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Obama's Medicaid expansion draws more Illinois residents than expected

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CHICAGO — Illinois is among a dozen states where the number of new enrollees surpassed projections for the expansion of Medicaid under President Barack Obama's health law. While the surge in sign-ups lifts the number of insured people, it has also stoked worries about the future cost to taxpayers.

Illinois and Cook County eventually will have to bear 10 percent of the cost of expanding the safety-net insurance program for the poor. The federal government agreed to pay all costs for the expansion through 2016, but it will begin lowering its share in 2017.

More than twice as many Illinois residents have enrolled under the expansion than was projected by former Democratic Gov. Pat Quinn's administration. It expected 298,000 people to sign up in 2015, but 623,000 newly eligible Illinoisans enrolled by the end of June. Sign-ups have outstripped forecasts in at least a dozen states, according to a new analysis by The Associated Press.

It's unclear why the Illinois estimates were so off, said Laurence Msall, president of the Civic Federation, a Chicago-based, nonpartisan government research organization. Consultants the state used couldn't have known how Cook County's expansion of Medicaid a year early, under a special arrangement with the federal government, would drive thousands to sign up. Or how a multimillion-dollar advertising campaign funded by federal grants would persuade many more.

With more people getting free health care, costs to Illinois and Cook County will increase as the federal government scales back what it pays from 100 percent to 90 percent by 2020.

In 2020, the Medicaid expansion will cost the state $208.6 million and Cook County $72.6 million, according to new projections from Gov. Bruce Rauner's administration. That year, the federal government's share of the Medicaid expansion costs will be $3.03 billion.

PHOTO: In this Monday, July 13, 2015 photo Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act.  More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years.   (AP Photo/Christian K. Lee)
In this Monday, July 13, 2015 photo Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act. More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years. (AP Photo/Christian K. Lee)

"These impending added costs are one more reason Illinois needs to control the reckless spending of the past right now," Illinois Department of Healthcare and Family Services spokesman John Hoffman said in an emailed statement.

Dr. Jay Shannon, CEO of the Cook County Health and Hospitals System, said the economic benefits to health care providers can offset the costs. After the Medicaid expansion, the county's taxpayer-funded health system flipped from serving mostly uninsured to mostly insured patients. Before expansion, more than half the patients using county hospitals and clinics had no insurance; now about two-thirds are insured.

"For the first time in this organization's history, we have a majority-insured population," Shannon said. "That's entirely because of the Medicaid expansion."

He said the expansion has already saved county taxpayers money and will continue to do so. The county's unreimbursed care costs fell from more than $500 million in 2013 to $342 million in 2014.

Chicago resident Earl Charles Williams Sr. is among the newly insured. The 59-year-old part-time social worker said he can't imagine what his life would be like without the Medicaid expansion and the county doctor who helps him keep his diabetes under control.

"I'm very grateful," Williams said. "I do feel every American should have insurance."


AP Medical Writer Carla K. Johnson can be reached at https://twitter.com/CarlaKJohnson

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