When a Springfield-area congressman recently described his support for reductions in Medicaid funding to a nationwide television audience, he repeated a Republican talking point in the GOP’s push to repeal and replace the Affordable Care Act.
Medicaid, paid for with both state and federal tax dollars and administered by states as an entitlement program, needs to be reined in so benefits can be focused on the low-income elderly and disabled population, U.S. Rep. Rodney Davis, R-Taylorville, told an MSNBC interviewer.
Able-bodied adults need to be removed from the program and placed into employer-based health coverage, he said. Otherwise, states such as Illinois “aren’t going to be able to afford to cover their share of Medicaid’s expenses” for people “who truly need it the most,” he said.
What Davis and other Republicans want to see happen — somehow moving low-income, non-disabled adults from the ACA-funded, expanded Medicaid program to jobs with employer-sponsored private coverage — won’t be easy, and their plans probably won’t work, according to a health-policy expert at the Chicago-based Sargent Shriver National Center on Poverty Law.
“It’s just unrealistic,” said Stephanie Altman, director of health care justice for the left-leaning, not-for-profit Shriver center. “I don’t see any of these being a silver bullet. Many have been tried before.”
Legislation passed by the U.S. House, and versions of legislation being considered by the GOP-controlled Senate, are expected to result in more than 20 million Americans losing insurance coverage, according to the nonpartisan Congressional Budget Office.
Millions of those losing coverage are expected to be among 11 million people nationwide and 657,000 in Illinois who are part of the ACA-funded Medicaid expansion.
The additional Illinoisans were able to sign up for Medicaid after the Democratic-controlled General Assembly and former Gov. Pat Quinn, also a Democrat, supported legislation to expand eligibility standards. Illinois is one of 32 states and the District of Columbia that have expanded Medicaid, with 95 percent of the total cost for the expansion population currently covered by the federal government.
The percentage covered by the feds is expected to drop to 90 percent, and remain there, in 2020 and beyond unless the ACA is repealed or changed.
It’s not known exactly how many people would be affected by the Republican plans if they have Medicaid coverage because of the ACA. Able-bodied adults can qualify if their annual income is below 138 percent of the federal poverty level, or $16,640 annually for an individual and $22,410 for a family of two.
Before the ACA, an adult in Illinois had to fit into certain categories to qualify for Medicaid. For instance, an adult had to be disabled, or caring for a child in a low-income household, or a low-income senior citizen needing long-term care.
Illinois’ total $21 billion Medicaid program, which covers 3.1 million people — about one-quarter of the state’s population — generally gets 50 percent of its costs for the non-ACA population reimbursed by the federal government. Most of the rest comes from state General Revenue Funds.
For the Medicaid expansion population, the state’s portion of GRF costs is estimated to be $61.8 million in the fiscal year that ended June 30 and $138.6 million in the current fiscal year, according to the Illinois Department of Healthcare and Family Services.
That cost, in the big picture, is a great deal for the state, Altman said.
Gov. Bruce Rauner, a Republican, has been largely silent during the debate in Congress about health care, though he said this spring that he was “very concerned” state residents might suffer under GOP reform plans.
“I want to make sure that people in Illinois are not left in the lurch or that, you know, there’s a lot of pressure to reduce insurance coverage for people in Illinois,” Rauner said in March.
A Rauner spokeswoman didn’t respond to a request for comment for this story.
In Rep. Rodney Davis’ 13th Congressional District, 32,735 people are covered by Medicaid through the ACA-funded expansion.
The nonpartisan Kaiser Family Foundation says that among non-disabled adults in the Medicaid system, eight out of every 10 in Illinois and nationwide are part of working families, and about 60 percent are working themselves. These adults may be in jobs that don’t come with health insurance or with coverage that’s unaffordable, Altman said.
Davis, 47, who represents part of Springfield, said on MSNBC that 44 percent of Illinois’ Medicaid expansion population is made up of able-bodied adults ages 19 to 34.
Davis wasn’t available to speak with The State Journal-Register, but his spokeswoman, Ashley Phelps, said the congressman actually was referring to men ages 19 to 34 in the Medicaid expansion population. Some of these men may be employed, and some may be unemployed, she said.
“We want to get these people off Medicaid and into employer-sponsored health insurance or group insurance,” Phelps said.
The reason for changing laws and policies to accomplish that goal, she said, is because the cost of Medicaid “is growing at an unsustainable rate.”
Phelps quoted the nonpartisan Congressional Research Service, saying that combined state and federal spending on Medicaid services and administrative activities totaled $464 billion in federal fiscal 2014. That cost is expected to grow to $835 billion in fiscal 2023.
“You are expanding Medicaid by so much that you’re eventually going to exhaust the system,” Phelps said.
Altman, however, said she doesn’t understand what Republicans mean when they say the Medicaid program is unsustainable. Policy-makers need to decide what to devote resources for, whether it’s national defense or health care.
“Medicaid is eminently sustainable,” she said.
Phelps said provisions in the House-approved American Health Care Act and other legislation passed by the House would make it easier for businesses to provide affordable coverage to their workers and for workers to purchase coverage on their own, sometimes with federal subsidies.
But Altman said many of the Republicans’ plans would lead to skimpier coverage and more gaps — the same situation before former President Barack Obama’s ACA became law.
A better option, Altman said, would be for Republicans to work with Democrats to expand federal subsidies to make coverage more affordable, replace financial supports for insurance markets that Republicans helped remove, and stabilize insurance rates by reducing uncertainty about the ACA’s future.
— Contact Dean Olsen: firstname.lastname@example.org, 788-1543, twitter.com/DeanOlsenSJR.