By Max Blaisdell
Hyde Park Herald, March 13, 2026
In January, a young man arrived at the University of Chicago Medical Center and received a cancer diagnosis expected to shorten his life to just a few years.
The patient was younger than the 27-year-old resident treating him, and he had no insurance. Instead of leaving with an oncologist and a treatment plan, he left with a referral to a safety-net hospital down the road.
âItâs devastating to have to say anything other than âHereâs how we can help,ââ said Zachary Pellis, a third-year internal medicine resident at UChicago Medicine, who treated the young man.
The case wasnât an anomaly. The same month, Pellis said he encountered a man who needed a liver transplant but could not resolve his insurance in time to remain eligible. His only option was to visit an emergency room every week for the lab work required to maintain his transplant candidacy. Pellis wrote him a handwritten list of lab tests to give whichever ER doctor he saw.
âThat is entirely because of his insurance,â Pellis said. âWeâre the richest country on Earth and thatâs our plan.â
Doctors told the Herald that cases like these are becoming more common across area hospitals, even before the most significant provisions of last summerâs One Big Beautiful Bill Act take effect. The law, signed by President Trump in July, is projected to cut federal Medicaid and Supplemental Nutrition Assistance Program (SNAP)Â spending by $1 trillion over the next decade. Illinois alone could lose as much as $48 billion in federal health funding.
The biggest changes, including new work requirements for Medicaid recipients and tighter eligibility rules for Affordable Care Act (ACA) Medicaid expansion enrollees, are slated to kick in on January 1, 2027. More than 300,000 Illinoisans are expected to lose coverage as a result.
More than 70% of UChicago Medicineâs patients receiving inpatient care are insured by Medicaid or Medicare, making it one of the hospitals in Chicago serving the highest share of patients on government-funded health care.
When Pellis started his residency two and a half years ago, he recalls being struck by how nearly all the patients at UChicago Medicine had some form of coverage, even if only Medicaid.
But now, Pellis said, he sees about 10 uninsured patients per month â âway more frequently than Iâm used to.â
Nick Pradhan, a fellow resident at UChicago Medicine, is also watching the situation closely, particularly for patients who currently rely on Medicaid expansion and whose eligibility could evaporate under the new rules. One patient Pradhan has seen for years in his primary care clinic, a young adult who recently enrolled in Medicaid and who had been receiving gender-affirming care, including hormones, that have transformed their life, may soon lose their coverage.
âIâve seen them go from someone who was stressed, who had issues with mental health, to a young adult with a job and hopes and dreams for their career,â Pradhan said.
Under provisions in the bill, federal Medicaid dollars no longer cover gender-affirming care, including hormone therapy. (Last July, UChicago Medicine suspended gender-affirming care for minors under pressure from the federal government.)
Whether Pradhanâs patient will remain eligible for Medicaid at all after the tightening of income-based enrollment rules is something he doesnât yet know, but fears.
Across the South Side, hospital administrators are bracing for similar ripple effects of the law, even as the full dimensions of the cuts remain uncertain. At La Rabida Childrenâs Hospital, 6501 S. Promontory Dr., where about 90% of the hospitalâs roughly 9,000 patients rely on Medicaid, CEO Dr. Rolla Sweis said the hospital is expanding its walk-in clinic capacity to meet what she expects to be an uptick in patients entering the emergency departments of nearby childrenâs hospitals.
âWhen patients lose coverage, they tend to turn to the emergency departments for care,â she said. âWe try to ensure that we are supporting not only the community but the childrenâs hospitals around us.â
Patients 19 and older with complex conditions who age out of typical pediatric care will be at heightened risk of losing Medicaid coverage, Sweis said. A recent study by U. of C. researchers found that roughly 38% of young adults with complex medical conditions lost coverage at some point in the three years after turning 19.
Parents of medically complex children, many of whom serve as around-the-clock caregivers for kids on ventilators or feeding tubes, could also lose their own health coverage, compromising their ability to provide that care. Hands-on training for those caregivers may also be curtailed.
La Rabida is also anticipating impacts beyond direct coverage losses. A temporary pause in SNAP benefits, the federal food assistance program, led to a 143% increase in use of the hospitalâs food pantry in the last six months of 2025 compared with the same period in 2024, rising from 2,288 people served to more than 5,500. Hospital leaders said further SNAP cuts could push demand even higher.
âFood is medicine,â Sweis said, noting that many of the hospitalâs diabetic patients depend on reliable access to nutritious food.
So far, state legislative relief has been limited. Safety-net hospitals received some additional line-item funding in last springâs legislative session, but La Rabida was not among the recipients. While Illinois Governor J.B. Pritzker promised continued relief for Illinoisans with medical debt in his February state of the state address, he made no mention of sustaining access to health care for those at risk of losing it in what is expected to be a deeply uncertain budget year.
At Cook County Health, which operates Provident Hospital, 500 E. 51st St., in Bronzeville and serves one of the largest concentrations of Medicaid patients in the region, Chief Hospital Executive Donnica Austin-Cathey drew a comparison between the current moment and the era before the ACA. Before Medicaid expansion took full effect in 2014, she said, nearly half of all patients at Cook County facilities were uninsured. After expansion, that figure dropped by roughly half.
âWeâre continuing to watch whatâs happening, bracing for what the impact would be,â Austin-Cathey said. âThere could be longer waits for care, higher costs, sicker communities.â
More than 40% of Providentâs patients are insured by Medicaid, according to its state hospital report card.
In light of those potential strains, Austin-Cathey said Cook County Health is focused on scenario planning, monitoring emergency department capacity and working to keep patients visiting their primary care physicians rather than waiting until a crisis forces a hospital visit.
âWe certainly donât want to see people managing care through the emergency department,” she said. âWe know itâs an expensive way to manage care.â
Meanwhile, some physicians are channeling their anger over the Medicaid cuts into legislative advocacy. Both Pellis and Pradhan are members of Physicians for a National Health Program, an advocacy organization pushing for a single-payer health care system, similar to those in Canada and the United Kingdom.
Pellis is helping lead a state-level effort to explore âdeprivatizingâ Medicaid in Illinois â removing the private managed care organizations that currently act as middlemen between the state and Medicaid recipients, and having the state administer coverage directly. Connecticut pursued a similar approach and saved more than $4 billion over 13 years since the change took effect, according to the Connecticut Health Policy Project. A 2025 report from Physicians for a National Health Program estimated that a state as large as Illinois could save billions annually through such a move.
âEven Republicans who donât want to raise taxes might find this appealing, because the moneyâs just sitting there,â Pellis said. âNobody wants to balance the budget on the backs of sick people. If there are billions of dollars to be saved, I think the political appetite is there.â
For now, physicians like Pellis and Pradhan are devising workarounds, such as handwritten lab lists, emergency room contingency plans and calls to social workers, but they say those measures are not a long-term solution or a substitute for insurance coverage.
âThe system is designed to make it so much harder to do the right thing,â Pellis said. âAnd there are not enough doctors to go above and beyond for everyone.â
