CHICAGO — If Alex Outlaw doesn’t get monthly infusions of medication for Crohn’s disease, he experiences painful symptoms that can make it difficult to hold down a job.

But he doesn’t make enough money as a manager at a rental car agency to pay for private health insurance or to cover those infusions, which can cost more than $1,000 each.

That’s where Medicaid comes in. The state- and federally funded health insurance program covers Outlaw’s monthly infusions, allowing him to manage his condition so he can work and support his family of five, he said.

“It’s pretty much saving my life right now,” said Outlaw, 38, who lives on the city’s West Side. If something happened to Outlaw’s Medicaid coverage, “it’s the end for me,” he said.

Outlaw is one of more than 3.4 million people in Illinois on Medicaid — more than one-quarter of the state’s population — who are anxiously watching discussions in Washington, D.C., over the future of the program. In late February, House Republicans passed a budget resolution instructing the committee that oversees Medicaid to cut $880 billion in costs over the next 10 years to help pay for new and existing tax cuts and enhanced border and national security, according to House Republicans.

Lawmakers have not yet said they plan to slash Medicaid, but it would not be possible to cut that much money without reducing Medicaid funding, according to figures released this week by the Congressional Budget Office. President Donald Trump has said he won’t cut Medicaid but has praised the budget resolution.

In the meantime, Illinois patients say they’re worried about losing their health coverage; Illinois hospitals that serve low-income areas say they may have to close or cut services depending on the depths of any cuts; and health care advocates say such a move could cost everyone more in the long run.

“I think people don’t realize how much Medicaid pays for,” said Stephanie Altman, director of health care justice and senior director of policy at the Shriver Center on Poverty Law in Chicago, noting that Medicaid covers most nursing home stays in addition to traditional health care costs for people with low incomes and disabilities.

If hospitals are forced to absorb the expense of treating uninsured patients, those costs will ultimately be passed on to everyone, she said. “Even if you’re not technically on Medicaid, Medicaid probably has an impact on your life one way or another.”

Chicago-area hospital leaders say it could be difficult for some safety-net hospitals to keep their doors open if significant cuts are made to Medicaid.

“We pride ourselves on being a safety-net institution that takes care of a predominantly Medicaid population,” said Dr. Ngozi Ezike, president and CEO of Sinai Chicago, where about 70% of the patients are on Medicaid. “If that was to be significantly changed, safety nets like Sinai Chicago, it would be almost impossible to survive, and most safety nets would probably disappear and leave a lot of patients without access to care.”

About 75% to 80% of Humboldt Park Health’s patients are on Medicaid, said CEO Jose Sanchez, who is also chair of the Association of Safety-Net Community Hospitals.

“There will be clinics that will close. There will be hospitals that will close,” Sanchez said. “Some of us that remain open, we will have to cut services.” It could mean longer waits in the emergency department or cuts to transportation the hospital provides to patients who need help getting there, he said.

Chicago-area federally qualified health centers also rely heavily on Medicaid revenue. They’re clinics that receive federal funding to help them care for underserved communities.

About 63,000 of Erie Family Health Centers’ 95,000 patients are on Medicaid, said Dr. Caroline Hoke, chief clinical officer at Erie, which has locations in Chicago and the north suburbs.

If Medicaid were cut, “We would be in the unfortunate situation of having to look at how many patients we can serve and how many services we can offer,” Hoke said.

She thinks health disparities between different groups of Chicago-area residents would grow if federally qualified health centers weren’t able to provide as much preventative care and care for chronic conditions.

Phantasha Gray, 25, of Grayslake, has been a patient at Erie for most of the last decade. “If something is wrong, they take the time out to listen to you,” Gray said. “They get you the resources that you need. They actually care.”

Gray recently gave birth to a son after receiving prenatal care at Erie. She works part-time as a school bus driver and doesn’t make enough money to pay for private health insurance.

The Medicaid coverage she receives, along with the income from her job, allows her “to be on my feet and stable,” she said.

“The help that I have gets me to where I need to be,” said Gray, who also has a 10-year-old daughter. If she lost her Medicaid coverage, “I would have to figure out what do I do next on top of everything else.”

State and local Democratic leaders hope Illinois residents mobilize to oppose the potential cuts.

“We’re facing a real challenge. Red alert, everybody,” Gov. JB Pritzker said during a news conference with Illinois U.S. Sen. Dick Durbin in late February. “I mean, it is time to wake up. Get out. Do something.”

Meanwhile, some state Republicans say it’s too early to get up in arms about the issue, noting that Congressional Republicans have not actually said they’re going to cut Medicaid.

