Several service providers in Bloomington-Normal say proposed Medicaid cuts threaten health care locally, after the U.S. House recently passed a measure that would slice $880 billion over the next decade.
“I'm concerned. I'm alarmed. I'm scared by what I hear, by what this administration is trying to do," said Democratic U.S. Rep. Eric Sorensen, who represents parts of Bloomington-Normal and Greater Peoria.
Sorensen said the Energy and Commerce Committee is supposed to flesh out the details of the reduction. Although the budget resolution does not mention Medicaid, the federal program comprises $8.2 trillion out of the $8.6 trillion in mandatory spending the committee must use to come up with spending reductions — if reductions to Medicare are off the table.
"The only place where you can take that money out is in Medicaid. And so somebody who says this is not a cut to Medicaid is lying," said Sorensen, who met Tuesday with social service providers in Bloomington.
The size of the reduction represents 29% of state-financed Medicaid spending per resident. Sorensen said there are 40,000 people in McLean County on Medicaid, or 1 in 5 people.
Chestnut Health Systems impact
Chestnut Health Systems CEO Dave Sharar said federal money is 60% of Chestnut's budget, and 70% of its clients are on Medicaid. He said that could threaten Chestnut's integrated care model.
"Particularly if Federally Qualified Health Centers are not funded. Yes, it could create more silos and it could definitely be a negative impact on integrated care," said Sharar.
Here's a human example of how that might play out.
Eliazar Mendiola is a board member for Chestnut. He also chairs Chestnut's FQHC Committee. Mendiola said he was talking to a woman who had a baby and came in for health care. The woman had been sick, but couldn't afford to buy insurance on the exchange. It turns out she had a cardiac issue that Mendiola said without treatment was very serious.
"The doctor had told her, had you not sought medical assistance with this issue, you probably would have lost your life in the next year. And as she was telling me this, I'm looking at her daughter and thinking this poor child could have been an orphan had she not made it through the doors of Chestnut," said Mendiola.
Mendiola said he's heard dozens of comparable stories about how integrated care helps people in unexpected ways.
What's being considered
Under Republican discussion on how to meet the targeted reductions is revocation of an expansion of the Affordable Care Act and Medicaid eligibility that happened several years ago.
Sharar and Sorensen said if that is changed, the state has been clear Illinois cannot pick up that tab. Sharar said rolling back eligibility would decimate Medicaid. A lot of single adults would lose access to care at a time substance abuse and mental health treatment needs are worsening.
Chestnut also worries about proposals that require people to have a job to be Medicaid-eligible. Sharar said Chestnut supports the idea of work, but believes GOP estimates of non-working but able Medicaid recipients are too high. Sharar said two-thirds of those already on Medicaid have jobs. They are working poor who can't afford to buy insurance on the exchange.
Sharar said he's afraid the huge administrative burden of work verification would be on providers.
"I think it would add cost. For those who are able to work and are not working, those people need job coaching, support to find and keep a job. And then for us to verify and prove their work status means some of them will just naturally fall off the rolls if we can't do it. And then we can't get paid," said Sharar.
And he said there are plenty of people who are elderly or disabled and not able to work. Sorensen said if the Medicaid cuts go through, it wouldn't reduce the need for service; it would just shift it elsewhere.
"If Chestnut isn't here, that means that not only are people not going to get the care, but then they're going to have to find another source. So, the other source is going to be at one of the hospital systems," said Sorensen.
Emergency rooms are more expensive than clinics, and Sorensen said there already are long wait times in many ERs, adding that will increase health care costs, not reduce them.
The stated goal of the cuts is to reduce waste fraud and inefficiency. Sharar said Chestnut is all for that, but not on the backs of direct care providers.
"There's not much to squeeze here. We operate really lean. There's a workforce shortage challenge and we're caring for the most complex patients in the community," said Sharar.
Service providers and Sorensen said they don't believe there's enough bad spending to make up the size of the cuts.
"We absolutely know that if that care is held up, we'll have higher caseloads. We could have layoffs. We could have reduced access problems. Where do they go? The emergency room. What happens? There are more arrests. This trickles down to other systems," said Sharar.
Lifelong Access
Medicaid cuts could particularly affect the youth of Bloomington-Normal. Lifelong Access Interim CEO Rebecca Brennan talked about the Care Collaborative for Youth, planned for a remodeled Pantagraph newspaper building in downtown Bloomington.
"The reduction of Medicaid could jeopardize our entire model. This program to us is a one-stop shop so it makes access to care easy for families to not have to go to multiple locations. And that cut to Medicaid is really going to take that whole project and change its pathway," said Brennan.
Mark Jontry, regional superintendent of McLean, Logan, Livingston, and Dewitt counties, said that's in part because in the last few years, schools in Illinois gained the ability to bill for school psychologists and behavioral health, and services to low-income kids and kids with Individual Education Plans [IEPs].
“That's been a revenue stream that has come in and really this would cause us to have to re-examine how we're going to operate long term," said Jontry.
Chestnut's Sharar said "it would be a shame" if after spending $22 million federal grant dollars renovating the old Pantagraph building a new center for youth health couldn't open.
"It would be a barrier because some of the partners there would rely on Medicaid funding," he said.
The $880 billion in Medicaid reductions over a decade broadly averages to $88 billion per year. In practice, it's almost certainly not going to be proportional. Some states would get hit harder, depending on the policies committees are considering and on what finally passes.
Sorensen said the Agriculture Committee, on which he sits in the minority, also is looking at $400 billion in cuts to the SNAP food assistance program.
"Let's just call this for what it is: We need to find money that poor people and hungry people aren't using. That's as simple as this is. And people, I think, need to understand that. They need to understand that here in this community there will be implications," said Sorensen.
Of the 40,000 people in McLean County on Medicaid, Sorensen said many also get help from SNAP too. He said he doesn't know how people in need would be able to cope without health care and food.
As the House committees do their work, a lot remains unknown. Sharar said there are so many U-turns and whiplashes it's really hard to plan.
