The Republican Party’s proposed replacement for Obamacare might be tolerable if the lives of real people were not on the line.
But at least here in Illinois, we can assure Congress, the harm would be real and great. Hundreds of thousands of people likely would be left without health insurance, and our state’s economy, already so shaky, would take another hit.
The American Health Care Act, simply put, is not good for Illinois.
Especially hurt in Illinois could be some 3.2 million people who receive health insurance through the Medicaid program. This year, our state will receive roughly $14.1 billion in federal money to cover those Medicaid bills, but the proposed Republican health care plan would reduce federal funding to many states by imposing hard caps. Illinois in particular, given the income-based formula to be used for setting the caps, would be among the hardest hit states.
The Republican health care plan also would roll back a big expansion of the Medicaid program in recent years, once again restricting coverage to specific low-income Americans, such as pregnant women and the blind and disabled. The general working poor — folks who earn no more than 138 percent of the official federal poverty level — would not be eligible for Medicaid beginning in 2020.
Right now, this expansion of Medicaid covers about 650,000 people in Illinois, with the feds picking up about 95 percent of the tab, about $3 billion a year. But without that federal money, Illinois would be hard-pressed to keep it going. And by law, the state would not have to. When the state Legislature wrote its Medicaid expansion law in 2013, it included an escape clause: If the federal government at any point failed to pay 90 percent of the costs, everybody covered by Medicaid expansion could be dropped.
Not that any governor or legislator running for re-election would be eager to do that.
As the Civic Federation noted in a report in January, Medicaid expansion not only made it possible for hundreds of thousands of previously uninsured people to see doctors more regularly; it also gave our local economy a jolt and taxpayers a break. Medicaid expansion, states the report, “has brought in billions of dollars in new federal funds for hospitals, clinics, pharmacies and other healthcare providers at no cost to the state.”
The gains for Cook County’s public health care system have been significant, improving the system’s finances while allowing the county to reduce the amount of local tax money spent for that purpose. Many adults who previously were treated free of charge at county hospitals and clinics now are covered by Medicaid, the Civic Federation notes, “leading to a dramatic reduction in the cost of uncompensated care.”
Because of the Medicaid expansion, which was part of the Affordable Care Act, Cook County now sees more insured patients than uninsured patients. If the Republican plan becomes law, that won’t last.
Gov. Bruce Rauner and Mayor Rahm Emanuel don’t agree on much lately, but they do seem to agree that the AHCA is trouble for Illinois. Rauner has told reporters he fears Illinois will be “left in the lurch,” while Emanuel has predicted “more people are going to lose health care.”
More generally, the proposed Republican health care plan is bad for Illinois in the same way that it is bad for the whole country, making insurance coverage less accessible or affordable for those who are likely to need it the most — older Americans.
Currently, under Obamacare, insurance companies can charge their oldest enrollees no more than three times what they charge their youngest enrollees. This pushes down premiums for people in their 50s and 60s. But the Republican plan would allow insurers to charge the oldest Americans five times what they charge the youngest Americans. And tax credits, though they would be larger for older Americans, wouldn’t come close to offsetting those higher insurance premiums.
If Speaker Paul Ryan has his way, the full House will take a vote on the AHCA as early as next week, which would be irresponsible. The plan has not even been analyzed yet by the nonpartisan Congressional Budget Office. Nobody has a clue as to what it would cost or how many people would be covered.
The AHCA is not ready for prime time, certainly not in Illinois.
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