Cuts to Medicaid and strict, "bureaucratic" work requirements to keep the insurance won’t just harm poor people; they will push the costs of health care higher, nationwide, according to the head of one of Chicago’s largest groups of health clinics.

"It’s a misappropriation, under the guise of saving money, which, in the long run, won’t work," said Dr. Lee Francis, longtime president and CEO of Erie Family Health Centers, a network of 13  federally qualified health centers in the Chicago area.

Medicaid providers in Illinois have aimed their criticism of cuts to Medicaid and new proof-of-work requirements by saying the so-called "Big, Beautiful Bill" sounds good for curbing "fraud, waste and abuse" but in reality just shift the cost burden to other parts of the health care system and the economy.

An analysis by the Congressional Budget Office published yesterday found the overall Republican tax-and-spending-cuts legislation, approved by the U.S. House and now before the Senate, would take more than $1 trillion out of the health care system over a decade and would lead to 10.9 million people becoming uninsured, including 7.8 million who would lose Medicaid benefits, Crain’s sister brand Modern Healthcare reports.

Erie, an FQHC that cares for patients regardless of ability to pay, serves more than 95,000 patients, some 63,000, or about 67%, of whom are insured by Medicaid across 13 locations.

Francis said to Crain’s that, based on the CBO estimates, thousands of his patients would lose their insurance.

"We’ll still see them, asking them to pay on a sliding scale, but the delta between what Medicaid pays versus sliding scale fees is hard to make up," he said.

A ballpark estimate for a typical visit might be a Medicaid payment in the $189 range and the average collection from uninsured patients of $21.

"But we’re never going to say no, or take them to collections. Even though we will still see those patients, many of them will end up delaying care and using the emergency room, instead," he said.

Another critical factor: Having to pay for the cost of medications alone will disrupt the care for patients who’ve relied on Medicaid insurance.

Medicaid provides a source of primary care, preventative care and chronic care that saves the health care system millions a year compared to care for people who become sicker without that insurance, Francis said.

Francis, who is also an internal medicine doctor, said strict work-reporting requirements will be difficult for may Medicaid recipients to  comply with.

"I know my patients work. I’ve had patients who are office cleaners, musicians, locksmiths and food concession workers at O’Hare," he said, and adding a layer of bureaucracy is just "death by 1,000 paper cuts, or at least poor health by 1,000 paper cuts."

The added requirements, setting the bar much higher, he said, won’t increase employment around the nation. It will just cut working people’s insurance access.

"It’s hard to conclude the requirements are more than put out under the guise of something (politicians) will agree to upon the surface," he said.

On May 22, Illinois Rep. Darin LaHood, R-Peoria, praised the passage of the GOP budget bill by the House.

"House Republicans are focused on strengthening and investing in Medicaid for those who need it most by ensuring the program continues to provide high-quality patient care for expectant mothers, children, people with disabilities and the elderly," LaHood said in the statement. "To protect Medicaid for future generations, we must establish a common-sense approach to address waste, fraud and abuse. House Republicans have taken a scalpel approach by enacting work requirements for the 4.8 million able-bodied adults without dependents who are choosing not to work and removing 1.4 million illegal immigrants from the program."

Most of the health care cuts come from the section of the bill authored in the House Energy & Commerce Committee, totaling $1 trillion, Modern Healthcare reported.

Further, the House Ways & Means Committee’s part of the bill includes several policies targeted at the Affordable Care Act that would crimp premium tax credits for migrants and step up eligibility checks for everyone to save about $230 billion. Those provisions account for about 2.3 million people losing insurance.

The combined effects of many different policies would result in 16 million more uninsured people by 2024, the CBO concluded.

Francis predicted that some FQHCs won’t survive the effect of the cuts and others would need find efficiencies, collect more private donations and cut out some services that are not required or reimbursed.

One of the most devastating cuts, he predicts, will be to dental care.

"Cuts to dental services are most devastating, he said, because providing people with dental is the ‘poster child’ for the power of preventative care," he said. "Oral pain and dental emergencies are one of the most common, avoidable emergency room visits."

Without insurance, patients will let their dental health slide and faced with severe mouth paid, they head to the ER for pain medications, he said, but ER doctors cannot fix the root cause of the pain in their mouth, so the problem persists.

"It’s a perfect example of having things backwards," he said.