JBE at Health & Welfare

Gov. John Bel Edwards and state Rep. Chad Brown, D-Plaquemine, discuss on Wednesday, April 24, 2019, legislation to protect most popular aspects of the Affordable Care Act.

Louisiana lawmakers on Wednesday began hearings on competing bills by two powerful political rivals that would enshrine in state law some of the most popular aspects of the Affordable Care Act, in case lawsuits seeking to overturn the health law are successful.

But both bills, one pushed by Democratic Gov. John Bel Edwards and another by Republican Attorney General Jeff Landry, ran into a major issue in their first hearings at the State Capitol: The state can’t afford to pay for the popular provisions of the law without help from the federal government.

Democratic state Rep. Chad Brown, who is carrying House Bill 237 for Edwards, and Republican state Sen. Fred Mills, who is carrying Senate Bill 173 for the attorney general, both made significant changes to their legislation after facing a price tag of hundreds of millions of dollars.

Neither bill made it out of committee. The governor’s legislation, by Brown, D-Plaquemine, didn’t get a vote after the House Insurance Committee Chairman, Republican Kirk Talbot, R-River Ridge, said he didn’t have enough time to review changes made to the bill.

“What happened this morning in committee was pure politics on display. The kind of politics that people are tired of,” Brown said in a text. “My bill to protect over 800,000 Louisianans with pre-existing conditions was scheduled for over a week and had a fiscal note prepared prior to the meeting showing no cost to the taxpayers. A vote should have been taken. To say the least, it is disappointing.”

Mills, R-Parks, pulled his bill after facing opposition from several members of his Senate Health and Welfare Committee.

The proposals would only go into effect if Landry and several other Republican attorneys general are successful in repealing the health law, commonly called “Obamacare.” Landry has joined a lawsuit that seeks to declare the health law unconstitutional, now that Republicans in Congress have repealed the law’s penalty on people who don’t buy insurance.

However, both Mills and Brown had to amend their legislation after state officials estimated consumers would be hit with hundreds of millions of dollars in higher premiums if the health law was killed and the state tried to offer the law’s more popular protections.

Without the subsidies that help offset the costs of insurance and effectively pay for the health law, Edwards said “there’s no way the state of Louisiana can support” the bill to protect people with pre-existing conditions.

Instead, Edwards and Brown changed their bill, HB237, to only go into effect if portions of the health law, like pre-existing conditions protections, were tossed, while the subsidies remained intact.

Jeff Landry pushes fail-safe legislation to address health care if his anti-Obamacare suit succeeds

“Invalidating it will be a tremendous disservice to the state of Louisiana, not just to the 480,000 with health insurance because of the Medicaid expansion, but also the 850,000 who have pre-existing conditions,” Edwards said after testifying to the House Insurance Committee Wednesday morning.

Mills added a provision to his bill that made it go into effect only if the federal government appropriated money to pay for the lost premium tax credits, which are part of the current health system under the health law. “No one right now can come up with a funding piece that will make that work without a true partnership between the parties involved,” he said.

State Sen. Dan Claitor, R-Baton Rouge, said he wouldn’t “mislead people” by voting for Mills’ bill, SB173, which he said wouldn’t actually do anything after the amendments.

Originally, the measures sought to create a statewide fall-back in case the health law was thrown out, a move that would protect people with pre-existing conditions and establish rules for what insurance must cover, among other things.

Following exodus, more insurers could be coming to Louisiana's individual health exchange

Analyses done by the Louisiana Department of Insurance on those proposals showed that by 2024, costs would rise by between $634 million and $834 million in the individual exchange. Those costs would be borne by consumers, unless the state or federal government decided to step in.

The governor has criticized Landry for seeking to repeal the health law, pointing to the 800,000 people with pre-existing conditions and half a million Medicaid expansion recipients who would be hurt by such a move.

Landry has said the state can create a better system on its own.

“It was kind of strange the attorney general has a bill that seeks to protect what he’s in court trying to invalidate,” Edwards said after testifying Wednesday.

The hearings Wednesday, and analyses on the costs of the health law repeal, showed the state would likely have to rely on the federal government if it wanted to create an affordable insurance system for people with pre-existing conditions.

“I remain committed to working with state leaders to find constitutionally sound, state-based solutions to the ongoing issues with #Obamacare,” Landry said on Twitter. “I thank the Speaker (Taylor Barras), Chairman Mills, & Insurance Commissioner (Jim) Donelon for working with me to protect Louisiana patients.”

Louisiana’s individual exchange under the Affordable Care Act has seen premiums fall recently, after years of cost hikes and insurers fleeing the market. Blue Cross and Vantage, which is being acquired by Blue Cross, are the only insurers offering plans in the exchange this year, though Donelon has said more insurers could be entering the market soon.

The Affordable Care Act has had a large effect on Louisiana’s health landscape, primarily through Medicaid expansion, which has extended health coverage to about half a million people. Fewer than 100,000 people obtain coverage through the state’s individual exchange through the health law.

Follow Sam Karlin on Twitter, @samkarlin.