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. Furthermore, the state’s lawmakers have a history of resisting the Affordable Care Act; however, some continue to push for Medicaid expansion.
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 takes 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 2014 America’s Health Rankings, consistent with 2013. A high percentage of people who lack health insurance is one factor that pulls Louisiana’s ranking down. The two-year average used in this rating showed that 16.7 percent of the population did not have access to health insurance in the private marketplace, through an employer or from the government. Other challenges included high rates of infectious disease, low birthweight and preventable hospitalizations. The state’s strengths include a low incidence of pertussis, a small disparity in health status by educational attainment and high immunization coverage.
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 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.
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.
Louisiana’s uninsured rate dropped from 21.7 percent in 2013 to 17.2 percent after the 2014 open enrollment period. The 4.5 percentage point drop is higher than the average 2.7-point decline seen among states that didn’t implement a state-run marketplace or Medicaid expansion or that implemented only one of those measures.
By mid-2015, Louisiana’s percentage of uninsured had decreased to 16.3 percent – that’s a 5.4 percentage point drop from 2013 to 2015. The average decline among the other 28 states that did not implement a state-run marketplace or Medicaid expansion or only implemented on of those measures was 5.3 percentage points.
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.
At the end of 2015 open enrollment, 186,277 people had enrolled in coverage through Louisiana’s exchange. By the end of June, some of them had dropped coverage for one reason or another, which brought the total down to 141,740. Of these remaining enrollees, 90.7 percent had a plan with an advanced premium tax credit and 57.9 percent received cost-sharing reductions.
When 2016 open enrollment begins, Louisiana consumers will notice a few carriers have left the marketplace. Louisiana Health Cooperative, an ACA-created CO-OP, announced on July 24, 2015, that it would cease operations at year-end. Likewise, Assurant announced this year that it would exit the individual market nationwide after this year. As such, neither company will participate in 2016 open enrollment.
Louisiana Medicaid/CHIP enrollment
Louisiana Medicaid has not been expanded. 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’s decision not adopt the expanded eligibility criteria excludes 364,000 state residents from the program, according to the Kaiser Family Foundation.
In 2015, there were 192,000 Louisianans in the Medicaid coverage gap, meaning they don’t qualify for Medicaid or Obamacare subsidies to help make health insurance affordable. Nonetheless, Louisiana’s average monthly Medicaid enrollment increased 5 percent from mid-2013 to mid-2015 – among the smallest increases in the nation.
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 information about Louisiana’s Medicaid programs is available at Louisiana.gov.
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.
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.
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.
Louisiana’s gubernatorial election will take place this fall, and three of the four candidates say they will seek Medicaid expansion.
Medicare in the state of Louisiana
In 2015, there were 787,036 people, 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 $11,699 per enrollee each year, which puts it among the 20 states that spend $10,000 or more. In terms of overall annual spending, Louisiana ranks 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, 32 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 also 43.