On his second day in office, Louisiana’s new Democratic Gov. John Bel Edwards undermined years of Republican resolve by signing an executive order to expand Medicaid, as called for under the Affordable Care Act. If executed successfully, nearly 300,000 uninsured adults could gain coverage in addition to 224,000 adults enrolled in private insurance like Blue Cross and Blue Shield of Louisiana or UnitedHealth Group, the state’s two largest commercial carriers.
Supporters see Medicaid expansion as a long overdue strategy to improve Louisiana’s consistently poor health rankings and to significantly reduce the number of uninsured residents. The Louisiana Hospital Association released a statement applauding Gov. Edwards for signing the executive order, citing improved access to care, limited costs for families with private insurance, and greater stability in the state budget as likely outcomes.
Opponents, championed by former governor, Republican Bobby Jindal, cite instead the billions of dollars of taxpayers’ money the expansion could cause over the course of a decade. Starting next year, Medicaid expansion states will shoulder up to 10 percent of the cost of the program, which for three years, from 2013 through the end of this year, has been funded in full by the federal government.
Louisiana may get a reprieve from shouldering these costs if Congress passes President Obama’s recent legislative proposal to extend three years of full federal funding to non-expansion states. The legislation, due a vote by Congress in February, is a bold attempt to expand coverage to hundreds of thousands of working-class Americans across the country before Obama leaves office.
If the proposal does not go through, Louisiana already has a financing plan in place, one passed by state lawmakers in mid-2015 that will pool hospitals’ money to attract additional federal Medicaid money. Regardless of criticisms, Gov. Edwards hopes to have Medicaid cards in the hands of eligible recipients by July 01, 2016.
Effects of Medicaid expansion will be felt throughout Louisiana. On the payer side, Centene’s Louisiana Healthcare Connections and UnitedHealth Group stand to gain thousands of additional enrollees, along with Louisiana’s other three managed Medicaid carriers in the fully capitated Bayou Health program, including Aetna, Amerigroup, and AmeriHealth.
Patients, meanwhile, may struggle with access to care in the short term. Providers of all types are in short supply, and unlike other Southeastern markets, the convenient care industry lags. As it stands now, formerly uninsured patients may need to wait months to book their first appointments, and some independent physicians may at last turn to hospital employment for additional administrative and financial support. Moving forward, telemedicine, retail clinics, and urgent care centers may be increasingly important components of care delivery in the state. Population health management like ACOs, spearheaded by Ochsner Health System, will also become more important in handling larger pools of patients.
Health systems and hospitals, overall, are well-positioned to benefit from expansion. The expansion could alleviate some of the pressures put on Baton Rouge’s overflowing emergency rooms after the closure of acute care hospital Earl K. Long in 2013, followed by the collapse of the Baton Rouge General Mid City emergency room in 2015. Both of these facilities shuttered as a result of former Gov. Bobby Jindal’s privatization of state hospitals in 2013. Previously uninsured residents will no longer need to visit these emergency facilities for primary care services, so emergency rooms may experience both a decrease in uncompensated care and a decrease in utilization. Non-emergency inpatient stays, on the other hand, are likely to increase, which will solidify the importance of facilities like New Orleans’ $1.1 billion University Medical Center, which opened in August 2015 and is three times the size of its predecessor, Interim LSU Hospital.
Ultimately, the decision to expand Medicaid foreshadows sudden, affordable access to primary and specialty care for hundreds of thousands of previously uninsured residents, which could in turn lead to improved management of chronic disease and dispensing of prescription drugs for patients suffering from previously undiagnosed conditions. Louisiana is ranked as the least healthy state in the entire nation, and supporters of Gov. Edwards’ plan hope improved access to care will not only help shed that title, but pounds, too.
Louisiana’s expansion comes at the same time that Republican Gov. Nathan Deal in Georgia reiterated his opposition. Louisiana is now the 31st state to expand the Medicaid program under the Affordable Care Act.