Nearly one-quarter of New Orleans residents have participated in the Affordable Care Act (ACA), whether they signed up for health insurance through the federal marketplace or gained access to Medicaid when the program for low-income families expanded in July. According to Mayor Mitch Landrieu's administration, some 46,000 people in New Orleans now have Medicaid coverage; another 24,000 have insurance through the marketplace. Landrieu says those 70,000 New Orleanians may see drastic changes in their health coverage if President-elect Donald Trump follows through with plans to repeal the ACA.
"I think the election of [President-elect Donald] Trump was a surprise for everyone in the country, including him," Landrieu told Gambit. "He's enigmatic and unclear in many ways, self-professedly on purpose. It's almost impossible to plan for. There's a certain stability that governance requires that the nation lacks at the moment, which goes to the issue of whether someone is fit. Stability is really important. You can only take somebody at their word. When you say 'I'm going to repeal,' all of a sudden we have to start thinking about what does a repeal look like, unless and until they articulate what 'replace' looks like, which they have not done."
Landrieu says the ACA has been a "tremendous assistance" in New Orleans since 2010, from insuring low-income families and funding clinics to providing a pipeline to primary care and preventative care that previously overburdened hospitals and emergency rooms. The ACA enshrined into law the "the notion that people have a right or privilege to affordable health care," Landrieu said, and a guiding principle that should be preserved in forthcoming health care legislation. But without a viable replacement from Republicans, who have battled President Barack Obama over health care, Landrieu fears Louisiana's health will decline. The Trump administration's next question, Landrieu says, should be "Now what?" Instead, Landrieu says, "They're basically saying ... 'We don't believe everybody has a right to ... adequate affordable health care.' It seems like they don't really believe that."
In outlining his concerns, Landrieu hews to the Democratic line of criticism that the GOP has no plan of its own.
"One of the things that really troubles me with this entire rhetorical flourish that has been going on for years is [Republicans] have never taken the responsibility to articulate what they're going to replace it with," Landrieu says. "Every model they've looked to is one that restricts access to health care for working men and women rather than expands it. That's not a prescription for a healthy economy or for making America great. That's a prescription for choosing winners and losers, and letting some people eat cake, and letting people go without what they need."
In the days leading up to the inauguration in January, the U.S. Conference of Mayors — of which Landrieu is vice president — will meet in Washington D.C. and likely discuss the future of health care in the age of Trump. Like public health departments and organizations around the U.S. anticipating the ACA's repeal, cities are tentatively bracing for impact without seeing what's about to hit them. "We're like everybody else," Landrieu said. "The nascent Trump transition team — one day they're for blue, one day they're for red, one day they're for green. Nobody knows what they're for.
"Who's gonna pay, what's it going to cost, who's going to win, who's going to lose?" he adds. "My strong feeling is more people in Louisiana will lose than gain, and the state as a whole will lose. It's going to hurt working men and women, it's going to hurt the economy, and we're going to lose jobs."
Landrieu says the ACA is imperfect, though he supports strengthening the law, not "throwing the baby out with the bathwater." Without federal support, however, New Orleans alone can't ensure a continuity of care if the feds phase out health coverage.
"That's not something any city can do on its own," Landrieu said. "You can expect to see people who are suffering from certain illnesses not getting care, or filling up the emergency rooms, in waiting room lines — you know what happens when people don't have access [to health care]. The federal law is such that you can't deny people access to health care when they show up in an emergency room. The way it used to be was the way it will be again: If a mom had a little baby with an earache, they show up at the emergency room at Charity Hospital. She would get triaged or sit there for 13 hours. She would likely lose her job if she was an hourly employee. The child would get sicker, the health care would cost more, and the people of Louisiana would pay 100 percent of the bill. There's no justification for that system.
"In many ways, that's what the folks in Washington want to take us back to — unless they articulate really clearly how they'll stop that from happening."