Donald Trump's election creates several uncertainties for Louisiana, but one of the largest may be concerning the future of more than 336,000 residents who are getting health care coverage through the state's expanded Medicaid program.
Trump, a Republican who had a historic defeat over Democratic rival Hillary Clinton on Tuesday, campaigned heavily on the repeal of the federal Affordable Care Act, which made Medicaid expansion possible for the state earlier this year.
Trump's campaign didn't respond to The Advocate's request for comment on what he thinks should happen to the newly-covered Medicaid patients.
The Wall Street Journal reported Friday that Trump said in an interview he will consider keeping some pieces of President Barack Obama's signature health care law after meeting with Obama earlier this week.
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“I told him I will look at his suggestions, and out of respect, I will do that,” Trump told The WSJ. “Either Obamacare will be amended, or repealed and replaced."
Republicans who control Congress have long pushed for changes to the ACA. With GOP control of both chambers and the presidency beginning in January, their chances are better than ever.
"I think there are a lot of unknowns here, and I think that Louisiana and all the expansion states really need to watch what the Republican president and Republican congress plan to do with it," said Diane Rowland, a health policy expert at the Kaiser Family Foundation.
Gov. John Bel Edwards, a Democrat, signed the order expanding Medicaid shortly after taking office in January. Former Gov. Bobby Jindal, a Republican, had repeatedly refused to do so, citing his objections to the Affordable Care Act. Benefits kicked in for the newly-covered on July 1.
Enrollment has swelled to 336,688 and is on track to top 400,000 people by June 30. Nearly 40 percent of the new Medicaid patients are 25-39 year olds. According to the Louisiana Department of Health, 22 adults have been diagnosed with colon cancer after they were screened with their Medicaid coverage and are now seeking treatment, and 18 women have been diagnosed with breast cancer.
Under the expansion, adults who make below 138 percent of the federal poverty level — about $33,500 a year for a family of four or $16,200 for a single adult — are among the newly eligible population.
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Previously, childless adults were not eligible for Medicaid in Louisiana, and the income restrictions for people with children were tighter.
"I'm concerned because we don't have any answers," Edwards told The Advocate in an interview this week when asked about the future of Medicaid expansion under a Trump administration. "There's no information out there about what the repeal and replace looks like."
But Edwards said he's remaining optimistic that the expansion component will survive.
"I just don't believe at the end of the day that the new president or Congress will cause all these people around the country to lose their coverage," he said.
House Majority Whip Steve Scalise, a Jefferson Republican and ally of Trump, said the current Medicaid system isn't working and he supports Trump's efforts to put more in the hands of the states.
"Medicaid is the most broken form of health care in the country," he said. "Under Obamacare we put millions of people into a system that was already breaking."
"It costs billions of dollars and produces a very sub-par result in terms of what people could get," he added.
Under the ACA, the federal government will pick up 100 percent of the tab for the state’s new Medicaid enrollees through the end of the year. The federal match rate will gradually scale back to 90 percent, with the state picking up the other 10 percent by 2020.
The state budget that the Louisiana Legislature approved after two special sessions and the regular session earlier this year, relies on $184 million that the state will bring down in expansion dollars to fund other state services.
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U.S. Sen. Bill Cassidy, a Baton Rouge Republican who will become the state's senior senator in January, said he favors calls to change how the money comes to the state for Medicaid. Legislation he has backed for several years would set up a "per capita" model that reimburses states for each Medicaid-eligible patient but at a lower rate than the current match.
"We would make it more beneficial to both the state and the patient," Cassidy said.
A doctor, Cassidy said he hasn't heard from Trump's allies or advisers about whether the model he supports would be backed by the president-elect.
"I feel comfortable that this will be considered," he said. "If a federal taxpayer is giving money to provide medical services for poor people. It's not supposed to be a piggy bank for everything else."
Trump's campaign website says that he favors shifting Medicaid to a "block grant" program where the federal government gives each state an amount of money and lets it create its own version of Medicaid, with incentives to keep costs low.
"The state governments know their people best and can manage the administration of Medicaid far better without federal overhead," his website reads. "States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources."
Families USA, a health care advocacy group, argues that block granting Medicaid will make the program more costly for states or lead to sweeping cuts in eligibility.
“We will fight at the grass roots level and in the halls of Congress to make sure Mr. Trump’s proposed ACA repeal and Medicaid restructuring don’t happen," Ron Pollack, executive director of Families USA, said in a statement. "Millions of people should not have their lives placed in jeopardy through reckless action.”