Inside a conference room at Mount Sinai Hospital shortly after 9 a.m. Thursday, board members broke into an extended applause.
Elsewhere, the chief executive of Cook County's public hospital system, one of the nation's largest, said the U.S. Supreme Court's 5-4 ruling to uphold most of President Barack Obama's landmark health care law goes "a long way to correct injustice" in the country's health care system.
Not everyone was pleased. The Illinois director of the National Federation of Independent Business said the ruling guarantees Illinoisans will have their personal health care decisions made by politicians and bureaucrats in Washington.
The court's decision resonated throughout Chicago, Illinois and the rest of the country, providing relief to millions of uninsured, lifting, at least temporarily, a veil of uncertainty for businesses and reigniting debate about the role the government should play in health care.
The ruling also ratchets up pressure on Illinois to set up an insurance exchange that will allow people to shop for health policies, especially beneficial for the hard to insure, and raises questions about how the state intends to come up the money to pay for an expansion of coverage at a time when the state is billions of dollars in the red.
Though the court struck down a requirement that all states must participate in a giant expansion of Medicaid or face penalties, opening the door for some states to opt out of the program, Illinois Gov. Pat Quinn said Thursday the state would go along with the expansion.
"Illinois is going forward with the president … we are not backing down," Quinn said. "The bottom line is, more people in Illinois, folks who are raising kids, who are working jobs and who are living from paycheck to paycheck will now have an opportunity to get health care coverage."
The Medicaid expansion will lift several restrictions on eligibility in favor of a simplified standard. People younger than 65 generally will qualify for the program if their annual income is less than 133 percent of the federal poverty level (which amounts to $30,657 for a family of four.)
In Illinois, where about 1.9 million — or 17 percent — of residents are uninsured, as many as 500,000 more people will qualify for Medicaid coverage in 2014 at a cost to be paid exclusively by the federal government for the first three years of the program. By 2020, the state will be required to pick up 10 percent of the costs.
The law's critics, including Illinois Comptroller Judy Baar Topinka, said the Supreme Court's decision to allow the expansion would cost the state $2.4 billion over the next six years.
"There is no doubt that this will cost the state, the only question is how much?" Topinka said in a statement.
But state administration officials disputed her estimates, saying the costs might end up lower, potentially by nearly half.
The state's Medicaid program will end the current budget year on Saturday with what Topinka estimates will be about $2 billion in unpaid bills.
That's after the state sought to rein in Medicaid expenses this year with legislation that would cut the program by $1.6 billion and pump in an additional $700 million in state and federal money for the budget year that begins Sunday.
Some health care providers added that Medicaid expansion alone won't remedy systemic problems with health care delivery.
"We have fewer and fewer providers in Illinois who will accept Medicaid payment for provision of services," said Dr. Claudia Fegan, past president of the Chicago-based Physicians for a National Health Program, which advocates a single-payer system. "It's like giving somebody a credit card with no credit on it. …You're going to tell people, 'Now you're entitled to health care,' but they can't go anyplace to get that care. People are already struggling to find a provider who will accept Medicaid."
Setting up health exchanges
When the federal health care law goes into effect in 2014, the state estimates an additional 1 million people will be able to purchase insurance coverage through a state health insurance exchange.
The exchanges aim to create a competitive online marketplace for individuals to buy insurance coverage.
More than a dozen states have set up the exchanges. Illinois is not one of them.
State lawmakers punted on getting started on building its exchange during the previous session, leaving Illinois with little time to set one up by October 2013, when open enrollment in such plans is expected to begin.
Quinn said he will ask lawmakers to act when they return to Springfield this fall, but some health care advocates are urging Quinn to issue an executive order that would allow him to set up portions of the exchange on his own.
The governor did not answer questions Thursday about using his executive powers to move forward with the exchange. But he did acknowledge that the state will partner with the federal government to run the exchange, instead of operating the marketplace on its own.
Critics argue that the state would lose an element of control with a federal partnership.
"State lawmakers should feel like this is our responsibility, we know the Illinois insurance marketplace best, we should be establishing the exchange," said Brian Imus, director of the Illinois Public Interest Research Group, a consumer advocacy organization.
Although administration officials said the partnership with the federal government likely will be short term, such an arrangement carries risks, said Leemore Dafny, an associate professor of management and strategy atNorthwestern University'sKellogg School of Management.
Dafny argues that Illinois could forfeit the right to play an active role in selecting which insurance plans can be offered in the exchanges in order to negotiate better prices and quality.
Under federally run plans, every coverage option that meets federal guidelines is included in the exchange, which could overwhelm consumers and make selecting the right plan more difficult, Dafny said.
For the region's hospitals — from public to nonprofit safety nets and academic giants to for-profits — the court's decision was cause for celebration.
"It's a win, win, win for everybody" in Cook County, said Dr. Ram Raju, chief executive of the Cook County Health and Hospitals System.
About 100,000 of the county's poorest residents could gain Medicaid coverage as soon as next month if federal officials approve a waiver sought by the county hospital system to begin enrolling uninsured patients earlier. Along with that request, the county is seeking $70 million a year in new federal reimbursements.
Enrolling those patients earlier will allow the hospital system to begin implementing internal reforms, and the additional funding will help plug a $152 million shortfall in next year's budget, Raju said.
Although uncertainty remains about the fate of the insurance exchanges and other portions of the law, particularly around the November elections, Larry Goldberg, president and chief executive of Loyola University Health System, said that "at least we're all moving in the right direction."
Now that the health care overhaul is moving forward, officials at Access Community Health Network said they will refocus on how to best serve their 120,000 Medicaid patients and 45,000 uninsured patients. Access operates more than 40 community health centers in Chicago and the suburbs.
"As health care providers, we're going to have to be more nimble and innovative in how we approach preventive services," said CEO Donna Thompson. "A hallmark of this health care law is getting people a consistent provider and being focused on preventive services. In the long run, that's going to save money throughout the health care system."
Tribune reporter Ray Long contributed.Copyright © 2014, The Baltimore Sun