Illinois clinics and hospitals are reckoning with how to continue caring for patients after the recent expiration of Affordable Care Act subsidies.
Tax credits to reduce health insurance costs for patients enrolled under the ACA expired at the start of this year. The expiration followed a record-long federal government shutdown in the fall, caused by partisan gridlock over the credits.
The U.S. House of Representatives passed a three-year extension to the subsidies in early January, which has yet to pass in the Senate, where a similar vote failed in December.
“It was meant to be temporary. It was only meant to go through the end of 2025,” said Betsy Cliff, professor of public health sciences at the University of Chicago. “But Democrats and even some Republicans realized that when these subsidies expired, it was going to greatly increase cost for people who had previously been getting those subsidies.”
The subsidies were introduced in 2021 during the COVID-19 pandemic by President Joe Biden and later extended through the end of 2025 by the Inflation Reduction Act. The enhanced premium subsidies applied to those with incomes between 100% and 400% of the federal poverty level, which factors in both income and household size.
According to CNBC reporting, the expiration of enhanced subsidies could raise insurance premiums for about 22 million previous recipients. Additionally, a million fewer people signed up for an ACA plan this year than last, according to new data from the Centers for Medicare and Medicaid Services.
“It essentially comes down to whether you choose to have food on your table or see a doctor,” said Donnica Austin-Cathey, the chief hospital executive for John H. Stroger, Jr. Hospital of Cook County in Chicago.
Health care providers at Cook County Health have worked to continue providing care to patients who cannot afford insurance, she said. Cook County Health created a CareLink Program to help uninsured and unenrolled patients and residents afford care.
The Illinois Association of Free and Charitable Clinics also continues to provide care to uninsured and underinsured patients, according to its Executive Director Laura Starr. They anticipate a return to pre-ACA conditions and a dramatically increased demand for their services over the next year as more people seek out free health care options, she explained.
Notably, the changes in subsidies may disproportionately affect rural communities. According to a National Rural Health Association policy brief, more than a third of adult workers in rural areas are not offered employee health insurance, and 2.8 million ACA enrollees live in rural communities.
As more patients are unable to afford care due to the tax credit expiration, hospitals are left with less funding, which especially burdens rural hospitals in Illinois and elsewhere that already struggle with resources, according to an Urban Institute study.
“This could further exacerbate their challenges in low-income and rural communities where people have to travel longer or further to see or seek out medical attention,” Austin-Cathey said.
According to another study by the Urban Institute, the expiration of the subsidies will also reduce spending on hospital services by $14.2 billion nationwide, leaving hospitals to pick up the slack. The IAFCC does not have the resources to withstand the increased demand of hundreds of thousands of Illinoisans in need of care, Starr cautioned.
However, she remains hopeful.
“I would encourage folks not to lose hope yet, but to keep watching the news and see if our legislators are able to help to continue to provide this affordability,” Starr said. “But if they can’t, Free & Charitable clinics will continue to be here and be a resource.”
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