Louisiana and Georgia have many political similarities. Both states face significant health challenges affecting their populations. And until recently, both states had identical approaches to Medicaid expansion.
GeorgiaGov. Nathan Deal, a Republican, has rejected expansion since he took office in 2011, and GOP lawmakers have repeatedly backed him up. They point to concerns about the future cost of expansion, saying it would eventually put too much strain on the state budget.
But on Friday, Louisiana will become the 31st state — and only the third Southern state — to expand the government program, which is jointly financed by state and federal governments. Gov. John Bel Edwards, a Democrat elected last fall, on his second day in office reversed the course set by his predecessor, Republican Bobby Jindal, by signing an executive order that began the process. Already, have been signed up.
“This isn’t just aboutexpanding health care coverage and saving money,’’ Edwards said earlier this month when addressing reporters at a seminar sponsored by the Kaiser Family Foundation. “We wanthealthier people in Louisiana.” (KHN is an editorially independent program of the foundation.)
And there are small signs of a crack in the opposition to expansion in Georgia.
Georgia state Sen. Renee Unterman (R-Buford), who chairs the Senate Health andHuman Services Committee, recently madeheadlines calling for Georgia to “re-examine’’ the possibility of Medicaidexpansion, perhaps looking at a “waiver’’ plan similar to the Arkansas expansion program.
“We have to open that box and look just alittle bit and see what’s available,” , the NPR affiliate in Atlanta. “Hopefully, if youdraw down federal dollars, you can free up some of those state dollars. Rightnow, we’re just pumping out state dollars to stay in the midst of the crisis.”
A task force created by the Georgia Chamber of Commerce is formulating proposals that would extend coverage to more of the state’s uninsured but not along the lines of a conventional Medicaid expansion.
Yet Georgia state Rep. Sharon Cooper of Marietta, the Republican chairwoman of theGeorgia House’s Health and Human Services Committee, told Modern Healthcare that sheand her colleagues will entertain the proposals, but added that she doesn’tbelieve an expansion plan will solve the problem of access to care.
“The problem with expansion is, ‘Who is going totreat these people?’ ” Cooper said. “We don’t have the physicians, nursepractitioners or physician assistants to care for them in rural areas of thestate.”
Since the beginning of2013, five rural hospitals have closed in Georgia.
A Tale Of Two Southern States
puts Louisiana 50th among states — 10 spots behind Georgia. Thestate has high rates of obesity, hypertension and diabetes, and a highmortality rate from cancer. For Georgia, the rankings note its large number of low-birthweight babies.
Louisiana also has avery high share of people living in poverty, but Georgia has alarger percentage without health insurance (16 percent).
One key difference betweenGeorgia and Louisiana is the Peach State’s much stronger fiscal situation. Louisiana, where the energy industry is very important,has been hit hard by a decline in oil prices.Edwards inherited what he calls a record state deficit.
But ironically, thatdeficit eased the road for expansion, officials say. “The budget crisis was acatalyst for the Legislature to come aboard,” said Dr. Rebekah Gee, secretaryof the Louisiana Department of Health.
Aretha Frison, of the New Orleans area, works at an animal hospital part time and battles depression. (Andy Miller/Georgia Health News)
A study found that theexpansion would produce net savings of $184 million for Louisiana, including in-state money paid to hospitals and moving some current Medicaid patients into abetter federal matching rate of 95 percent.
Part of Louisiana’s push to enroll new people in Medicaidhas come through a unique mailing to 105,000 food stamp recipients,like Aretha Frison, of the New Orleans area, who works at an animal hospital part time and battles depression.
She said she “had been hitting a lot of brick walls” when trying to get psychiatric care but now “it seems like Medicaid is the golden ticket.”
About 180,000 other peoplewere ‘’auto-enrolled’’ from aprevious“waiver’’ program that did not provide coveragefor hospital services or prescription drugs.
Help For Hospitals
Advocates for Medicaid expansion in Georgia often tout the expected benefits for the state’s hospitals, many of which are financially stressed. Though hospitals inother states have reported substantial revenue gains as a result ofexpansion, Louisiana’s complicated system of funding for hospitals may notyield many clear winners.
Louisiana has had anunusually heavy reliance on ‘’disproportionate share’’ funding, which the statepays out to those hospitals serving a large number of indigent or uninsuredpatients.
While the giant OchsnerHealth System said Medicaid expansion would be slight improvement for the system financially, BatonRouge-based Our Lady of the Lake Hospital said expansion may bring a payment cut overall with the loss of disproportionate share funds.
But low-incomeresidents should benefit greatly.
More than half of the 4,000 medical patients at the New Orleans CrescentCare health center are expected to qualify for Medicaid under expansion, which may lead to better care options.
For example, Alicia Honomichl, a registered nurse there, said expansionwill help more people obtain PrEP, a medication that can prevent a person from getting HIV from an infected individual, whether through sexual contact or sharing of drug-injection equipment.
Dr. Peter DeBlieux, chief medical officer ofthe brand-new University Medical Center New Orleans, said the Medicaid change is“earth-shattering’’ for his patients.
Patient accessto regular medications will be “low-hanging fruit’’ that will come fromexpansion, and “I expect [cancer] screenings to skyrocket,” he said.
This story was done in partnership with .
