A compromise on health care for undocumented immigrants

When the Legislature and the governor enact a budget, they have to make the numbers balance.

The Illinois General Assembly reconvenes next week at the State Capitol Building, Springfield, for the final sprint until adjournment on May 31.

Advocates for important state services generally say those services need more money, often rightly so.

Education, underfunded pensions, public safety – the list is virtually endless. But when the Legislature and the governor enact a budget, they have to make the numbers balance.

In the fiscal year that started on July 1, they came up with what appears to be a sensible compromise on health care funding for undocumented immigrants in the state, even though advocates have protested it is nowhere near enough.

In the budget, a $550 million increase was set aside to pay those health care costs. Is it enough to cover everyone? No, because the cost of the program is soaring just three years after it was created. State officials estimate that, without changes, the program’s costs could balloon by $1.1 billion. Health care advocates say that’s not the point. The Healthy Illinois Campaign called the compromise “immoral and fiscally short-sighted.”

U.S. Rep. Delia Ramirez, D-Illinois, called the new limits “a false choice built on fear-mongering and anti-immigrant rhetoric.” Advocates have held protests, including one on Thursday outside the Illinois state offices in the West Loop. But look around the country, and you would be hard put to see many other states that provide even as much health care as Illinois does.

Some other states that did start providing some measure of health care for undocumented immigrants now are cutting back, or are debating whether to do so. Illinois was the first state to offer health care coverage to non-citizens. And this year the Legislature and Gov. JB Pritzker came up with more cash for health care coverage, even though many other priorities could also use a lot more money.

Under the deal, the state will stop enrolling immigrant adults aged 42 to 64 who lack permanent legal status in its Medicaid-like Health Benefits for Immigrant Adults program, at least temporarily. Existing enrollees in the Medicare-like Health Benefits for Immigrant Seniors program will be able to keep coverage, and additional seniors will be able to apply, though there will be a cap of 16,500 enrollees.

All enrollees will have to shell out for co-pays for hospital visits of $100 to $250. Children up to age 18 are covered under the All Kids program. Unlike traditional Medicaid, which is substantially subsidized by the federal government, Illinois has to pay for almost all of the Health Benefits for Immigrant Adults program.

Congress, where the U.S. House has been more focused on adding work requirements for Medicaid, isn’t likely to be much help soon. Having adequate health insurance is a challenge for many Americans. Some people have insurance plans with out-of-pocket maximums, premiums and deductibles so high they can’t afford health care if they get a serious illness.

A study in the Dec. 27, 2022, Journal of the American Medical Association found that even Americans with job-based health insurance have been skipping medical care because they can’t afford it. Some Illinois residents with Medicaid will lose their coverage now that emergency pandemic protections are ending.

Last year, the Kaiser Family Foundation found about half of U.S. adults had trouble paying health care costs. Ideally, should everyone have access to affordable health care coverage? Of course they should, just as every qualified student in the state should be able to get a college education without taking on crushing debt.

But if the federal government is not going to provide better health care coverage, or subsidize coverage for non-citizens, the gap may be too big for Illinois to close all by itself.

Chicago Sun-Times