The New Year began a new era, as Louisiana gained a new governor and the state became the 31st in the nation and the first in the deep South to move toward expanded access to Medicaid. As one of his first acts in office, Gov. John Bel Edwards signed an executive order that would expand access to include more than 330,000 additional residents. Of course the action was met with some controversy. All things considered, it was the right thing to do.
Since the passage of the Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act, in March, 2010, Louisiana had refused to expand its Medicaid program. But there were good reasons, medically, economically and morally, to reexamine this position and move to expand Louisiana’s Medicaid program.
Medicaid, developed in 1965 as part of the Great Society programs, is a partnership between the federal and state governments. It covers the poorest of our fellow American citizens. To understand who qualifies for Medicaid, one must start with the Federal Poverty Level which, last year, was an annual income of $24,300 for a family of four! To qualify for Medicaid, a person/family has to be at or below the FPL. In Louisiana, a family of four has to be 212 percent below the FPL. If you are not poor enough, you do not qualify. And those who are not eligible include children.
There are at least three arguments for expanding Medicaid: economic, medical, and ethical.
First, at this time of a beleaguered state budget, Louisiana will save an estimated $100 Million next year if Medicaid is expanded, because of the beneficial federal payment structure. And expansion brings in over a billion dollars of new money to the state. According to a 2013 report by Families USA, the $1.1 Billion increase should, in turn, result in the creation of approximately 15,600 new jobs across the state and approximately $1.8 Billion in increased economic activity in 2016. These jobs would be high-quality jobs – healthcare, retail, tourism, leisure, hospitality and personal services generated in virtually every district in the state. Increased economic activity would lead to approximately $120 million in net new state and local tax revenue each year, and at the same time lower out-of-pocket healthcare costs would allow consumer spending in other areas.
Second, making medical care available to more people can allow for better medical care for more Louisianians save our resources. Most people have had the experience of being ill and putting off going to see a doctor or health care professional. And, as often happens, the illness gets worse. Multiple medical studies have shown that prevention and ordinary care saves both lives and money. One recent study showed that if 90 percent of the population had access to tobacco cessation services, alcohol abuse screening, daily aspirin intake, and colorectal cancer screening, each of those four interventions alone would result in more than 100,000 years of life saved, the study found. And according to the state Department of Health and Human Services, Medicaid expansion would improve not only the health and lives of the underserved, the elderly and children, but the health of working people in industries important to Louisiana. There are nearly 30,000 restaurant workers and 15,500 construction workers in Louisiana who are uninsured today but would be covered by Medicaid expansion.
Finally, expanding Medicaid is ethically the right thing to do. As in most states, Louisiana’s share of expense for Medicaid is paid for by taxes and fees. So people who contribute through their taxes and fees are denied access to the very service for which they help to pay. That is simply wrong no matter what ethical language you speak. I have often used this analogy: Imagine all American citizens contributing to support the U.S. Defense Department but then, when we are invaded, denying vulnerable people access to the defense to which they contribute. It’s unconscionable.
The JustSouth Index, a major report that Loyola’s Jesuit Social Research Institute will release later this week, found that nearly one in three (32.1 percent) low-income adults (those in the lowest income quartile) in Louisiana did not have health insurance in 2014. This, compared to just 6.2 percent of low income adults without health insurance in Massachusetts, a state in which Medicaid eligibility was expanded years ago. Only five states have higher uninsurance rates among the poor than Louisiana, the study found. JSRI plans to update the JustSouth Index annually to measure improvements in each state, and moving forward with Medicaid expansion in our state certainly will be a significant mark of progress.
We can and need to do better.
Loyola University New Orleans President the Rev. Kevin Wm. Wildes, S.J., also is a bioethicist.