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What do Illinois’ Moms want for Mother’s Day?

How about continued health care coverage?  As of the beginning of this year, there were 1,679,700 women and girls enrolled under the state’s Medicaid program.

Medicaid provides health care coverage to low-income children and their families, pregnant women, persons who are disabled and seniors. In Illinois, the program currently covers approximately 3.1 million people overall. In addition, there are 649,000 Illinoisans are enrolled under the Affordable Care Act (ACA) – 288,464 of them are women.

Most women covered by the state’s Medicaid program are low-income women of color – 28% are African American and 26% are Hispanic. Medicaid covers services related to preventative screenings, maternal health and long-term care affecting senior women – services that impact women inter-generationally. As an example, Medicaid financed 50% of all births in the state of Illinois in 2014. With Medicaid responsible for funding so many services specific to women’s health care, the recent U.S. House passage of the American Health Care Act (AHCA) endangers crucial coverage for Illinois women and their children.

Medicaid and Women 1 - T

The bill is before the U.S. Senate for consideration. The Congressional Budget Office (CBO) estimated that an earlier version of the bill could lead to a loss of coverage nationally of 24 million people nationwide by 2026. The newest version has not been scored by the CBO. However, changes in the bill before the Senate could lead to higher costs and additional loss of coverage.

Fewer Uninsured
Prior to the ACA, eligibility for Medicaid coverage was limited to “children, cash assistance recipients, seniors, and people with disabilities”. The ACA’s Medicaid Expansion allowed 32 states, including Illinois, to include women with incomes at or below 138 percent of the poverty line. With Illinois choosing to opt into the Medicaid Expansion, the number of uninsured women in the state, aged 18 to 44 has dropped from almost 18% to 13.4% in 2016.

uninsured

Those improvements are now at risk.

Overall, the bill cuts $839 billion in federal spending from Medicaid over ten years. One estimate puts Illinois’ potential financial loss over ten years at $40 billion.

Two significant funding changes in the AHCA are lowering the federal matching rate (or Federal Medical Assistance Percentage -FMAP) for new enrollees covered under Illinois’ Medicaid expansion and implementing a spending cap for each enrollee in the state’s Medicaid  program. (In Illinois, if the FMAP falls below 90%, state law requires that coverage ceases at the end of three months following changes in the FMAP.)

Among its other changes, the federal bill allows a state to:

  • waive the ACA’s community rating (which contains a prohibition against charging higher premiums for pre-existing coverage) if it creates a “high risk pool” and
  • waive the “essential health benefits” requirements.

High Risk Pool
How did these high risk pools work in the past?  In the pre-ACA era, they generally led to enrollment caps and unaffordable premiums. While the AHCA has allocated $130 billion in funding for high-risk pools, even if all of the funding were used for these pools, they would still be underfunded by at least $200 billion.

The cost of higher premiums for pre-existing conditions places an undue burden on women. Prior to the ACA, pre-existing conditions included prior C-sections, breast or cervical cancer, receiving medical treatment for domestic or sexual violence, and/or clinical depression. In Illinois, 26% of the population would have had a pre-existing condition that would make  them uninsurable.

Essential Benefits
While essential health benefits vary by state, the ACA provides a floor with a list of benefits that insurers are required to cover. In Illinois, these include: hospitalization, maternity, coverage for prescriptions, pediatric oral and vision coverage and newborn care, as well as preventative services like mammograms and bone density screenings. While the AHCA maintains preventative services for private plans, those requirements would no longer apply to the Medicaid Expansion population, meaning a loss of much needed services by women in that population.

Instead of taking away Mom’s health care coverage, let’s remind our federal officials this week (which is National Women’s Health Week) of the great strides we’ve made under the ACA and the great gift it has provided to Illinois women and their families.

Written by Mayumi Grigsby

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