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Letters: What slashing Medicaid would do to health care in Cook County

Letters: What slashing Medicaid would do to health care in Cook County

Chicago Tribune01-05-2025

Medicaid is a crucial public health program in the United States, providing essential health care services to millions of low-income families, children, pregnant women, elderly adults and individuals with disabilities.
As Cook County commissioner, I know the importance of prioritizing health care access, recognizing its pivotal role in public health. Cook County Health, a trailblazer in health care regardless of financial ability, has served our community for over 180 years, and a substantial portion of our patient population relies on Medicaid. I convened public hearings on maternal health and secured funding for the inaugural Cook County Health doula program, aiming to reframe the narrative on maternal health in Cook County and address disparities for our pregnant mothers.
However, the GOP's looming Medicaid cuts pose a significant threat to health care. These cuts could reduce access to medical services, strain health care providers, and burden state and county budgets. They would disproportionately affect low-income families, the elderly and individuals with disabilities, who heavily rely on Medicaid. Reduced funding could diminish Medicaid eligibility and access to essential medical services.
Furthermore, these cuts would eliminate or reduce preventive care programs, leading to long-term health complications due to delayed detection and treatment. Hospitals and clinics serving a substantial portion of Medicaid patients may face financial challenges, resulting in staff reductions, decreased services and even facility closures. I understand the concerns of Illinois patients regarding losing coverage, especially if hospitals in low-income areas are forced to close or reduce services.
Health care advocates argue that such cuts could ultimately cost everyone more in the long run. Limited resources may compromise care quality, leading to longer wait times and reduced patient satisfaction. Medicaid cuts exacerbate health outcomes, causing individuals to forgo necessary medical treatments due to cost or lack of coverage. In the long term, the absence of preventive and basic care can lead to more severe health issues and increased health care costs.
Cook County Health could potentially lose $200 million annually in reimbursements if our patient population were to lose Medicaid coverage. Medicaid cuts would have far-reaching implications for individuals, health care providers, state and county budgets, and overall public health.
Policymakers must carefully consider these consequences when making decisions about Medicaid funding. This is precisely the reason why I firmly oppose cuts to Medicaid.
— Cook County Commissioner Donna Miller, 6th District
Threat to transit is real
Regarding the editorial 'Chicago's transit agencies want you to panic. They don't explain the whole truth' (April 27): Warning riders and lawmakers about an impending fiscal cliff isn't 'panic-stoking' — it's responsible leadership. Without immediate action this spring, Chicagoland faces devastating transit cuts that would gut service, strand riders and devastate our economy.
Unfortunately, the editorial minimizes the urgent reality facing our region. Public transit in the Chicago region is at a crossroads. We are here because Illinois has undervalued and underfunded transit for decades — despite the essential role the CTA, Metra and Pace play in providing an average of 1.2 million rides a day that connect people to jobs, education and health care. Illinois contributes just 17% to transit operations, far behind peer states like New York (28%), Boston (44%) and Philadelphia (50%).
When the Regional Transportation Authority and other agencies warn of a crisis, it's because the threat is real. A 40% cut to transit service would be catastrophic. It would mean longer wait times, the loss of 24-hour service in Chicago, the elimination of weekend options for suburban riders, higher fares for working families and devastating impacts for our most vulnerable riders. This cut in service would mean $2.6 billion lost from our region's annual gross domestic product, on top of the loss of tens of thousands of jobs — all in just the first year.
Advocates, independent experts and residents across the region — who have already sent thousands of letters at SaveTransitNow.org — are united behind the call for a $1.5 billion investment to not just stabilize transit but also to strengthen it. An empowered RTA that would deliver more frequent, reliable service and reforms. Independent analysis estimates that this investment will add $2.7 billion to our region's GDP annually and 28,000 jobs in the first year.
