You may recall that when this bill was debated in committee, proponents were allowed an hour of testimony – I was given less than one minute to testify in opposition. It’s a shame that members were not given adequate time in committee to hear the many reasons why the Medicaid expansion is wrong for Illinois.
During the floor debate, several Republican senators raised serious concerns over the bill that remained unaddressed. Why is Illinois rushing to implement a voluntary expansion that Democratic and Republican lawmakers in other states have been very cautious about? Why does this bill expand Medicaid eligibility to people who would qualify for federal subsidies to buy better, private health insurance? Why does this bill take those subsidies away, trapping these people in the failing Medicaid program instead? What happens if the federal government shifts more costs to the states – which President Barack Obama has proposed in each of his last two budgets – and imposes a new maintenance of effort requirement so that the state can’t back out? These questions on and on.
Although the bill’s sponsors had no good answers to any of these questions, the Senate pushed through the bill anyway. It now heads to the House, where Democrats are eager to get political cover on this issue from Republican lawmakers.
Here are just a few reasons lawmakers in the House should say no:
- Illinois is under no obligation to expand Medicaid eligibility.
- To date, few states have enacted legislation to implement this expansion.
- Democratic and Republican state lawmakers all over the country are taking a very cautious approach and are not rushing into this decision.
- Many of the people this bill makes eligible for Medicaid are currently eligible to receive federal subsidies to buy private health insurance, but would lose those subsidies under this bill.
- Many more currently have private coverage, but could be forced to join Medicaid under the exchange’s automatic enrollment procedures.
- The federal government has already tried shifting more Medicaid costs to the states. Obama’s last two budgets have proposed shifting more of these costs to the state, and this shift was part of the debt ceiling and fiscal cliff negotiations.
- Although this is a voluntary expansion, the federal government could impose a new maintenance of effort requirement on states that choose to expand, just as they did on the voluntary expansions in 2009 and 2010.
- The Medicaid program is already on the brink of collapse. Low reimbursement rates and long payment delays in Illinois’ Medicaid program have forced many doctors to stop seeing Medicaid patients altogether. Adding more people to a failing program will only make these problems worse.
Such important issues deserve careful consideration and thought. State lawmakers owe it to Illinoisans to say no to an irresponsible Medicaid expansion that would cost taxpayers big and hurt the state’s most vulnerable residents.
Jonathan Ingram is Director of Health Policy at the Illinois Policy Institute