Posts Tagged ‘Health’
Human service advocates say they are worried after Pritzker’s status-quo budget proposal
Some advocates expressed concern over the state’s inability to offset federal funding cuts.
Read MoreIllinois extends open enrollment deadline for health care plans starting Jan. 1
The deadline was extended from Dec. 15 to Dec. 31.
Read MorePritzker signs ‘medical aid in dying’ bill amid religious opposition
Gov. JB Pritzker signed legislation Friday legalizing end-of-life care for terminally ill adults in Illinois.
Read MorePesticide drift is catching schools off guard. Lawmakers want to require notice before spraying.
More than 700 Illinois schools are within a quarter-mile of crop fields, yet state law doesn’t require pesticide applicators to notify them before spraying.
Read MorePritzker signs bill allowing Illinois to issue state-specific vaccine guidelines
Gov. JB Pritzker said the bill will protect Illinoisians using science-backed guidelines, rather than “junk science.”
Read MoreIllinois hospitals fear massive cuts under Trump domestic policy law
Capitol News Illinois
Article summary
President Trump’s domestic policy bill contains massive cuts in federal Medicaid spending over the next 10 years.
One analysis predicts $48 billion in spending reductions in Illinois over a decade.
The cuts limit states’ ability to raise money through provider taxes to fund their share of Medicaid costs.
The cuts also limit the way states use Medicaid to direct additional payments to hospitals.
SPRINGFIELD — Hospital officials in Illinois say they will have to make some difficult decisions in the next few years that could involve laying off staff, cutting back services and even closing some facilities entirely.
That’s the expected result of federal funding cuts built into the recently passed domestic policy bill that President Donald Trump signed into law July 4, a law that will cut federal spending on Medicaid by more than $1 trillion over the next 10 years.
A.J. Wilhelmi, CEO of the Illinois Health and Hospital Association said in an interview with Capitol News Illinois that the financial pressures will fall heaviest on hospitals that serve rural areas, where a larger share of the population is covered by Medicaid.
“The hospitals in these communities are already on the brink, based on some of the increases in labor, drug and supply costs coming out of COVID, a continuation of claim denials by payers and relatively flat reimbursement rates,” Wilhelmi said. “So, all of that is creating significant pressures. And when you add these Medicaid cuts to an already challenging situation, we know that there are several hospitals that close because of these changes.”
Enrollment, reimbursement reductions
The new law contains provisions that are expected to reduce the number of people enrolled in Medicaid, particularly in states like Illinois that expanded eligibility for the program under the Affordable Care Act, the 2010 law commonly known as Obamacare.
Those include work requirements for people who enrolled through the expansion as well as requirements that they verify their continued eligibility for the program twice a year instead of annually.
But the law also includes changes in aspects of the program that most people outside the health care industry never see. Those mechanisms – known as provider taxes and directed payments – affect the way states finance their share of the cost of Medicaid and the way they direct additional payments to certain health care providers such as hospitals.
Like many states, Illinois levies special taxes on certain health care providers, including hospitals. The money those taxes generate is used to draw down additional federal matching funds, then is paid back to the providers in the form of directed payments to increase their overall reimbursement rate and to reward them if they meet certain performance or quality standards.
Currently, IHA estimates the hospital tax generates about $2 billion a year in revenue. This past session, lawmakers passed a bill to increase the assessment in order to fund a 54% increase in hospital payments, subject to federal approval of the state’s plan. But state lawmakers passed that bill before Congress passed Trump’s domestic policy bill, dubbed the “One Big Beautiful Bill Act.”
Prior to passage of the new federal law, the tax rate states could levy was effectively capped at 6% of a hospital’s net patient revenue. But under the new law, for states like Illinois that expanded Medicaid under the ACA, that cap will gradually be lowered by half a percentage point each year starting in 2028 until it reaches 3.5% in 2032.
In addition, Wilhelmi said, the new law imposes a cap on the directed payments that expansion states like Illinois can send to hospitals so that the total does not exceed the maximum allowed under Medicare – the federal health insurance program for seniors, which has a lower reimbursement rate than Medicaid.
“And that will result in a significant reduction in Medicaid reimbursements for hospitals,” Wilhelmi said. “It means literally hundreds of millions of dollars in less reimbursement to hospitals.”
$48 billion impact over 10 years
According to the nonpartisan health policy research organization KFF, federal Medicaid spending in Illinois is expected to be reduced by about $48 billion over 10 years under the new legislation. That includes an estimated $6.73 billion in spending cuts in rural parts of the state.