We are advocating for a future in which the RTA would be accountable for fares, service quality and capital investment — giving riders a better system and taxpayers better results. Shorter waits, more frequent service and a more seamless experience — all backed by a stronger RTA, one empowered to intervene when needed to fix issues riders are facing whether that be ghost buses or implementing a Transit Ambassador pilot to help improve safety.
Illinois lawmakers have a clear choice: Listen to the research, to the advocates and, most importantly, to the thousands speaking out to save transit for our region and for our future.
— Kirk Dillard, chairman, Regional Transportation Authority
Culture, history at risk
Culture, heritage, identity and history — these are not luxuries. They are the foundation of our democracy. Illinois has long led the way in preserving and celebrating them, from our iconic Chicago museums to rural libraries and local historical societies across the state.
Today, those very institutions are under attack.
The federal government has moved to gut funding that supports Illinois Humanities and similar organizations nationwide. These are not bloated bureaucracies — they are community lifelines, hosting after-school programs for underserved kids, amplifying veterans' stories, and bringing artists and scholars into classrooms to spark critical thinking.
As chair of the Museums, Culture, Arts, and Entertainment Committee in the Illinois House, I find this moment alarming — not just as a policymaker but also as an Illinoisan who understands the power of public memory.
This is not simply about budgets. It is about ideology.
One of President Donald Trump's recent executive orders — cynically titled 'Restoring Truth and Sanity to American History' — threatens to erase narratives deemed 'divisive' or unpatriotic. In practice, it means silencing Black, Indigenous, immigrant, LGBTQ+ and other historically marginalized voices. It means replacing honest reckoning with historical whitewashing. It means undermining education to manipulate patriotism for political gain.
We have seen this playbook before. Authoritarian regimes have always sought to control culture — because when you silence a museum, you mute a people. When you erase a curriculum, you narrow a generation's understanding of justice. Illinois will not be complicit in that erasure.
Our libraries, historic sites and museums are not relics of the past; they are living classrooms. They teach empathy, civic responsibility and critical thought. They drive our economy, create jobs and make Illinois a destination for millions.
And they are in danger. We must act.
I urge every Illinoisan to contact their federal representatives and demand the restoration of funding to the National Endowment for the Humanities and related programs. Tell them we will not allow our stories — or our democracy — to be rewritten by fear and ideology.
This is not a red-state or blue-state issue. It is a question of whether we have the courage to confront the full truth of our shared journey — and to defend the spaces that protect and preserve it.
The stakes could not be higher. History does not erase itself. It is erased when good people stay silent.
Now is the time to raise our voices — before those who fear the truth silence them for good.
— State Rep. Kimberly Neely du Buclet, D-Chicago
Yes to upzoning plan
Op-ed writer John Holden's attack on the plan to upzone Broadway contains the misleading claim that opposing upzoning is somehow 'environmentally friendly' ('Zoning plan for Broadway a nonstarter,' April 25). This is as far from true as Chicago is from Australia.
As an environmental attorney, I know all too well the challenge we face in cutting our greenhouse gas emissions in order to avoid the worst effects of climate change. In Illinois, transportation accounts for more carbon dioxide emissions than any other sector. One of the best ways to cut per-capita emissions is to allow more people to move to transit-rich neighborhoods such as Edgewater and Uptown, where car-free and car-lite lifestyles are possible. Unfortunately, zoning rules that prohibit dense new housing across much of Chicago limit the city's growth, pushing potential Chicagoans to car-oriented Sunbelt cities such as Houston.
If Chicago is going to be the environmental leader so many of us want it to be, it needs to loosen restrictions on climate-friendly housing. The Broadway upzoning plan is a good start.

