A proposed bill in the Illinois statehouse would expand access to health care for thousands of people.
Dubbed Healthy Illinois For All, the proposal would add an estimated nearly 150,000 low-income people to the state’s Medicaid health insurance program. This group includes people who are undocumented or have been legal residents for fewer than five years and are 19 to 54 years old. These are the last populations in Illinois who aren’t eligible for Medicaid, or for insurance through the Affordable Care Act, according to the Shriver Center on Poverty Law, which is part of the Healthy Illinois campaign.
Glo Choi, who is undocumented and came to the U.S. from Korea as a boy, was among several community organizers, advocates and lawmakers who supported the proposal at a news conference on Monday. He spoke of his 27-year-old sister, who has severe autism and can’t live independently.
“I remember when we were growing up, she would often have violent seizures, watching her writhing in pain, unable to control her body, I felt helpless,” said Choi, 29. “We’re trying to survive in a system that wasn’t designed for people like us in mind.”
He shared his own recent experience of being so sick with COVID-19 and afraid of an expensive hospital emergency visit that he went to an urgent care center instead.
“After waiting three and a half hours in the cold, I finally got to my point in line, and they said, ‘We’re at capacity,’” Choi recalled. “I just kind of sat in my car, and I just broke down because I was in so much pain. It’s too typical a story I feel. Trying to get care, not being able to get it, or when you do, you become financially insolvent.”
Experts say a growing number of states have expanded or are planning to expand state-funded coverage to low-income adults regardless of their immigration status.
Illinois lawmakers have expanded Medicaid twice since 2020, to add immigrants who are 55 and older. Children 18 and younger are already covered by the state.
Advocates say the proposed bill would not only increase health care access for people, but it would also save money. They argue that many uninsured patients wouldn’t avoid going to the doctor until they’re so sick that they’re more expensive to treat.
If the proposal were to pass, hospitals could be in a position where they may not lose as much money by writing off so-called charity care — in which hospitals treat patients who can’t afford to pay, but aren’t reimbursed for that care. Plus, the number of charity care patients hospitals serve isn’t equal. Cook County’s John H. Stroger Jr. Hospital on the Near West Side provided the most charity care by far of any hospital in the state — nearly $225 million in 2020, the most recent state data show. That represents just over a quarter of all charity care hospitals provided that year.
While the Illinois Department of Healthcare and Family Services, which runs Medicaid, supports extending coverage to immigrants who are 19 to 54, an agency spokeswoman points out that the federal government would not chip in and share the cost to cover their medical care. That’s unlike traditional Medicaid for U.S. citizens. The price tag to provide Medicaid for this population is estimated to be at least $270 million per year, according to advocates. The projected cost includes doctors visits, hospital treatment, vision and dental, but not long-term care facilities. The Illinois General Assembly would have to budget to shoulder those costs, the HFS spokeswoman said.
To help make up the financial difference, advocates say HFS could apply for other buckets of federal money.
Laurence Msall, president of the Chicago-based fiscal watchdog The Civic Federation, said that while there could be public health and humanitarian reasons for expanding Medicaid once again, the state should be transparent in how it would pay for the program for years to come.
“It has potentially very significant financial implications, which require more thoughtful and transparent projection,” Msall said. “It’s not unlimited, the state’s resources.”
Msall, whose organization analyzes government budgets including Illinois’, said the first phase of the state’s Medicaid expansion in 2020 for non-citizens who were at least 65 years old was initially projected to cost about $45 million to $50 million, but ended up costing around $60 million.
The Illinois Legislature and Democratic Gov. JB Pritzker still must approve the proposed legislation.
Kristen Schorsch covers public health and Cook County on WBEZ’s government and politics desk. Follow @kschorsch.