2016 Election Trump

Vice president-elect Mike Pence, right, watches as President-elect Donald Trump speaks during an election night rally, Wednesday, Nov. 9, 2016, in New York. (AP Photo/ Evan Vucci)

Big changes could be ahead for health care under President-elect Donald Trump's administration, and hundreds of thousands of Louisiana residents could feel the impact.

Trump remained relatively light on details about his plans for Medicaid and Medicare during his campaign, but health experts say that the advisers he's tapped are providing some clues as to what might be ahead for the safety net programs for seniors and the poor.

"The signals, if you call them that, from President-elect Trump have been varied," Bill Corr, a former deputy secretary for the U.S. Department of Health and Human Services in the Obama administration and now a senior adviser at Waxman Strategies, said during a health care forum this week in Maryland. "I think maybe President-elect Trump's signals are not the ones we should be looking at."

Trump this week named U.S. Rep. Tom Price as his pick to become the next secretary of Health and Human Services, and health care policy consultant Seema Verma to serve as administrator of the Centers for Medicare and Medicaid Services.

Price, a Georgia Republican who currently chairs the House Budget Committee, has advocated legislation that would turn Medicare into a voucher system, in which the elderly would be given money to seek coverage on the private market.

He also supports efforts to overhaul Medicaid, that would allot states blocks of money and leave major decisions to them as to who and what is covered.

Supporters of privatizing Medicare and shifting Medicaid to the states say that the efforts will cut costs to the federal government and ensure longevity.

Opponents argue that the changes ultimately threaten safety nets for the needy and shift costs to individuals and to states.

The naming of Price, a staunch opponent of the federal Affordable Care Act and orthopedic surgeon, as the incoming HHS secretary won widespread praise from Republicans.

U.S. Majority Whip Steve Scalise, R-Jefferson, tweeted that he "can't think of a better person for the job!"

"He is the right leader to help Congress replace Obamacare," former House Speaker Newt Gingrich, R-Georgia, tweeted.

Trump said consistently on the campaign trail that he planned to "repeal and replace" the Affordable Care Act and vowed to "protect" Medicare, but often didn't elaborate on what the future of health care might look like under his administration.

It remains unclear how Trump's views will shake out with the newly appointed cabinet members and GOP-controlled Congress. But what's at state could be the health care of more than a million Louisiana residents.

More than 351,000 people have received health care coverage in Louisiana through Medicaid thanks the federal Affordable Care Act since the state adopted expansion in July.

And that population isn't strictly skewed toward Clinton-backing parishes.

Similar in population size, East Baton Rouge Parish and Jefferson Parish show how the program's popularity spans voting trends.

East Baton Rouge voted 52.3 percent in favor of Clinton to 43 percent Trump. Jefferson, meanwhile, voted 55 percent in favor of Trump to 40.5 percent for Clinton.

But the number of Jefferson Parish residents who have enrolled in Medicaid under the recent expansion is 33 percent higher than East Baton Rouge, with 38,695 new enrollees in Jefferson Parish to 28,696 in East Baton Rouge.

On top of Medicaid, there are more than 793,000 Medicare beneficiaries in Louisiana who could be impacted by changes to that program – a number that has been steadily rising since 2011, when there were about 704,000.

"Although President-elect Trump has not yet indicated any specifics, some of his promises made during the campaign would have a profound and significant impact in Louisiana," State Health Secretary Dr. Rebekah Gee said.

The Associated Press reported this week that Senate Republicans are signaling a multi-step process with a repeal of the Affordable Care Act tied to a multi-year replacement.

“This is a failed piece of legislation, and it’s coming apart at the seams,” Sen. John Cornyn of Texas, the No. 2 Senate Republican, was quoted as saying, “but it’s going to take us a while to make that transition from the repeal to actually replacing it with more affordable coverage.”

Gee said the Louisiana Department of Health is currently analyzing the impact of various ideas that have been floated, including calls to eliminate the expansion or turn Medicaid into a block-grant program, and the Edwards administration is voicing its concerns about the impact on the state to Louisiana's congressional delegation.

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 in Louisiana. 

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.

The ACA provides that the federal government will pick up 100 percent of the tab for the state’s new Medicaid enrollees through the end of this year. The federal match rate will gradually scale back to 90 percent, with the state picking up the other 10 percent by 2020.

"We are committed to working with President-elect Trump's Administration to ensure continued access to affordable health care to Louisiana residents," Gee said.

A poll released Thursday by the nonprofit Kaiser Family Foundation shows a quarter of respondents believe the Affordable Care Act should be entirely repealed.

Nearly half of the poll's respondents said that the law should move forward as-is or be expanded upon, and 17 percent said that it should be scaled back.

Some health experts predict that numbers will shift as plans move forward and more details emerge.

"Once the public understands what's at stake, they will push back," Johns Hopkins professor Karen Davis said. "We need to assume they are going to try to fast track changes and that they want to move before the opposition is organized."

Davis said that block grants will put it back onto the states to decide how to move forward with expansion, with many of them ultimately deciding that it's too costly to continue.

"The poor and sick are going to be hurt," she said. "The healthy and the wealthy will generally be OK."

Follow Elizabeth Crisp on Twitter, @elizabethcrisp.