ACA Position Paper

The Future of the Affordable Care Act and Medicaid


As Congress debates the repeal of the Affordable Care Act (ACA) and the future of healthcare, IHA and the Illinois hospital community strongly support ensuring access to meaningful and affordable healthcare coverage.

The ACA should not be repealed without an adequate and simultaneous replacement plan that continues to ensure meaningful and affordable coverage. If ACA coverage is repealed prior to a replacement plan taking effect, Congress should also repeal the payment reductions to hospitals that were outlined in the law. 

The residents of Illinois and hospitals simply cannot operate with the unpredictability of what may come if coverage for over 1 million Illinoisans is repealed, without a replacement in place.

If Congress moves forward with new Medicaid financing mechanisms, we urge you to correct a long-standing financing inequity for Illinois, which has one of the lowest federal matching rates.


More than 1 million Illinoisans have obtained health coverage under the ACA through Medicaid expansion and the Marketplace.

Illinois hospitals have already absorbed more than $1 billion in Medicare payment reductions since 2010 based on assumptions regarding a decrease in uncompensated care due to increased healthcare coverage under the ACA.

If the ACA (including Medicaid expansion) is repealed, preliminary estimates are that Illinois would sustain a potential loss of 84,000 to 95,000 jobs and $11.6 billion to $13.1 billion in reduced annual economic activity.

Illinois is ranked 49th among the states in Medicaid spending per beneficiary. This is a result of low state spending and a low federal match rate.

Working for Solutions

IHA and the Illinois hospital community stand ready to serve as a resource and work with you as Congress considers these important issues.