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'Expensive and complicated': Most rural hospitals no longer deliver babies
'Expensive and complicated': Most rural hospitals no longer deliver babies

Yahoo

time19 minutes ago

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'Expensive and complicated': Most rural hospitals no longer deliver babies

Jun. 11—Nine months after Monroe County Hospital in rural South Alabama closed its labor and delivery department in October 2023, Grove Hill Memorial Hospital in neighboring Clarke County also stopped delivering babies. Both hospitals are located in an agricultural swath of the state that's home to most of its poorest counties. Many residents of the region don't even have a nearby emergency department. Stacey Gilchrist is a nurse and administrator who's spent her 40-year career in Thomasville, a small town about 20 minutes north of Grove Hill. Thomasville's hospital shut down entirely last September over financial difficulties. Thomasville Regional hadn't had a labor and delivery unit for years, but women in labor still showed up at its ER when they knew they wouldn't make it to the nearest delivering hospital. "We had several close calls where people could not make it even to Grove Hill when they were delivering there," Gilchrist told Stateline shortly after the Thomasville hospital closed. She recalled how Thomasville nurses worked to save the lives of a mother and baby who'd delivered early in their ER, as staff waited for neonatal specialists to arrive by ambulance from a distant delivering hospital. "It would give you chills to see what all they had to do. They had to get inventive," she said, but the mother and baby survived. Now many families must drive more than an hour to reach the nearest birthing hospital. Nationwide, most rural hospitals no longer offer obstetric services. Since the end of 2020, more than 100 rural hospitals have stopped delivering babies, according to a new report from the Center for Healthcare Quality & Payment Reform, a national policy center focused on solving health care issues through overhauling insurance payments. Fewer than 1,000 rural hospitals nationwide still have labor and delivery services. Across the nation, two rural labor and delivery departments shut their doors every month on average, said Harold Miller, the center's president and CEO. "It's the perfect storm," Miller told Stateline. "The number of births are going down, everything is more expensive in rural areas, health insurance plans don't cover the cost of births, and hospitals don't have the resources to offset those losses because they're losing money on other services, too." Staffing shortages, low Medicaid reimbursement payments and declining birth rates have contributed to the closures. Some states have responded by changing how Medicaid funds are spent, by allowing the opening of freestanding birth centers, or by encouraging urban-based obstetricians to open satellite clinics in rural areas. Yet the losses continue. Thirty-six states have lost at least one rural labor and delivery unit since the end of 2020, according to the report. Sixteen have lost three or more. Indiana has lost 12, accounting for a third of its rural hospital labor and delivery units. In rural counties the loss of hospital-based obstetric care is associated with increases in births in hospital emergency rooms, studies have found. The share of women without adequate prenatal care also increases in rural counties that lose hospital obstetric services. And researchers have seen an increase in preterm births — when a baby is born three or more weeks early — following rural labor and delivery closures. Babies born too early have higher rates of death and disability. Births are expensive The decline in hospital-based maternity care has been decades in the making. Traditionally, hospitals lose money on obstetrics. It costs more to maintain a labor and delivery department than a hospital gets paid by insurance to deliver a baby. This is especially true for rural hospitals, which see fewer births and therefore less revenue than urban areas. "It is expensive and complicated for any hospital to have labor and delivery because it's a 24/7 service," said Miller. A labor and delivery unit must always have certain staff available or on call, including a physician who can perform cesarean sections, nurses with obstetric training, and an anesthetist for C-sections and labor pain management. You can't subsidize a losing service when you don't have profit coming in from other services. — Harold Miller, president and CEO of the Center for Healthcare Quality & Payment Reform "There's a minimum fixed cost you incur [as a hospital] to have all of that, regardless of how many births there are," Miller said. In most cases, insurers don't pay hospitals to maintain that standby capacity; they're paid per birth. Hospitals cover their losses on obstetrics with revenue they get from more lucrative services. For a larger urban hospital with thousands of births a year, the fixed costs might be manageable. For smaller rural hospitals, they're much harder to justify. Some have had to jettison their obstetric services just to keep the doors open. "You can't subsidize a losing service when you don't have profit coming in from other services," Miller said. And staffing is a persistent problem. Harrison County Hospital in Corydon, Indiana, a small town on the border with Kentucky, ended its obstetric services in March after hospital leaders said they were unable to recruit an obstetric provider. It was the only delivering hospital in the county, averaging about 400 births a year. And most providers don't want to remain on call 24/7, a particular problem in rural regions that might have just one or two physicians trained in obstetrics. In many rural areas, family physicians with obstetrical training fill the role of both obstetricians and general practitioners. Ripple effects Even before Harrison County Hospital suspended its obstetrical services, some patients were already driving more than 30 minutes for care, the Indiana Capital Chronicle reported. The closure means the drive could be 50 minutes to reach a hospital with a labor and delivery department, or to see providers for prenatal visits. Longer drive times can be risky, resulting in more scheduled inductions and C-sections because families are scared to risk going into labor naturally and then facing a harrowing hourlong drive to the hospital. Having fewer labor and delivery units could further burden ambulance services already stretched thin in rural areas. And hospitals often serve as a hub for other maternity-related services that help keep mothers and babies healthy. "Other things we've seen in rural counties that have hospital-based OB care is that you're more likely to have other supportive things, like maternal mental health support, postpartum groups, lactation support, access to doula care and midwifery services," said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health, whose research focuses in part on maternal health policy with a focus on rural communities. State action Medicaid, the state-federal public insurance for people with low incomes, pays for nearly half of all births in rural areas nationwide. And women who live in rural communities and small towns are more likely to be covered by Medicaid than women in metro areas. Experts say one way to save rural labor and delivery in many places would be to bump up Medicaid payments. As congressional Republicans debate President Donald Trump's tax and spending plan, they're considering which portions of Medicaid to slash to help pay for the bill's tax cuts. Maternity services aren't on the chopping block. But if Congress reduces federal funding for some portions of Medicaid, states — and hospitals — will have to figure out how to offset that loss. The ripple effects could translate into less money for rural hospitals overall, meaning some may no longer be able to afford labor and delivery services. "Cuts to Medicaid are going to be felt disproportionately in rural areas where Medicaid makes up a higher proportion of labor and delivery and for services in general," Kozhimannil said. "It is a hugely important payer at rural hospitals, and for birth in particular." And though private insurers often pay more than Medicaid for birth services, Miller believes states shouldn't let companies off the hook. "The data shows that in many cases, commercial insurance plans operating in a state are not paying adequately for labor and delivery," Miller said. "Hospitals will tell you it's not just Medicaid; it's also commercial insurance." He'd like to see state insurance regulators pressure private insurance to pay more. More than 40% of births in rural communities are covered by private insurance. Yet there's no one magic bullet that will fix every rural hospital's bottom line, Miller said: "For every hospital I've talked to, it's been a different set of circumstances." Stateline reporter Anna Claire Vollers can be reached at [email protected]. YOU MAKE OUR WORK POSSIBLE.

