Imagine standing at the pharmacy counter, knowing you need an inhaler to breathe and being forced to choose between spending the rest of your paycheck on an inhaler or rent. Thousands of uninsured Chicagoans have been in this position before, and Medicaid expansion — passed in January 2014 through the Affordable Care Act — provided much needed relief to thousands of Chicagoans. If Congress follows through on the plan by President Donald Trump’s administration to roll back Medicaid expansion, 900,000 Illinoisans could lose their health insurance, and millions more would lose coverage across the country.
For doctors who perform trauma surgery, the assumption is that they are meeting patients on the worst day of the patients’ lives — after car accidents, falls from ladders or injuries at the workplace. But in reality, the worst day often comes months later when a patient can no longer work due to an injury, loses employer-provided insurance and faces hundreds of thousands of dollars in medical bills. Before any cuts to Medicaid, medical expenses and illness-related work loss already contributed to more than half of bankruptcies in the United States. If Medicaid expansion is cut, trauma will continue to occur. However, the injured will have nowhere to turn for recovery.
For individuals relying on Medicaid, losing coverage means skipping doctor visits altogether. When faced with the choice between paying for medication and paying rent, small health issues are ignored — until they escalate into life-threatening conditions. A minor infection that could have been treated with a short course of antibiotics becomes a severe case requiring hospitalization, surgery and long-term intravenous treatment. These preventable complications come at a much higher cost — not just for the patient but for the entire health care system.
Rolling back Medicaid expansion would also likely expand the underground economy of medical care. Take the case of a diabetic mother in Chicago who routinely bought insulin from a friend because pharmacy prices were unaffordable. This informal “supplier” was not a dealer in the traditional sense — just another uninsured person rationing medication to help others in need. If Medicaid expansion is cut, more people will be forced into unregulated and risky networks to obtain life-sustaining medicine.
These markets already exist for asthma inhalers, blood pressure medications and opioids — not for recreational use but for survival. Cutting Medicaid does not eliminate the demand for these drugs; it simply pushes vulnerable individuals toward riskier means of obtaining them. Desperation leads to counterfeit medications, unsafe substitutions and, in extreme cases, theft.
Medical debt has pushed families into desperate situations, with some turning to shoplifting over-the-counter medications for their children or falling prey to scams promising cheap but ineffective treatments. Research has also established a link between losing health benefits and increases in violent crime. When financially cornered, individuals sometimes resort to robbing pharmacies, committing fraud or engaging in street-level drug sales just to afford a relative’s surgery. Reducing Medicaid access will only exacerbate these crises.
Hospitals, too, bear the financial burden. Trauma continues to occur, and emergency rooms do not turn away patients. But when Medicaid is cut, the number of uninsured patients rises, while the reimbursements hospitals rely on disappear. To compensate, hospitals reduce staffing, stretching nurses thin. Services such as extended clinic hours — allowing patients to see doctors without missing work — are eliminated, and in some cases, entire clinics are shut down. The costs are also shifted to insured patients, leading to higher co-pays and out-of-pocket expenses for everyone. If cost-cutting and price increases fail to sustain operations, hospitals are forced to close.
The expansion of illegal drug markets, the rise in survival-driven crime and the increased strain on emergency services are all predictable — and preventable — consequences of Medicaid cuts. If lawmakers proceed with these reductions, they will not be improving government efficiency; they will be manufacturing crises that will cost the state far more in law enforcement, emergency care and lost lives.
Uninsured Chicagoans did not ask to be uninsured. They are working parents, students, retirees and small business owners caught in a system that prioritizes profit over people. Stripping Medicaid from those who need it most will not make them healthier — it will make them more desperate. And desperation has consequences for everyone.
Robert Vargas is a professor of sociology at the University of Chicago and the author of “Uninsured in Chicago.” Tony Christiano is an assistant professor of orthopedic surgery and rehabilitative medicine at the University of Chicago.
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