Democratic Gov. JB Pritzker has been harshly critical of the new law, and particularly the Medicaid cuts contained in it.
“Donald Trump isn’t just cutting health care — he’s also closing hospitals in Illinois and across the country with his latest scheme,” Pritzker said in one social media post while the bill was moving through Congress. “Hard-working Illinoisans will spend more time in overcrowded waiting rooms and lose access to life-saving care.”
Wilhelmi, meanwhile, said there is still time before the cuts begin to take effect, and he is urging state officials to begin work immediately to develop strategies to adapt to the changes.
“I think the state will need to work with stakeholders like IHA and our hospitals, other provider groups, to identify creative options to ensure that the Medicaid program can continue to be that lifeline for vulnerable patients and communities,” he said. “And that will include identifying options to fortify those programs and services, as well as identify working with our congressional delegation on ways to mitigate or further delay these changes.”
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
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Pritzker warns 330,000 Illinoisans could lose Medicaid under Trump’s budget plan
Capitol News Illinois
Article Summary
The U.S. House gave final passage Thursday to a bill that will cut federal Medicaid spending in Illinois by an estimated 20%, or $48 billion, over 10 years.
Medicaid pays for about 40% of all childbirths in Illinois as well as 69% of all nursing home care, according to an independent analysis.
State officials estimate 330,000 Illinoisans could lose Medicaid coverage if President Donald Trump signs the bill into law.
The Illinois Department of Public Health said nine rural hospitals in Illinois would face closure or severe service reductions due to the cuts.
This summary was written by the reporters and editors who worked on this story.
SPRINGFIELD — The U.S. House gave final passage Thursday to a budget bill that will cut federal Medicaid spending by an estimated $1 trillion over 10 years.
All three Republican members of the Illinois congressional delegation voted in favor of the bill, despite a last-minute plea from Democratic Gov. JB Pritzker who warned the bill will result more than 330,000 Illinoisans losing Medicaid coverage and have a devastating effect on some rural hospitals.
“As those who are entrusted with protecting the health of all your constituents, I urge you to oppose these harmful Medicaid provisions and work to protect healthcare access for rural Illinois families, workers, and veterans,” Pritzker wrote in the letter addressed to GOP Reps. Mike Bost, Darin LaHood and Mary Miller.
The cuts would translate to about $48 billion in Illinois over that period, or about 20% of what the state would otherwise receive, according to an analysis by KFF, a nonpartisan health policy research organization.
That would be one of the largest percentage reductions in any state in the nation, according to KFF, a nonpartisan health policy research organization formerly known as the Kaiser Family Foundation. Louisiana and Virginia would each see cuts of about 21%, KFF said.
The state-level analysis is based largely on Congressional Budget Office estimates showing the bill would reduce federal Medicaid spending by $1 trillion nationwide over the next decade.
The KFF analysis does not include estimates of the number of people who would lose Medicaid coverage under the bill, noting how that will depend on how individual states respond to the policy changes contained in the bill. But overall, it estimates the number of uninsured Americans will grow by 11.8 million.
The bill, which includes many of President Donald Trump’s domestic policy priorities – including tax cuts and increased spending on border security – passed the Senate on Tuesday by a vote of 51-50, with Vice President J.D. Vance casting the tie-breaking vote. Both senators from Illinois, Democrats Dick Durbin and Tammy Duckworth, voted no.
The final vote in the House was 218-214.
“The One Big, Beautiful Bill is a once-in-a-generation victory for the American people,” Miller said in a statement after the House vote. “It delivers on President Trump’s America First agenda with bold, decisive, and immediate action. This is the most pro-worker, pro-family, pro-America legislation I have voted for during my time in Congress, and I was proud to help get it across the finish line for the hardworking Americans across my district.”
Medicaid and the health care marketplace
Medicaid, which is jointly funded by states and the federal government, provides health coverage for lower-income individuals and families. It was established in 1965 alongside Medicare, the federally funded health coverage program for people over 65.
Today, according to the Illinois Department of Healthcare and Family Services, the program covers about 3.4 million people in Illinois, or a fourth of the state’s population. At a total cost of $33.7 billion a year, it is one of the largest single categories of expenditures in the state’s budget. It pays for about 40% of all childbirths in the state, according to KFF, as well as 69% of all nursing home care.
But questions about its future loomed over the Illinois General Assembly during the just-completed legislative session as both Congress and the General Assembly were crafting their respective budgets for their upcoming fiscal years.
