Healthcare in Louisiana & Medicaid Expansion

1. Healthcare in Louisiana & Medicaid Expansion Statewide Issues Conference February 15th, 2014

2. Laissez les bon temps rouler! Louisiana has … Great food Mardi Gras Football Friendly people Sportsman’s paradise

3. But that’s not the whole story. Not everyone has equal access to the good life here.

4. There is a darker side…. • 49th in cancer • 49th in obesity • 46th in diabetes • 48th in preventable hospitalizations • 47th in premature death • 49th in overall poor health outcomes

5. Louisiana has the 3rd highest uninsured rate in the nation (behind only Texas and Nevada) 64,635 uninsured children 719,470 uninsured adults 785,105 total uninsured Capacity crowd at tiger stadium. X 9

6. Uninsured rates are high across the entire State. 22% of adults in EBR parish are uninsured 82,000 adults uninsured in metro BR area

7. Why are so many Louisiana citizens uninsured? Estimated annual cost of health insurance (family of four) Let’s do the math … $15,000 per year $15,000 per year Salary at minimum wage

8. 20% of Louisiana families earn below poverty level of $22,000 per year. Louisiana has 2nd highest poverty rate in nation after Mississippi. Many LA residents simply can’t afford private health insurance.

9. Healthcare costs have increased at about 14% per year Earnings & inflation have increased at about 3% per year

10. The stakes are high. Lack of health insurance … … causes 44,789 excess deaths annually in the US. … caused nearly 17,000 deaths among children between 1988-2005. … causes 13,000 deaths of people aged 55-64 every year. (Expected to exceed 30,000 by 2015.) … is the THIRD leading cause of death among people aged 55-64 (behind only heart disease and cancer) … caused 3,346 deaths of Louisiana residents aged 25-64 between 2005 and 2010.

11. How do poor and working residents get healthcare in LA? Provide insurance to 1.21 million Louisiana residents. Coverage: 56% children in LA, 26% adults, 4% elderly, 19% people with disabilities. Medicaid provides nursing care for seniors & serves 217,000 people with disabilities.

12. Medicaid in Louisiana predominantly serves pregnant women, children and people with disabilities. Very good health outcomes for those groups! But what about other uninsured adults?

13. LA Medicaid has among most narrow eligibility rules in the nation for adults: • Only covers adults earning below about • $2,700 per year(that’s not a typo) • (12% of the poverty level of $22,500)

14. We have an opportunity to change this Medicaid Expansion

15. So what is Medicaid Expansion? • Part of the Affordable Care Act. • Encourages states to offer Medicaid to adults earning up to 138% of poverty line. • That’s up to about $30,000 per year for a family of four. • And about $15,000 for single individual

16. Supreme Court ruled Medicaid Expansion must be optional for states. Governor Jindal has refused to accept Medicaid Expansion.

17. What would Medicaid Expansion do for Louisiana? • Provide health insurance to about 400,000 LA residents. • (That’s more than 4 Tiger Stadiums of LA citizens)

18. Louisiana Budget Project (2013).

19. What ELSE would Medicaid Expansion do for Louisiana? Bring $15.8 billion to the Louisiana economy over 10 years. Create approximately 15,600 new jobs in 2016 alone. “Louisiana’s Economy Will Benefit from Expanding Medicaid”, Families USA & Louisiana Consumer Healthcare Coalition (2013).

20. How much would Medicaid expansion cost Louisiana? • Feds pay 100% of expansion costs for first 3 years. • Feds pay 90% of expansion costs after 10 years. • Every $1 in State funding brings $9 in federal funding.

21. How much would Medicaid expansion cost Louisiana? • Legislative Fiscal Office: Medicaid Expansion would bring NET SAVINGS to State of about $400 million. • Max cost estimate (DHH): • $1. 7 billion over 10 years. • Even using max estimate, cost would be only $350 per year to state for every newly insured resident.

22. What are the consequences of NOT accepting Medicaid Expansion? • 400,000 LA residents would remain uninsured. • 44,000 currently insured residents in New Orleans will likely lose their coverage.

23. What are the consequences of NOT accepting Medicaid Expansion? • Louisiana would lose out on $15.8 billion in federal funding • LA hospitals lose out on hundreds of millions.

24. One more consequence: people will die. In the United States, 3 people die EVERY HOUR due to a lack of insurance. 4 to 5 people will die during this course of this meeting. New England Journal of Medicine (2012)

25. Governor says he wants negotiate “flexibility” on 5 points: 1) “Eligibility process should be simple, accurate and fair” 2) “States must be allowed to set reasonable premiums and copays” 3) “Flexibility on eligibility levels and program design” 4) “Streamline funding and waiver process & accountability tied to health outcomes” 5) “Flexibility to prevent undermine of the private insurance market What’s Governor Jindal’s position?

26. Arizona accepted Medicaid expansion, with a trigger to pull out if federal match ever went below 90%. • Arkansas won preliminary approval to use Medicaid expansion funding to subsidize families below 138% of poverty buying insurance through healthcare exchanges. States have won approval to run expanded Medicaid through private managed care. Other states are WINNING flexibility

27. BUT LOUISIANA IS NOT CONDUCTING NEGOTATIONS.

28. Medicaid Expansion is not a panacea… Low reimbursement rates for providers can lead to shortages (especially for specialists) Limited choices for drugs and procedures.

29. But it is the most significant thing our state can do now to improve the health of our citizens.