SPRINGFIELD — The U.S. House gave final passage Thursday to a budget bill that will cut federal Medicaid spending by an estimated $1 trillion over 10 years.

All three Republican members of the Illinois congressional delegation voted in favor of the bill, despite a last-minute plea from Democratic Gov. JB Pritzker who warned the bill will result more than 330,000 Illinoisans losing Medicaid coverage and have a devastating effect on some rural hospitals.

“As those who are entrusted with protecting the health of all your constituents, I urge you to oppose these harmful Medicaid provisions and work to protect healthcare access for rural Illinois families, workers, and veterans,” Pritzker wrote in the letter addressed to GOP Reps. Mike Bost, Darin LaHood and Mary Miller.

The cuts would translate to about $48 billion in Illinois over that period, or about 20% of what the state would otherwise receive, according to an analysis by KFF, a nonpartisan health policy research organization.

That would be one of the largest percentage reductions in any state in the nation, according to KFF, a nonpartisan health policy research organization formerly known as the Kaiser Family Foundation. Louisiana and Virginia would each see cuts of about 21%, KFF said.

The state-level analysis is based largely on Congressional Budget Office estimates showing the bill would reduce federal Medicaid spending by $1 trillion nationwide over the next decade.

The KFF analysis does not include estimates of the number of people who would lose Medicaid coverage under the bill, noting how that will depend on how individual states respond to the policy changes contained in the bill. But overall, it estimates the number of uninsured Americans will grow by 11.8 million.

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The bill, which includes many of President Donald Trump’s domestic policy priorities – including tax cuts and increased spending on border security – passed the Senate on Tuesday by a vote of 51-50, with Vice President J.D. Vance casting the tie-breaking vote. Both senators from Illinois, Democrats Dick Durbin and Tammy Duckworth, voted no.

The final vote in the House was 218-214.

“The One Big, Beautiful Bill is a once-in-a-generation victory for the American people,” Miller said in a statement after the House vote. “It delivers on President Trump’s America First agenda with bold, decisive, and immediate action. This is the most pro-worker, pro-family, pro-America legislation I have voted for during my time in Congress, and I was proud to help get it across the finish line for the hardworking Americans across my district.”

Medicaid and the health care marketplace

Medicaid, which is jointly funded by states and the federal government, provides health coverage for lower-income individuals and families. It was established in 1965 alongside Medicare, the federally funded health coverage program for people over 65.

Today, according to the Illinois Department of Healthcare and Family Services, the program covers about 3.4 million people in Illinois, or a fourth of the state’s population. At a total cost of $33.7 billion a year, it is one of the largest single categories of expenditures in the state’s budget. It pays for about 40% of all childbirths in the state, according to KFF, as well as 69% of all nursing home care.

But questions about its future loomed over the Illinois General Assembly during the just-completed legislative session as both Congress and the General Assembly were crafting their respective budgets for their upcoming fiscal years.

“This was a difficult year because of the unprecedented changes and cuts that are looming on the horizon in Washington,” state Rep. Anna Moeller, D-Elgin, said on the floor of the Illinois House during debate over a Medicaid bill on the final day of the session.

Read more: Amid uncertainty in Washington, Illinois lawmakers pass slimmed-down Medicaid package

Speaking with reporters at an unrelated event Tuesday, Pritzker predicted “hundreds of thousands” of people in Illinois will lose Medicaid coverage if the Senate bill is signed into law.

“This is shameful, if you ask me, and it’s going to be very hard to recover,” Pritzker said. “The state of Illinois can’t cover the cost – no state in the country can cover the cost of reinstating that health insurance that is today paid for mostly by the federal government, partly by state government.”

Policy changes under the bill

According to KFF, most of the reductions in Medicaid spending would result from just a few policy changes contained in the bill

Those include imposing a work requirement on adults enrolled in Medicaid through the Affordable Care Act, also known as “Obamacare.” That law expanded eligibility for Medicaid to working-age adults with incomes up to 138% of the federal poverty level. About 772,000 people in Illinois are enrolled under that program.

The bill also calls for requiring people enrolled through the ACA expansion to verify their continued eligibility for Medicaid twice a year instead of annually. That is expected to filter out enrollees whose incomes rise above the eligibility limit as well as those who simply fail to complete the verification process.

Another provision would limit the ability of states to finance their share of the cost of Medicaid by levying taxes on health care providers. Illinois imposes such taxes on hospitals, nursing facilities and managed care organizations that administer the program. Revenue from those taxes is used to draw down federal matching funds that are then used to fund higher reimbursement rates to health care providers.

The final version of the bill does not, however, include a provision penalizing states like Illinois that also provide state-funded health care to noncitizens who do not have lawful status to be in the United States. That provision, which was included in the earlier House version, was not included in the Senate bill, according to KFF.

Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.