Ngozi Ezike, MD (Host): Hello, everyone. It's me, Dr. Ngozi Ezike, and thank you for tuning into another episode of More Than Medicine. I am super, super excited to welcome today's guest. Not only is a personal friend of mine, but he's a respected healthcare leader and advocate. He's known for advancing collaboration and innovation across hospitals and health systems throughout the state of Illinois.

Please welcome President and CEO of the Illinois Health and Hospital Association, AJ Wilhemi. AJ, thank you so much for joining me. This is so great.

AJ Wilhemi: Yeah, I'm really excited about our time together today. Thanks for the invitation.

Host: Awesome. Awesome. So as we usually do, we like to get a little feel for our guests and understand a little bit about their journey. That's kind of grounding to get a peak of how people got to where they are. And you're interesting. You didn't begin your career in healthcare. You actually started in law and in public service. So, can you walk us through what kind of drew you into healthcare policy and advocacy?

AJ Wilhemi: Yeah, happy to. It's funny, you'll get a kick out of this. I was originally going to follow my dad and go into dentistry. And then, I realized you have to be good in math and science to get into dental school. So after my freshman year at Loyola, Chicago, I started taking courses that I really enjoyed, like English and speech, political science.

And during my junior year, I thought, "Okay, practicing law would be a good fit for my interests and my skillset," which definitely wasn't math and science. So, I enrolled at Chicago-Kent College of Law and graduated in the early '90s. And then, after law school, I decided to go back home, to my hometown of Joliet to practice law. And Dr. Ezike, about 10 years into my law practice, I was appointed to the state Senate to represent the Joliet area. And a few years later, about halfway through my seven years in the state senate, I left the law firm and joined a healthcare consulting firm, mere consultants at the time. Now, it's Advis. I had the pleasure of meeting and working with a young lawyer by the name of Bob Morgan, who's now an outstanding state rep. And I'd say it was about four years later, in late 2011, when I received a call from a search firm asking if I'd be interested in applying for the government relations job with the Illinois Hospital Association.

And I knew my political career was keeping me away from my family, especially on weekends. And I have pretty good experience working with IHA and knew it was a topnotch trade association. So, I was very interested in the GR job with IHA. I applied and the next thing I know, I'm meeting with the president and CEO at the time, Maryjane Wurth. She offered me the job a month later. And I started with IHA in February of 2012. And I got to say Maryjane was an incredible boss and mentor, still a dear friend. And I can't thank her enough for the opportunity she gave me back in 2012. And I also want to give a shout out to our former state comptroller, Dan Hynes, who gave my name to Roger Quick and his executive search firm. And if it weren't for Dan and Maryjane, I wouldn't be celebrating my 14-year anniversary with IHA next month. And I wouldn't be talking with you today, Dr. Ezike. So, it's been a great honor and a privilege to serve and represent Illinois Hospitals for these almost 14 years now.

Host: That's amazing. Congratulations on your 14 years and just thank you. I have seen and worked with you on both sides, both as the director of IDPH and now as a hospital leader. So, thank you so much for your advocacy. We really appreciate working with you. So, given that really wonderful background and being a member of the General Assembly, tell me how that specific experience helped shape your understanding of the connection between policy decisions in Springfield and health outcomes in the community.

AJ Wilhemi: It's a great question. And to be honest, I didn't lead on healthcare policy issues during my time in the state Senate. But I will say that serving on the judiciary committee, And then later being chair of that committee, that experience was helpful in terms of working through complex legislation, complex legal policies.

And I'll never forget just one example, I was chairing the committee hearing on the bill to abolish the death penalty in Illinois. And then, State Senator Kwame Raoul was the sponsor of that bill. And of course, he engaged with the committee and the committee chair and many stakeholders on that complex issue. I learned throughout my time in the Senate how it's so important to understand not only the words on the page, but the implications of these policy issues. So, in my time on the judiciary committee, while we didn't take up many healthcare issues, there is a corollary in terms of the complexity of legal policy with its many components and the complexity of healthcare policy and all of its components.

So, I also want to say that my time in healthcare consulting was very helpful. It really was valuable training ground to learn about healthcare policy, our healthcare delivery system, key reimbursement issues, all of which are quite complex. So, my time in the Senate, my time with the healthcare consulting firm, I think that was really good training ground for my opportunity at IHA.

Host: I love to mentor young people, and I'm always telling them that no experience is ever wasted. It's just you're building and building expertise that you don't know how you'll use it in the future, but it always comes together to benefit the older you with all that experience under your belt.

AJ Wilhemi: Yes.

