Jul 3, 2025 Current Resources

Twin City health care providers brace for Medicaid cuts wrapped in GOP megabill

The Republican tax cut and spending bill is massive. Among its many provisions are an extension to tax cuts passed during President Trump's first term and other attempts to fulfill Trump’s campaign promises.

To pay for the tax cuts, Republicans are targeting the social safety net, including food assistance and Medicaid. The Senate-passed version makes $930 billion in cuts over a decade to Medicaid, Medicare and the Affordable Care Act. The House version includes nearly $800 billion in cuts.

Chestnut Health Systems CEO David Sharar giving remarks at Chestnut Family Dental grand opening. — Chestnut Health Systems CEO David Sharar.

“The Senate version is actually a bit worse,” said Dave Sharar, CEO of Chestnut Health Systems in Bloomington.

The Congressional Budget Office predicted the Senate version of the bill, which must again be approved by the House, could result in 12 million Americans losing their insurance — including 500,000 people in Illinois.

“As I understand it, the central goal of this legislation is to throw up a number of hurdles and roadblocks to cause a lot of disenrollment,” said Sharar. “So, it’s technically not cutting benefits per se, but it is creating these barriers for people to either get enrolled or stay enrolled on Medicaid.”

Nearly 70% of patients who use Chestnut's community health clinic in Bloomington are covered by Medicaid. That percentage is higher in Chestnut's addictions management programs. Much of the GOP bill’s changes to Medicaid are aimed at an expansion of the Affordable Care Act [ACA], often referred to as Obamacare.

In the first Trump administration, efforts to repeal the ACA benefits were derailed by Sen. John McCain, R-Az, who sided with two moderate Republicans to vote against their party’s interests.

In McLean County, more than 32,000 people were enrolled in Medicaid in 2024. A predicted $1 trillion in Medicaid cuts in the Senate version of the current bill, according to Republican lawmakers, target those who are abusing the system.

In defending the bill, several lawmakers have painted a picture of lazy freeloaders grifting off the social safety net.

“Even, I think, Speaker [Mike] Johnson, [R-La.], threw out that there’s a large number of young adults who are able-bodied sitting home playing video games who are on Medicaid,” said Sharar. “I’m not saying that doesn’t exist, but that is a very small number. The vast majority of people on Medicaid who are part of this adult expansion population do work.”

Even those who do not have a work requirement, including children, seniors, people with disabilities and full-time caretakers, will have more stringent requirements to keep their coverage, which Sharar said could bog down an already bogged-down filing system with the state of Illinois.

“Many of our clients and patients don’t come to an appointment with a payroll report,” he said. “There’s churn in this work, too. People change jobs, lose jobs, they could be seasonal workers — unfortunately part of the goal is those people will fall through the cracks and become uninsured.”

A woman stands in front of a wall with a sign for "CHCC." She smiles at the camera. — Holly Wayland-Hall, executive director of the Community Health Care Clinic in Normal.

Normal's free clinic

The Community Health Care Clinic in Normal is bracing for an uptick in patients if that happens. Executive director Holly Wayland-Hall said the free health clinic is prepared to absorb patients who may lose their insurance if Medicaid cuts take effect.

“Our goal is to be that medical home for the uninsured,” said Wayland-Hall. “That population fluctuates for a lot of different reasons. We’re used to needing to adjust to a fluid patient population. But as long as they’re uninsured or as long as they don’t have adequate coverage, that’s why we’re there.”

The Community Health Care Clinic recently accepted about 30 new patients following Illinois’ decision to end Medicaid coverage for some undocumented immigrants. That came shortly after raising income eligibility requirements to 250% of the federal poverty line — and further increased the agency's caseload. The clinic occasionally admits underinsured clients who have a health policy with an unmanageably high deductible or copay.

Even with the increased client load, Wayland-Hall said the Community Health Care Clinic is not at capacity at current staffing levels. The clinic employs a full-time RN and nurse practitioner, plus social workers who can assist with helping patients apply for Medicaid when they become eligible. A volunteer medical director advises the team. Dentists also are volunteers.

“We also are open to the fact that if our patient population grows to that point that we may add clinical staff to be able to meet that need,” Wayland-Hall said.

Chestnut Health Systems also is thinking ahead, planning for changes in Medicaid reimbursement and needing to add resources to support patients hoping to remain on Medicaid.

Sharar said Chestnut’s philosophy is to serve every patient who walks through their doors, regardless of ability to pay. They and other health care providers are preparing to give more uncompensated care.

“This is really not cost saving,” Sharar said of the bill. “It’s cost shifting. As people become uninsured, they tend not to access care. They don’t get preventative care. It evolves into an emergency. It evolves into a chronic illness.”

Organizations like Chestnut Health Systems and the Community Health Care Clinic are designed to help keep people from relying on emergency departments that may also see an uptick in uncompensated care.

“Those costs get shifted,” said Sharar. “What happens to health systems is they charge more to people who can pay, and commercial insurers will raise their rates.”

Illinois lawmakers react

As House members weigh whether to pass the bill, some senators punted.

Republican Sens. Josh Hawley of Missouri and Susan Collins from Maine requested a carve out protecting rural hospitals, many of which operate on slim margins and are put at risk by steep cuts to Medicaid. Hawley voted yes, essentially pledging to fix it later. Collins voted no. Alaska Republican Sen. Lisa Murkowski was eventually persuaded to vote for the bill after securing protections for Alaska, then admitting to media it would hurt people in the lower 48 states.

Men speak into a microphone — U.S. Rep. Eric Sorensen gets a tour of the Chestnut Family Health Center in West Bloomington from Stephanie Paxton, director of integrated support services at Chestnut Health Systems.

In a news conference Wednesday, Democratic Rep. Eric Sorensen noted the potential harm to residents of his 17th District that includes parts of Bloomington-Normal and Greater Peoria.

"We have nearly a dozen nursing homes in our district that will be at risk of closing," Sorensen said. "I don't know how we save them when the GOP cuts Medicaid. That won't help the economy when we have to take people out of work because they're going to be taking care of an elderly person."

Republican Rep. Darin LaHood, who also represents parts of Bloomington-Normal and Greater Peoria, has expressed support for changes in Medicaid eligibility requirements that require more stringent attention to ensuring people are working or looking for work.

"House Republicans are focused on strengthening and investing in Medicaid for those who need it most by ensuring the program continues to provide high-quality patient care for expectant mothers, children, people with disabilities and the elderly,” he said in a statement to WGLT. “To protect Medicaid for future generations, we must establish a common sense approach to address waste, fraud, and abuse."

Sharar said reforming Medicaid is an important goal, but doubts there is as much fraud and abuse as Republicans would have you believe.

“I think, for example, the number of dead people who receive benefits is pretty tiny, but [we] can all agree, let’s figure that out,” he said. “My concern is there are a lot of people that are going to get caught up in this that are going to become dis-enrolled. It's not a work requirement; it's a paperwork requirement."