Together Baton Rouge's "Civic Academy" analyzing the healthcare crisis in Louisiana and the potential impact of Medicaid Expansion.

1. Healthcare in Louisiana
& Medicaid Expansion
Civic Academy Series
“Education for Action”

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. State of Health in Louisiana
49th in obesity
46th in diabetes
49th in cancer
45th in infectious disease
49th in low birth weight
49th in infant mortality
American Health rankings United health Foundation 2012
American Health rankings United health Foundation 2012

5. Our low health access leaves us …
48th in preventable hospitalizations
47th in premature death
49th in overall health outcomes
American Health rankings United health Foundation 2012

6. 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.
X9

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

8. Why are so many
Louisiana citizens
uninsured?
Let’s do the math …
Full cost of health insurance $20,000 per year
(for family of four)
Salary at minimum wage $15,000 per year

9. 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.

10. This is a matter of life and death.
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. 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.

12. How do poor and working
residents get healthcare in LA?
Charity Hospital System
But that system is being
dismantled Statewide.
Being replaced by
partnerships with private
hospitals.

13. 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.

14. 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?

15. 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)

16. We have an opportunity to
change this
Medicaid
Expansion

17. So what is Medicaid Expansion?
Part of the Affordable Care Act.
Encourages states to offer Medicaid to
adults earning up to 133% of poverty line.
That’s up to about $30,000 per year
(for family of 4)
vs. current cutoff of about $2,700 per year.

18. Supreme Court ruled it must be optional
for states.
At this time, Governor Jindal has NOT YET
ACCEPTED Medicaid Expansion.

19. 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)

20. Louisiana Budget Project (2013).

21. 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).

22. 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.

23. 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.

24. How much would Medicaid
expansion cost Louisiana?
Maximum Estimate: $1 billion over 10 years.
Is that a lot?
State cost for each newly insured citizen:
$250 per year!
Other estimates indicate it would cost the state ZERO,
due to savings from having fewer uninsured.

25. Where to get the money?
First 3 years are fully funded by Fed Gov.
After that, total needed is about $100m per year.
$1.25 cigarette tax
$278 million per year.
would raise …
Enough to fund ALL of
Medicaid expansion
(and then some)

26. Current Louisiana cigarette 49th among all
tax is 36 cents US States
A coincidence?
Louisiana’s cancer mortality rate 49th among all
US States

27. Smoking Frequency
See any
patterns?
Cancer mortality

28. Annual healthcare expenditures in
Louisiana directly caused by tobacco use:
$1.47 billion PER YEAR
Smoking-caused State
Medicaid program spending:
$663 million PER YEAR
American Cancer society (2012)

29. Other benefits of raising
cigarette tax
38,900 current adult smokers would quit.
21,900 LA residents would be saved from
smoking caused deaths.
30,7000 kids won’t become addicted to smoking.

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

31. 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.
Could bankrupt new
hospital in New Orleans.

32. What are the consequences of NOT
accepting Medicaid Expansion?
People will Compared to the uninsured,
people with Medicaid have a 6%
die! LOWER DEATH RATE.
How much
is a human Is it worth $250?
life worth?
New England Journal of Medicine (2012)

33. Who is for Medicaid Expansion?
American Medical Association
American Hospital Association
AARP
American Academy of Family Physicians
Louisiana Primary Care Association
US Conference of Catholic Bishops
Nearly all major religious denominations.

34. 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

35. 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”

36. Other states have WON flexibility
Arizona 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.

37. BUT LOUISIANA IS NOT
CONDUCTING NEGOTATIONS!

38. 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.

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