The Republican plan to replace the Affordable Care Act could have major repercussions in Illinois, according to multiple health-care experts. Even Gov. Bruce Rauner expressed some reservations about the plan on Tuesday, less than 24 hours after the GOP’s proposal was unveiled.
Here are the top three takeaways on how the long-awaited proposal could play out in Illinois:
1. Changes to Medicaid could hit Illinois harder than other states
“While everyone around the country will be in trouble, Illinois might be in one of the worst positions of any state,” said Stephanie Altman, a Medicaid expert at the Sargent Shriver National Center on Poverty Law.
Illinois took advantage of Obamacare’s expansion of Medicaid, so there are now more people here to cover. If federal funds run short, as health policy experts expect they would, the state’s on the hook.
That would be true for any of the 31 states that expanded Medicaid, but Illinois is in worse financial shape than any of them: The state has been racking up billions of dollars in new debt because of the ongoing budget impasse in Springfield.
Even if a balanced budget were to pass tomorrow, Altman said, “It’s still decades before we crawl out of that hole, and this would just make it so much worse.”
2. Some hospitals might have to cut back services or close
Hospitals have been winners under Obamacare: More people with medical insurance—through Medicaid and private insurance—means more income, less bad debt, and less “charity care”—free care for uninsured, financially-needy patients.
Even so, lots of hospitals are struggling.
“More than 40 percent of hospitals across Illinois are either losing money or barely making it. They’re struggling to survive financially,” said Danny Chun, a spokesman for the Illinois Health and Hospital Association. “The ACA and the Medicaid expansion has been a great help to keep them afloat.”
Some hospitals may cut back the range of services they offer, Chun said.
“And in some cases—this is worst-case scenario—some hospitals may not make it,” he said.
3. People buying their own insurance for 2018 could have fewer options
This one is less about the substance of the health-care legislation than the timing. Republicans in both the Senate and the House have expressed significant concerns about elements of the ACA-replacement proposal.
So, passing a bill could take a while.
Meanwhile, insurance providers are supposed to outline the 2018 plans they will offer on the existing Obamacare exchanges in just a few weeks.
Keeping insurers in the exchanges has already been a problem here. Aetna, United, and other companies pulled out of the Illinois exchanges for 2017.
Uncertainty about the ACA’s future will make things worse, said Joel Shalowitz, a professor of health-industry management at Northwestern University.
“The insurance companies are going to be even less willing to participate this year,” he said.
Dan Weissmann is a reporter for WBEZ. You can follow him at @danweissmann.