Since Medicaid was expanded in Louisiana under the Affordable Care Act last July, more than 408,000 Louisianans have gained access to medical care, according to Gov. John Bel Edwards. That’s just one of many big, positive numbers the Democratic governor is touting at a time when the future of the ACA is in doubt and funding—both at the federal and state levels—is in limbo.
Though champions of Medicaid expansion like the governor could cheer the failure of House Republicans to move an ACA repeal and replace plan forward in late March, there’s no question that significant changes to the act—and possible outright abolishment—are on the horizon. Meanwhile, supporters such as the Louisiana Association of Health Plans worry the program could take a funding hit in the legislative session that began on April 10.
“From a budget standpoint, that is going to be the most critical factor as we go into the next legislative session. … Because the governor and the Legislature said there will be no new taxes, the only way to balance the budget then is to offset with cuts or just find a way to do things differently,” says Jeff Drozda, CEO of LAHP, the state trade association for Louisiana’s health benefits industry.
With lawmakers facing an estimated $400 million budget shortfall for the fiscal year that begins on July 1, cuts are going to have to be made somewhere in the budget, and health care spending is always at risk. If Healthy Louisiana—as the state’s program for Medicaid and LaCHIP recipients is known (formerly called Bayou Health until it was rebranded by the Edwards administration about a year ago)—loses any funding, Drozda says a few areas will likely suffer.
“It would come in terms of services to the Healthy Louisiana recipients and as well as decreased incentive payments and quality payments to the physicians,” he says. “We’ve committed to the governor and to the health secretary that we want to be part of the solution, so we just hope that it does not have to come to cutting services or provider payments.”
In an effort to advocate for Healthy Louisiana and stave off cuts during the session, LAHP has launched an outreach effort highlighting the human and community impact it has in the state. The governor, meanwhile, is encouraging Louisianans to share personal stories about how their lives have been positively impacted by the Medicaid expansion via his website. The governor and state Department of Health also say $184 million has been saved by the Medicaid expansion—money that Edwards contends will help fund education, the TOPS college scholarship program and partner hospitals across the state.
Former state treasurer and Republican U.S. Sen. John Kennedy strongly disagrees. In fact, Kennedy penned an op-ed that he submitted to newspapers across the state in January, blaming Medicaid for everything from TOPS cuts to traffic jams in Baton Rouge.
Kennedy says Louisiana’s Medicaid costs have increased by 81% in less than 10 years, while the amount of state taxpayer dollars spent has increased 94%. He adds spending on the program is “just going to grow and grow and grow until we’re slashing schoolteachers’ salaries just to sustain Medicaid.”
“We’ve committed to the governor and to the health secretary that we want to be part of the solution, so we just hope that it does not have to come to cutting services or provider payments.” —Jeff Drozda, CEO, Louisiana Association of Health Plans
“Do you know what’s even worse? Medicaid isn’t achieving the results it should,” reads his op-ed. “Our people aren’t getting appreciably better as a result of all the money taxpayers are spending.”
Health Secretary Dr. Rebekah Gee issued a lengthy statement refuting virtually all of Kennedy’s claims, saying hospitals and other providers are benefitting by having fewer uninsured patients to treat.
“One hospital reported that before expansion they had more than 12,500 uninsured patients come through their ER,” Gee says in her statement. “Several months after expansion, this same hospital stated they had one month in which every one of their patients had some type of health coverage. Just as our program is allowing greater access to primary care, hospitals in Louisiana say they are seeing similar results.”
Roughly 35% of Louisiana’s population relies on the Medicaid program, on which the state is poised to spend about $11 billion on this budget year—about 69% of which comes from the federal government.
Five managed care organizations offer private health plans for Healthy Louisiana, providing health care coverage and services to more than 1.4 million recipients. The care is managed by the MCOs because the service prior to Bayou Health, called fee-for-service, was very costly to the state, and because the managed care model has led to better care for members, Drozda says.
“With fee-for-service, there were no quality measures, there were no outcome thresholds and there was a limit on how many times a recipient could see their primary care physician,” he says. “Under Healthy Louisiana, there is no limit on those physician visits, so not only does managed care help improve outcomes but it also saved the state dollars.”
While saving the state money is part of the overall goal of Healthy Louisiana, the program also aims to improve access and quality
as well.
“We want every dollar spent and every policy to reflect the improvement of health here in Louisiana, and to that end, make sure that all of our efforts are consistent with our mission, which is to create a healthier Louisiana overall,” says Andrew Tuozzolo, chief of staff at the Louisiana Department of Health.
A Gallup report released earlier this year shows Louisiana is among the top 10 states for reducing its uninsured rate over the last three years, thanks in large part to the Medicaid expansion under the ACA. The percentage of Louisianans who do not have health insurance was nearly cut in half, from 21.7% in 2013 to 12.5% in 2016.
“And that did not even take into account the entire enrollment of the expansion,” Tuozzolo says. “I think we’re going to end up having an even lower rate when they survey us again in the years to come. It will just continue to drop.”
Tuozzolo says the decrease in the state’s uninsured rate is particularly impressive considering it has come at a time when the state’s economy has been hurt by the continued downturn in the oil and gas industry.
“Even as some people are losing jobs, we are still decreasing the uninsured rate because of the Medicaid expansion,” he says.
Tuozzolo also points to recently released figures from the state that show more than 67,000 adults have received preventative health care or new patient services since the expansion, while about 1,400 have been diagnosed and treated for diabetes, and more than 3,600 for hypertension. Another 5,700 have patients have been screened for breast cancer due to the expansion, with 74% being diagnosed, while roughly 5,900 have received colon cancer screenings.
“These statistics are, in essence, the proof in the pudding that this is not just coverage,” says Tuozzolo. “These are services provided. These are cancers avoided. These are people who are getting preventative care measures that avoid not just the health conditions but also the costs. You have 60,000 primary care visits that wouldn’t have happened without the expansion.”
Dr. Dawn Vick, a pediatrician at Red Stick Pediatrics in Baton Rouge, says she did not see a huge difference from the expansion with her patients as it affected adults more than children. However, she has seen the impact the program has had on families.
“This should help promote a healthier home, which is good for everyone,” she says. “I believe that the Healthy Louisiana program has allowed a more free market approach to finding the best ways to meet the needs of the patients and the providers that take care of these patients. With multiple companies, both patients and providers have the freedom to find an insurance program that best meets their needs. The insurance companies have more flexibility to change policies, formularies and administrative support services than the single governmental payer system allowed.”
