2018 enrollment update
- 32 parishes have a hurricane-related special enrollment period until Dec. 31.
- Humana exiting exchange at end of 2017; enrollees losing coverage get an SEP.
Residents in 32 parishes in Louisiana have until December 31, 2017 to enroll in coverage for 2018. Open enrollment ended December 15, but there’s a special enrollment period for people in areas that were hit by hurricanes in 2017, and 32 parishes of Louisiana were deemed eligible for the special enrollment period. People who sign up during the hurricane-related special enrollment period will have coverage effective January 1, 2018.
Humana is exiting the individual market in Louisiana at the end of 2017, and there’s a special enrollment period for Humana members that extends until March 1, 2018. For exchange enrollees with Humana coverage, the exchange picked a replacement plan if the member hadn’t picked a new plan by December 15, 2017. But there’s still a special enrollment period during which those members can pick a different plan instead.
In Louisiana, a historically red state with consistently low public health rankings and resistance of the Affordable Care Act, the demand for health insurance is strong. When the state expanded its Medicaid program in June 2016, residents rushed to enroll in such volume that extra workers were brought in to process applications.
Expanded Louisiana Medicaid/CHIP enrollment
Louisiana Medicaid expanded Medicaid in June 2016. Expanding Medicaid to cover individuals and families with incomes up to 138 percent of the federal poverty level is one of the ACA’s main strategies to reduce the uninsured rate. In 2015, there were 192,000 Louisianans in the Medicaid coverage gap, meaning they didn’t qualify for Medicaid or Obamacare subsidies to help make health insurance affordable.
Now, however, that has changed. As of December 2017, a year and a half after the state expanded Medicaid, there were 456,004 Louisiana residents enrolled in expanded Medicaid.
Louisiana’s average monthly Medicaid enrollment increased 3 percent from mid-2013 to June 2016 – among the smallest increases in the nation since the ACA took effect. However, in less than a year and a half following Medicaid expansion, Louisiana’s average monthly Medicaid enrollment increased by 42 percent (as of October 2017).
More information about Louisiana’s Medicaid programs is available at Louisiana.gov.
Louisiana health ratings
The Scorecard on State Health System Performance, produced by the Commonwealth Fund, ranks the states and the District of Columbia by overall health. Louisiana ranked 48th in the 2015 evaluation, and fell to 49th in 2017.
In the 2017 report the state ranked in the fourth quintile for all five measures: Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, Access, and Equity.
Visit the Louisiana scorecard to learn more about how Louisiana fared on each indicator.
In America’s Health Rankings 2015, Louisiana slid to 50th after holding 48th for the past two years. The state was in the bottom 10 percent for 21 of 33 core measures. Its strongest measure was disparity in health status by education level, for which the state ranked 4th.
For additional public health information, see Key Health Data About Louisiana. Parish-level data is available from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Has Obamacare helped Louisianans?
At the start of 2014, amid the first ACA open enrollment period, the Kaiser Family Foundation estimated that 866,000 Louisianans did not have health insurance. Through the ACA, about 298,000 of uninsured, nonelderly people in the state now qualify for tax credits to purchase health insurance through the marketplace.
As with other states that that didn’t implement a state-run marketplace or Medicaid expansion, Louisiana has seen a reduction in its uninsured population since the Affordable Care Act took effect.
Though Louisiana’s uninsured rate dropped from 16.6 percent in 2013 to 10.3 percent in 2016, it remains above the national average, which was 8.6 percent as of 2016.
For those who have purchased health insurance in Louisiana, the ACA has helped make coverage more affordable. Of those enrolled in 2017 Louisiana exchange plans, 90 percent were receiving subsidies. And Medicaid expansion has helped hundreds of thousands of low-income Louisiana residents obtain coverage and life-saving treatment: 456,000 people had enrolled in expanded Medicaid by December 2017, and nearly 154,000 of them had obtained preventive care under their new coverage.
Health plan rates, carriers for 2018
Louisianans can purchase health insurance from the state’s federally facilitated exchange as well as in the private market. Humana is exiting the individual market at the end of 2017, but three carriers are continuing to offer exchange plans in Louisiana for 2018, with the following average rate increases:
- Blue Cross Blue Shield of Louisiana: 35.45 percent for Blue Saver, and 31.1 percent for Blue Max
- HMO Louisiana: 14.9 percent
- Vantage Health Plan: 28.5 percent
Although these percentage rate increases are smaller than they were for 2017, the average rate increases are much larger than they would have been for 2018 if the Trump Administration hadn’t cut off funding for cost-sharing reductions. But ironically, the higher silver plan rates (to account for the cost of cost-sharing reductions) are resulting in much larger premium subsidies for 2018, and after-subsidy premiums are are lower in some cases than they were in 2017.
