Civic Academy Series“Education for Action”

Healthcare in Louisiana & Medicaid Expansion

Laissez les bon temps rouler!

Louisiana has …Great food

Mardi Gras Football

Friendly peopleSportsman’s paradise

Not everyone has equal accessto the good life here.

But that’s not the whole story.

49th in obesity46th in diabetes49th in cancer45th in infectious disease49th in low birth weight49th in infant mortality

American Health rankings United health Foundation 2012American Health rankings United health Foundation 2012

State of Health in Louisiana

Our low health access leaves us …

48th in preventable hospitalizations47th in premature death49th in overall health outcomes

American Health rankings United health Foundation 2012

Louisiana has the 3rd highest uninsured rate in the nation(behind only Texas and Nevada)

64,635 uninsured children719,470 uninsured adults785,105 total uninsuredCapacity crowd at tiger stadium.

X 9

Uninsured rates are high across the entire State.

22% of adults in EBR parish are uninsured

82,000 adults uninsured in

metro BR area

Why are so many Louisiana citizens

uninsured?

Full cost of health insurance $20,000 per year (for family of four)

Salary at minimum wage

Let’s do the math …

$15,000 per year

Louisiana has 2nd highest poverty rate in nation after Mississippi.

20% of Louisiana families earn below poverty level of $22,000 per year.

Many LA residents simply can’t afford private health insurance.

… caused nearly 17,000 deaths among children between 1988-2005.

… causes 44,789 excess deaths annually in the US.

… caused 3,346 deaths of Louisiana residents aged 25-64 between 2005 and 2010.

… 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)

Lack of health insurance …

This is a matter of life and death.

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.

Charity Hospital System

But that system is being dismantled Statewide.

Being replaced by partnerships with private hospitals.

How do poor and working residents get healthcare in LA?

Provide insurance to 1.3 million Louisiana residents.Cover 58% of insured children in LA, 8% of elderly, 15% of adults, 19% of people with disabilities.Medicaid provides nursing care for seniors & serves 250,000 people with disabilities.

How do poor and working residents get healthcare in LA?

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?

LA Medicaid has among most narrow eligibility rules in the nation …

Only covers adults earning below about

$2,700 per year (that’s not a typo)

(12% of the poverty level of $22,500)

We have an opportunity to change this

Medicaid Expansion

Encourages states to offer Medicaid to adults earning up to 133% of poverty line.

So what is Medicaid Expansion?

That’s up to about $30,000 per year (for family of 4)

vs. current cutoff of about $2,700 per year.

Part of the Affordable Care Act.

Supreme Court ruled it must be optional for states.

At this time, Governor Jindal has NOT YET ACCEPTED Medicaid Expansion.

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)

Louisiana Budget Project (2013).

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 Louisiana in 2016 alone.

“Louisiana’s Economy Will Benefit from Expanding Medicaid”, Families USA & Louisiana Consumer Healthcare Coalition (2013).

Positive outcomes of accepting Medicaid Expansion

• People engage in more preventive healthcare.• People access healthcare earlier, preventing

worse outcomes.• MONEY SAVED because fewer people go to

emergency rooms.• People with better health miss less work.

Feds pay 90% of expansion costs after 10 years.

How much would Medicaid expansion cost Louisiana?

Every $1 in State funding brings $9 in federal funding.

Feds pay 100% of expansion costs for first 3 years.

How much would Medicaid expansion cost Louisiana?

Other estimates indicate it would cost the state ZERO, due to savings from having fewer uninsured.

Is that a lot?

State cost for each newly insured citizen:

Maximum Estimate: $1 billion over 10 years.

$250 per year!

Where to get the money?First 3 years are fully funded by Fed Gov.

$1.25 cigarette tax would raise …

After that, total needed is about $100m per year.

$278 million per year.

Enough to fund ALL of Medicaid expansion

(and then some)

Current Louisiana cigarette tax is 36 cents

Louisiana’s cancer mortality rate 49th among allUS States

A coincidence?

49th among all US States

Smoking Frequency

Cancer mortality

See any patterns?

