Ripperda, a family and addiction medicine physician at Shawnee Health Care in Murphysboro , said hospitals across the region already operate on razor-thin margins.
“None of the hospital systems in Southern Illinois are making a high percentage of profits,” he said.
Ripperda said the largest healthcare network in Southern Illinois operates at about a 6.6% profit margin, while several others range from 1% to 4%. He said that with such thin margins, hospitals already struggle to balance revenue between profitable and unprofitable services and can’t afford to lose much income and remain stable.
“Hospitals generally lose money on uninsured patients because these patients can almost never afford to pay what it costs to care for them,” he said.
Ripperda pointed to three provisions in H.R. 1, the “One Big Beautiful Bill Act,” as especially concerning.
“H.R. 1 put stricter requirements on qualifying for Medicaid and made the process of applying more complicated and time-consuming,” he said. “A chunk of people will lose Medicaid coverage from these changes.”
He also noted that “H.R. 1 effectively eliminated subsidies for insurance premiums purchased by people on the Affordable Care Act Marketplace ,” adding that about one in fifteen Americans receives such assistance.
The legislation further limits the amount that states can collect through provider taxes that help fund Medicaid reimbursements.
Ripperda said H.R. 1 reduces the state provider tax from 6% to 3.5%, which means significantly less money will flow into the fund that helps reimburse hospitals serving large numbers of Medicaid patients.
“Right now, about 7% of people in Southern Illinois don’t have health insurance,” he said. “That number is projected to rise to about 12% because of H.R. 1.”
Ripperda said the region’s largest health systems expect to lose roughly $100 million a year — money that would otherwise stay in the local economy through hospital operations, construction projects, and employee wages.
“Healthcare is a major economic driver in Southern Illinois,” he said, “and H.R. 1 will do significant financial harm to that driver.”
According to the Illinois Health and Hospital Association , approximately two-thirds of Illinois counties are rural, with more than 500,000 residents enrolled in Medicaid. Most small hospitals in these areas have fewer than 150 beds and depend heavily on Medicare and Medicaid, leaving many with tight or negative budgets.
“A weakened healthcare system doesn’t just affect those who will lose their insurance,” Ripperda said. “For those who have good insurance, a weakened healthcare system locally still means longer wait times, older facilities, and fewer locally available services.”
Ripperda said that in his conversations with healthcare leaders, none mentioned illegal immigration or the cost of caring for undocumented patients as a factor in their financial concerns.
Ripperda urged Southern Illinois residents to speak up about how these federal changes could affect care close to home. He said the consequences of weakened hospital systems would reach far beyond financial strain.
“If the worst happens and hospitals close, the area around that closed hospital will see a decrease in life expectancy over the coming years,” Ripperda said. “Living close to a hospital greatly increases the odds of surviving a medical emergency.”
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