As efforts to overhaul health care move through Congress, Jewish organizations, including JUF, the Jewish Federations of North America and the Jewish Council for Public Affairs , are raising concerns over proposed massive cuts to the Medicaid program that appear in both the U.S. House and Senate bills -- and urging action.
"Medicaid represents over $208 million in federal funding that comes into the Chicago-area Federation system every year," said David Golder, chair of JUF's Government Affairs Committee. "It is a vital program that funds health care, behavioral health services, nursing home care, and services for at risk youth and people with disabilities and must be protected."
Concerns over the future of the Medicaid program took center stage during both JUF's 2017 agency advocacy missions to Washington, D.C. , and Springfield , as changes to the federal health care bill will ultimately have a significant impact at the state level.
Based on nonpartisan Congressional Budget Office cost estimates, conservatively, Illinois could be facing the loss of at least $40 billion in federal Medicaid funding over 10 years under the House bill. Additionally, the Commonwealth Fund has projected that the bill passed by the House would result in the loss of coverage for 23 million nationally and a loss of 46,000 jobs in Illinois alone. Urban safety-net hospitals, such as Mount Sinai Hospital, and rural health systems are especially vulnerable to the proposed changes.
"What is being proposed by the House of Representatives includes a 25 percent cut in Medicaid over 10 years and, unfortunately, what is being proposed in the Senate's version would be even more damaging to our community's ability to serve our most vulnerable members," said Emily Sweet, executive director of JUF's Jewish Community Relations Council and Government Affairs department. "These type of cuts would be devastating not only to our affiliated agencies, such as Sinai Health System, CJE SeniorLife, Jewish Child & Family Services and Keshet, but to the millions of Illinoisans, including 1.5 million children, whose overall health and well-being depends on the Medicaid system.
"Although we recognize the economic concerns associated with the ACA, rolling back Medicaid is not the solution," she continued. "As the number of uninsured people rises, as expected under the current proposals, states will face an even greater economic burden in the long run. The proposed cuts would also place additional strain on Federation agencies, which are already stretched due to the state's fiscal crisis.".
Services provided by JUF's agencies under the Medicaid program include long-term care and community-based care services for older adults, primary care services for children and adults with developmental and intellectual disabilities, and the full range of inpatient and outpatient medical care and rehabilitation services provided by Sinai Health System.
Proposals included in the bills would have devastating effects on Illinois .
First is the rollback of Medicaid expansion. Illinois and seven other Medicaid expansion states will be hit particularly hard by the Senate version because Illinois has laws on the books that automatically remove the Medicaid expansion program if the federal government decreases what it pays towards Medicaid.
This means that 650,000 adults covered by Medicaid will be at risk should they cycle off of Medicaid, because, for example, if they got a job with health insurance, they will not be allowed to re-enter should they lose their health insurance. Approximately 50 percent of the Medicaid expansion population cycles off in a year.
Second, under the current proposal, the federal government will decrease the amount of Medicaid dollars given to Illinois, triggering the removal of the Medicaid expansion. An equally significant problem, the bill includes limiting or capping the total amount of Medicaid dollars that would go to the states every year.
Currently, in Illinois, the federal government matches a percentage of every state dollar that is put into the Medicaid pot. Under the current proposal, costs would shift to states as health care costs -- and the numbers of people needing Medicaid due to our aging population -- increases.
For Illinois, this would be especially problematic. With a current backlog of $14 billion in unpaid bills and a structural deficit of approximately $6 billion, Illinois is unlikely to be able to fill the gap between what the federal government pays now and what they would pay in the future under a capped funding structure.
"Whether the proposed cuts to Medicaid begin in 2020 as included in the House-passed bill or are phased out over four years as provided in the Senate bill, both proposals would have a devastating impact on our agencies and the people they serve," said Lisa Shuger Hublitz, director of JUF's Washington, D.C. Office.
Golder added, "This program provides vital health and behavioral health services to some of our community's most vulnerable and we must do all we can to protect it. With such steep cuts projected, there is no way private philanthropic dollars can cover the difference."