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LA's expanded Medicaid enrollment swells as ACA future hangs in balance

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.

Now, however, the future of Obamacare in Louisiana and elsewhere is in question as President-elect Donald J. Trump prepares to take office and fulfill his campaign promise to repeal the healthcare reform law. Residents are encouraged to enroll in coverage; 2017 open enrollment remains in effect along with the state’s newly expanded Medicaid program. Those interested in learning more about how the Trump administration could impact access to health insurance now and in the future can read more here.

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 August 2016, there were 265,723 low-income Louisianans newly enrolled in 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, following Medicaid expansion, Louisiana’s average monthly Medicaid enrollment swelled 30 percent by August 2016.

More information about Louisiana’s Medicaid programs is available at

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 once again takes 48th in the 2015 evaluation, the same as it did last year and in 2009 when the rankings began.

The state ranked in the fourth quintile for four of five measures: Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity. It cracked into the third quintile for Access, however, with top-15 placement for its number of uninsured children (#13 with 5 percent) and percentage of at-risk adults without a routine doctor visit in the past two years (#7 with 10 percent).

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 small reduction in its uninsured population since the Affordable Care Act took effect.

Though Louisiana’s uninsured rate dropped from 21.7 percent in 2013 to 15.7 percent between 2013 and 2015, it remains among the nation’s highest and above the 11.7 percent national average.

For those who have purchased health insurance in Louisiana, the ACA has helped make coverage more affordable. Of those enrolled in 2016 Louisiana exchange plans, 92.6 percent were receiving subsidies.

Health plan rates, carriers for 2017

Louisianans can purchase health insurance from the state’s federally facilitated exchange as well as in the private market. Four carriers are offering exchange plans in Louisiana for 2017; they are listed along with their average approved rate increases:

  • Blue Cross Blue Shield of Louisiana: 41 percent
  • HMO Louisiana: Varied, ranging from 23.3 percent to 29.97 percent
  • Humana: 29.5 percent
  • Vantage Health Plan: 31.47 percent

Benchmark premiums for Louisiana increased by an average of 17 percent, which means larger subsidies will help eligible enrollees offset higher rates to some degree. 2017 open enrollment began November 1, 2016, and runs through January 31, 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.

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.

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.

Gov. Bobby Jindal, whose term ends in 2015, 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.

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.

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.

Stand-alone prescription drug plans are available to Medicare enrollees. About 43 percent of all Louisiana enrollees also chose Medicare Part D plans. The national percentage is 45.

Louisiana’s state-based reform legislation

Here’s what’s happening with healthcare reform in Louisiana legislatively:

  • There is still a push to expand Medicaid in Louisiana, and the state has incentive to do so by April 1, 2016, because members of the Louisiana Hospital Association have agreed to use hospital fees to cover the state’s matching funds starting in 2017.

Other state-level health reform legislation: