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Another Threat to Health Care for Illinois Women and Children

If Illinoisans were worried about losing coverage under the last version of the American Health Care Act (AHCA) proposed at the federal level, the latest incarnation will do little to reassure them.[1] Medicaid provides health coverage to low-income children and their families, pregnant women, persons who are disabled, and seniors.[2] The program currently covers 36 percent of Illinois children with a mix of federal and state funds.[3] Approximately 3.1 million people are currently enrolled in Illinois’ Medicaid program and 649,000 are enrolled under the Affordable Care Act (ACA).[4] Seventeen percent of Illinois women are covered by Medicaid.[5]

A reported agreement in the U.S. House of Representatives by the conservative Republican House Freedom Caucus and the moderate Republican Tuesday Group has revitalized the bill that failed to garner enough support at the federal level last month. The newest version keeps the base of the original AHCA bill while adding provisions that would further endanger coverage for vulnerable populations.[6] The previous proposed changes to the ACA, would have led to a loss of medical coverage for 14 million people in 2018.[7]  Changes to the tax subsidies allowing citizens to buy coverage and to the Medicaid program would have increased the number of uninsured from 14 million to 21 million in 2020, and to 24 million in 2026.[8]

The version garnering the endorsement of the House Freedom Caucus adds the following: a) it allows states to waive the ACA’s “community rating” requirements, which is the prohibition against charging people higher premiums for preexisting coverage, so long as the state creates a “federal high risk pool”;  b) it allows states to waive the ACA’s “Essential Health Benefits” standards, which are key services health market plans must cover, such as prescription drugs, mental health treatment and maternity care.[9] In Illinois, these benefits also include pediatric oral and vision coverage for children and coverage for autism spectrum disorders.

States would receive automatic approval for these waivers within 90 days if they attest that their purpose is to lower premiums, improve coverage levels, or advance another benefit to the public interest.[10]

These are significant steps. High-risk pools existed in many states prior to the ACA and they led to “enrollment caps, long waiting lists, unaffordable premiums, exclusions for pre-existing conditions, high deductibles, benefit caps, and annual and lifetime limits on coverage”.[11]

Illinois has existed without a complete budget for almost two years.[12] The state faces a FY 17 revenue shortfall of $5.7 billion and has amassed a backlog of bills totaling more than $13 billion.[13] Delayed payments or actual cuts continue to lead to providers curtailing vital human services.[14]

Under the previous version of the AHCA, Illinois stood to lose $40 billion over a ten-year period. Inaction by the Illinois General Assembly and the Governor to address the state’s revenue shortfall has already threatened services for vulnerable Illinois residents including low-income children and their families, persons with disabilities and seniors. The current changes proposed at the federal level further exacerbate that threat.

Written by Mayumi Grigsby


[1] http://www.chicagotribune.com/news/local/politics/ct-congress-illinois-aca-repeal-met-0316-20170315-story.html
[2] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[3] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[4] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[5] http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/
[6] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[7] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[8]http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[9] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[10] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[11] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[12] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[13] http://www.cbpp.org/research/state-budget-and-tax/many-states-face-revenue-shortfalls
[14] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/

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