On a recent Thursday night, I sat in a ballroom at the University Club of Chicago for the 20th annual Bridging the Gap conference, hosted by University of Illinois Chicago’s departments of surgery, medicine and emergency medicine. The evening’s theme was emerging health issues in underrepresented minorities. The story I can’t stop thinking about came from Dr. Enrico Benedetti, interim executive dean of the University of Illinois College of Medicine.
In 1989, Benedetti arrived from Florence, Italy, to begin his internship at the University of Illinois Hospital. Early on, he watched a pregnant woman wait 16 hours in our emergency room for routine prenatal care. She had nowhere else to go. He has spent his career trying to make sure no one waits like that again.
Thirty-seven years later, Washington is on track to bring those waits back.
The federal budget law known as H.R. 1 is projected to cut $1 trillion from Medicaid nationally over the next 10 years, including $26 billion in cuts to Medicaid funds for Illinois. The Robert Wood Johnson Foundation estimates roughly 400,000 Illinoisans could lose coverage. The state already HAS sent letters to about 700,000 residents who could be affected by new work requirements. Cook County Health estimates up to 330,000 Illinoisans could lose healthcare coverage, with half of them living in Cook County. Starting in January, some enrollees will have to prove at least 80 hours a month of work, volunteering or school, and will have to renew their coverage every six months instead of every 12.
Immigrant families are being hit first. H.R. 1 narrows Medicaid eligibility for certain noncitizens, and some lost coverage Oct. 1. That includes people living here lawfully. Those losses come on top of Illinois’ own decision to close its immigrant adult health program. That program covered people ages 42 to 64, and its last day of coverage was June 30, 2025.
Most people losing coverage are American citizens, including working adults, caregivers and people between jobs. Losing insurance does not stop anyone from getting sick. It means they get care later, when the illness is harder to treat.
As a vascular surgeon, I see what that delay looks like. A wound that could have been managed in a clinic turns into an amputation, and the amputation happens in an operating room at a safety-net hospital.
This is where the math becomes dangerous. Statewide, Medicare and Medicaid make up 30% to 40% of hospital revenue, but at safety-net and critical-access hospitals, they make up more than half. The governor’s budget office warns the law’s new caps on provider taxes will reduce Medicaid funding by a total of $4.5 billion by fiscal 2031. Once the rate caps fully phase in, the annual hit reaches $6.1 billion by 2033. The Illinois Health and Hospital Association warns that roughly half the hospitals in Illinois could be forced to reduce staff, cut back on services or close altogether. We already have seen what closure looks like here: Weiss Memorial Hospital in Chicago closed in August 2025 because of financial struggles. Cook County Health is already projecting a $100 million increase in charity care in 2027.
UI Health is the only public academic health center in Chicago. It includes a 451-bed tertiary hospital and the Mile Square network of 11 federally qualified health centers. We treat everyone who comes through our doors, and that is exactly why these cuts threaten us.
The threat goes beyond patient care, because UIC also is where Illinois trains its health workforce. More than 1 in 3 physicians practicing in Illinois trained at the College of Medicine, and 1 in 5 earned their medical degree there. Almost half of all Black and Latino healthcare professionals in Illinois, and up to 70% in Chicago, are alumni of UIC’s health science colleges. The college graduates more African American students than any U.S. medical school except Howard and Meharry.
Residents learn medicine by caring for patients, and a teaching hospital’s clinical revenue pays for that training. If a safety-net academic center must close clinics, freeze hiring or cut services, fewer doctors and nurses get trained. Chicago’s future physicians, including the ones most likely to practice in the neighborhoods that need them most, would lose the place where they learn.
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The economic damage would spread well beyond the hospital. UIC added $10.6 billion to the Illinois economy in 2023 and supported almost 97,000 jobs, which is 1 of every 85 jobs in the state. UI Health’s spending alone generated $1.6 billion in added income for the state. If UIC is destabilized, the effects reach the Illinois Medical District, the Near West Side and every business that depends on the paychecks of people who work there. Uncompensated care doesn’t go away, either. Taxpayers and families with private insurance end up paying for it.
There is still time to act. Congress can delay the work requirements and the payment caps before they take full effect. Springfield can make protecting safety-net hospitals a budget priority. Chicagoans can tell their representatives that a hospital serving everyone who walks in is part of the city’s infrastructure, just like its roads, bridges and power lines.
Benedetti has spent 37 years making sure no woman waits 16 hours for prenatal care at our hospital. We should not let Washington undo that work.
Dr. Albert D. Sam II is a visiting clinical professor of surgery and chief of vascular surgery at the University of Illinois College of Medicine in Chicago.
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