“This was a difficult year because of the unprecedented changes and cuts that are looming on the horizon in Washington,” state Rep. Anna Moeller, D-Elgin, said on the floor of the Illinois House during debate over a Medicaid bill on the final day of the session.
Read more: Amid uncertainty in Washington, Illinois lawmakers pass slimmed-down Medicaid package
Speaking with reporters at an unrelated event Tuesday, Pritzker predicted “hundreds of thousands” of people in Illinois will lose Medicaid coverage if the Senate bill is signed into law.
“This is shameful, if you ask me, and it’s going to be very hard to recover,” Pritzker said. “The state of Illinois can’t cover the cost – no state in the country can cover the cost of reinstating that health insurance that is today paid for mostly by the federal government, partly by state government.”
Policy changes under the bill
According to KFF, most of the reductions in Medicaid spending would result from just a few policy changes contained in the bill
Those include imposing a work requirement on adults enrolled in Medicaid through the Affordable Care Act, also known as “Obamacare.” That law expanded eligibility for Medicaid to working-age adults with incomes up to 138% of the federal poverty level. About 772,000 people in Illinois are enrolled under that program.
The bill also calls for requiring people enrolled through the ACA expansion to verify their continued eligibility for Medicaid twice a year instead of annually. That is expected to filter out enrollees whose incomes rise above the eligibility limit as well as those who simply fail to complete the verification process.
Another provision would limit the ability of states to finance their share of the cost of Medicaid by levying taxes on health care providers. Illinois imposes such taxes on hospitals, nursing facilities and managed care organizations that administer the program. Revenue from those taxes is used to draw down federal matching funds that are then used to fund higher reimbursement rates to health care providers.
The final version of the bill does not, however, include a provision penalizing states like Illinois that also provide state-funded health care to noncitizens who do not have lawful status to be in the United States. That provision, which was included in the earlier House version, was not included in the Senate bill, according to KFF.
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
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Pritzker signs health care legislation
Capitol News Illinois
Gov. JB Pritzker signed a pair of health care-related bills Tuesday that he said would put more controls on the pricing of pharmaceutical drugs sold through insurance plans while expanding insurance coverage for certain kinds of hospital costs.
“For too long our health care system has been infected by profit-seeking middlemen and predatory actors looking to make an extra dime at the expense of Illinois patients,” Pritzker said at a bill signing ceremony in Peoria. “Seniors have been forced to pay through the nose for life-saving medications. Families have had to delay or decline medically necessary treatments because they can’t afford it anymore. And family businesses like independent pharmacies have had to shut their doors.”
House Bill 1697, known as the Prescription Drug Affordability Act, will impose new restrictions on practices of pharmacy benefit managers, or PBMs, a powerful but little-understood segment of the pharmaceutical industry.
PBMs are companies that act as a kind of middleman between health insurance plans and pharmaceutical companies by negotiating drug prices and designing drug formularies that are intended to steer patients toward lower-cost medications.
But they have come under intense criticism in recent years for steering patients toward their own affiliated retail chain pharmacies, often to the detriment of smaller independent pharmacies, and for operating pricing systems that are designed to maximize profits for the PBMs rather than producing savings for patients.
Under the legislation, PBMs will be prohibited from steering consumers toward large pharmacies in which they have a financial interest. They will also be prohibited from engaging in “spread pricing” – the practice of charging health plans a higher price for a drug than the PBM pays a pharmacy for dispensing the drug.
The bill also establishes a grant program that will distribute $25 million a year in financial support for independent pharmacies, funded through a tax levied on PBMs operating in Illinois.
David Bagot, an independent pharmacist from Petersburg who is also president of the Illinois Pharmacists Association, called the bill “landmark legislation” that he predicted would be studied and replicated in other states.
“This bill represents the most comprehensive reform of pharmacy benefit managers we have seen in Illinois,” he said. “For far too long, these companies have used our nation’s drug supply chain to benefit shareholders and executives while driving up costs for people who rely on medications and driving pharmacies out of business.”
But the Pharmaceutical Care Management Association, the lobbying organization that represents PBMs, called the bill “misguided legislation” and predicted it would have little or no impact on the prices consumers pay for medications.
“Unfortunately, the legislation does nothing to address the fact that Big Pharma sets the price of the prescription drugs – and the price is the problem when it comes to some Illinoisans facing difficulty affording their prescription drugs,” the group said in a statement. “Lawmakers have passed 20 bills regulating and restricting PBMs since 2016, none of which have led to lower drug prices.”
