The much-maligned Affordable Care Act has helped more than 70,000 residents in a seven-parish area around Lafayette gain health care coverage, many for the first time in their lives, according to panelists in the Lafayette League of Women Voters' Acadiana Healthcare Forecast event held on Monday.
Brian Burton of Navigators for a Healthy Louisiana — a coalition of health information and education providers — told the 30 or so people who attended the event that numbers compiled by his organization through May 15 show that the ACA has brought a significant increase in the number of people in those parishes having health insurance coverage.
"If you look at the seven parishes in the area — Acadia, Evangeline, Iberia, St. Landry, St. Martin, Vermilion and Lafayette — you'll see that the number of people with coverage is significantly higher," Burton said. He distributed a flyer that showed that 17,305 individuals and families have found coverage through the health insurance marketplace established under ACA. Another 55,690 individuals have signed up to participate in Medicaid expansion, which only became available in Louisiana at mid-year in 2016 after Gov.John Bel Edwards authorized the state to join the program.
Nearly half (8,414) of the marketplace policy buyers were in Lafayette Parish. The ACA provides insurance premium subsidies based on a household's income level in relation to the poverty income level. The subsidies start at the poverty level and extend up to 400 percent of that level. The annual poverty income level is $12,060 for individuals and $24,600 for a family of four, according to information provided on the Healthcare.gov website.
By comparison, Lafayette Parish accounts for about one-third of the participants in Medicaid expansion in the seven parishes. People who live at or below 138 percent of the federal poverty level are eligible to enroll in Medicaid expansion.
Linda Hawkins, a retired federal worker who is the LWV's point person on healthcare, said that with Medicaid expansion now accessible in Louisiana, the percentage of Louisiana residents without healthcare coverage has fallen to just above 10 percent. "I can't recall a time where it's ever been that low," Hawkins said.
The great uncertainty hanging over all of this are the ongoing attempts in the Congress to replace the ACA with the American Health Care Act. The House has passed its version of the bill, but issues remain. Bloomberg News has reported that House leaders have not sent the bill to the Senate yet, pending the Congressional Budget Office's analysis of the budget implications of the bill.
The legislative strategy agreed upon by Republicans in the House and Senate is to allow a maneuver called reconciliation, which would limit debate on the bill and would allow for speedier passage of the bill on the Senate side. In order to enable that process, the bill must meet certain revenue and tax parameters.
The CBO is expected to issue its analysis of the bill this week. If the analysis finds the bill does not meet the Senate parameters, the House might have to revise and revote on the bill yet again.
The initial form of the bill that failed in March would have caused 24 million Americans with coverage to lose it, including many with health coverage through their jobs. The CBO's analysis of that bill showed that 600,000 Louisiana residents would have lost access to health coverage had it become law.
Kathy Hebert, who runs University Medical Center and Clinics for Lafayette General Medical Center, says the entire process is shrouded in uncertainty. "We're just watching at this point," Hebert said. "I really can't speculate about the impact of the bill."
Hawkins was not as reticent. She said the most troubling part of the bill that passed the House is the way the federal government achieves savings.
"What they essentially do is propose to make Medicaid a block grant program, give the money to the states and let them figure out how to spend it," Hawkins said. "Another thing that the law would do is leave it to states to set the provisions of insurance coverage, unlike now where you have uniform policy standards across the country."
Hawkins said that the block grant idea might work in some states that are well-off but not in states like Louisiana where budgets are constrained.
"If the federal government gives states the choice over what to fund and what not to fund, I can tell you right now — based on what we've seen happening here for the last five years — that our legislators are going to choose not to fund the things that are made optional for them," Hawkins said.
Burton said that the basic difference between the ACA and the AHCA is simple to discern.
"Under the ACA, the patient is at the center of the law, that's why there are things included in it like quality measures, wellness programs and free annual exams," Burton said. "The AHCA appears to put insurance companies at the center and that makes a big difference."
In matters closer to home, Hawkins and Landry differed sharply on their analysis of the public-private partnerships that are now running what were hospitals that were part of the LSU Hospitals System.
Hebert says services provided have expanded under the partnerships and the number of patients being treated has increased as well.
"At the time the partnerships began, UMC was down to 15 in-patient beds," Hebert said. "We're up to 52 now. The number of emergency room visits that ended without a patient seeing a provider has dropped from 16 percent to half a percent."
Hawkins said the state has given up transparency with the pubic-private partnerships and the ability to control costs.
"We've gone from 12,000 employees at Louisiana Department of Health to 5,000 today. We've essentially got contractors evaluating contractors," Hawkins said. "There is little actual monitoring of performance going on and we have no transparency."
Hawkins also lamented the fact that the Jindal administration shattered a system that was able to coordinate care among its members, an advantage that was squandered when the system was subdivided among the private contractors. Hawkins predicted that if the state was struck by a large hurricane the costs of dismantling that system would become apparent.