Permitless concealed carry in North Carolina faces uphill battle after some GOP pushback
Permitless concealed carry in North Carolina faces uphill battle after some GOP pushback

Hamilton Spectator

time23 minutes ago

  • Hamilton Spectator

Permitless concealed carry in North Carolina faces uphill battle after some GOP pushback

RALEIGH, N.C. (AP) — A bill to let adults carry concealed handguns without a permit cleared the North Carolina legislature on Wednesday, however the path to joining the majority of U.S. states with similar laws remains uncertain. The GOP-backed legislation faces a likely veto from Democratic Gov. Josh Stein, as well as pushback from a handful of Republicans who voted against the legislation in the state House. House Speaker Destin Hall acknowledged those concerns after Wednesday's vote. 'I would imagine that — math being math — that it's probably a low percentage relative to other bills,' Hall told reporters. If the bill becomes law, North Carolina would become the 30th state in the country to legalize permitless carrying of a concealed handgun, according to the National Conference of State Legislatures. North Carolina would also be one of the last states in the Southeast to implement that legislation. The legislation allows for eligible people with valid identification over the age of 18 to carry a concealed handgun. More than half of states with permitless concealed carry set their age limit at 21 and older, while the rest have the legal carrying age at 18, according to the NCSL. Currently, a person must be 21 and older to obtain a concealed handgun permit in North Carolina. To qualify, an applicant must pass a firearms safety training course and not 'suffer from a physical or mental infirmity that prevents the safe handling of a handgun,' according to state law. Approving permitless concealed carry has been a goal of gun-rights activists in North Carolina for years, with House Republicans historically supportive of the idea. Some see it as the next step after Republican lawmakers successfully eliminated the permit system that required sheriffs to conduct character evaluations and criminal history checks for pistol applicants in 2023. Conservative advocates for the bill say it would strengthen Second Amendment rights for North Carolinians. Republican lawmakers also disputed that the bill would make the state more dangerous, as 'law-abiding citizens' would be the only people that would benefit from the permit elimination, not criminals, Republican Rep. Brian Echevarria said. 'Rights to keep and bear arms are constitutionally inseparable,' Echevarria said. 'If a person cannot own a firearm, they cannot bear a firearm.' The bill's passage tees up one of the first opportunities for a likely veto from Stein if he stays aligned with his fellow Democrats in the legislature. Stein has a more powerful veto stamp than his predecessor Roy Cooper , after Republicans lost their House supermajority last year that allowed them to override vetoes and enact their legislative agenda with relative ease. Now, House Republicans would need to count on a Democrat to join in their override efforts. Reaching that goal seems especially daunting, considering all of the present House Democrats — and two Republicans — voted against the bill. The governor's office didn't respond to a request for comment on the legislation, but House Deputy Democratic Leader Cynthia Ball said in a committee Tuesday that Stein was opposed to it. Several Democratic legislators said it would make communities unsafe by loosening who can carry a concealed handgun without training. Democrats also raised issue with the age limit set in the bill, saying it would put guns in the hands of young people who aren't yet mature enough to have one. 'Do you not remember when you were 18? We are prone and so susceptible to peer pressure, we are hotheaded, we are emotional,' Democratic Rep. Tracy Clark said on the House floor after retelling her personal experience of losing two friends in college to gun violence. Those seeking a permit for their concealed handgun — such as for the purpose of traveling with a firearm to a state that requires a permit — would still be able to do so. The bill also heightens the felony punishment for those who assault law enforcement officers or first responders with a firearm. A separate bill that makes gun safety courses available at North Carolina community colleges for people 18 and up passed in a near-unanimous House vote directly after the concealed carry permit repeal legislation was approved. ___ Associated Press writer Gary D. Robertson in Raleigh contributed to this report. Error! Sorry, there was an error processing your request. There was a problem with the recaptcha. Please try again. You may unsubscribe at any time. By signing up, you agree to our terms of use and privacy policy . This site is protected by reCAPTCHA and the Google privacy policy and terms of service apply. Want more of the latest from us? Sign up for more at our newsletter page .