Insurance coverage expansion
Pritzker also signed House Bill 3019, known as the Healthcare Protection Expansion Act.
Among other things, it prohibits state-regulated health plans from requiring prior authorization for outpatient mental health services. Last year, lawmakers imposed a similar prohibition for inpatient and emergency mental health services.
It also requires insurance plans to cover a patient’s travel-related expenses whenever they have to travel long distances to receive in-network care, a problem often faced by patients who live in rural areas of the state.
“Building on protections that make mental health care accessible for all Illinois residents, this law gives people more opportunities and flexibility to receive necessary services,” state Sen. Laura Fine, D-Glenview, a lead sponsor of the bill, said in a statement.
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
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Amid uncertainty in Washington, Illinois lawmakers pass slimmed-down Medicaid package
Capitol News Illinois
SPRINGFIELD — Nearly every year, Illinois lawmakers pass a package of measures dealing with the state’s Medicaid program, the joint federal and state health care program that covers low-income individuals.
Known as the Medicaid omnibus bill, it sometimes includes bold components, like a 2021 initiative that made millions of dollars available to local communities to help them plan and design their own health care delivery systems. Other packages have focused on smaller changes like guaranteeing coverage for specific conditions and medications or adjusting reimbursement rates for different categories of health care providers.
And moThe Illinois General Assembly passed a scaled-back Medicaid package on the last day of the session Saturday.st years, the packages receive bipartisan support because they are negotiated, largely behind closed doors, by an unofficial, bipartisan Medicaid Working Group.
This year, however, lawmakers passed one of the narrowest packages in recent memory, due mainly to the Trump administration’s vows to make sweeping cuts in federal funding for the program while state lawmakers faced their own set of budget constraints.
“There were many, many, very worthy program expansions, rate increases that we considered during this process that we were unable to include because of the uncertainty in Washington,” Rep. Anna Moeller, D-Elgin, the current chair of the Medicaid Working Group, said on the House floor Saturday.
The Illinois Medicaid program currently costs about $33.7 billion a year, according to the Department of Healthcare and Family Services. Of that, $20.9 billion, or about 62%, comes from the federal government while much of the state’s share comes from taxes levied on hospitals, nursing homes and managed care organizations – money the state uses to draw down federal matching funds.
The program covers nearly 3.5 million people in Illinois, or about a quarter of the state’s population. According to the nonpartisan health policy think tank KFF, the program pays for 40% of all child births in Illinois while covering 69% of all nursing home residents.
This year’s Medicaid omnibus bill, a 231-page amendment inserted into Senate Bill 2437, contains items that could be hugely beneficial to many Medicaid enrollees, but which don’t carry large price tags. In fact, the entire package is estimated to cost just under $1 million.
One of this year’s additions would make it easier for family members of medically fragile children who qualify for in-home nursing care to receive training to become certified family health aides, a designation that would enable them to administer medications, help with feeding and perform many of the same tasks as a certified nursing assistant.
Another provision would require all hospitals with licensed obstetric beds and birthing centers to adopt written policies that permit patients to have an Illinois Medicaid certified doula of their choosing to accompany them and provide support before, during and after labor and delivery.
Although those provisions enjoyed bipartisan support, another provision that extends coverage to certain categories of noncitizens drew Republican opposition Saturday, resulting in a partisan roll call vote.
The program covers noncitizens who meet the income requirements for Medicaid and have pending applications for asylum in the United States or for special visas as victims of trafficking, torture or other serious crimes. Those individuals can receive coverage for up to 24 months, provided they continue to meet the eligibility requirements.
Moeller said the language was not a new extension of health care benefits to noncitizens, but instead a “technical and administrative fix” to an existing program that had been requested by the Department of Healthcare and Family Services.
But for Republicans, the programs sounded too similar to the more controversial programs, Health Benefits for Immigrant Seniors and Health Benefits for Immigrant Adults, that extend health care to a large category of people who are not U.S. citizens, including some who are in the country illegally.
“For us on this side of the aisle, that is the poison pill,” said Rep. Noreen Hammond, R-Macomb, the deputy House minority leader. “So in spite of the fact that we have article after article in here, that is very worthy of a yes vote, I would urge a no vote.”
At Gov. JB Pritzker’s request, the budget bill lawmakers passed Saturday night cancels the program for immigrant adults, which had covered about 31,000 noncitizens age 42-64. But it provides $110 million over the next year, all in state funds, for the immigrant seniors program, which covers about 8,900 noncitizens age 65 and over.
