Cook County, which runs one of the largest public health systems in the nation, is braced for a blow to its budget, because the American house republicans are radical cuts on health insurance for millions of people with a low income.
But the uncertainty about how steep the cutbacks could be, can now take months with the broad proposal On the way to the US Senate. The measure would Scale medicaid drastically backThe Public Health Insurance Program for people with a low income or disabled. The federal government and states usually divided the costs.
“We are clearly going to suffer a financial hit,” said Cook County Board President Toni Preckwinkle. “The only question is what the size of it is.”
At the same time, with a huge budget hole, the legislators of Illinois are ready an end to health insurance For more than 30,000 immigrants adults mainly without legal status from 1 July. But Preckwinkle is preparing in the event that the state laws have cut even more, so that the coverage for immigrants seniors is also deleted. Combined, Cook County receives around $ 160 million a year in income from these state care insurance programs for immigrants.
The cascade of financial losses can be in-depth for the Bottom Line of the province and the people they serve, largely low income and immigrant patients at Cook County Health, and broader to ordinary residents who rely on provincial services such as the courts or for obtaining real estate tax accounts.
In Illinois, more than 3 million people have Medicaid – about one in four in the state. This program applies Everything from seniors in nursing homes and mothers and their newborns to people with disabilities and people who live with HIV. New research suggests that having medicaid coverage saves lives.
What Preckwinkle said that she is most concerned is cuts on Medicaid, which is about 56% of how much cook County Health is paid to treat patients. The province has a mission to treat people, regardless of whether they can pay and offer by far The most discounting care to patients throughout the state, Data for public health appears.
County officials expect this amount to climb. Health centers for the community and other hospitals that serve communities with a low income are all brace for possibly more patients to lose the coverage of Medicaid. If that happens, leaders in these clinics are considered whether they should dismiss employees, take hours or close. This would possibly lead more patients to the province, which can now have difficulty to be paid to treat them.
Then Fulwiler, CEO of Esperanza Health Centers, who mainly treats Latino patients on the southwest side, predicts a potentially dangerous and expensive cycle that includes longer waiting times to see a doctor. Patients who, for example, postpone their diabetes will become sicker and become much more expensive to treat in the Emergency Department.
“All those things are going to cause more pressure on the province,” said Fulwiler. “They are the absolute end of the safety net.”
Planning in the dark
All this is unfolding when Cook County starts planning the budget of next year. This year the spending plan is in total Almost $ 10 billionstimulated with $ 1 billion in Pandemic auxiliary Dollars Soon to hit that financed Guaranteed incomeAnti-violence measures and housing for homeless people.
But it’s hard to plan without knowing how much they could lose in federal support, said Preckwinkle. She will not provide any details about what could be scaled back, although she said that her administration is looking carefully at what is absolutely necessary and what they might not be able to maintain.
Yet there are some indications for how much is at stake. The house account requires, for example, that, with a few exceptions, Medicaid -ing -written work (Research shows Most already do). The province says that work requirements can lead to an annual loss of $ 88 million. That is based on estimates of the state and what happened in Arkansas, nearby 18,000 people lost coverage Either because they had no job or because of the confusing process to maintain their insurance, according to KFF, a non-party-related research organization for health policy.
The federal government would do that too reduce 90% to 80% How much they have joined the costs of adults who have joined Medicaid when the program expanded under the affordable care act to states such as Illinois who finance health care for adults and children without paper. If this were to happen, the State would have a law that would end the expansion program and dares At least 700,000 people would lose insurance. The expected impact on Cook County Health: about $ 200 million a year.
All these losses can translate into an increase in the care provider or a discount for a discount, for provincial patients if they cannot afford to pay their medical accounts. In 2023 this was almost $ 140 million in the flagship of the province of John H. Stroger Jr. Hospital only on the nearby west side, almost six times more than the next nearest hospital, according to a WEbe -Analysis of the most recent Illinois Public Health Data.
The enormous health system of the province also includes Provident Hospital on the south side and a group of clinics in the city and the suburbs. Most patients are low income, black or latino.
“It’s hard to know if people will change to us immediately,” said Preckwinkle. “Sometimes, when their own system is no longer available for them, they simply postpone healthcare until they are really sick, and then perhaps end up in our first aid, and from there to our system. There is no way to predict that kind of individual decisions and the size of the impact they will have on us.”
Dr. Erik Mikaitis, CEO of Cook County Health, predicts that even people with private insurance will be affected by Medicaid cuts. For example, they were able to find the there in their local hospital full of patients who are suddenly uninsured, which increases everyone’s waiting time to see a doctor and possibly make medical accounts more expensive, because hospitals find out how they can earn lost Medicaid income.
Mikaitis said he is not going to reduce services or to dismiss staff at the health system he runs.
“We will do as much as possible as we can,” said Mikaitis. “We are committed to our mission to ensure that everyone has access to care.”
Sean Morrison, the only republican in the provincial administration, said that he is “cautiously optimistic” potential medicaid changes, not cut too deeply. He supports the mission of Cook County Health, but said that “much of it has been political theater” of Democrats, and disputes that Republicans would actually reduce Medicaid. He points to work requirements instead.
But he acknowledges that the province should absorb the costs for treating people who lose health insurance, and that may mean that other district services can pay the price. He proposes that some solutions, such as having it return to their home country, increasing taxes or reducing programs such as guaranteed income to finance medical care instead.
“Is the idea of the government for everything ever a sustainable model? No, of course not,” said Morrison.
Hope in the midst of uncertainty
Dr. Mark Loafman has worked for about 30 years to try to prevent some of the poorest people from getting so sick that they come to the Emergency Department where he is outside.
Recently he said that there is a lot of fear in his agreements. His patients at Cook County Health ask how the potential medicoid cuts can influence them.
“And of course I have no answer for them,” said Loafman, who leads family and community medicine. “We know a bit that our immigrant population is probably first place (to lose the insurance), and that will come soon, and then others will follow.”
Over the years, while politicians throughout the country are debating whether they should reduce medicaid, he said he has learned not to panic. Both sides of the political aisle in Washington usually come together to give a budget that makes sense.
But this time Looafman said that it feels different – unprecedented.
“I think this is harder and more certain that there will be an almost devastating level of cuts for some of our patients,” Loafman said. “We just have to find a way to get through it, as we always do.”
Yet he is hopeful.
“I think it will be difficult, but that will create the visibility we need, so that the people who don’t pay attention to this, who don’t see what I see every day, can have a bit of a change in heart and perhaps vote and speak and something different on their social media feed and start to pay attention,” Loafman said. “I think that’s what we will get from this.”
Kristen Schorsch deals with the health of the region for Wbez.
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