Host: So, tell me, so you represent more than-- is it 211? More than 200 hospitals? I think it's maybe 210 now. I don't know-- across very different communities, right? We have critical access hospitals, the rural hospitals. We have academic medical centers. And we have public hospitals, government hospitals. And we have safety net hospitals, rehab hospitals, psych hospitals, a lot of different hospitals. I want to focus-- surprise, surprise-- on safety net hospitals. From your vantage point, why are safety net hospitals so critical to the overall state of health for Illinois?

AJ Wilhemi: There's no question that our safety net hospitals, like Sinai Chicago and your free hospitals. Our safety nets play a unique, I would say, and critical role really in serving their vulnerable communities. And when I think about our safety net hospitals, they care for a significant number of Medicaid beneficiaries, as you know, and also uninsured and underinsured individuals. They serve as critical access points for behavioral healthcare, trauma care, maternal healthcare, chronic disease management, and they care for people regardless of their ability to pay.

Also, I'd like to say that safety in hospitals like Mount Sinai and Holy Cross are deeply rooted in their communities. You know, I know Mount Sinai has been serving the west side of Chicago for over 100 years, and Holy Cross, I think, is going to be celebrating its centennial in a couple years. And that's not unique to your hospitals, right? Most safety hospitals have been in their communities for a hundred plus years. So they understand the social, economic and structural factors that really shape health outcomes, whether that's housing instability or food insecurity, violence. And they design care models and support structures that really reflect those realities.

One other key point I want to raise is most of our safety net hospitals are financially strained, and they've had to take a hard look at what services they can provide. They've had to look at reducing their workforce to make ends meet. And there's a ripple effect here that's felt across the entire healthcare continuum from emergency rooms to public health systems, as you certainly know, Dr. Ezike. So, we know many of our safety net hospitals are having difficult conversations internally about how they can continue to meet the needs of their communities. And many of them are involved in the healthcare transformation collaboratives that IHA supported a few years ago. And those collaboratives really involve the notion of partnerships. And you mentioned many of our members, we have a diverse constituency, safety net hospitals, academic medical centers are involved in those collaboratives along with FQHCs and other community organizations.

And really the goal is how to ensure access to the right care, you know, at the right time And in the right setting to achieve the best possible outcomes. So at the association, you know, we know that viable safety net hospitals are critically important for the communities they serve, and also for the entire healthcare ecosystem in Chicago and in vulnerable communities across the state. So, we're very fortunate to have outstanding leadership in our safety net hospital community and, certainly, that includes you, Dr. Ezike.

Host: Thank you for that. We are a special bump. We all need healthcare, and every community needs it. And so, I just thank you for lifting up that critical nature of the safety net hospital. So, given how critical they are, but also thinking about the changes that are happening in the federal healthcare policy, that's going to significantly impact, well, all hospitals across the country, all hospitals in Illinois, but particularly safety nets. So, what are the biggest threats that you are seeing from your perspective?

AJ Wilhemi: Yeah. As we think about our work with our membership, and you mentioned it, we have a diverse constituency of hospitals, we work very closely with our safety net hospitals on a number of key policy issues. And we have a safety net hospital constituency section. As you know, you're very engaged with that. I also have one-on-one conversations with our safety net hospital leaders, so we try to make sure that we're taking that feedback and building that feedback into our policy and advocacy the way we structure our priorities. And we want to make sure that we're meeting the needs of all of our hospitals. All of our hospitals are facing challenges, and of course, the unique challenges of our safety net hospitals.

And so, at the federal level, the One Big Beautiful Bill Act, which we can talk about today, and the trillion dollars in Medicaid cuts nationally over the next 10 years, we're going to see about $48 billion in lost federal matching funds over the next 10 years here in Illinois. So, we know that that's a significant threat at the federal level here at the state level. We've got to continue to maintain adequate funding under the Medicaid program. We've got to make sure we're doing everything we can to address workforce challenges. And I can get into some specifics about that. And then, of course, you know, 340B, I know that's very important to Sinai Chicago. And we have a piece of legislation at the state level to make sure that pharmacies can't restrict you on how many local pharmacies that you can use to disperse those 340B discounted drugs to your patients.

So, those are just a few of the key policy issues that we're working very collaboratively with our entire membership, but also with our safety net hospitals because we know the unique challenges that you face in caring for your vulnerable community. So, I hope that gives you a little bit of a flavor of some of those key threats and challenges that we see at the policy level.

Host: They're very real. We think about them every day. But you also mentioned some of the things that are happening. So, we can't be a moan and groan and gloom and doom type of people. We have to be thinking about what are the strategies that we can move forward with to actually make sure that we continue working closely with IHA to sustain care and, even more than sustain care, actually improve health outcomes and reduce inequities.