Louisiana enrollment in qualified health plans
Nearly 102,000 Louisiana residents signed up for a qualified health plan (QHP) through Louisiana’s federal exchange during 2014 open enrollment. Eighty-eight percent qualified for tax subsidies to reduce their premiums. A federal report released in June showed the average premium, after subsidies, for Louisiana residents was $83 a month.
By the end of 2016 open enrollment, the number of Louisiana exchange enrollees reached 214,148 – more than double 2014 enrollment. As of March 31, nearly 93 percent of Louisiana’s 184,403 effectuated enrollees had premium subsidies.
But Medicaid was expanded in Louisiana in mid-2016, resulting in many lower-income enrollees becoming eligible for Medicaid instead of premium subsidies. The result was much lower enrollment in the exchange for 2017, with 143,577 enrollees by the end of open enrollment.
Enrollment continues to decline fore 2018, however, with just 109,855 people enrolled as of December 23, 2017 (open enrollment ended December 15, but people in areas impacted by the hurricanes in 2017 have until December 31 to enroll). In terms of a percentage of 2017’s enrollment, Louisiana is by far the lowest in the country for 2018, reaching just 76 percent of last year’s enrollment total.
Louisiana and the Affordable Care Act
In the 2010 vote that established the Affordable Care Act, Sen. Mary Landrieu voted yes, while Sen. David Vitter voted no. Among Louisiana’s House delegation, just one of the state’s seven representatives favored healthcare reform. Louisiana’s Senate delegation is now entirely Republican — Bill Cassidy and John Kennedy, both of whom are opposed to the ACA. Cassidy in particular, played a pivotal role in 2017 in the GOP’s efforts to repeal the ACA. In the House of Representatives, there continues to be just one Democrat (Cedric Richmond), who supports the ACA.
At the state level, Louisiana is dominated by Republicans, and the ACA has not gained traction. While legislation to establish a state-run exchange was considered, it did not pass.
Former Gov. Bobby Jindal, whose term ended in January 2016, strongly opposed the Affordable Care Act. He returned a $1 million federal planning grant for exploring a state-run insurance marketplace, defaulted to the federally facilitated marketplace, and rejected Medicaid expansion. Four years after the ACA was signed into law, Jindal continued to call for repeal of the health reform law.
But Jindal was replaced in 2016 by John Bel Edwards, a Democrat who supports the ACA. One of Edwards’ first actions as governor was to expand Medicaid in Louisiana.
Does Louisiana have a high-risk pool?
The Louisiana Health Plan was created in 1992 in order to provide a coverage option for state residents who couldn’t get private plans in the individual market because of their medical histories.
But Obamacare’s guaranteed issue provision means that pre-existing conditions are now covered on all policies, and are no longer factored into the application process. As a result, the need for high-risk pools no longer exists the way it once did. The Louisiana Health Plan terminated all coverage on December 31, 2014, per the terms of House Bill 638 (passed in June, 2013). Members were able to transition to new ACA-compliant plans instead.
Other ACA reform provisions
The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program was established to promote market competition through nonprofit, consumer-run health insurance companies. Twenty-four CO-OPs received loans totaling $2.09 billion as of January 2014. See where CO-OPs were launched and where they ceased operations — only four are still offering coverage for 2018.
Louisiana Health Cooperative received a $65.8 million start-up loan. Louisiana Health Cooperative competed against Blue Cross and Blue Shield of Louisiana, Vantage Health Plan, and Humana during 2014 open enrollment, but struggled with its enrollment goals.
On July 24, 2015, Louisiana’s CO-OP announced it would continue to cover enrollees until the end of the year but would not sell plans in 2016.
Medicare in the state of Louisiana
In 2015, there were 798,159, about 17 percent of Louisiana’s population, enrolled in Medicare – a figure on par with the percentage of people enrolled in Medicare nationwide.
Louisiana Medicare spends about $10,754 per enrollee each year, which puts it among the three that spend $10,316 or more. In terms of overall annual spending, as of 2009, Louisiana ranked 22nd with $7.9 billion.
Louisianans can enroll in Medicare Advantage plans instead of Original Medicare if they want additional benefits. About 30 percent of Louisiana’s Medicare recipients selected a Medicare Advantage plan in 2015; nationally, 31 percent of beneficiaries do so.
Louisiana’s state-based reform legislation
Here’s what’s happening with healthcare reform in Louisiana legislatively: