Louisiana is likely to lose nearly $2 billion in health care funding and thousands of people will lose their current health care plans if the Affordable Care Act (ACA) is repealed next year. Several recent reports have painted a grim picture of American health care detailing if or when President-elect Donald Trump follows through with plans to gut the ACA, including Medicaid, without a replacement that ensures and extends continuity of care to millions of people who have relied on the federal health insurance program. Louisiana is especially vulnerable, with a health network relying largely on federal funding to care for people in low-income households.
Moderate-income families also would take a hit. A report this month from the Urban Institute and Center on Budget and Policy Priorities predicts a repeal would reduce tax credits by more than $360 million used to support premiums for moderate-income earners. The average subsidy for moderate- and middle-income families in Louisiana is $362 per month. Nationally, it's $291.
But critics and many people enrolled in the federal marketplace have argued their health care is more expensive now, despite the subsidies and plans intended to reduce costs and maintain care quality. The White House's Council of Economic Advisers released a report — a few days before the Dec. 15 deadline to sign up for health care through the federal marketplace to ensure coverage by Jan. 1 — detailing the ACA's impact in Louisiana since its introduction in 2010. The council argues that the ACA slowed premium growth, with the average premium for Louisiana families growing at 5.4 percent a year, compared to 7.3 percent over the previous decade.
"Assuming Louisiana premiums grew in line with the national average in 2016," the report says, "family premiums in Louisiana are $2,400 lower today than if growth had matched the pre-ACA decade."
The state's overall uninsured rate is down 33 percent since 2010. But those numbers don't yet include previously uninsured people who enrolled in Medicaid when it opened in 2016.
More than 2.2 million people in Louisiana are covered through their employers; more than 183,000 people purchased health insurance through the marketplace; and since its expansion began in July, more than 350,000 people in Louisiana have enrolled in Medicaid, totaling the program's enrollment to more than 1.3 million people. That includes the Children's Health Insurance Program, with 758,432 children, and 104,841 seniors and people with disabilities covered by both Medicaid and Medicare.
As Louisiana's Medicaid expansion finishes its first six months, a large network of health clinics and community health centers — relying on the dedicated Medicaid coverage funded by the feds, and treating many Medicaid patients — brace for a likely decrease in funding. The ACA has provided roughly $11 million to community health centers in the state and to help enroll patients into the marketplace and Medicaid. More than 30 centers and dozens of clinics are the only primary care points for thousands of patients, mostly African-Americans and Hispanics and Latinos.
So what is the GOP planning to replace the ACA? Last week, Louisiana's U.S. Sen. Bill Cassidy met with incoming U.S. Department of Health and Human Services (HHS) Secretary Tom Price — who supports the ACA's repeal — to discuss the future of the country's health care. Cassidy's plan, dubbed "The World's Greatest Healthcare Plan," rolls back elements of the ACA but doesn't necessarily require a full repeal and would retain the Medicaid expansion. ("Everyone should be insured," Cassidy told The Washington Post last week.) He also supports states choosing whether to stay with the ACA rather than it being under federal control. But Cassidy also supports and says his plan closely mirrors a plan from Price, who wants a repeal. Price also called for getting rid of birth control coverage under the ACA mandate; Cassidy says it should be provided over the counter.
Trump has said he wants to keep some provisions of the ACA, such as allowing people under age 26 to stay on their parents' insurance plans, and to continue banning insurance companies from denying coverage to people with preexisting conditions. According to the HHS, roughly 34,000 young people remained on their parents' insurance through the ACA, and rules covering preexisting conditions have impacted nearly 2 million people.
Read more about the Affordable Care Act's repeal and impact on New Orleans and Louisiana in our Dec. 13 cover story, "Trumpcare?".