Permitless concealed carry in North Carolina faces uphill battle after some GOP pushback
Permitless concealed carry in North Carolina faces uphill battle after some GOP pushback

Yahoo

time40 minutes ago

  • Yahoo

Permitless concealed carry in North Carolina faces uphill battle after some GOP pushback

RALEIGH, N.C. (AP) — A bill to let adults carry concealed handguns without a permit cleared the North Carolina legislature on Wednesday, however the path to joining the majority of U.S. states with similar laws remains uncertain. The GOP-backed legislation faces a likely veto from Democratic Gov. Josh Stein, as well as pushback from a handful of Republicans who voted against the legislation in the state House. House Speaker Destin Hall acknowledged those concerns after Wednesday's vote. 'I would imagine that — math being math — that it's probably a low percentage relative to other bills," Hall told reporters. If the bill becomes law, North Carolina would become the 30th state in the country to legalize permitless carrying of a concealed handgun, according to the National Conference of State Legislatures. North Carolina would also be one of the last states in the Southeast to implement that legislation. The legislation allows for eligible people with valid identification over the age of 18 to carry a concealed handgun. More than half of states with permitless concealed carry set their age limit at 21 and older, while the rest have the legal carrying age at 18, according to the NCSL. Currently, a person must be 21 and older to obtain a concealed handgun permit in North Carolina. To qualify, an applicant must pass a firearms safety training course and not 'suffer from a physical or mental infirmity that prevents the safe handling of a handgun,' according to state law. Approving permitless concealed carry has been a goal of gun-rights activists in North Carolina for years, with House Republicans historically supportive of the idea. Some see it as the next step after Republican lawmakers successfully eliminated the permit system that required sheriffs to conduct character evaluations and criminal history checks for pistol applicants in 2023. Conservative advocates for the bill say it would strengthen Second Amendment rights for North Carolinians. Republican lawmakers also disputed that the bill would make the state more dangerous, as 'law-abiding citizens' would be the only people that would benefit from the permit elimination, not criminals, Republican Rep. Brian Echevarria said. 'Rights to keep and bear arms are constitutionally inseparable,' Echevarria said. 'If a person cannot own a firearm, they cannot bear a firearm." The bill's passage tees up one of the first opportunities for a likely veto from Stein if he stays aligned with his fellow Democrats in the legislature. Stein has a more powerful veto stamp than his predecessor Roy Cooper, after Republicans lost their House supermajority last year that allowed them to override vetoes and enact their legislative agenda with relative ease. Now, House Republicans would need to count on a Democrat to join in their override efforts. Reaching that goal seems especially daunting, considering all of the present House Democrats — and two Republicans — voted against the bill. The governor's office didn't respond to a request for comment on the legislation, but House Deputy Democratic Leader Cynthia Ball said in a committee Tuesday that Stein was opposed to it. Several Democratic legislators said it would make communities unsafe by loosening who can carry a concealed handgun without training. Democrats also raised issue with the age limit set in the bill, saying it would put guns in the hands of young people who aren't yet mature enough to have one. 'Do you not remember when you were 18? We are prone and so susceptible to peer pressure, we are hotheaded, we are emotional,' Democratic Rep. Tracy Clark said on the House floor after retelling her personal experience of losing two friends in college to gun violence. Those seeking a permit for their concealed handgun — such as for the purpose of traveling with a firearm to a state that requires a permit — would still be able to do so. The bill also heightens the felony punishment for those who assault law enforcement officers or first responders with a firearm. A separate bill that makes gun safety courses available at North Carolina community colleges for people 18 and up passed in a near-unanimous House vote directly after the concealed carry permit repeal legislation was approved. ___ Associated Press writer Gary D. Robertson in Raleigh contributed to this report.

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