State likely to expand Medicaid
SPRINGFIELD – Illinois probably will enact an 18 percent expansion of the Medicaid program in 2014, with the federal government paying almost the entire bill for the first three years as part of the Affordable Care Act.
But the expansion, which is expected to add about 500,000 people to a program that already covers 2.7 million of the state’s 12.8 million residents, may not come without vigorous debates in the Illinois House and Senate, lawmakers said last week.
Votes could come as soon as the fall veto session, House Majority Leader Barbara Flynn Currie said, though it’s unclear whether the expansion requires legislative approval.
“There will be a lot of partisan teeth-gnashing and whatever, but at the end of the day, I don’t see how you turn down this opportunity to provide real health care for large numbers of people who otherwise wouldn’t have it,” said Currie, D-Chicago.
Republicans, on the other hand, are concerned about the potential for additional state costs and providing incentives for people to avoid buying private health insurance even if they can afford it, said Sen. Larry Bomke, R-Springfield.
“People are not going to be responsible,” said Bomke, a part-owner of an insurance agency who will retire from the Senate in January. “Anyone who votes on this will have to look at whether the costs are worth it.”
Sen. Bill Brady, R-Bloomington, said he isn’t confident the federal government will keep its Medicaid funding promise to the states, and he doesn’t believe Illinois can afford to expand Medicaid.
“We’ve got $7.5 billion in unpaid bills,” Brady said.
If needed, Currie said, the Democrat-controlled General Assembly probably will approve the expansion. The ACA would, for the first time, make Medicaid available to adults in Illinois who don’t have minor children in their homes if their household income doesn’t exceed 138 percent of the federal poverty level, or less than $15,415 a year for an individual and $31,800 for a family of four.
The state would receive 100 percent federal reimbursement for these new enrollees until 2017, when the federal subsidy would begin to drop. Under the ACA, the federal share never would be lower than 90 percent for this income group.
Adults without children qualify for Illinois’ Medicaid program now only if they are senior citizens or have permanent disabilities and have incomes at or below the poverty line. Disabled adults can get Medicaid coverage if they are granted Social Security disability benefits.
The ACA also is expected to help other people get insurance coverage through state-level health-insurance exchanges that will distribute federal subsidies to help people pay the cost of private coverage.
Those premiums aren’t available to people under 100 percent of the federal poverty level. So if Illinois fails to expand Medicaid eligibility, many low-income people won’t be able to either afford private coverage or qualify for Medicaid, Currie said.
“I don’t see how you turn your back on them,” she said.
Some Republican governors have said their states will turn down the Medicaid expansion.
In Illinois, Democratic Gov. Pat Quinn supports the ACA and the Medicaid expansion.
“We are awaiting federal guidance and interpretation of the Supreme Court decision, and our attorneys are looking into state law issues to determine whether legislative approval is needed,” Quinn aide Brooke Anderson said.
No welfare queens
Quinn’s support and the likelihood that Illinois Senate and House will remain in Democratic control after the November election make it likely that both chambers will vote to expand the program, according to Kent Redfield, professor emeritus of political science at the University of Illinois Springfield.
“This is not food stamps,” he said. “This is a more effective and efficient way of delivering health care. There really are no ‘welfare queens’ here.”
Republicans such as state Comptroller Judy Baar Topinka have said Illinois could face as much as $2.4 billion in new costs associated with the Medicaid expansion over the first six years.
The 2010 study that Topinka’s statement was based on – from the Kaiser Commission on Medicaid and the Uninsured – also says Illinois would receive a total of $22.1 billion in additional federal Medicaid funding in the 2014-19 period because of the expansion.
Most of the state cost in the study is attributed to the “woodwork effect,” in which people already eligible for Medicaid but not currently enrolled might enroll in 2014 and beyond because of new outreach campaigns. Illinois would receive only a 50 percent federal match for those enrollees.
Quinn aides said Topinka’s $2.4 billion estimate is too high. The governor’s staff is preparing its own cost estimates but isn’t ready to release them, according to Michael Gelder, Quinn’s senior health-care policy adviser.
John Holahan, an Urban Institute researcher who co-authored the Kaiser study, said state costs associated with the Medicaid expansion may be offset by reduced state spending on programs that help hospitals care for the uninsured.
Advocates of the Medicaid expansion say it will lead to a healthier, more-employable population.
Gelder said Medicaid is a “very cost-effective program for the people who are enrolled in Medicaid, so we want to see more people in Medicaid,” a position echoed by Cristal Thomas, Quinn’s deputy governor for public policy.
“It would be a lot more efficient and effective to pay for them under Medicaid, where we can help make sure they get into prevention programs and get access to primary care and iwmmunizations and all those things that will ultimately bring down the cost of care, rather thawn just serving them in emergency rooms as uncompensated care,” she said.
Illinois Medicaid moratorium
The U.S. Supreme Court’s tweaking of the Affordable Care Act may prompt Gov. Pat Quinn to ask the Illinois General Assembly to lift a moratorium on Medicaid expansions, Quinn aides said.
House Bill 5007, which was passed by the Illinois House and Senate in May and signed by Quinn in June, allows for expansion of Medicaid eligibility in Cook County to all adults under 138 percent of the federal poverty level.
However, the bill, passed before the U.S. Supreme Court’s ruling on the ACA, puts in place a four-year moratorium on any Medicaid expansions elsewhere in the state.
The moratorium expires in January 2015, but the bill says the moratorium doesn’t apply to “expansions required as a federal condition of state participation in the medical assistance program.”
However, the U.S. Supreme Court, in its ACA ruling, said federal officials aren’t allowed to take away all of a state’s federal Medicaid funding if the state turns down the expansion. That raised the question of whether HB 5007’s moratorium would stop Illinois’ statewide Medicaid expansion, Currie said.
Lawyers and federal officials are examining Illinois’ quandary, deputy governor Cristal Thomas said.
“But right now,” she said, “I think there is a likelihood that we would have to go back and get legislative authority to do the expansion under that moratorium.”