June 26, 2012

An Open Letter to Illinois House Republican Leader Tom Cross: Why the ObamaCare Obfuscation?
Dear Leader Cross: I recently heard your June 8 interview on Cities 92.9, where you discussed the end of this years legislative session. Sadly, you left many listeners misinformed. During the segment you discussed House Bill 5007, a component of the Medicaid package that was signed by Gov. Quinn earlier this month. House Bill 5007 implements key provisions of President Obamas misguided, big-government health takeover two years early. Yet you denied this throughout the interview. I would like to address your comments point by point. Its not ObamaCare. While on the show, you said emphatically that House Bill 5007 was not ObamaCare. That is not true. HB5007 allows Illinois to implement key provisions of ObamaCare two years ahead of schedule, as long as the federal government approves a federal waiver. Illinois has filed a waiver on behalf of Cook County. If approved by the federal government, Cook County would implement eligibility rules that otherwise would not take effect under the Affordable Care Act until 2014. This is made clear in the waiver itself, which states that Section 2001(a)(1) of the Affordable Care Act requires states to cover a new population of low income persons and that the waiver population directly comport[s] with the ACA population.1 In fact, the title of the waiver references ObamaCare: Cook County Health and Hospitals Systems care coordination enhancements and bridge to ACA. In a letter to the federal government accompanying the waiver, Illinois Department of Health Care and Family Services Director Julie Hamos wrote that Illinois was seeking a waiver regarding early enrollment of new Medicaid eligibles under the Affordable Care Act.2 The only provisions of federal law that allow Illinois the ability to request this waiver are in ObamaCare.3 Moreover, the bill itself references the Affordable Care Act in later pages, specifying what happens if the Supreme Court strikes down the Medicaid expansion or it is repealed by Congress.4 Chris Christie did it in New Jersey and Rick Perry did it in Texas. During the interview, you made statements about New Jersey and Texas that were misleading. First, Texas has not filed any waivers to expand Medicaid eligibility under ObamaCare.5 Not only did Texas refuse the federal governments offer to implement the Medicaid expansion early, it actually sued the federal government to block those very provisions.6 As for the few states that did seek waivers, they had already covered the expansion populations with state-only funds in their Medicaid programs.7 This was the case with New Jersey.8 By contrast, the Cook County waiver will add up to 250,000 people to the Medicaid rolls who otherwise are not eligible for the state program.9

It saves the state $50 million; it saves Cook County $100 million. Near the end of the interview, you stated that the waiver would save the state $50 million and Cook County taxpayers another $100 million. These statements are untrue. The waiver will not save the states Medicaid program a single penny. What it will do instead is increase the tax burden on Illinois families. Beyond the fact that Illinois families will be saddled with additional federal debt at a time of record deficits, the waiver will likely increase the local tax burden on Cook County residents as well. This is largely because uncompensated care costs typically are lower than the cost to provide Medicaid services. According to federal data, the people targeted by this plan cost an average of $742 per year in uncompensated care.10 By contrast, the waiver predicts these people will use more than $2,300 of health services per year.11 Even with a federal match, the costs associated with adding these people to the Medicaid rolls exceeds the costs currently borne by Cook County taxpayers. If the bill was so great, why didnt you vote for it? You began the interview by saying you didnt support the bill. Thats true you didnt vote for it, though more than one-fifth of your caucus did. But you then spent the next several minutes of the interview defending the bill. If the bill were as great as you described, why not vote for it yourself? At this very moment, a majority of states are suing the federal government over these provisions of ObamaCare, and the U.S. Supreme Court is about to hand down its decision. Instead of fighting this dangerous government overreach, you took to the airwaves to defend it. Illinois deserves principled policy leadership, and this isnt it. Sincerely,

John Tillman CEO P.S. Perhaps most unfortunate is that these steps will actually hurt the very people Medicaid was intended to help the poor and disadvantaged by leaving in place a dysfunctional program that remains largely unreformed.
1

Julie Hamos, Cook County Health and Hospitals Systems care coordination enhancements and bridge to ACA, Healthcare and Family Services (2012), http://illinoispolicy.org/uploads/files/Cook%20County%201115%20Waiver.pdf. 2 Julie Hamos, Cook County Health and Hospitals Systems care coordination enhancements and bridge to ACA, Healthcare and Family Services (2012), http://illinoispolicy.org/uploads/files/Cook%20County%201115%20Waiver.pdf. 3 Public Law 111-148, Section 2001(a)(4) (2010), http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. 4 Public Act 097-0687 (2012), http://ilga.gov/legislation/publicacts/97/PDF/097-0687.pdf. 5 Kaiser Commission on Medicaid and the Uninsured, How is the Affordable Care Act leading to changes in Medicaid today? State adoption of five new options, Kaiser Family Foundation (2012), http://www.kff.org/medicaid/upload/8312.pdf. 6 Florida et al., Brief of the state petitioners on Medicaid, Florida v. HHS, No. 11-400 (2012), http://acalitigation.wikispaces.com/file/view/States+brief+as+petitioner+%28Medicaid%29.pdf. 7 Kaiser Commission on Medicaid and the Uninsured, How is the Affordable Care Act leading to changes in Medicaid today? State adoption of five new options, Kaiser Family Foundation (2012), http://www.kff.org/medicaid/upload/8312.pdf. 8 Kaiser Commission on Medicaid and the Uninsured, Performing under pressure: Annual findings of a 50-state survey of eligibility, enrollment, renewal, and cost-sharing policies in Medicaid and CHIP, 2011-2012, Kaiser Family Foundation (2012), http://www.kff.org/medicaid/upload/8272.pdf. 9 Julie Hamos, Cook County Health and Hospitals Systems care coordination enhancements and bridge to ACA, Healthcare and Family Services (2012), http://illinoispolicy.org/uploads/files/Cook%20County%201115%20Waiver.pdf. 10 Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Health and Human Services (2009), http://meps.ahrq.gov/mepsweb/. 11 Julie Hamos, Cook County Health and Hospitals Systems care coordination enhancements and bridge to ACA, Healthcare and Family Services (2012), http://illinoispolicy.org/uploads/files/Cook%20County%201115%20Waiver.pdf.