Trump Medicaid cuts threaten ‘the little hospital that could’ on Chicago’s Far South Side

As Dr. Khurram Khan walks around the intensive care unit of Roseland Community Hospital, he sees a list of things to improve.

A handful of nurses work surrounded by 10 beds, each closed off with a curtain. But there are no doors or individual bathrooms for each patient. There are no windows either. The unit was at the center of the hospital’s response to the COVID-19 crisis and now Khan, a 49-year-old internist, has a vision for something better.

“If we can ever get the financing, the plan is to have a new 15-bed ICU on top of our current [emergency room] because this is really antiquated,” says Khan, who juggles roles as a physician and administrator at the Far South Side hospital.

Roseland Community Hospital, open since 1924, describes itself as,“the little hospital that could.” But it’s expected to face one of its biggest challenges yet in the coming years as President Donald Trump’s “Big Beautiful Bill” makes significant changes to Medicaid, the federal and state health insurance program for low-income individuals. A “firing squad” is how Tim Egan, the hospital’s president, describes the expected cuts. A majority of Roseland patients are on Medicaid, according to the Illinois Hospital Report Card.

In Illinois, as many as 330,000 people are expected to lose Medicaid coverage over the next decade as work requirements in the bill passed this summer are implemented for the first time, and enrollees will have to prove eligibility more frequently. Hospitals will lose revenue because people without health insurance will seek medical care less frequently, says Fred Blavin, a senior fellow at the Urban Institute, a Washington, D.C.-based research organization. And when they do, the care the patient needs at a hospital will likely be uncompensated.

As Khan walks around the 134-bed hospital, he says the expected funding cuts will mean the hospital will make do with fewer support staff, like certified nurse assistants and specialists who help treat wounds. They are also already thinking of how to save money by reducing medical equipment like ventilators that were in demand during the peak of the coronavirus pandemic.

During a recent visit through the halls of the five-story, red-brick hospital, most of the patients Khan pointed out were on Medicaid or Medicare, the public health insurance program for seniors. All the patients were Black.

Because of its high Medicaid numbers, it’s considered a safety net hospital, one of 20 in Chicago that are particularly vulnerable to the cuts expected to be coming to Medicaid. It doesn’t turn anyone away and provides health care for the Far South Side community of about 36,700 residents, according to a data analysis from Chicago’s Metropolitan Agency for Planning. A majority of residents in this part of the city identify as Black.

About 10% of residents in Roseland lack health insurance. And about a quarter have a household income below $25,000.

As a result, many people walking into Roseland’s emergency room often use it for primary and urgent care, Khan says. Doctors see patients who are often in a more advanced stage of a disease because they weren’t able to seek medical care sooner.

And even for people who aren’t patients of Roseland, area doctors often refer people to the hospital for tests, including mammograms, ultrasounds and CAT scans.

A community hub

“This is like a hub,” says Khan, who wears a long light blue medical coat. “There’s not a lot of access to health care, so pretty much it would void out a big portion of the access that patients have to primary health care, but also when they’re critically ill.”

Fluorescent lights illuminate the muted hospital hallways. In a mostly empty part of the hospital’s third floor, the chemical smell of dialysate — a fluid used for dialysis — fills one of the beige-colored hospital rooms. There’s usually seven to eight patients a day who undergo dialysis, but Khan says this is one service that could soon be eliminated as a way to save money. It would impact emergency patients and other facilities.

“The ambulance would just have to take them further and further and further, and it just increases the burden on the further hospitals,” he says. “But furthermore, it’s more dangerous the longer the patient waits to get dialysis — even like minutes, hours matter.”

Down a white and beige hallway from the dialysis room, Khan and Yvonne Springfield, a registered nurse, check in on two patients in the acute care unit. The two elderly patients share a small room cooled with a window air conditioning unit. This part of the hospital is mostly quiet except for Khan’s voice as he talks to a patient.

Because Roseland doesn’t have a specialized ear, nose and throat department, Khan is trying to move one of the patients to another hospital that offers the care they need. He’s had no luck so far — nearby Christ Medical Center turned them down.

In the meantime, Springfield places the patient’s feet in a device to prevent blood clots in the legs.

As Springfield walks over to the patient, the person groans as a nurse repositions the woman to ease the pressure she says she is feeling.

“Feeling a little better?” Springfield asks.

For nurses like Springfield, the work load is only expected to grow because of funding cuts. While the hospital has nursing requirements it must maintain, it can make cuts to other support staff like certified nursing assistants. Nurses would have to step in to help.

“The nurse [would have] … more responsibilities, like she would do wound care, she’s doing like what CNAs would do — helping her out and positioning patients,” Khan says.

Roseland already struggles financially

The hospital is already in a financial hole related to the extra costs of paying for nurses during the coronavirus pandemic. Khan estimates that the hospital owes millions to nursing staffing agencies.

“We’re just falling behind because of the lack of funding as it is,” he says. “But imagine, like, if there’s another 50% cut at the federal level . … Any cuts, at this point, as it is, for safety net hospitals would result in complete closure of services.”

Across the state, 3.4 million residents rely on Medicaid and thousands are expected to be pushed out of the program as changes roll out, according to Gov. JB Pritzker’s office. Those changes are bound to affect Roseland Community Hospital.

In 2023, between 58% and 65% of in-patients and out-patients at Roseland Community Hospital were on Medicaid, according to the most recent figures from the Illinois Hospital Report Card.

Safety net hospitals could also lose funding because of the loss of revenue from provider taxes, which states use to finance Medicaid. Trump’s “Big Beautiful Bill” placed a moratorium on increasing these taxes, and an analysis by KFF found that Illinois was one of 22 states that would have to reduce its provider taxes.

But the Illinois Health and Hospital Association is holding out hope that those cuts may be staved off until 2028 if state legislation moves forward that increases hospitals’ provider taxes, which would provide a funding boost for safety net hospitals. For Roseland, that would mean a $10 million funding infusion, says David Gross, senior vice president of government relations and communications for the association.

“This plan would be a lifeline for safety net hospitals in Chicago,” Gross says.

But the plan is pending approval from the Centers for Medicare and Medicaid, a federal entity.

ER expected to only grow busier

On the first floor, the 19-bed emergency department, brightly lit and bustling, is the part of the hospital where people who lose Medicaid will likely end up. Because of state and federal regulations, the hospital has to treat all patients and can’t turn someone away because they can’t pay, Khan says.

“I have a patient everywhere,” Khan says, as he checks in on a woman who came into the emergency room with shortness of breath and high blood pressure. As medical machines beep in the background, Khan explains the woman, who he believes is on Medicaid, was diagnosed with pneumonia and will likely remain hospitalized for five days.

As a technician walks alongside Khan on the first floor, he points out how updating X-ray equipment will also be an issue with less funding.

“Every ounce of the hospital will be affected," he says. “There’s not an area of the hospital that will be not affected by it.”