A Challenge to Governor Rauner

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On January 31, Illinois Senators Richard Durbin and Tammy Duckworth urged Governor Bruce Rauner to speak out in support of The Affordable Care Act. Their letter is reprinted here.

January 31, 2017

The Honorable Bruce Rauner
Governor, State of Illinois
207 State House
Springfield, IL 62706

Dear Governor Rauner:

As you are aware, Republican leaders in Congress have begun the process of repealing the Affordable Care Act (ACA) without enacting a simultaneous replacement plan. Nationwide, this strategy threatens to disrupt our entire healthcare system—subjecting patients, providers, hospitals, and insurers to chaos. As Governor of our state, we seek your input on how to improve our health care system and urge you to stand on the side of Illinoisans in opposing any action that would reduce coverage, increase costs, reduce the quality of health care, burden our providers, or harm our state’s economy.

In December 2016, House Republicans sent a letter to governors and insurance commissioners seeking feedback on their plan to repeal the ACA and make dramatic changes to our healthcare system. We were disappointed that in your response letter, dated January 17, 2017, you failed to provide any information regarding the potential fallout or benefit from repealing the ACA. You also failed to provide answers to the questions asked and failed to detail many of the concerns that we have been hearing from Illinois patients, stakeholders, and institutions.

For instance, the Illinois Health and Hospital Association (IHA) has expressed concerns that “people will not be able to get the care they need; local economies will suffer; and jobs will be lost.” In our state alone, the IHA estimates that Congressional Republican plans to repeal the ACA without replacing it would result in “potential losses of $11.6 billion to $13.1 billion in annual economic activity, which translates to a potential job loss of 84,000 to 95,000 jobs.”

In contrast, Republican governors from at least seven states that, like Illinois, have chosen to expand Medicaid as a result of the ACA issued strongly worded statements warning Congressional Republicans against hasty efforts to repeal the ACA without replacement. They also have expressed serious concerns about dramatically altering the Medicaid program, such as through block grants or per-capita caps. Many of these Republican governors have highlighted the existing flexibilities that their states have, the coverage gains made under the ACA, and the positive impact on health outcomes for their constituents.

As part of the existing flexibilities afforded to states under the Medicaid program, your administration has submitted a Section 1115 Medicaid Demonstration waiver to the Centers for Medicare and Medicaid Services (CMS) to improve the delivery of behavioral health care services for Illinoisans. We support this waiver application because of the numerous positive provisions for addressing substance use disorders, mental health, child trauma, and the justice-involved population. However, we cannot ignore the reality that Congressional Republican plans to restructure the Medicaid program toward a block grant or per-capita cap could obviate any potential gains from this 1115 waiver because of the deep funding cuts and benefit reductions that would certainly occur. Based off prior Congressional Republican proposals to restructure the Medicaid program, such plans would have the net effect of eliminating up to 40 percent of the state’s Medicaid funding over ten years that would make implementing the 1115 waiver impossible and could result in Medicaid beneficiaries being subjected to waiting lists, the erosion of consumer protections and benefits, and draconian requirements for cost-sharing or work requirements—the opposite intent of this 1115 waiver. Combined, repeal of the ACA and a dramatic restructuring of the Medicaid program would have an immediate and lasting negative effect for Illinois and could undercut any potential benefits from the 1115 waiver.

Independent analyses paint a very grim picture of the health care environment that Illinois would face if Republican “repeal without replace” efforts are successful. For instance, 1.2 million fewer Illinoisans would have health insurance in 2019. Repeal would mean the loss of $12.5 billion in federal marketplace spending between 2019 and 2028 and an additional $37.4 billion in federal Medicaid funding between 2019 and 2028. Demand for uncompensated care also would increase by $1.1 trillion nationwide between 2019 and 2028. Given the state’s ongoing budget challenges, these added costs on providers and state and local governments could be catastrophic.

We support and stand ready to work in a bipartisan fashion to reform and improve the ACA for Illinoisans, such as by increasing competition and choice in the marketplaces, improving affordability by expanding financial assistance and balancing the risk pool, and addressing the skyrocketing price of prescription drugs which are driving up insurance premiums. However, repealing without replacing the ACA terminates all of the important and life-saving benefits we have achieved in recent years.

We strongly urge you to reconsider your position towards these destructive Republican plans and to stand firmly with Illinoisans against efforts to repeal the ACA without an adequate replacement plan in place to protect the coverage gains, affordability, benefits, and consumer protections that Illinoisans currently enjoy. Further, we would welcome your thoughts on how best to improve the ACA for Illinoisans state-wide. Thank you for your attention to this important issue.


Richard J. Durbin
United States Senator

Tammy Duckworth
United States Senator