What repealing the Medicaid expansion provisions in the Affordable Care Act would mean to Illinois

President Trump has promised to repeal the Affordable Care Act (ACA), often known as “Obamacare.”   However, he and the Republican leaders in Congress have not yet made clear whether some provisions of the ACA will survive and, what, if anything, would replace the ACA.  The ACA provision which has been most helpful to persons with mental illnesses in Illinois is the one which allowed Illinois to substantially expand its Medicaid program.

Under the ACA, states are allowed to chose whether to expand coverage of their Medicaid program.  Historically Medicaid has been available only to persons whose income is at or below 100% of the Federal poverty level.  The Medicaid expansion provisions of the ACA allow persons making up to 138% of the poverty level to be covered.  Importantly, the Federal government covers between 90 and 100% of the cost of care for persons in the Medicaid expansion program.  For persons in the “traditional” Medicaid population the Federal share is typically only 50%.  Thus, Illinois and the 30 other states which have thus far elected to expand Medicaid are able to provide health care to more than 11 million new people at little or no cost to state taxpayers.  In Illinois, more than 650,000 people are now covered by Medicaid due to the expansion provisions of the ACA.  In the 18-month period between January 2014 and June 2015, the Federal government paid $3.3 billion for health care for persons in the Medicaid expansion population in Illinois.  Illinois paid only $52 million as its share–less than 2%.  This data is from “What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion?” The Kaiser Commission on Medicaid and the Uninsured (December, 2016)

Illinois is already in very bad fiscal shape. If President-elect Trump and the United State Congress eliminate the Medicaid expansion program, it is extremely unlikely that Illinois would be able to find additional billions of dollars to cover health care costs for more than 650,000 Medicaid expansion enrollees.  Many of these people have serious mental illnesses.  They will no longer be able to get treatment for their mental illness or any other health care condition.  This will harm them and their families and communities.

  1. Action items:  Tell your United States Senator and Congressperson  not to repeal the Medicaid expansion provisions in the ACA.
  2. Show up at a town hall meeting and tell your Senator and Congressperson not to repeal the Affordable Care Act.

Letter to Governor Rauner concerning the possible repeal of the ACA: protect-medicaid-aca-governor-rauner-letter_final_12-15-2016

Click here for a link to a Petition to Save the Affordable Care Act.

Urban Institute; The Implications of Partial Repeal of the ACA.

Latest House Republican plan for ACA repeal 

Click here for a link to the Protect our Care Illinois website.


Still no budget–Things about to get worse

In June, 2016, the Illinois legislature finally passed and the Governor signed a “budget” for Fiscal Year 2016 which was just ending on June 30th and for the first six months of Fiscal Year 2017.  This “budget” ends on December 31,2016.

The budget which is ending on December 31st is not real.  That is because it is just a spending plan with no new revenue.  Every day for the past 18 months, Illinois has gone deeper into debt.  indeed, for many, many years we have put off raising taxes and borrowed from our future.  The current “budget” just accelerated our borrowing.  Every day that we postpone raising taxes and cutting spending makes the task of enacting a balanced budget more difficult because our existing debt gets bigger.

Everyone knows that spending cuts alone will not solve this problem.  No public official from either party has proposed a balanced budget which does not include a tax increase.

Action item:  Advocates for a decent mental health system in Illinois must continue to tell their state senator and state representative and the Governor to agree on a balanced budget and agree to raise taxes.