By: Monique Garcia
July 1, 2012
When sweeping health care cuts take effect Sunday, the parts of Illinois that stand to be hit hardest are the places where folks already are struggling to get by.
City neighborhoods like Austin and Englewood, Humboldt Park and Pilsen. Inner-ring suburbs like Cicero. Rust Belt cities like Rockford. Whole swaths of rural Illinois. They're areas where people make less, jobs are scarce, and more rely on the government for help.
Medicaid cutbacks mean hundreds of thousands will see health care benefits greatly curtailed, tens of thousands will lose coverage altogether, and those who keep it will face higher copayments. The fear, critics say, is that it's about to become even tougher to live in areas already caught up in a cycle of poverty.
"Even before we made these cuts, the communities I represent were struggling," said Rep. LaShawn Ford, who represents parts of Chicago's West Side. "This is only going to make it worse."
Wielding the budget ax is Gov. Pat Quinn, who pushed a plan through the General Assembly this spring to make drastic cuts and raise the cigarette tax by $1 a pack. The liberal Democratic governor said he had to do it to ensure that any health care for the poor remained at all. Otherwise, he said, the Medicaid system would collapse under billions of dollars in debt.
The grim irony is that some of those losing state coverage will regain it come January 2014 after the Supreme Court last week upheld President Barack Obama's national health plan. The state plans to add 500,000 people to the Medicaid rolls and estimates an additional 1 million will get coverage through a new health care exchange, an online marketplace that helps people buy more affordable insurance.
For now, critics say the administration was so focused on saving dollars that it overlooked the impact the cuts will have on people, particularly in low-income communities where the cutbacks will be felt more acutely. Quinn administration officials say they haven't yet calculated how the cuts will fall. But opponents say it's clear that those areas that rely the most on the services will bear the brunt of the cuts, which amount to some of the largest in state history.
Take Ford's West Side district, where 45 percent of the 105,000 people he represents get some sort of health care benefit from the state, according to the Department of Healthcare and Family Services.
Ford said the cuts will be particularly hard on the working poor, who are barely scraping by on jobs that often pay minimum wage. Under the new rules, a family of four cannot earn more than $30,657 a year to qualify for health care coverage under the state's Family Care plan. A single parent with one child cannot earn more than $20,123.
Ashley Branch, a single parent with a 5-year-old son, said she exceeds that threshold by about $50, meaning she stands to lose health care coverage. Branch works as a medical assistant at a clinic in Austin run by the Circle Family HealthCare Network, where administrators say 700 patients they treated in the last year will no longer qualify for care.
Branch, 27, said she is lucky and is in good health, but she fears what will happen if something goes wrong.
"I'm very worried," Branch said. "It's not fair. I understand they have to make budget cuts, but I feel like the rich are getting richer and the poor are getting poorer. We are human beings just like everyone else. Even though we aren't in certain tax brackets, we still deserve at least the opportunity to have health care."
Those who don't lose coverage altogether will be asked to pay more for the care they do get, including new copays ranging from $2 for generic medicines to $3.65 for name-brand drugs and doctor's visits.
Although it might not seem like a lot of money, it's enough to discourage people from getting treatment when they often have to choose between health care and food, said Nadeen Israel, a health care policy expert with the Heartland Alliance for Human Needs & Human Rights.
"If you look at the numbers, and how little money many of these families have to live on, every dollar makes a huge difference," Israel said. "It comes down (to), 'Do I save that and put it toward food, or am I going to get a checkup to see if my blood pressure is OK?' "
When the choices are that stark, it means people don't seek regular care to stay healthy. Preventive care is vitally important in poor communities, where rates of preventable illnesses like diabetes and heart disease are already higher than in more affluent areas, said Dr. Andre Hines, chief executive officer of the Circle Family HealthCare Network.
Hines said she also is worried about the unintended consequences the copays might bring, including requiring clinics to absorb the cost when patients can't pay. Though clinics can turn patients away for not being able to pay, most won't, Hines said.
"It's really hard for us and personally frustrating for me, because these are patients that need to be taken care of," she said. "These people are not going to go away. We will see them. We just won't get paid."
A spokesman for the office that oversees Medicaid acknowledged that clinics as well as hospitals will be responsible for covering the cost of unpaid copays.
"While the department certainly understands the concerns that are being voiced, inaction would have led to the collapse of our Medicaid system," spokesman Mike Claffey said.
Claffey added that officials were careful to protect services for the state's most vulnerable, including children, and did not cut reimbursement rates to providers that Medicaid clients rely on the most. That includes all doctors and dentists, as well as safety-net hospitals in the city and critical-access hospitals in rural Illinois.
But lawmakers who represent areas with the highest level of Medicaid recipients said more should have been done to offset the need for deep cuts.
"It's about the haves and the have-nots," said state Sen. William Delgado, a Chicago Democrat whose district includes parts of Logan Square and Humboldt Park. "All of these people who made these decisions at the top levels, they don't walk in these people's shoes."
State Sen. Donne Trotter, a Democratic budget expert, said lawmakers should have looked at raising money by closing corporate loopholes or sweeping funds. He said gambling dollars also could be used to minimize cuts, noting that lawmakers sent Quinn a plan that would add five new casinos and slot machines to horse racing tracks. Quinn already has indicated his opposition to the gambling plan.
"I understand something had to be done. I just think that we went overboard," said Trotter, who represents a South Side district where 42 percent of 210,000 constituents currently get some health care coverage from the state.
Trotter said the pain is worsened by years of budget cuts for other social service programs, including mental health and drug treatment.
That leaves people who need help with fewer places to turn. Trotter said that creates a whole other set of problems, including more crime.
"There is going to be this sense of urgency, this sense of desperation for many," Trotter said. "People have the audacity to call these cuts a smart plan. It's not smart, not when you take a look at what can happen."
State Sen. Martin Sandoval, D-Cicero, said the cuts will forever change the communities he represents, where more than 44 percent of the population is enrolled in Medicaid.
"This throws Latino families in a cycle of poverty which will never be made up," Sandoval said. "These cuts couldn't come at a worse time."
Sandoval said he's disappointed that efforts to cut health care spending were led by Quinn and Democrats, who typically work to beef up the state's safety net, not pick it apart.
"It was a shameful moment," Sandoval said.