Many factors affect the overall health status of a state’s residents: the incidence of various diseases, smoking and alcohol consumption, immunization rates, uninsured rates, and many more. Unfortunately, many of these factors are negatives for Louisiana, making for consistently low public health rankings.
Follow the links below to dig into the details of Louisiana’s health scores and read how the Affordable Care Act could offer a path to improvement.
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 is at 48th in the 2014 evaluation, unchanged from 2009. See how Louisiana ranked on the individual health measures that make up the overall score.
Louisiana also ranked 48th in the 2013 America’s Health Rankings, a one-spot improvement from 2012. Louisiana’s health challenges are many: high rates of physical inactivity, obesity, diabetes, children living in poverty, infant mortality, and low birthweight babies.
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.
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 health care 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 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.
Has the ACA help Louisianans?
According to the Kaiser Family Foundation, about 866,000 people in Louisiana do 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.
Louisiana’s uninsured rate dropped from 21.7 percent in 2013 to 18.4 percent after the 2014 open enrollment period. The 3.3 percentage point drop is higher than the average 2.2 point decline seen among states that didn’t implemented a state-run marketplace or Medicaid expansion or that implemented only one of those measures.
Louisiana enrollment in QHPs
Nearly 102,000 Louisiana residents signed up for a qualified health plan (QHP) 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.
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. Louisiana did not adopt the expanded eligibility criteria, a decision that excludes 364,000 state residents from the program according to the Kaiser Family Foundation.
Under current criteria, non-disabled Louisiana adults without dependent children are not eligible for Medicaid no matter how little they earn. Those with dependent children are eligible only if their household income is under 24 percent of the federal poverty level. More than 14,000 state residents qualified for Medicaid or the Children’s Health Insurance Program (CHIP) under the state’s existing eligibility criteria during the 2014 open enrollment period.
Learn about Louisiana’s Medicaid programs.
Does Louisiana have a high-risk pool?
Medical underwriting was a standard procedure prior to 2014, when the the ACA reformed the individual health insurance market. In nearly all states – including Louisiana – pre-existing conditions could result in applications being rejected, or in applicants being able to purchase only plans that excluded their medical conditions or charged significantly higher premiums to provide comprehensive coverage.
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 the ACA’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.
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.
Louisiana’s state-based reform legislation
Here’s what’s happening with healthcare reform in Louisiana legislatively: