The Cook County Health and Hospitals System is looking to get approval on adding thousands of uninsured patients to Medicaid almost two years before the federal health care reform law calls for such a move. A Cook County Health System executive told Crain's that the application is part of their "life or death" list for achieving financial security. The health system treats some 100,000 uninsured patients, although not all of them are eligible for Medicare.

Nonetheless, adding eligible uninsured patients to the Medicaid rolls could not only reduce the $550 million in free care the health system provides, but could also reduce the millions of dollars taxpayers provide to help subsidize the care, which is slated to reach $252 million in 2012.

The Obama administration has already approved early Medicaid starts in four states, according to the Crain's report, and an approval for the Cook County health system would provide a leg up in helping them keep the uninsured patients they have been serving for so long.

“When 2014 comes, almost all the people that we would treat would have Medicaid available to them, and unless we perform with a very good patient focus, we’ll end up with a fairly sizable operation with even greater need for a subsidy because we won’t have offsetting revenues coming from regular Medicaid patients,” Warren Batts, a Cook County health system chairman, told Crain's.

The U.S. Department of Health and Human Services will make the final determination on the Cook County health system's request.