Members of the Illinois Congressional delegation voted along party lines Thursday on the latest proposal to repeal and replace the Affordable Care Act.
The bill keeps controversial provisions from an earlier version — like a rollback of Medicaid funds — and adds a new wrinkle that would allow states to waive Obamacare’s rules against charging more for people with pre-existing conditions.
Here’s a quick rundown of how the bill could affect Illinois.
Medicaid reductions still make lots of people nervous, including Gov. Bruce Rauner
Obamacare’s expansion of Medicaid added more than 600,000 Illinoisans to the rolls, who would stand to lose coverage.
That expansion saved Cook County taxpayers more than $300 million a year, county officials said. That’s care provided to county residents who were uninsured before the Medicaid expansion.
The bill would also cap federal Medicaid spending, which the Urban Institute estimates would cost Illinois $24 billion in federal funds over ten years.
“Where those cuts would come, we don’t know,” said Stephanie Altman, director of health care justice at the Shriver Center on Poverty Law. “Would it be in services? Would it be in reimbursements to providers? Would we just be able to cover fewer categories of people?”
Medicaid dollars are also important to other hospitals across the state, said Danny Chun, a spokesman for the Illinois Health and Hospital Association.
“More than 40 percent of hospitals across Illinois are either losing money or barely making it,” he said.
Gov. Bruce Rauner, a Republican, issued a statement expressing “deep concern” about the Medicaid cuts and other changes, shortly after the vote.
Schools could feel Medicaid cuts too
Schools in Illinois get more than $286 million in Medicaid reimbursements, according to an analysis by The Center for Budget and Policy Priorities, a liberal-leaning think-tank.
That could stop, under a provision that would allow states to stop considering schools eligible for Medicaid reimbursement.
How Illinois might respond to that is “a toss-up,” according to Susan Hilton, director of government relations for the Illinois Association of School Boards. “I know there’s a lot of interest in continuing services for kids, but the reality is the money is not going to be there.”
Essentially, losing Medicaid funds would mean a budget cut for districts because schools mostly get Medicaid money for services they’re legally obligated to provide to students with special needs, like occupational therapy, physical therapy, and speech therapy, she said.
That cut would hit poor districts the hardest. “The districts that struggle financially are going to feel this more than those who don’t,” she said.
Illinois may not be immune to changes of pre-existing conditions rules
The new bill allows states to opt out of Obamacare’s rules against higher rates for people with pre-existing conditions.
Even if officials in Illinois are opposed in principle, they might feel significant pressure to do just that, according to Cynthia Cox, who watches health-insurance issues for the Kaiser Family Foundation.
That pressure could come from the bill’s other provisions: Rising rates and lower subsidies for some groups could put insurance out of reach for many people, Cox said.
“The state may be under pressure to try to find a way to bring down premiums,” she said. “And one way to do that would be to say that insurance companies don’t have to cover certain benefits. Or that they can start charging higher premiums for people who have pre-existing conditions and lower premiums for people who are healthy.”
One potential solution — so-called “high risk pools” that provide insurance for people with pre-existing conditions — was tried in Illinois before Obamacare came along.
At least one local expert describes the old Illinois program as “a disaster.”
“It was under-funded, the premiums were really high, and then there was also a waiting period to get it,” said Joel Shalowitz, a Northwestern professor who teaches at both the university’s medical school and it’s business school. “So the people who needed it found it hard to get, and then it was un-affordable.”
Dan Weissmann is a reporter for WBEZ. Follow him at @danweissmann.