Illinois’ burgeoning Medicaid costs, and the program’s expansion in 2014 when more of the Affordable Care Act provisions take effect, could impact voters in the state’s March 20 GOP primary, some analysts predict.
But health care in general won’t play a huge role in terms of the difference among candidates, since all of the GOP hopefuls are trying to distance themselves from the federal health law, said Robert Kaestner, Ph.D., professor at the Institute of Government and Public Affairs at University of Illinois at Chicago.
"They view their conservative base as very opposed to this, so they want to be on the record that they want to repeal all of it or parts of it," he said.
Roughly 16% of Illinois’ non-elderly population (more than 1.8 million people) is uninsured, according to the Kaiser Family Foundation. The state is expected to see a nearly 26% increase in Medicaid enrollment between 2014 and 2019, which is slightly lower than the projected national average of 27.4%, according to the foundation.
"Health care reform is going to expand Medicaid and although the federal government is going to pay a bigger share of it than it has in the past, the state will also bear some of that cost, and it’s a non-trivial cost that will worsen state finances," said Dr. Kaestner.
But some physician groups have a different take on the health law, because it not only increases workforce and payments, but also it expands insurance coverage for the patients.
"Implementing all the elements of ACA would impact the state budget," said Dr. Ellen Brull, the government relations committee chair for Illinois Academy of Family Physicians, which supports the health law. "However, the goal of universal coverage remains our national policy and in Illinois we would see an increase of 600,000 more individuals receiving health care coverage."
Meanwhile, the candidates haven’t put forth any alternatives or specific plans of their own. Although they’ve said they would get rid of certain aspects of the health law, such as the insurance exchanges or the individual mandates, "they haven’t specifically talked about rolling back Medicaid expansions," said Dr. Kaestner.
"Nobody’s really talking about how to reform Medicaid, not just in Illinois, but in all the states," he added.
With Democrats in control of the state House and Senate as well as a Democratic governor, Illinois is working to implement health reform and is in the process of establishing its health insurance exchange. The state has received more than $5 million in establishment grants so far from the federal government, according to the Kaiser Family Foundation.
But the process has been politically controversial. The General Assembly is working on a compromise language in the House to address the next steps in establishing an exchange, Dr. Brull said. "Enabling legislation should have already passed so that actual work in building the infrastructure could have started."
While elected state leaders support the ACA, the Illinois Chamber of Commerce joined 14 other state chambers and business organizations in February to file an amicus brief in the U.S. Supreme Court challenging the health reform law. The brief requests that that the constitutionality of the law "be decided without delay in order to relieve uncertainties now facing employers and their employees."
There are 69 delegates at stake in the Illinois GOP primary, and with no clear front-runner so far, the state’s primary could play a more important role than it has in previous elections.
A recent poll by Chicago Tribune/WGN-TV showed former Pennsylvania Sen. Rick Santorum (31%) is trailing only slightly behind former Massachusetts Gov. Mitt Romney (35%) in the March 20 primary. Former House Speaker New Gingrich came in third place at 12% and Rep. Ron Paul (R-Tex.) was at 7%.
In a February Gallup poll, health law was ranked the 4th most important issue in the upcoming presidential election among U.S. registered voters; two-thirds said that the issue was extremely or very important to them. The economy, unemployment, and the federal budget deficit took the top three spots. Health law outranked terrorism and taxes.