Senate approves federal Medicaid expansion

By Meredith Colias 

The Illinois Senate approved a measure to expand Medicaid coverage beyond mothers and children to low-income single adults as part of the federal health care reform law.

Senate Bill 26 would expand Medicaid eligibility to an estimated 350,000 adults who do not currently qualify for Medicaid. Adults from 19 to 64 earning up to 138 percent of the federal poverty level would now qualify. The Patient Protection and Affordable Care Act calls for coverage to be extended for those making 133 percent of the federal poverty level. However, the feds are allowing states some wiggle room, so in practice, the coverage will be extended to those making 138 percent, which was $31,809 for a family of four and $15,415 for a single person in 2012.

The bill’s sponsor, Sen. Heather Steans, a Chicago Democrat, said the expansion would be better for providers such as hospitals, local townships and health care clinics that currently are not reimbursed for providing health care services for uninsured adults. She said it would shift individuals now without health insurance away from using hospital emergency rooms as a costlier last resort for injury and illness. “We can get them up front into care coordinated programs…make sure they are getting the preventative health care they need to stay healthier, which is a much better system when you actually get people care they need,” she said.

Sen. Jacqueline Collins, a Chicago Democrat, said the expansion is important for vulnerable citizens of the state, such as those who “were asked to bear the brunt” of the Medicaid cuts last year. The federal government will pay 100 percent of the costs of the Affordable Care Act for the first three years. Afterward, the state will be responsible for 10 percent of the total cost per year. The bill has specific language allowing Illinois to opt out of the expansion if the share of the federal government's payment falls below 90 percent, and the state has to pick up more than 10 percent of the total cost.

No Republican voted in favor of the legislation. They said they were concerned it was a commitment the state could not afford, and would force newly eligible participants to choose Medicaid over other options, such as buying insurance in the online marketplace that is another component of the Affordable Care Act. "At some time, we have to understand that we have to take responsibility" for its cost when the federal government stops footing the full bill, said Sen. Bill Brady, a Bloomington Republican.

Minority Leader Christine Radogno said that Illinois should do more to negotiate the terms of the expansions with federal officials before agreeing to sign on. Arkansas recently struck a deal with the United States Department of Health and Human Services that will allow that state to spend some of its Medicaid dollars to buy Medicaid-eligible residents insurance in the online exchange. “What I think we lose by getting on more quickly than we need to is any leverage to work with the federal government to make the program fit better for Illinois,” Radogno said.

Steans said she was confident that proper safeguards were built into the law to avoid a risk to the state budget. “We are going to have control over this program as we want,” she said. She said it is more important to change how the current costs are paid and said governors throughout the country are also embracing the expansion. “We pick it up in [the budget now], it doesn’t get any federal matching dollars … Folks are coming in and getting this care [anyway],” Steans said.

 She added, “It just makes total economic sense, as well as it’s the right thing to get people more health care coverage.” The measure now heads to the House.

For more on the implementation of the Affordable Care Act, see Illinois Issues September 2012.