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Preckwinkle: GOP proposal would have dramatic effect on local health care

Friday, March 10, 2017
Chicago Tribune
by TONI PRECKWINKLE AND DR. JAY SHANNON

In the last several weeks, we have been inundated with news stories out of Washington of Congress' efforts to "Repeal and Replace" the Affordable Care Act. And this week we got our first look at a bill that will have far-reaching impact beyond our nation's capital into communities—urban, suburban and rural.

People can debate the overall impact of the program on the federal government, the insurance industry, the hospital community and the pharmaceutical companies—and in the end, reasonable people can disagree. But one thing we should all be able to agree on is that health coverage through the ACA has transformed the lives of millions of individuals in this country. And while these national debates are necessary, we must not forget that health care is delivered locally and is intensely personal. By all accounts, the impact of the ACA, specifically Medicaid expansion, in Cook County has been transformative—for providers, for employers, for government, but most importantly, for patients.

 

As a direct result of Medicaid expansion, hundreds of thousands of Cook County residents now have a medical home, where they can access primary care services, education and medications to control chronic conditions like diabetes and high blood pressure rather than seek care in emergency rooms. They can also receive community-based behavioral health or substance abuse services. This level of access eliminates unnecessary costs and suffering that extend beyond the hospital bill to families, employers, the community and taxpayers.

Should the ACA be repealed, the annual loss of revenue for care provided by the Cook County Health & Hospitals System would probably exceed $300 million annually and could be as high as $800 million. Additionally, other hospitals and providers in Cook County would stand to lose more than $300 million in reimbursements from our CountyCare Health Plan, which is on top of the hundreds of millions more lost from other Medicaid health plans.

Financial losses like these to local health care and safety net providers will surely threaten the ability of smaller community-based health care institutions to carry out their mission. Repeal of the ACA will threaten jobs and dramatically increase the amount of uncompensated care that ours and other hospitals are asked to provide. The Cook County health system has been able to withstand a 75 percent decrease in local tax support since 2009, from $481 million to $111.5 million in 2017, in large part due to the ACA. Cuts mentioned in repeal proposals thus far are unsustainable and would require increased state or local revenues to meet the needs of the uninsured in Cook County.

Even though the current funding methodology for Medicaid does not fully cover the cost of care, it is fairer and far simpler than enacting a block grant or per capita cap methodology. If current spending served as the baseline for block grants, federal revenues that flow to Illinois would be significantly lower, as the federal contribution toward our Medicaid expenses and Medicaid per-enrollee spending is currently at the bottom of all states nationally, based on a complex funding formula that varies state to state.

In the per capita caps proposal, the intention is to use 2016 expenses as the baseline for 2020 rates, which puts Illinois at a disadvantage and sets the template for years to come. Under the current proposal, states would be forced to reduce services, reduce payments or limit enrollment in economic downturns.

The argument that states understand their needs better is a cop-out. Medicaid has always been a partnership between the states and the federal government that sought to create healthier communities by providing an effective safety net for Americans' most fundamental need: health care. Dismantling that partnership will threaten the local health care delivery system and have a lasting and devastating effect on the individual lives and the communities we proudly serve in the Cook County Health & Hospitals System.

Toni Preckwinkle is the president of the Cook County Board of Commissioners. Dr. Jay Shannon is CEO of the Cook County Health & Hospitals System



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