Health Care in New Orleans Before and After Hurricane Katrina Adele Shartzer, MPH Policy Analyst, Kaiser Commission on

1. Figure 1 Health Care in New Orleans Before and After Hurricane Katrina Adele Shartzer, MPH Policy Analyst, Kaiser Commission on Medicaid and the Uninsured for kaiserEDU

2. Figure 2 Tutorial Overview • Pre-Katrina Louisiana • Devastation after Hurricane Katrina • Impact on Health Care in New Orleans • Progress and Challenges

3. Figure 3 Key Characteristics of Pre-Katrina Louisiana Compared to the U.S., 2004-2005 32% 26% 23% 21% 17% 12% 9% 7% SOURCE: www.statehealthfacts.org. Data is from the Census Bureau’s March 2005 and 2006 Current Beneficiary Survey.

4. Figure 4 Health Care Access in Pre-Katrina New Orleans • High percentage uninsured • Low rates of employer sponsored insurance • Restricted Medicaid eligibility for adults • State and federal funding to support care to the uninsured concentrated in the LSU-operated safety-net hospital system • Care delivery characterized by a “two-tier” system based on insurance coverage • Uninsured: primarily served by safety-net hospitals (Medical Center of Louisiana at New Orleans/MCLNO); limited access to physicians’ offices and other community clinics • Insured: primarily used other hospitals; broader access to care in community • Specialty services offered to uninsured through MCLNO (aka Charity) as a teaching hospital

5. 40.0 Figure 5 Devastation After Katrina 1,464 900,000 158,353 (~64%) 73,214 165,100 (~26%) 16,000 40 22 million tons Lives lost People displaced Orleans household population Occupied FEMA travel trailers Jobs lost* Businesses flooded Schools destroyed Debris generated Data represents peak impact of Katrina. SOURCE: Louisiana Recovery Authority, Hurricane Katrina Anniversary Data for Louisiana, August 2006, and Brookings/Greater New Orleans Community Data Center, “The New Orleans Index,” January 2008.

6. Figure 6 New Orleans East Gentilly Lakeview Lower 9th Ward French Quarter Lake Pontchartrain Orleans Parish Jefferson Parish Algiers (Orleans) St. Bernard Parish Jefferson Parish Plaquemines Parish

7. Figure 7 Health Care for the Poor in New Orleans in the Aftermath of Katrina • Closure of most acute care hospitals, including Charity Hospital (MCLNO) • Loss of Level 1 Trauma, mental health beds, other specialty care • Open hospitals operating at reduced capacity but almost full • Open safety-net clinics decreased from 90 to 19 • Doctors and other health workforce relocated • Pharmacies closed, including Charity’s low-cost pharmacy • Half of nursing homes closed

8. Figure 8 Insights from Survivors After the Storm • The stress of situation was exhausting, and for some basic needs like housing and food were not being met adequately • Many had unmet mental health needs • Many who had chronic conditions experienced gaps in their prescription drugs in the weeks and months following Katrina • They were disconnected from usual sources of care, and finding new providers was very difficult • When enrollment was successful, Medicaid coverage was helpful • It was hard to maintain healthy behaviors while living in hotels and trailers, particularly in very cramped conditions SOURCE: Voices of the Storm: Health Experiences for Low-Income Katrina Survivors, KCMU publication #7538, August 2006

9. Figure 9 Profile of Adults in the Greater New Orleans Area and Orleans Parish One Year After the Storm 54% 54% 53% 45% 43% 43% 35% 30% 16% 9% Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area (conducted September 12 – November 13, 2006)

10. Figure 10 Satisfaction With Quality of Life In general, can you tell me how satisfied or dissatisfied you are with your overall quality of life? And what about before Hurricane Katrina? Before Katrina Percent “very satisfied” with overall quality of life: One Year Later 65% 65% 63% 38% 34% 25% Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area (conducted September 12 – November 13, 2006)

11. Figure 11 Portrait of Problems Faced by Greater New Orleans Residents Percent who reported having a problem in each of the following areas: 27% have no usual place of care; 25% of adults uninsured Health care coverage and access problems 49% Physical health challenges 43% 13% said job doesn’t pay enough to cover basic expenses 27% No job or inadequate wages Mental health challenges 18% 9% of those with children said their child didn’t get needed health care Child in home troubled or not getting needed care 11% PROBLEMS IN AT LEAST 1 AREA 77% PROBLEMS IN 3 OR MORE AREAS 19% Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area (conducted September 12 – November 13, 2006)

12. Figure 12 Usual Source of Care, Insured vs. Uninsured Respondents Insured Respondents Uninsured Respondents Other Don’t Know/ Refused 2% Don’t Know/ Refused 3% 13% Doctor’s Office Doctor’s Office 10% No Usual Source of Care other than the ER No Usual Source of Care other than the ER 55% 12% Hospital Clinic 19% 54% 5% Hospital Clinic 9% 18% Neighborhood Clinic Neighborhood Clinic Total Adults with No USOC other than the ER=27% Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area(conducted September 12 – November 13, 2006)

13. Figure 13 Health Care Utilization in Past 6 Months, Uninsured vs. Insured Adults in the New Orleans Area 55% 49% 46% 29% 25% 25% 23% 19% 15% 14% 14% 13% Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area(conducted September 12 – November 13, 2006)

14. Figure 14 Progress and Challenges • University Hospital reopened November 2006, other hospitals also open • Plans to build a teaching hospital to replace VA and Charity, open in 2012 • Restoring hospital capacity • Developing community clinics • Recruitment and retention of health professionals • Increasing mental health capacity to meet population needs • Capacity improved; however, considerable unmet need remains • Health coverage expansions • New clinics in response to need • $100 million federal grant to support access to primary care • Incentive grants to recruit physicians and other workforce • Medical education • Plan for reform developed; some elements stalled by negotiations between stakeholders and transition in administration • LaCHIP expansion for children

15. Figure 15 Additional Resources • Kaiser Family Foundation http://www.kff.org/katrina • Greater New Orleans Community Data Center www.gnocdc.org • Louisiana Department of Health and Hospitals www.dhh.louisiana.gov • Louisiana Public Health Institute www.lphi.org • CMS Katrina Waivers http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/07_KatrinaWaivers.asp • HHS Hurricane Katrina Information http://www.hhs.gov/disasters/emergency/naturaldisasters/hurricanes/katrina/index.html