I can name lots of things that you personally with IHA have done on behalf of hospitals and especially safety nets. But tell us, take a minute to brag and wave your flag of some of the great things that you've done or doing and are looking to do with and for safety net hospitals.

AJ Wilhemi: Yeah, thank you for the question. And I'll tell you this. First and foremost, we've been really engaged with our safety and hospital community on finding ways to enhance Medicaid reimbursement. So, going back five or six years, we've been on this journey where-- I'll give you a couple examples: the safety net add-on payment, we took that from $57.50 up to $210. So, that was very important for our safety nets.

And then, we worked very collaboratively with the administration, the Pritzker administration, and we created this $50 million tiered add-on payment program in addition to the safety net add-on. We also looked at opportunities to enhance our hospital assessment program with safety net hospitals deriving about one-third of the net gain from our hospital assessment program to drive significant Medicaid funding for our safety net hospitals. So, that's one piece.

The other piece that we know is very important is state grants that many of our safety net hospitals really need to continue to fulfill their mission. And that's been part of our portfolio of advocacy priorities. And then, when you drill down, you know, look at what we've been able to do, and your voice in this has been very important in educating legislators about the flaws of certain policies like mandatory nurse staffing ratios, we have a statute in Illinois, nurse staffing by patient acuity, and that's the approach that our hospitals are taking and it's working. So, we don't need rigid ratios here in Illinois, like they did in California that had no benefit in terms of quality and outcomes.

To your point, I'd end on this, that we created a committee on health disparities in 2010-- again, you're very engaged with that-- to address opportunities for us as a hospital community to really drill down and identify opportunities to advance optimal health for all. And that's been really the charge of that group. And we've made strides, you know, to address some of the inequities that we know need to be addressed.

So, that's just a sampling, but it really does start with making sure our safe nets have the reimbursement they need, but then some of the other regulatory and key policy issues. I mentioned a few, and I would be remiss if I didn't mention how important our 340B legislation is, and I know again, you've been actively involved and there's a big rally to get the word out about the importance of our 340B legislation coming up this Sunday.

Host: Yeah. Again, I can't thank you or salute you and IHA enough for just being there for these safety nets without these tremendous strides, these tremendous initiatives that you got over the finish line, we know that many of our hospitals wouldn't be here today. So, we just thank you for this partnership, and we thank you for just really having a special eye also for the safety net and understanding how critical our survival is to the whole healthcare ecosystem.

So as we think about all the great work you're doing, and then we also look at the calendar and say, "Hey, midterms are around the corner," the politics of healthcare are actually more challenging than they've been in the past. So, how is this going to impact you? How is this going to impact IHA's advocacy and legislative agenda, both at the state level And the federal levels? You know, so what are your priorities and what do you think is going to happen?

AJ Wilhemi: There's no question that the politics around healthcare, they're always interesting and I would agree with you that they continue to become more and more challenging. And we know that the stakes are very high as we gear up for the 2026 midterm elections. This is a consequential midterm for many, many reasons, both at the federal and state level, but certainly at the federal level.

And one point I'd like to make about election year dynamics is that, you know, they have an impact on the legislative process. And let's just say that the focus for incumbents really does kind of shift to the political side and winning reelections.

So, we see more legislative activity during non-election years than in even numbered election years, but they're still going to do the people's work, pass the state budget and advance important legislation. And we certainly hope that they advance our 340B bill in the House of Representatives this spring session.

The other dynamic that elections really do draw attention to key issues that are top of mind to voters and in this climate, that certainly includes access to affordable healthcare. In fact, I think one member of our congressional delegation said in a recent interview that healthcare is on the ballot in the 2026 midterms. So, we're continuing to focus our attention on protecting access to care, addressing affordability, supporting hospitals and caregivers that, you know, patients in communities rely on. At the federal level, there's no question that we got to make sure policymakers understand the implications of the One Big Beautiful Bill Act and how funding reductions and coverage losses will directly impact patients and providers, especially in our urban centers and rural communities. So, we're going to be working closely with IHA on that strategy. And then, other key policy issues, such as Medicare funding, holding Medicare Advantage plans accountable, again, protecting the 340B program at the federal level.

At the state level, we'll continue working closely with lawmakers in Springfield, as well as the Governor's administration on our key advocacy priorities. At the top of that list is passing our 340B legislation, House Bill 2371. And as I said, the bill passed the Senate last May. And now, it's into the house ready for action, but we continue to face an aggressive, well-funded effort from the pharmaceutical industry that doesn't want this bill to pass. So, we're actively countering these efforts through our engagement with legislators. And our FQHC partners have been terrific in this effort. So in addition to 340B, you know, we want to continue to work to hold the Medicaid MCOs accountable. They like to engage in denials of services, denials of payment, and then workforce is a key priority.

