Download - Healthcare in Louisiana & Medicaid Expansion
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Statewide Issues ConferenceFebruary 15th, 2014
Healthcare in Louisiana & Medicaid Expansion
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Laissez les bon temps rouler!
Louisiana has …Great food
Mardi Gras Football
Friendly peopleSportsman’s paradise
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Not everyone has equal accessto the good life here.
But that’s not the whole story.
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There is a darker side….
• 49th in cancer• 49th in obesity• 46th in diabetes• 48th in preventable hospitalizations• 47th in premature death• 49th in overall poor health outcomes
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Louisiana has the 3rd highest uninsured rate in the nation(behind only Texas and Nevada)
64,635 uninsured children719,470 uninsured adults785,105 total uninsuredCapacity crowd at tiger stadium.
X 9
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Uninsured rates are high across the entire State.
22% of adults in EBR parish are uninsured
82,000 adults uninsured in
metro BR area
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Why are so many Louisiana citizens
uninsured?
Estimated annual costof health insurance(family of four)
Let’s do the math …
$15,000 per year
$15,000 per yearSalary at minimum wage
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Louisiana has 2nd highest poverty rate in nation after Mississippi.
20% of Louisiana families earn below poverty level of $22,000 per year.
Many LA residents simply can’t afford private health insurance.
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Earnings & inflation have increased at about 3% per year
Healthcare costs have increased at about 14% per year
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… caused nearly 17,000 deaths among children between 1988-2005.
… causes 44,789 excess deaths annually in the US.
… caused 3,346 deaths of Louisiana residents aged 25-64 between 2005 and 2010.
… causes 13,000 deaths of people aged 55-64 every year. (Expected to exceed 30,000 by 2015.)
… is the THIRD leading cause of death among people aged 55-64 (behind only heart disease and cancer)
Lack of health insurance …
The stakes are high.
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Provide insurance to 1.21 million Louisiana residents.Coverage: 56% children in LA, 26% adults, 4% elderly, 19% people with disabilities.Medicaid provides nursing care for seniors & serves 217,000 people with disabilities.
How do poor and working residents get healthcare in LA?
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Medicaid in Louisiana predominantly serves pregnant
women, children and people with disabilities.
Very good health outcomes for those groups!
But what about other uninsured adults?
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LA Medicaid has among most narrow eligibility rules in the nation for adults:
Only covers adults earning below about
$2,700 per year (that’s not a typo)
(12% of the poverty level of $22,500)
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We have an opportunity to change this
Medicaid Expansion
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Encourages states to offer Medicaid to adults earning up to 138% of poverty line.
So what is Medicaid Expansion?
That’s up to about $30,000 per year for a family of four. And about $15,000 for single individual
Part of the Affordable Care Act.
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Supreme Court ruled Medicaid Expansion must be optional for states.
Governor Jindal has refused to accept Medicaid Expansion.
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What would Medicaid Expansion do for Louisiana?
Provide health insurance to about 400,000 LA residents.
(That’s more than 4 Tiger Stadiums of LA citizens)
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Louisiana Budget Project (2013).
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What ELSE would Medicaid Expansion do for Louisiana?
Bring $15.8 billion to the Louisiana economy over 10 years.
Create approximately 15,600 new jobs in 2016 alone.
“Louisiana’s Economy Will Benefit from Expanding Medicaid”, Families USA & Louisiana Consumer Healthcare Coalition (2013).
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Feds pay 90% of expansion costs after 10 years.
How much would Medicaid expansion cost Louisiana?
Every $1 in State funding brings $9 in federal funding.
Feds pay 100% of expansion costs for first 3 years.
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How much would Medicaid expansion cost Louisiana?
Max cost estimate (DHH): $1. 7 billion over 10 years.
Even using max estimate, cost would be only $350 per year to state for every
newly insured resident.
Legislative Fiscal Office: Medicaid Expansion would bring NET SAVINGS to State of about $400 million.
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44,000 currently insured residents in New Orleans will
likely lose their coverage.
400,000 LA residents would remain uninsured.
What are the consequences of NOT accepting Medicaid Expansion?
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LA hospitals lose out on hundreds of millions.
Louisiana would lose out on $15.8 billion in federal funding
What are the consequences of NOT accepting Medicaid Expansion?
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One more consequence: people will die.
New England Journal of Medicine (2012)
In the United States, 3 people die EVERY HOUR due to a lack of insurance.
4 to 5 people will die during this course of this
meeting.
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What’s Governor Jindal’s position?
Governor says he wants negotiate “flexibility” on 5 points:
1) “Eligibility process should be simple, accurate and fair”2) “States must be allowed to set reasonable premiums and copays”3) “Flexibility on eligibility levels and program design”4) “Streamline funding and waiver process & accountability tied to health outcomes”5) “Flexibility to prevent undermine of the private insurance market
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Other states are WINNING flexibilityArizona accepted Medicaid expansion, with a trigger to pull out if federal match ever went below 90%.
Arkansas won preliminary approval to use Medicaid expansion funding to subsidize families below 138% of poverty buying insurance through healthcare exchanges.
States have won approval to run expanded Medicaid through private managed care.
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BUT LOUISIANA IS NOT CONDUCTING NEGOTATIONS.
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Medicaid Expansion is not a panacea…
Low reimbursement rates for providers can lead to shortages (especially for specialists)
Limited choices for drugs and procedures.
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But it is the most significant thing our state can do now to improve
the health of our citizens.
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