The federal government incentivized states to expand Medicaid to this population with the promise of enhanced federal funding, currently bringing an additional $7.4 billion to Illinois to cover this population. The results have been overwhelmingly positive. States that expanded Medicaid saw greatly improved health outcomes for chronic disease, preventative care and mental health — all while saving consumers money and bolstering chronically underfunded health care systems. Stripping away care will impact the mental, physical and economic well-being of our people.

After the expansion took effect in Illinois, the statewide uninsured rate dropped by 44%, while hospitals saw uncompensated care costs decrease because providers were absorbing fewer costs for people who were unable to pay. In order to expand Medicaid, lawmakers passed a “trigger law” to protect the state’s budget: If the federal government strips Medicaid expansion funding, 770,000 Illinoisans will lose coverage. States cannot simply absorb billions more dollars into their budgets overnight. This would be catastrophic for Illinois and blame would lie solely with the Trump administration.

Also among Republican proposals is a drastic change to the Medicaid payment structure, to institute a per-member cap on federal Medicaid spending. The federal government currently contributes a percentage of Medicaid costs to states based on per-capita income. A cap would severely limit the federal payment structure, forcing states to find new revenue or cut enrollees or services. If a cap is set at current funding levels, Illinois could lose a staggering $30 billion in federal funding over nine years.

In any of these scenarios, it wouldn’t just be the people losing coverage who would feel this loss, but also the state’s health care infrastructure and, ultimately, its economy. Last fiscal year, the Illinois Medicaid program invested more than $20 billion to support hospitals, long-term care facilities, pharmacies and physicians. Illinois hospitals and health systems collectively generate $117.7 billion for the state annually. These systems also support roughly 445,000 full-time jobs, or 11% of Illinois’ workforce. During the last congressional attempt to eliminate the ACA Medicaid expansion, estimates projected the loss of 55,000 to 60,000 jobs and roughly $7.5 billion in annual economic activity in Illinois.

Proposed Republican cuts have even broader impacts. Medicaid is the third-largest funding stream for K-12 public schools. In Illinois, over $250 million in federal Medicaid funding annually supports schools. Moreover, experts predict that Medicaid cuts would lead to lower credit ratings for states.

In Illinois, we are guided by the vision that health care is a right, not a privilege, because it is the humane thing to do, and it makes economic sense. Make no mistake, the Trump administration and congressional Republicans may erroneously couch their plans for Medicaid in terms of efficiency. But in reality, any of these changes could result in the largest health care coverage loss this country has experienced in recent years, with ripple effects for generations to come.

Elizabeth M. Whitehorn is acting director of the Illinois Department of Healthcare and Family Services.