Louisiana and the Affordable Care Act (ACA)

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1 Louisiana and the Affordable Care Act (ACA) Steve Spires, Louisiana Budget Project

2 About Louisiana Budget Project Provides independent, nonpartisan research and analysis of Louisiana fiscal issues and their impact on low-income Louisiana families Visit

3 What does the ACA really do? Improves access to health care Helps make insurance more affordable for families and small businesses Strengthens the quality of health care coverage Encourages delivery system innovation

4 Louisianans are already benefiting! More than 50,000 seniors are paying less for prescription drugs 45,000 young adults have been able to stay on their parents insurance plan 1.4 million people with private insurance no longer subject to a lifetime cap on coverage More than 1 million consumers now protected by the Medical Loss Ratio (MLR) At least 700,000 people have access to preventive services with no cost sharing

5 Why is the mandate important? 1 of 3 interlocking pieces We don t want anyone to be denied coverage because they are sick, BUT Unless everyone signs up BEFORE they get sick, premiums will remain too high SO We need the individual mandate, paired with tax credits to help people who can t afford insurance today

6 Like a chair with three legs if any single leg is broken off, the whole thing falls over.

7 Vital Statistics Currently, Louisiana has some of the highest rates of poverty and residents who lack health insurance in the country: Nearly 20 percent of Louisianans live below the poverty line, which is $11,170 for an individual, $19,090 for a family of 3 750,000+ uninsured residents, including 1 in every 4 adults under age 65

8 Where is Medicaid eligibility today? Currently, eligibility for working adults is severely limited at 15% of the poverty line ($2,860 for a family of three) Adults without minor children are ineligible altogether, regardless of income On the other hand

9 Eligibility for children is much better Eligibility for children, through the LaCHIP program, goes up to 200% FPL $38,200 for a family of three This is the primary reason that only 5% of Louisiana s kids are uninsured Before LaCHIP was implemented in the late 1990s, around 20% of kids lacked health coverage

10 250% Eligibility is generous for children and pregnant women, could be expanded for adults in % 150% 100% 50% 0% Children Pregnant Women Parents Current Eligibilty (as % of Federal Poverty Level) Adults without Children People with Disabilities Nursing Home/ Long Term Care 2014 Expansion up to 133% FPL

11 Medicaid expansion is crucial for the working poor The ACA allows states to expand Medicaid for all adults up to 133% FPL $14,850 for an individual and $25,390 for a family of three Here in Louisiana, as many as 400,000 or more residents could gain coverage mostly the working poor Unfortunately, Gov. Jindal has so far rejected the expansion.

12 Ten industries with the largest numbers of uninsured workers who could gain Medicaid coverage in 2014 Restaurants and Food Service 34,970 Construction 25,764 Department Stores 8,925 Grocery Stores 8,093 Nursing Homes 7,260 Elementary and Secondary School 7,161 Child Day Care Centers 6,740 Hotels and Motels 5,846 Hospitals 5,346 Landscaping Services 4,609

13 The expansion is a GOOD DEAL for Louisiana s budget The federal government will pay for 100% of the cost for the first three years The state will slowly chip in after that, but never have to pay for more than 10% of the cost By comparison, today the feds only pay for around 65% of Louisiana s Medicaid program, with the state responsible for 35%

14 will result in some new costs and some new savings Some mental health programs and clinics for the uninsured are currently funded only with state and local dollars The LSU health system and other providers incur costs due to uncompensated care As the uninsured gain Medicaid coverage, new federal funds will help offset some of the cost of state-funded care

15 and would help the state economy. Expansion would bring in billions in new federal funds money that would not otherwise be spent in Louisiana Would have positive ripple effects statewide Today, Medicaid already supports an estimated 50,000 health care jobs, and thousands of other indirect jobs

16 Health Insurance Exchange Online marketplace where consumers can comparison shop for insurance Tax credits for working families and small businesses Greater purchasing power will bring down high premium costs Will benefit as many as 350,000 Louisianans Federal government will run Louisiana s exchange

17 The Alternative = Not Good Recent cuts to the LSU health system are serious and situation is getting worse Cuts could threaten access to needed health care services for the uninsured Refusing to expand Medicaid leaves the uninsured with no other coverage option and increases financial stress on health care providers

18 Funding for the LSU Health System would have been slashed by 25 percent this year, but one-time money was used to partially offset the loss. LSU Health has been cut by 20 percent since 2009 (in millions) $1,600 $1,400 $1,200 $1,000 One-time funding $800 $600 $400 FY2009 (Adjusted for Inflation) FY2013 (Before & After Medicaid Cut)

19 750,000...while the number and percent of uninsured adults in Louisiana keeps growing % 730, % 710, % 690, % 670, % 650, % 630, Number Uninsured Percent Uninsured 24.00%

20 So, the ACA is constitutional. Now what happens? Debate begins over whether Louisiana will expand Medicaid. Despite Gov. Jindal s opposition, the Legislature can act Federal government will set up and operate a health insurance exchange in Louisiana Beginning in 2014, the other main sections of the law will take full effect

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22 How Can You Help? BCBL represents a growing number of environmental, business, faith-based, labor, health, education, community groups, and consumer groups from throughout Louisiana Calling for a balanced approach of RESPONSIBLE revenue measures and COMMON SENSE savings Visit for more info! Contact: mary@lano.org