Just a year ago, Illinois was trying to reduce Medicaid expenses. Now it's presiding over a dramatic expansion in program size and costs.
Illinois is effectively bankrupt and deeply in debt as state legislators in Springfield fret about underfunded pensions and the lack of money to provide such important core functions as education.
But that grim reality didn't merit even a passing glance Monday as members of the Illinois House of Representatives approved a huge expansion of Medicaid that will cost taxpayers a fortune, not now but soon.
The Senate, which has already passed similar legislation, soon will adopt the slightly different House version and send the bill for signing to Gov. Pat Quinn. Once that is done, Illinois will officially join the list of states providing Medicaid coverage to uninsured adults making up to $16,000 a year under President Barack Obama's Affordable Care Act.
But just how affordable it will be remains to be seen, because there is considerable uncertainty as to how many uninsured Illinoisans will enroll in Medicaid and what it will cost the federal and state government. Under Obamacare, the federal government has promised to pick up 100 percent of the new costs for three years and then 90 percent after that.
But the administrative costs, which the state will bear, are expected to be high, and so much is unknown about implementation that estimates about almost everything vary.
State Rep. Susan Feigenholtz told fellow House members that the expansion will put 342,000 more people on Medicaid. The Center on Budget and Policy Priorities estimates that there are 700,000 uninsured adults in Illinois who could end up on Medicaid, including 178,000 currently eligible but not covered.
Perhaps that's why the House debate was filled with wishful thinking. State Rep. Mike Smiddy, D-Hillsdale, described the Medicaid expansion as a "cost-saving measure" that poses "little risk" to state finances because the feds will pay the expansion costs for three years.
This is not a cost-saving measure, and the risks in a state as financially weak as Illinois cannot be overstated.
Minority Republicans pleaded with Democrats not to approve the expansion, to wait to see how other states fare under this dramatic Obamacare expansion before Illinois joins them. But Democrats viewed the measure as a moral and political imperative.
"This is a cornerstone of our president's agenda. Many of us have been waiting for this moment," Feigenholtz said.
It is somewhat ironic that Democrats were joined in this financial apostasy by the business community, which showed once again that it will support any policy it perceives to be in its financial interests.
"Our organizations believe Medicaid expansion is an important part of a very complex equation in alleviating overall costs on employers in the short and long term," wrote three prominent state business leaders, including Doug Whitley, president of the Illinois Chamber of Commerce.
They said the expansion will "protect employers from even higher short-term costs and employees from missed coverage opportunities."
There really was never any doubt that Illinois would join the states embracing this dramatic expansion of their Medicaid rolls. Fortunately for almost all of the other states that have done or will do so, only a few are as destitute as the Land of Lincoln.
Illinois is barely hanging on, stiffing its creditors and double-crossing those who depend on the state's public pension programs. Now it's rolling the dice with respect to unknown costs and patient enrollments associated with Medicaid expansion. It's hardly a prudent decision, but it is consistent with the state's long-term financial-management practices.