You know, last year, we led the charge on legislation that would create the healthcare workforce task force. That task force took effect January 1st. And it's going to be charged with finding solutions to address workforce shortages, addressing licensure delays and workplace violence that occurs in our hospitals each and every day. So, the politics, that's some of our priorities. And we do expect, you know, a robust debate on healthcare policy in this midterm election year of 2026.

Host: I'll say, my friend, you have a lot of work ahead of you, but we're really grateful that you're taking all this on. And I know Sinai has directly benefited from most of all of your efforts. So, keep charging on. So, you have to tell me as you being the advocacy leader and doing all this great work, what would you say that people need to do to help the community? What does the community need to do to help protect and support the safety net care in today's political environment? Do you have any advice for us to really share with community in terms of what they can do?

AJ Wilhemi: Yeah I really think leaders such as yourself, clinicians that work at Mount Sinai and Holy Cross and Schwab, members of the community, the words that come to my mind are sustained engagement. We need individuals from our hospitals, leaders from our hospitals, and folks from the community to really engage in a very impactful way.

And I'd say that state-level advocacy is more important than ever. We know that lawmakers need to hear directly from members of the community as well as hospital leaders and clinical teams about the real life impact of their policy decisions. And the best way to advocate, and you do this so well, is to tell your story, right? Clearly and convincingly and with passion. Policy makers respond to stories and data about real-world impacts and how many patients would lose access to medications if we lost the 340B program or service lines that would have to be reduced if these Medicaid cuts under the Big Beautiful Bill Act go into effect, how many jobs are at-risk because of these pressures. And then, ultimately, what happens to communities when significant numbers of people lose their healthcare coverage? So, these stories really help counter misinformation that's out there. And they also underscore, you know, the programs like Medicaid and 340B. They're not abstract policy issues. They're really lifelines for hospitals, for providers, and most importantly for patients.

Host: Thank you so much. I will remember that sustained engagement and really telling the story. And I don't know if I got to share it with you, AJ, but I spent all almost seven months trying to find just the right words to tell the story of the safety net in a TEDxArlington Heights Talk. I don't know if you got to see it. You got to go see it if you haven't, but I think it is part of that storytelling and really getting people to understand what's at stake and how important this is. So, I'm going to ask you to share it with people as well after you look at it, because I think we've all got to get more people engaged and understand how the plight of the safety net hospital will affect every hospital, not just the safety net hospitals. And so, we all need to get behind this.

So as I try to wrap up, I'm trying to end with the interesting question, like if you could wave that magic wand and change maybe one thing policy-wise or culturally about how we think about healthcare, how we approach healthcare here. And I guess not just Illinois, but in the country, to make it more just and equitable, like what would that be or what would be at the top of your wishlist?

AJ Wilhemi: Yeah. And you and I have had this conversation right, about how do we make sure that we do everything we can from a policy and advocacy perspective to have just an equitable healthcare system. And I think it has to start with every resident of our country, certainly of our state, having access to affordable healthcare coverage. That leads to having access to primary care, to specialty services, behavioral healthcare, which we talk quite a bit about at the association. Access to prescription drugs, chronic disease management, all the services needed to result in each person being able to achieve their optimal health.

Now, we know there are many other components that need to be addressed, including social determinants of health, like food insecurity, housing insecurity, violence, employment opportunities. But at the end of the day, if each resident had access to affordable healthcare coverage and the full array of necessary healthcare and social services, I think we'd have healthier individuals, healthier families and, ultimately, healthier communities.

Host: Preach, preach. Amen. I appreciate that. Oh my gosh. Thank you so much. Again, thank you as the leader of Sinai and knowing specifically what you've done for Sinai and safety nets. And from my other role, I know how you've helped all hospitals. So, thank you for that challenging role that you fill to try to take care of everybody. You are a healthcare hero. And I'm really grateful to be partnered with you again in this role. And just thank you for your role in the state of Illinois. And thank you for joining me today. You are a very special guest. And I'm so honored that you made time to join us. Thank you for the incredible words that you shared here, your leadership, your advocacy, and your unwavering commitment to strengthening healthcare across Illinois and actually even beyond our state's borders. It's really making a difference in the lives of millions. So, we're so grateful for your voice, your vision, and all that you do to advance the health and wellbeing of our communities. Thank you again for being with us on More Than Medicine.