The Medicaid bill passed the House late Saturday night, 76-39. It then passed the Senate shortly after midnight, 36-19.
It next goes to Pritzker’s desk for his consideration.
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
The post Amid uncertainty in Washington, Illinois lawmakers pass slimmed-down Medicaid package appeared first on Capitol News Illinois.
‘Medical aid in dying’ bill moves forward in Illinois
Capitol News Illinois
SPRINGFIELD — Terminally ill Illinoisans may have the legal option to end their own life with the help of a physician next year under a bill approved by lawmakers Thursday.
The procedure, which advocates and the bill call “medical aid in dying,” would give people in a sound mental state with severe health issues the option to end their life with the help of a doctor.
Under Senate Bill 1950, doctors would be allowed to prescribe terminally ill patients a lethal dose of medication that they could self-administer at a time of their choice.
Advocates for the procedure, which is legal in 10 states and the District of Columbia, say it provides agency to people at the end of their life.
“I want to enjoy the time I have left with my family and friends,” Deb Robertson, a terminally ill woman, told lawmakers via Zoom on Wednesday. “I don’t want to worry about how my death will happen. It’s really the only bit of control left for me.”
The measure passed in the House 63-42 after more than an hour of intense, sometimes tear-filled debate. It now awaits action in the Senate. Senators have a matter of hours to pass the bill before their scheduled adjournment Saturday.
The bill outlines a process that includes two doctors recommending the procedure, sometimes referred to as medically assisted suicide, and limits the people who are eligible. People must be of sound mind and have a prognosis of less than six months.
Death certificates of those who use the procedure would also list their underlying diseases, not “suicide,” reflecting the common belief among advocates that the procedure should not be called suicide. Bill sponsor Rep. Robyn Gabel, D-Evanston, noted in debate Thursday that the provision would also “prevent inappropriate suicide investigations.”
But even with these protections, some oppose allowing the procedure.
Medical associations are divided on the issue. The American Medical Association, the largest and most influential medical association, notes an “irreducible moral tension” inherent in the practice.
The AMA’s Code of Ethics, for many years, said the procedure is “fundamentally incompatible with the physician’s role as healer.” The association has recently softened its stance, opening the door for physicians to act on their own conscience on the matter.
Rep. Bill Hauter, R-Morton, a practicing physician, opposed the bill and told his colleagues during debate Thursday that it “changes forever the soul of medicine.”
During the House debate, the division among the health care industry reared its head. Rep. Nicolle Grasse, D-Arlington Heights, is a hospice chaplain and was supportive of the bill.
“I’ve seen hospice ease pain and suffering and offer dignity and quality of life as people are dying, but I’ve also seen the rare moments when even the best care cannot relieve suffering and pain, when patients ask us with clarity and peace for the ability to choose how their life ends,” she said.
Outside of health care, religious groups and disability rights advocates are also divided. Members of both parties invoked their faith during floor debate, including Rep. Maurice West, D-Rockford, an ordained Christian minister.
“Life is sacred. Death is sacred, too,” West said. “The sanctity of life includes the sanctity of death. This bill allows, if one chooses by themselves, for someone with a terminal diagnosis to have a dignified death.”
Republicans, who are generally more aligned with pro-life religious groups, opposed the bill. Catholic groups say procedures like medically assisted suicide violate the church’s teachings and many conservative protestant groups oppose the practice as well.
Rep. Adam Niemerg, R-Dietrich, said the procedure does not “uphold the dignity of every human life.”
“This does not respect the Gospel,” Niemerg, who is Catholic, said during debate. “This does not respect the teachings of Jesus Christ or uphold the values of God.”
Disability rights activists are also split on the issue. Sebastian Nalls, a policy analyst at the disability rights organization Access Living, said that if the procedure is legalized, insurers may pressure some sick people into it instead of expensive treatment.
“This bill carries far too many loopholes and lacks oversight to be safe and equitable, but the bottom line for Access Living is this: The existence of assisted suicide is a threat, to not just the kind of health care we deserve, but a threat to our ability to live and die with dignity,” Nalls said in a committee hearing Wednesday.
Other disability rights advocates, like Beth Langen, note that “disability is not terminal.”
“Death, like life, is easier to navigate when you know you will have options to choose from, even if you never need to,” Langen said at Wednesay’s hearing.
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
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