The new federal health care law will be many people’s first chance to get coverage. But a key demographic may not get that option. It’s up to states to decide if they will allow individuals who make less than about 15 thousand dollars and who don’t have kids to sign up for government-backed insurance. Illinois lawmakers are set to debate that during their spring legislative session, which is just getting underway.
The Affordable Care Act is a complicated, bureaucratic, ever-evolving law that even its creators are still trying to get a grip on. But its mission is straightforward.
President Barack Obama’s namesake program is supposed to make health care available to EVERYONE. Including by expanding eligibility for Medicaid.Well – at least – that was the plan.
Medicaid has been helping poor people get health care since 1965. But not ALL poor people – just those that fit into four categories.
Julie Hamos is Director of the Illinois Department of Healthcare and Family Services:
HAMOS “We’ve covered children, their parents, seniors – seniors who are also sometimes Medicare eligible – and people with disabilities.”
Leaving low-income people between ages 19 and 64 who don’t have kids. Obamacare tried to coerce states … for the first time … into covering these childless adults. Obamacare originally threatened to withdraw ALL federal Medicaid funding from states that refused to expand it.
But while the Supreme Court held up most of the health care law, justices ruled that portion unconstitutional. So now it’s no longer a mandate. It’s a choice, left up to states to decide. And while the Supreme Court may have taken away the feds’ stick, they still have a carrot to offer … paying 100 percent of the cost for all the new people eligible for Medicaid.
Hamos wants Illinois to take the offer … which she says will bring the state $12 billion. Not only could Illinois use the money. Democratic Representative Sara Feigenholtz says the state is already spending plenty on these childless, poor adults.
FEIGENHOLTZ “This is historically a population – that, although we don’t get Medicaid for them, we still, in our state budget, pay enormous amounts of money.They get sick they want into an emergency department or a they walk into a community health center, a public health department …”
Take that example of someone sick going to the ER. Hospitals can’t turn anyone away – but head of the Illinois Hospital Association A.J. Wilhelmi says that doesn’t make them the right place for someone with a health issue. He says people need coverage … so they can see a primary care doctor.
WILHELMI “Now with coverage under the Medicaid program, we know that these individuals will lead healthier lives, as they receive comprehensive care including wellness and prevention. Because of this comprehensive care, early detection of conditions will take place … as opposed to having those conditions undetected and people admit to emergency department and create a significant cost for the state of Illinois.”
A cost that inevitably gets passed on … to local governments, or to people who DO have insurance. People without coverage don’t have to go to the ER – they can also go to community health centers.
The Illinois Primary Health Care Association’s Jill Hayden says everyone who walks through the door is treated equally. But … as the name of Hayden’s organization implies … all they provide is primary care.
HAYDEN “While it is true that health centers have been the medical home for millions of individuals, providing primary, preventative, and enabling services to the nation’s most vulnerable populations for over 40 years, we can only do just that. And even with access to quality primary care, our patients often require care for conditions beyond the scope we are allowed to provide.”
In other words … if a patient has a disease, say cancer, but doesn’t have Medicaid … Hayden says it’s harder for them to get a specialist. Hayden says if Illinois gets all that federal money, it’ll allow community health centers to expand.
HAYDEN “What new revenues will mean for health centers is simply more capacity – which comes in the form of more sites, more services and more economic and job opportunities in the areas of our state in most need of them.”
Even the Illinois Chamber of Commerce - an opponent of the Affordable Care Act – supports the Medicaid expansion.
MINZER “The expansion of Medicaid as originally envisioned by the Affordable Care Act is the best way to mitigate additional cost pressures on employers and consumers in the near term.”
That’s Laura Minzer, of the Illinois Chamber. She says it’s important to note the health care law requires companies with 50 or more employees to offer affordable coverage; if they don’t, the company could have to pay a penalty upwards of $3,000. The trigger for the fine is when a worker takes a government subsidy to help buy insurance.
MINZER “So if the state were to forgo expansion, employers would face greater penalty exposure.”
Which brings up another point. The federal subsidy is available to low-income people who AREN’T eligible for public assistance to help them afford coverage. But people under 133 percent of the poverty level won’t get a subsidy – after all, a subsidy probably wouldn’t be enough to make coverage affordable for someone making about $14,000 or less.
Meaning that if states DON’T expand Medicaid … it’s the poorest of the poor who won’t get it. Again, Department of Healthcare and Family Services Director Julie Hamos:
HAMOS “They’re not allowed to purchase on the exchange, they’re not allowed to get tax subsidies, and they would not qualify for Medicaid. So that’s about 200,000 people of our lowest income people with significant health care needs would be really nowhere. They would be, S.O.L., as we say.”
With all of those arguments – and strange bedfellows – backing the expansion – why not do it? After all – the feds will pay for all of it! For the first three years, anyway. Then it ramps down annually, so come 2020, Illinois will have to pick up 10 percent of the cost … a low percentage, maybe, but converted to dollars, not so much.
Republican Representative Patti Bullock of Hinsdale says not only is that money Illinois doesn’t have … she fears the state will be on the hook for a lot more. There’ll be a big marketing push to enroll these impoverished, childless adults. And it’s expected people who were PREVIOUSLY eligible for Medicaid, but who – for whatever reason – never signed up for it – will then. And the feds won’t pay 100 percent of those costs.
Bellock points to at least one study that estimates it’ll bring an extra 900,000 people onto Illinois’ Medicaid rolls.
BELLOCK “We’re just trying to get the facts and figure on the table so we can make a good, concise decision as to whether we should move forward in a long range-plan. Too many times in Illinois government -that’s why we’re in this fiscal crisis – they have not looked toward a plan of action for five, seven or ten years. They just look at free money coming in the first two or three years. Plus there have been on figures given as to the administrative cost, which the state has to pick up.”
Bellock also says she doesn’t trust the federal government to hold up its end of the bargain.
What happens, she asks, when the feds – the nation has its own debt problems after all – change their mind, and decide to give states less? Democrats have tried to assure the GOP that Illinois would be off the hook. The proposed legislation has a clause that says if the federal match gets below 90%, Illinois will rescind the growth in Medicaid. But Bellock says she doesn’t believe Illinois would ever do it.She was a key player in bipartisan negotiations that JUST LAST YEAR cut a bevy of Medicaid programs, and instituted a moratorium on any Medicaid expansion.
Bellock says it was painful to make those cuts.
BELLOCK “I don’t think that that’s ethical, that if you’ve taken on 500,000 new people that you’re just going to turn around say two days later and say, ‘oh the rates have changed and we’re going to take you off.’ You know that Illinois would never do that.”
It’s simply not political – or human – nature to take something back once it’s been given. (Amanda Vinicky)