The U.S. House’s Energy and Commerce Committee
released its recommendations for budget reconciliation early last week. A
preliminary review by the Congressional Budget Office projected that, if
implemented, at least 8.6 million Americans would lose their Medicaid coverage
during the coming decade.
That translates to well over 300,000
Illinoisans.
In addition, the CBO projected that 5.1
million more people would lose their health insurance because of the federal
Centers for Medicare & Medicaid Services’ new rules regarding Affordable
Care Act tax credits and restrictions on obtaining and retaining eligibility,
including work requirements.
That would be roughly 190,000 more
Illinoisans, for a total of somewhere around half a million people losing
coverage here.
Another part of the U.S. House’s budget
reconciliation proposal would reduce the federal Medicaid expansion match under
the Affordable Care Act from 90% down to 80% for any state that used its
Medicaid “infrastructure” to provide health insurance to undocumented
residents.
Illinois’ All Kids program and its health
insurance for undocumented senior citizens, as well as the adult insurance
programs that Gov. JB Pritzker wants to cut off, all use the state’s Medicaid
infrastructure to provide state funding for undocumented residents.
If that ultimately passes, the reduction to 80%
would trigger a state law which halts all state funding for Medicaid expansion
under the Affordable Care Act if the federal match falls below 90%.
So, either the state would have to give up
funding health care for undocumented residents or continue to fund them with
state dollars and then pay perhaps $1 billion dollars a year to make up for the
10-point reduction in the federal match.
No way the state could afford to step in and
spend billions upon billions to cover all those folks.
The Congressional Budget Office also released
cost estimates last week for the House Republican budget reconciliation plan,
and it included even more eye-popping numbers about state Medicaid cuts and
increased state costs.
The estimates cover the federal budget years
of 2026 up to and including 2034 (apparently nine fiscal years). According to
the non-partisan CBO estimates, changes to the Medicaid program would result in
“$698 billion less in federal subsidies.”
A back of the envelope calculation shows that
would work out to about $24.4 billion in federal Medicaid cuts for Illinois, or
about $2.7 billion a year on average, although the cuts are backloaded. A KFF
report earlier this month showed Illinois received $21.1 billion in annual
federal Medicaid funding out of $606.3 billion in total federal Medicaid
funding, or 3.5%.
The CBO also estimates “$78 billion in
additional state spending, on net, accounting for changes in state
contributions to SNAP and Medicaid and for state tax and spending policies
necessary to finance additional spending,” during the same time period.
That would be about $2.73 billion in
additional expenses for Illinois, or about $303 million per year on average.
Later in the week, Congressional Republican
honchos proposed a “manager’s amendment” to their massive reconciliation bill.
One new item would prohibit private insurance
companies in the Affordable Care Act exchange to pay for abortions unless
“necessary to save the life of the mother or if the pregnancy is a result of an
act of rape or incest.”
Illinois currently requires companies in the
ACA health insurance marketplace to cover abortion if they offer
pregnancy-related benefits, according to the Department of Insurance.
So, if the congressional provision is enacted,
Illinois would have to decide whether to pick up the tab itself or find another
work-around.
The same could happen with the amendment’s
language banning Medicaid coverage of gender-affirming care for adults. The
proposed ban earlier applied only to children.
The amendment would also move up Medicaid work
requirements from the original 2029 start date to 2026, which will undoubtedly
result in more Illinoisans being kicked off, if Arkansas’ disastrous experience
is repeated here.
The budget office claimed that household
resources for those in the bottom 10% of earners would “decrease by an amount
equal to about 2% of income” in 2027 and 4% in future years, due to Medicaid
and SNAP cuts.
Household resources for those in the top 10%
would “increase by an amount equal to 4% for households in the highest [ten
percent] in 2027 and 2% in 2033, mainly because of reductions in the taxes they
owe,” the CBO reported.
We’ll just have to wait and see what the U.S.
Senate does now that the ball is in its court.