The Obamacare replacement bill being considered by Congress would hurt Louisiana far more than it would hurt most other states. The changes to Medicaid that are being talked about would devastate our state budget and lead to huge cuts in services for our most vulnerable citizens.

These changes will affect the whole country, but their impact will be much greater in states like Louisiana that have high poverty, high unemployment, and large rural and minority populations. Other factors that will increase the impact in Louisiana are our overall poor health status; large numbers of people with disabilities, including mental health problems; high opioid abuse; and high rate of new HIV cases. In fact, according to the Kaiser Family Foundation, Louisiana is one of 11 states that is likely to bear the brunt of the cuts in Medicaid.

Medicaid is the only source of health care for hundreds of thousands of Louisianans. Most of our Medicaid expenditures go to care for people who are elderly or disabled. These include people who qualify for nursing home or community-based care, children with autism and other severe disabilities, people with severe mental illness, and people with cognitive impairments. Much of the remainder goes to health care for poor children and pregnant women. Over 1.5 million Louisianans depend on Medicaid for health care coverage.

Nationally, studies show that having Medicaid coverage improves health and financial security, boosts long-term educational and health outcomes for children, and saves lives.

Since 1965, Medicaid has operated as a federal-state partnership where the federal government pays a share of the payments to health care providers. The federal share is based on actual costs of providing services.

Louisiana currently receives 62 percent of the costs of Medicaid from the federal government for the “traditional” Medicaid population of elderly, disabled, and poor children and pregnant women.

The ACHA passed by the House (now being considered by the Senate) would put a per capita cap on federal spending on Medicaid, with the federal share set at a rate that is not expected to keep pace with the State’s actual costs. Estimates by the Urban Institute indicate that the per-capita caps will cut the federal Medicaid payments to Louisiana by $10 billion between 2019 and 2028.

The ACHA also effectively eliminates the Medicaid expansion that helped Louisiana provide coverage for 400,000 low-income Louisianans in 2016. Under Obamacare, the federal government pays 95 percent of the cost of care (going to 90 percent by 2020) for working-age adults who earn below 138 percent of the federal poverty limit ($1,354 a month for a single person). If the ACHA were to become law, this federal share would virtually disappear after 2020. Between fiscal years 2020 and 2023, an estimated $2.6 billion in Medicaid costs would be shifted from the federal government to the state of Louisiana.

These billions of dollars will be taken directly from doctors, hospitals, nursing homes, and other health care providers, who care for our poorest citizens.

It is money Louisiana cannot afford to lose.

Neil Hahn

retired advocate for elderly and disabled

Lafayette