With the U.S. House securing the passage of President Donald Trump’s landmark tax bill, health care advocates and Illinoisans are sorting out the sprawling impacts of a measure that could shutter nine hospitals in the state, kick more than 427,000 off food assistance plans and more than 500,000 low-income residents off health care coverage.
The House on Thursday delivered Trump one of his most consequential second term victories in passing the measure that will knock more than 11 million Americans off health insurance within the next decade to help offset $4.5 trillion in tax cuts. Trump planned to celebrate its passage with a bill signing on the Fourth of July.
Unions and advocates for Illinois hospitals warn that hospitals will close due to the legislation.
SEIU Healthcare, which represents more than 91,000 health care workers in Illinois, Indiana and Missouri, says Chicago’s safety net hospitals — hospitals that have at least 70% Medicaid utilization — will be hit hard.
When Medicaid work requirements kick in at the end of 2026, program enrollment will go down and the need for charity care will increase. Safety net hospitals will lose their critical Medicaid reimbursement payments, all while caring for more uninsured patients. They’re also at risk of closure, and health care employees are also in danger of losing their jobs if their services are reduced, the union said.
The union is now switching efforts from educating members about the bill to working with the state to try to find new revenue to offset the bill’s cuts and continuing a larger discussion about how Illinois can operate under this new healthcare landscape.
SEIU is also planning to keep the cuts front and center — especially ahead of next year’s midterm elections. Much of the changes are earmarked for 2026 and 2028, meaning voters may not immediately feel the impacts of the consequential bill.
Alice Jones, a unit secretary at Mount Sinai Hospital’s emergency room, said she expects to see the already busy hospital “packed” with uninsured patients.
“The emergency department is going to be overwhelmed, worse than it was with COVID because these Medicaid patients won’t be able to get to the specialty clinics because of these cuts. Those with diabetes, wound injuries of that nature, follow ups from car accidents. They already don’t have health care insurance,” Jones, 59, said. “…Now we’ll have to see what the fall out is and how long we’ll see the effects of it.”
Jones has worked at the hospital for 35 years. She said the measure will have a devastating impact.
“It appears to be very drastic for people,” Jones said. “Because they’re poor they don’t have the right to health care.”
Meanwhile, the Illinois Hospital Association, which represents hospitals across the state, said hospitals will be forced to make painful decisions, including shuttering altogether.
“The most regrettable outcome of this legislation is the loss of healthcare for hundreds of thousands of our state’s residents,” said A.J. Wilhelmi, President and CEO of the Illinois Hospital Association. “While the vast majority of the proposed Medicaid cuts will fall on hospitals, they will continue to provide care for the uninsured, consistent with their moral and legal obligations. But this will come at the cost of service and staff reductions, and higher healthcare costs for all.”
Gov. JB Pritzker’s administration says up to a half million Illinoisans could lose their Medicaid coverage under the federal bill, which would require most of Illinois’ 3 million-plus enrollees to prove they’ve worked, volunteered or gone to school for at least 80 hours in the month before signing up for coverage.
The Illinois Department of Healthcare and Family Services doesn’t collect work statuses of Medicaid recipients — raising more questions about the state infrastructure needed to enforce the new requirements.
And the overhaul of the Supplemental Nutrition Assistance Program would cost Illinois $1.2 billion, the governor’s office said.
The state’s congressional delegation voted down the party line. U.S. Rep. Darin LaHood, R-Ill., said the measure will “give rocket-fuel to the United States’ economy, provide predictability and certainty for small businesses, and deliver historic tax relief for the American people.”
LaHood called it a win for his 16th District, despite the number of his constituents who are likely to lose food assistance and Medicaid.
Ahead of Thursday’s vote, Pritzker penned a letter to the three Republican members of the Illinois delegation, citing his “deep concern” for the bill’s impact on rural parts of the state. He also outlined the number of Illinoisans in their districts that would lose Medicaid coverage, including more than 15,000 in LaHood’s district.
“The Illinois Department of Public Health (IDPH) is also warning that the Medicaid cuts could force the closure or severe service reductions at nine rural hospitals, affecting over 500 inpatient beds and jeopardizing care for 54,000 rural Illinoisans,” Pritzker wrote in the letter. “If H.R. 1 becomes law, many hospitals will be forced to eliminate critical services, cut staff, or even close, creating ripple effects that harm all patients in their communities, regardless of whether they rely on Medicaid coverage.”
The nine rural hospitals at risk of closure, according to the University of North Carolina’s Cecil G. Sheps Center for Health Services Research, are OSF Sacred Heart Medical Center in Danville, Hoopeston Community Memorial Hospital, Crawford Memorial Hospital in Robinson, Richland Memorial Hospital in Olney, Harrisburg Medical Center, Franklin Hospital in Benton, Massac Memorial Hospital in Metropolis, Hardin County General Hospital in Rosiclare and Katherine Shaw Bethea Hospital in Dixon.