“We don’t know what will happen,” Rep. William Hauter, R-Morton, said at the recent legislative hearing on the issue. “There are a lot of things we have no control over, budget negotiations going on at the national level. I think we’re here today as a performative exercise to say Trump is bad and we’re going to lose the Medicaid system.”

Hauter, an anesthesiologist and emergency medicine doctor, said he’d rather see Illinois lawmakers focus on what they do have more control over, such as Medicaid reimbursement rates for providers.

Though congressional Republicans have not yet said whether they’ll cut Medicaid, they’ve floated a number of ideas.

One of those is capping how much money the federal government sends to states to help them pay for Medicaid. Now, the federal government pays about 51% of the cost of Medicaid for most beneficiaries in Illinois, with no limit on the dollar amount.

If the government caps the amounts it sends to states, that could leave Illinois with tough choices, state leaders say.

“Federal cuts would mean we’d have to limit services or eligibility, and we don’t have the money as a state to make up the difference,” Elizabeth Whitehorn, director of the Illinois Department of Healthcare and Family Services, said at a recent legislative hearing on the topic in Springfield.

The federal government sent more than $20 billion to Illinois in fiscal 2024 to help pay for Medicaid, Whitehorn said.

Congressional Republicans have also discussed the idea of requiring able-bodied Medicaid recipients to work in order to keep receiving assistance. It’s an idea long favored by many conservatives.

“Implementing working requirements for able-bodied adults, while being sympathetic to struggling mothers and other vulnerable demographics, will ensure people who can work are incentivized to get back on their feet through work,” Josh Bandoch, head of policy for the Illinois Policy Institute, said in a statement.

Others, however, point out that many Medicaid recipients already work. In Illinois, about 58% of adults on Medicaid work, according to KFF, a nonprofit organization focused on health policy.

Another idea congressional Republicans have considered is reducing the amount the federal government pays states for adults who gained Medicaid coverage through the Affordable Care Act — a move that could mean a loss of coverage for more than 770,000 Illinois residents.

Under the Affordable Care Act, states were allowed to expand Medicaid coverage to more adults, namely those earning up to 138% of the federal poverty level. To help states do that, the federal government pays 90% of the costs for those adults.

“It allowed many states like Illinois to be able to do something they probably would never have been able to do with a 50% match,” Altman said. But Illinois has a “trigger” law saying the state will end its participation in the Medicaid expansion program if the federal match dips below 90%. Illinois is one of 12 states that passed such laws to ensure they weren’t left holding the bag if federal leaders changed their minds about the program.

“We simply don’t have the state budget to make up for this,” Whitehorn said.

In Cook County, 381,000 people are on Medicaid because of that Affordable Care Act expansion, said Cook County Board President Toni Preckwinkle.

The county’s health system, Cook County Health, would stand to lose $200 million in reimbursements a year if everyone in that group lost their Medicaid coverage, said Dr. Erik Mikaitis, Cook County Health CEO.

“We could very well end up in a place where we have to make tough decisions about the services we provide and where we provide them,” Mikaitis said of potential Medicaid cuts.

Preckwinkle called each of the options for cutting Medicaid funding “nightmare scenarios.”

“We’re going to do the best we can for as long as we can,” Preckwinkle said. “The county is in pretty good shape financially, but we don’t have infinite resources.”

While members of Congress hash out exactly how to cut $880 million, Illinois residents on Medicaid can do little but watch and wait.

Mark Czyzewski, 55 of Chicago, has relied on Medicaid for more than 10 years because mental illness has left him unable to work, he said. Thanks to Medicaid, he pays only “nominal” amounts for his medications, which can be expensive, he said.

“If something happened where I wasn’t able to get my medication, it would not be good,” Czyzewski said.

He’s worried but hopeful. “I hope people have some kind of compassion.”

Olivia Arbuckle, 77 of Normal, tries to not think about what would happen if she lost her Medicaid coverage. She changes the channel when the topic comes up on the news. She tries to stay busy by reading books and watching tennis.

Arbuckle receives Medicare and Medicaid, to help her pay for expenses that Medicare alone does not cover. She used to work as a caregiver for older adults and children, but she now has problems with her hands, back and legs because of rheumatoid arthritis.

Arbuckle no longer drives and depends on a part-time caregiver to take her to doctors’ appointments and help her care for herself and the mobile home where she’s lived for more than 20 years.

“I’m just afraid of what would happen,” Arbuckle said of potential cuts to Medicaid. “We just have to live every day and hope for the best, and hope that there are compassionate people out there, knowing they have mothers and fathers, too.”

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