PI Original Adam Doster Wednesday March 17th, 2010, 11:46am

Schock Ignores Value Of A Medicaid Expansion

Republicans like Rep. Aaron Schock don't like the Democrat's proposal, but officials at public, non-profit, and community health centers across the Chicago area are understandably excited about health care reform.

Those Illinois health care providers that serve the uninsured and underinsured are buckling under the pressure of delayed state payments and are desperate for action -- either in Springfield or on Capitol Hill.  With regards to the latter, the Tribune's Judith Graham tracked down officials at public, non-profit, and community health centers across the Chicago area who say national health care reform could help them better manage their increasing caseloads.

For starters, the state estimates that 400,000 to 600,000 low-income Illinois adults who currently lack insurance would qualify for Medicaid under the Democratic proposal. That would limit costly hospital emergency room visits and trim the glut of patients flooding free or low-cost clinics. "My hope," Dr. Leslie Zun, chair of Mount Sinai's department of emergency medicine, told Graham "is that people will get more of their basic medical needs met outside the ER."

The bill would also pour more money into community health centers, thanks in part to efforts from Sen. Bernie Sanders (I-VT), who added an extra $10 billion for the program in the Senate bill. Officials at both small community centers and from Access Community Health, the nation's largest chain of federally qualified health centers, are cheering the proposed investment. Sarah Allen, director of primary care services for Access, calls it "a huge, huge advantage."

Republicans disagree. Speaking to WGIL Radio in Galesburg, GOP Rep. Aaron Schock characterized the Medicaid expansion as an unfunded mandate on state government, citing January research from the Federal Funds Information for States that estimated the Senate bill could could cost Illinois $2 billion from 2014 to 2019.  While that figure is accurate, it overlooks that both the White House and Congressional leaders are planning to boost assistance to states when they pass the small package of amendments to the Senate bill via budget reconciliation. The president has proposed covering, for three years, 100 percent of the funding required to care for any newly-eligible Medicaid participants once reforms are implemented in 2014. Between 2017 and 2019, the reimbursement would drop to 95 percent. It would remain at 90 percent beginning in 2020.

This tracks closely with the bill passed by the House last fall and the price tag would not be nearly as large as Schock claims.

So how much would it cost? The Social Security Administration reports that it cost, in FY 2008, $9,656 to cover a Medicaid patient in Illinois. Therefore, expanding access to 500,000 new residents would add $4.828 billion annually to the state budget. But Illinois won't have to foot the bill for those patients between 2014 and 2017. In the subsequent three years, Illinois will pick up 5 percent of the tab. In other words, the state would pay just $724 million between 2014 and 2019 to insure roughly 5 percent of the state's entire population. That's just $482 per patient per year.

It's also important to remember that the Medicaid expansion is just one mechanism the bill uses to expand access to insurance. The Department of Health and Human Services thinks that another 1.2 million residents who do not currently have insurance (along with 612,000 residents who have expensive individual insurance) could purchase regulated insurance plans through the health insurance exchange. About one million of those folks would qualify for federal subsidies to pay those premiums.

Seniors and small business owners benefit, as well. In Schock's district alone, 162,000 households and over 13,000 businesses owners (PDF) would receive tax credits to pay for skyrocketing premiums.

Congressional leaders, still hashing out their procedural strategy, expect the House to take a vote this weekend. The GOP is crying bloody murder about the potential "deem and pass" tactic, even though they used the rule 35 times in 2005 and 2006, the last session in which Republicans controlled Congress. (Rep. Jan Schakowsky raises a similar point in her discussion with WLS' Don Wade and Roma this morning.) We should find out the House timeline soon.


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