House approves Medicaid expansion

By Jamey Dunn

National politics played out on the Illinois House floor as lawmakers voted to approve a massive Medicaid expansion, which is a key component to federal health care reform.

Senate Bill 26 would allow people who have a household income of 133 percent of the poverty level to qualify for Medicaid. The federal government will pick up the cost of the expansion until 2017, when the funding drops to 95 percent. In 2020, federal support will drop to 90 percent. The U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act, sometimes dubbed “Obamacare” after President Barack Obama by its opponents, allowed states the option not to participate in the Medicaid expansion. (For more on the ruling and the expansion, see Illinois Issues September 2012.)The Department of Health and Family Services estimates that an additional 342,000 residents would be eligible for Medicaid under the bill. About 140,000 more who are Medicaid-eligible but not enrolled will also likely sign up for Medicaid once the federal mandate that requires Americans to have health insurance kicks in 2014.

The expansion comes after lawmakers approved more than $1 billion in cuts to the Medicaid program last year and put a moratorium on future expansion. However, Rep. Sara Feigenholtz, sponsor of SB 26, said that when the moratorium passed, lawmakers assumed the expansion under the Affordable Care Act would happen because the Supreme Court had not given states the ability to opt out yet. The Medicaid changes made last year are known as the SMART Act. The Illinois House debated the expansion for more than two hours today. “These things don’t come easy. These are big, big measures. This is probably the biggest bill on health care that the Illinois General Assembly will have ever passed,” Feigenholtz said.

Republicans called for lawmakers to skip the expansion because they say they are concerned that the federal funding may not come as promised. “A year ago, we voted to scrub individuals from the Medicaid rolls who no longer qualify because it was the only way to save the program,” said Rep. Jim Durkin, a Western Springs Republican. “Now the majority party wants to add another 500,000 people to Medicaid when we cannot afford those who are currently on Medicaid.” No Republicans voted in favor of the bill. Some urged delaying the vote until the budget picture on the federal level is clearer. “I ask you to defer this decision. We do not have to make this decision now. We can make this decision in veto session or we can make it in next spring session after the [federal deficit reduction] talks have taken place and we have more certainty as to what the figures are going to be and how they will affect the state of Illinois,” said Hinsdale Republican Patricia Bellock, who was a key player along with Feigenholtz in crafting the SMART Act.

Feigenholtz said that she thought that a lot of the reactions from Republicans are driven by the national partisan fight over the president’s signature health care law. The Republican-controlled U.S. House has voted 37 times to repeal the law, but the Democrat-controlled Senate just ignores the repeal bills when they are sent to that chamber. “I think that there has been for a long, long time a drum beat against Obamacare. I think it was a very political drumbeat,” Feigenholtz said. The Illinois Senate has already approved the expansion, but the House tacked on some changes to the SMART Act, so the bill will now go back to the Senate. “There are very minor tweaks in SB 26 when it comes to the SMART Act, the two most notable ones we were sued in court on, and these are ultimately where we feel the settlement will end up,” Feigenholtz said.

She said many lawmakers wanted to see further rollbacks to the SMART Act’s cuts but that she wanted to keep as much of the savings in place as possible. She said some legislators “whose communities were disproportionately affected by the SMART Act were still a little concerned about how it has affected their communities, but at the end of the day, I really believe that this bill, this measure, is really going to be the game changer” for health care in Illinois.