More than 3 million Illinois residents receive health care coverage through Medicaid. They are people of all ages and races living in our cities, suburbs, small towns and rural areas. They include 50 percent of our children, as well as people with disabilities or chronic conditions, those requiring long-term care, women during pregnancy, labor and delivery, and those needing treatment for special circumstances such as opioid addiction.

These are our friends, families and neighbors with limited resources whose lives have been saved, extended or improved thanks to Medicaid coverage.

Now, the future of this safety net is uncertain as discussions continue in Washington about the Affordable Care Act, which the Trump administration announced it intends to repeal.

While the impact of a potential repeal will be felt across the nation, the stakes could not be higher for Illinois. If the ACA is repealed and the state is expected to assume costs currently being borne by the federal government, the consequences for those enrolled in Illinois Medicaid would be serious.

Unfortunately, that is exactly what is being proposed.

Medicaid was established in 1965 as a program, funded jointly by the U.S. government and the states, to provide health coverage to low-income people. In Illinois, the federal government matches each Medicaid dollar spent by the state.

In 2014, the ACA extended health care coverage to uninsured adults across the country earning less than 138 percent of the federal poverty level by expanding Medicaid. In Illinois, more than 600,000 people enrolled. The federal government has picked up 100 percent of the cost of this expansion, but this will go down to 90 percent in the next few years.

A total of about $17 billion is spent annually in Illinois on Medicaid. Only 25 percent of state spending is from general revenue funds; 75 percent comes from federal funds or assessments paid by hospitals. Although this seems like a large total, Illinois spends only $4,500 annually per enrollee — less than virtually every other state, including Mississippi, Alabama and Louisiana, and less than half the amount spent by New York and Rhode Island.

This low level of investment in the health and well-being of the most vulnerable members of our community likely contributes to the fact that some of the highest health disparities and worst health outcomes in the country are in Illinois neighborhoods. This is not a record of which we can be proud. The low reimbursement puts stress on health care providers, who lose money on services to Medicaid recipients for which they are being paid substantially less than providers in other states.

Central to the repeal proposals is cutting back on the ACA Medicaid expansion and applying alternatives to the current Medicaid payment methods, including block grants to the states and/or per-capita payments, contributions to health savings accounts or income tax credits, or some combination of all of the above. The overall goal is to reduce federal Medicaid spending by as much as 20 percent and place more of the financial burden on the state, a burden that Illinois is unable to meet. Cuts of this magnitude would mean reductions in federal funding of hundreds of millions of dollars every year for Illinois — and therein lies the danger.

In light of Illinois' dire financial circumstances and the impasse in the General Assembly that has left us without a budget for the past two years, the state is in no position to make greater contributions to overall Medicaid funding. And reductions in funding mean cuts would be passed on to those who depend on Medicaid and on their health providers.

Additional cuts would inevitably boost the number of uninsured people, force providers to curtail services that they can no longer afford to provide, and lead to the elimination of health care-related jobs to reduce expenses. Hospitals and other health providers may be forced to close.

The decisions that will be made in Washington in the coming weeks will have a major impact on access to health care for many years to come. Illinois faces particular challenges. If the revised Medicaid funding system locks in historically low federal reimbursements for our state, patients will face major hurdles in accessing care. This is not a partisan issue: Everyone in Illinois who is concerned about the well-being of our fellow citizens should be concerned about the impact of this process on our state.

Essential elements in protecting the 3 million Illinoisans who rely on Medicaid are for lawmakers in Springfield to pass a balanced budget immediately that supports Illinois Medicaid, and for lawmakers in Washington to address the limitations of the current health system and ensure that affordable health insurance continues to be available to everyone with adequate financial support for the program.

Merely trying to shift the costs to states, patients or providers will inevitably increase the number of people who do not have insurance and lead to diminished health and other unintended consequences.

Dr. Kenneth S. Polonsky is executive vice president for medical affairs at the University of Chicago.

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Northwestern University medical students and doctors on Jan. 30, 2017, lay down their white coats to raise awareness that patients may lose their health insurance if the Affordable Care Act, also known as Obamacare, is repealed. (Phil Velasquez / Chicago Tribune)

Northwestern University medical students and doctors on Jan. 30, 2017, lay down their white coats to raise awareness that patients may lose their health insurance if the Affordable Care Act, also known as Obamacare, is repealed. (Phil Velasquez / Chicago Tribune)

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