Activists throughout Illinois dedicated to making healthcare a right, stood proudly with the Healthy Illinois campaign, state legislators, and Governor Pritzker in 2020 as they successfully passed legislation providing healthcare coverage to immigrants regardless of their status for those beginning at age 65. Victories were won again in 2021 and 2022 with an expansion of this Medicaid-like program covering low-income immigrant adults from ages 42 to 64. We now face a major setback with the implementation of co-pays and the end of enrollment to the program known as Healthcare Benefits for Immigrant Adults (HBIA).
Extensive research on co-pays has documented that cost-sharing premiums serve only as a barrier to obtaining health care and greater unmet health needs result only in increased financial burdens. Even relatively small levels of cost sharing in the range of $1 to $5 are associated with reduced use of care, including necessary services. Research also finds that cost-sharing can result in unintended consequences, such as increased use of the emergency room, and that cost-sharing negatively affects access to care and health outcomes. For example, studies find that increases in cost-sharing are associated with increased rates of uncontrolled hypertension and hypercholesterolemia and reduced treatment for children with asthma. Additionally, research finds that cost-sharing increases financial burdens for families, causing some to cut back on necessities or borrow money to pay for care.
State savings from premiums and cost-sharing in Medicaid and Children’s Health Insurance Program (CHIP) are limited. Research shows that potential revenue gains from premiums and cost-sharing are offset by increased dis-enrollment; increased use of more expensive services, such as emergency room care; increased costs in other areas, such as resources for uninsured individuals; and administrative expenses. Studies also show that raising premiums and cost-sharing in Medicaid and CHIP increases pressures on safety net providers, such as community health centers and hospitals.
Ubri, Petry, et al. “The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings.” KFF, 1 June 2017, https://www.kff.org/medicaid/issue-brief/the-effects-of-premiums-and-cost-sharing-on-low-income-populations-updated-review-of-research-findings/.