFirstHalf.gif” here
- JS Mill - Tuesday, May 27, 25 @ 11:35 am:
= Maybe catastrophic?=
That is the desired effect.
Funny how people are concerned about deficits when their party is not in the majority, when they are not so much. In Illinois, the blaine wilhours are big on austerity budgets for the state but not for the federal government when it comes to social nets.
- Decaf Coffee Party - Tuesday, May 27, 25 @ 11:36 am:
Yep. The MAGA crowd has changed it to “ whatever you do TO the least among you”
- TheInvisibleMan - Tuesday, May 27, 25 @ 11:39 am:
“In Matthew 25:40, Jesus says”
The king says that in the parable, not Jesus. That’s the first part of the verse that’s being cut off here for some reason. Personally, I’m not a fan of any Monarchy and wouldn’t want to think my purpose in life is to please the monarchy. Maybe that’s why the first part of that sentence is always cut off? Anyway, back to the point…
Because Matthew 25 also contains the parable of the ten virgins;
–
The foolish ones said to the wise, ‘Give us some of your oil; our lamps are going out.’
‘No,’ they replied, ‘there may not be enough for both us and you. Instead, go to those who sell oil and buy some for yourselves.’
–
Maybe using that book for a reference in these matters isn’t a great idea? Maybe using that book in any way at all to decide public policy is also not a great idea.
- Jerry - Tuesday, May 27, 25 @ 11:51 am:
I agree with Grandson if we expand TrumpCare and got rid of the idea that you can only get health insurance if you have a full time job.
- Huh? - Tuesday, May 27, 25 @ 12:04 pm:
“I guess they didn’t get that far in Sunday school.”
I wonder what their childhood sunday school teacher would think of them and their behavior now.
The current versions of evangelical christianity and their interpretation of the bible are the anthesis of what I grew up with.
- Irreverent - Tuesday, May 27, 25 @ 12:06 pm:
@Career
Rural voters are getting what they’ve spent their lives voting for. It’s about time we stopped protecting them from themselves.
- Huh? - Tuesday, May 27, 25 @ 12:06 pm:
“… lot of the ilgop/gop constituents will be hurt by these cuts …”
They will cheer the cuts until they figure out that it is too late and they have been adversely impacted.
- JS Mill - Tuesday, May 27, 25 @ 12:10 pm:
=Maybe using that book for a reference in these matters isn’t a great idea? Maybe using that book in any way at all to decide public policy is also not a great idea.=
I think it fits just fine. You can have your opinion and I will have mind thank you very much.
My opinion highlights the hypocrisy of those wishing to legislate christianity into government yet failing to follow the basic tenets of said religion.
- illinifan - Tuesday, May 27, 25 @ 12:18 pm:
Reducing the number of people eligible for Medicaid will result in higher costs in the health system. Already overwhelmed ERs will become even worse. I know folks at HFS have got to be running plans to figure out a way to reduce impact (maybe changing who handles the processing of health coverage for the undocumented so we retain the 90% match). Another option is take the state funds used for this population and distribute it to public health systems and hospitals in the state and not have the cost of building an infrastructure. Besides lawsuits regarding impact on state rights there has to be a way to get around the meanness of the legislation.
- Rich Miller - Tuesday, May 27, 25 @ 12:36 pm:
People, try not dragging your personal religious views into this stuff in order to bash what you think others believe.
Stick to your own selves.
- JS Mill - Tuesday, May 27, 25 @ 12:47 pm:
My bad, apologies to Rich and all.
- btowntruth from forgottonia - Tuesday, May 27, 25 @ 1:26 pm:
Grandson Of Man:
Stop giving them ideas.
- Irreverent - Tuesday, May 27, 25 @ 3:18 pm:
Are we not supposed to notice that Jesus said to feed and clothe the poor? Or are we not supposed to notice that Republicans exist to kill the poor? Or maybe it’s just the hypocrisy of killing the poor why claiming to follow a guy who said to clothe and feed them that we’re not supposed to point out? Are we supposed to pretend that politics and religion haven’t been intertwined by team “Kill the Poor?”
- Leslie K - Tuesday, May 27, 25 @ 5:06 pm:
=They can do their own research and teach each other medical procedures that can be done inexpensively=
In line with this (that was posted /s), I am reminded of a meme I saw recently that describes hippos as loyal and smart and able to be trained to do complex medical procedures.
- Dotnonymous x - Tuesday, May 27, 25 @ 8:15 pm:
In some rather supportive gambling circles I’ve known…when a losing player taps out, its customary to throw the loser a stake so he might level up…when other players see anyone give too little to the loser…those other players might exclaim sarcastically, ” Man, button up your shirt, your heart’s fallin’ out”…America’s heart is fallin’ out.
- homer - Wednesday, May 28, 25 @ 9:45 am:
Why shouldn’t people allow their religious beliefs to inform their views, and thus their comments? Seems those beliefs would be a key aspect of their worldview.