Smoking-caused State Medicaid program spending:

$663 million PER YEAR

Annual healthcare expenditures in Louisiana directly caused by tobacco use:

$1.47 billion PER YEAR

American Cancer society (2012)

Other benefits of raising cigarette tax

30,7000 kids won’t become addicted to smoking.

21,900 LA residents would be saved from smoking caused deaths.

38,900 current adult smokers would quit.

44,000 currently insured residents in New Orleans

would lose their coverage.

400,000 LA residents would remain uninsured.

What are the consequences of NOT accepting Medicaid Expansion?

LA hospitals lose out on hundreds of millions.

Louisiana would lose out on $15.8 billion in federal funding

What are the consequences of NOT accepting Medicaid Expansion?

Could bankrupt newhospital in New Orleans.

Compared to the uninsured, people with Medicaid have a 6%

LOWER DEATH RATE.

What are the consequences of NOT accepting Medicaid Expansion?

People will die!

New England Journal of Medicine (2012)

How much is a human life worth?

Is it worth $250?

Who is for Medicaid Expansion?

American Medical AssociationAmerican Hospital AssociationAARPAmerican Academy of Family PhysiciansLouisiana Primary Care AssociationUS Conference of Catholic BishopsNearly all major religious denominations.

Who ELSE is for Medicaid Expansion?

American Cancer Society Cancer Action Network, Inc. AARP Acadiana CARES Advocacy Center Advocates for Louisiana Public Healthcare Belle Reve Bienville House Brotherhood, Incorporated Capitol City Family Health Center Center for Health Law and Policy Innovation, Harvard Law School Children's Bureau of New Orleans Citizens United for In-Home Support Classic Homes & Services, Inc. Connect to Protect Council on Alcohol & Drug Abuse for Greater New Orleans Crescent City Media Group Doctors for America Greater New Orleans American Association of University Women Greenlight Operations Gulf Coast Environmental and Health Coalition Health Law Advocates of Louisiana HOPE for the Homeless Independent Women's Organization Integrative Consulting, Inc Interfaith Sponsoring Committee jacobs family medical clinic LA NOW LA Primary Care Assoc Liberty Heights Community Cente Louisiana AIDS Advocacy Network Louisiana Alliance of Direct Support Professionals Louisiana Association of Nonprofit Organizations Louisiana Budget Project Louisiana Center for Health Equity Louisiana Consumer Healthcare Coalition Louisiana Federation of Families for Children's Mental Health, Inc. Louisiana Housing Alliance Louisiana Latino Health Coalition for HIV/AIDS Awareness (LLHC) Louisiana Primary Care Association Louisiana Progress Louisiana Supported Living Network Louisiana Trans Advocates Louisiana Women's Network Marillac Community Health Center Mental Health America of Louisiana Mid South Division/ National Association of Social Workers, LA Chapter New Orleans Chapter of NOW New Orleans Chapter of NOW New Orleans Medical Association New Orleans Medical Association New Orleans Regional AIDS Planning Council (NORAPC) New Orleans Society for Infectious Disease Awareness (NOSIDA) New Orleans Society Infectious Disease Awareness (NOSIDA) NO/AIDS Task Force NOELA Community Health Center Northshore Democratic Women's Club One Voice Louisiana Priority Health Care, Inc. St. Landry Democratic Parish Executive Committee The Philadelphia Center The Truth Campaign Tulane T-Cell Clinic UniteWomen.org UNITY of Greater New Orleans Women With a Vision

What’s Governor Jindal’s position?

Governor says he wants “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 as was done with SCHOP program”

Other states have WON flexibilityArizona accepted Medicaid expansion, with a trigger to pull out if federal match ever went below 90%.

Florida won approval to run expanded Medicaid through private managed care.

Arkansas won approval to use Medicaid expansion funding to subsidize families below 133% of poverty buying insurance through healthcare exchanges.

BUT LOUISIANA IS NOT CONDUCTING NEGOTATIONS!

Medicaid Expansion is not a panacea…

Low reimbursement rates for providers can lead to shortages (especially for specialists)

Limited choices for drugs and procedures.

Problems with access.

But it is the most significant thing our state can do now to improve

the health of our citizens.