EDITORIAL: Medicaid math and Illinois: How lawmakers’ money grab primed taxpayers for a reckoning

March 03--"The fastest thing that is going to go when we are cutting spending in Washington is the 100 or 90 percent match rates for Medicaid. There is no way. It doesn't matter if Republicans are running Congress or Democrats are running it. No way we are going to keep match rates like that."

-- U.S. House Budget Committee Chairman Paul Ryan to the Tribune Editorial Board, April 22, 2013, on Obamacare's robust expansion of Medicaid

Remember that warning from now-House Speaker Paul Ryan? It came as Illinois and other states were eager to lap up Obamacare funding to expand Medicaid -- a 100 percent federal match for the first three years! -- while pooh-poohing the prospect that Uncle Sam would snap his wallet shut, as Ryan warned governors and legislatures nationwide. The heedless response from Gov. Pat Quinn and other ruling Illinois Democrats: It's just too good a deal, don't you see?

Ryan's red alert informed what we wrote in 2013:

We ... hope that, a decade or two from now, Illinois citizens don't look back to 2013 and say: What were they thinking? How could the politicians be so willfully blind to the billions that the Medicaid expansion would cost taxpayers? In other words, will future Illinoisans regard this Medicaid expansion with the same disdain and rage of citizens who today see pension programs devour funds that can't go to schools, social services and other priorities? Will they ask how pols who had been burned by the pension crisis could again commit Illinois to spend money the state didn't have?

Today, not decades but four years later, that reckoning looms. Medicaid rolls have expanded here and nationwide. Since 2014, the state has added almost 650,000 Illinoisans to Medicaid rolls under the Obamacare expansion. Right now, Illinois picks up only a small percentage of the $3-billion-plus cost of this expansion. The feds pick up 95 percent of the tab this year. But soon the state could face a much ... much ... much bigger price tag.

That's because Republican lawmakers in Washington are crafting plans to repeal and replace Obamacare. Included in those plans could be a long-sought Republican goal: big changes in how Medicaid is funded. Congressional Republicans and the Trump administration favor giving the states block grants -- fixed chunks of money -- to supply care to low-income people. States would decide how best to spend the money, presumably with fewer Washington mandates. And the generous federal match for all those Medicaid recipients added under Obamacare? Could be gone.

Democratic and Republican state officials nationwide fear that a block grant replacement for this facet of Obamacare could mean less federal Medicaid funding, forcing states to cut benefits, toss people off Medicaid rolls or divert other spending.

We don't know yet how well -- or how poorly -- Illinois could fare in a new Medicaid funding system. GOP leaders haven't produced a detailed Obamacare replacement proposal yet. But a proposed Medicaid rewrite is expected soon.

In some states, including Wisconsin, Missouri, Ohio, Kentucky, and Arizona, Republican leaders are already seeking federal permission to try innovative approaches to trim expenses, The Wall Street Journal reports. That includes drug testing for enrollees and lifetime enrollment caps.

And in Illinois? Crickets, mostly. Springfield did build an escape hatch into the Medicaid expansion law back in 2013: If Congress pays less than 90 percent of the costs, everyone who gained coverage under the expansion would automatically be dropped from Illinois' rolls. That's the law. But -- political reality check -- that's not likely. Gov. Bruce Rauner is also pushing an overhaul of the state's Medicaid managed care system to cut costs.

The vast Medicaid expansion means that an astonishing 1 in 4Illinois residents -- 3.14 million people -- is now on this federal/state health program, including thousands covered through Cook County's health system. Many, of course, are grateful for the coverage. So, too, are county taxpayers who've had to shell out less to subsidize the county's health system in recent years because of the federal largesse.

We didn't oppose the Medicaid expansion. But we did worry and warn about Illinois lawmakers' obliviousness toward predictable future costs to state taxpayers. Illinois' finances are worse now and its Medicaid rolls much larger. Do the Medicaid math.

In 2012, before and separate from the Obamacare expansion, Illinois lawmakers passed a major and smartly constructed Medicaid reform bill to rein in costs, in part by scrubbing the rolls of ineligible recipients. Lawmakers should get to work on a sequel now.

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