“Public funding of healthcare coverage for the uninsured pays for itself in a panoply of benefits that reach well beyond the individuals who receive such assistance.” 

So says the “The Benefits of Health Coverage for Immigrants in Illinois” report conducted by the Great Cities Institute (CGI) at the University of Illinois Chicago, commissioned by the Healthy Illinois Campaign and released Friday at a symposium at the North Lawndale Employment Network offices. 

“We’ve known all along that covering the uninsured creates benefits that ripple out to society as a whole,” Campaign Director Tovia Siegel said in a press release. “Now, thanks to the work GCI has done, we can see numbers that reinforce our position. Covering everyone, regardless of their immigration status, is not only good for those covered. It’s good for all of us. We’re in this together.”

Healthy Illinois commissioned the study as a part of its campaign to maintain funding and expand eligibility for the Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs. Those programs fill coverage gaps for undocumented Illinois residents who are unable to qualify for Medicaid due to their immigration status. 

"Health Illinois Campaign is advocating for the existing immigrant health coverage programs to be funded which would allow for the temporary enrollment caps to be removed" the campaign told The Daily Line.

“One of the benefits of HBIA and HBIS enumerated in the report that I found compelling was that when their family members are getting healthcare coverage, there’s a better chance the kids will get health care when they need it,” Graciela Guzman, the Democratic Party nominee for the state Senate District 20 seat, said in a press release. 

The HBIS program initially started in 2020 sponsored by then-state Rep. Delia Ramiez (D-Chicago). It granted health insurance to undocumented seniors, and in 2022, coverage expanded to cover adults over the age of 42 with the HBIA program. Currently, around 69,000 Illinoisans are covered by the program. 

The report finds that the costs of the program, which have far exceeded initial budget expectations, are a comparatively small expense when measured against overall medical assistance at just 1.8 percent of overall medical assistance spending.

The Department of Healthcare and Family Services (HFS) most recent projections published in January show the program will cost $697 million. That’s a decline from the previous estimate of $832 million following the governor's contentious cost-saving measures, but still far above the $550 million appropriated in the Fiscal Year 2024 budget. 

The report compares this cost with the economic impact of immigrants on the state. In Illinois, noncitizens comprise 8.2 percent of all workers, which pay around $8.6 billion in state and local taxes in 2021.

“Non-citizens are crucial for filling unmet labor needs and are heavily concentrated in sectors that generally negatively impact one’s health and are less likely to provide health insurance,” the report said. 

Overwhelmingly those same workers are unlikely to have health insurance – an effect that recent research has identified means that undocumented workers subsidize the broader U.S. healthcare system for U.S.-born citizens. The report found that 50 percent of undocumented immigrants were lacking health insurance.   

This lack of care leads to far less healthcare utilization and a reliance on the emergency room. The report found that “thirty-eight percent of likely undocumented immigrants have no usual source of care other than an emergency room, 37 percent have no visit in the past 12 months to a doctor, and 31 percent skipped or postponed care in the past 12 months.”

The reliance on emergency rooms that have to provide care often leads uninsured immigrants to utilize hospitals’ charity care programs, which in turn increases costs for hospitals as they provide uncompensated care. This uncompensated charity care tends to burden rural public hospitals the most. 

The report finds that expanding HBIA and HBIS could limit that burden. “HBIA and HBIS being targeted toward individuals that are lower income and less insured could reduce the uncompensated care that hospitals provide,” the report said.

The report details the transformational effects of attaining health insurance for both the adults and their children. It highlights how medical coverage improves health outcomes by making routine checkups and preventative care accessible. This not only impacts patients themselves but the broader community by stopping communicable diseases.

The report detailed this effect by looking at health outcomes pre-and post Medicaid expansion and suggesting a similar effect will occur for HBIA and HBIS enrollees. 

“Comparing preventive care and health behaviors of individuals before and after receiving coverage via the ACA Medicaid expansion showed increases of 20 percent for dental visits [and] 14 percent for breast exams, contributing to early detection and prevention of breast cancer and other diseases,” the report said.

The report was released amid a legislative battle on the fate and future of the HBIA and HBIS programs. Last year HFS introduced a series of major program restrictions on both programs after costs ballooned to a projected $1.2 billion if changes were not made. 

The changes included a pause on new enrollees and the introduction of co-pays for hospital stays, emergency room visits and outpatient surgery. Other cost-saving mechanisms that don’t fall onto patients were also introduced such as seeking more federal reimbursement, moving enrollees to the Medicaid Managed Care program, increasing drug rebates, and addressing Cook County Hospital overpayment. 

Initially, the copayments were paused, however, the pause was lifted on Feb. 1. 

Changes to the program frustrated lawmakers, especially the state’s Latino caucus who had been fighting to expand the program to include those age 19 and up. 

For the FY 2025 budget, Gov. JB Pritzker proposed increasing the budget for HBIA and HBIS to $629 million, an increase of $79 million – an increase in funding from FY 2024, though funding remains below FY 2024 projected costs. h Eliminating enrollment caps remains the primary focus for advocacy groups. 

“We recognize the real fiscal challenges facing the state, but urge both the General Assembly and the governor to pass a FY25 budget that fully funds the existing HBIA and HBIS programs as they currently exist in statute, with no caps and no co-pays,” Siegel said in a statement. The program is also being audited following a resolution introduced by Rep. Amy Elik (R-Alton) back in November. Elik said she wants lawmakers to have more information about where the money in the program is going and what people are using their health benefits for.