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From left to right, Gov. John Bel Edwards, flanked by Dept. of Health and Hospitals Secretary Dr. Rebekah E. Gee, (center), shakes hands in January 2016 with his health care transition team co-chairs, Gary Wiltz, CEO of Teche Action Clinic, and Ronald A. Goux, president of the Louisiana Nursing Home Association, at the State Capitol after Edwards signed his his first executive order to provide for Medicaid expansion in the state of Louisiana.

Along with the large-scale layoffs due to the coronavirus pandemic and resulting business shutdown, the Kaiser Family Foundation estimates that some 27 million Americans may have also lost access to employment-based health insurance. Talk about a one-two punch.

The best fallback option for many is the Medicaid expansion available through the Affordable Care Act and largely paid for by the federal government. The law’s authors meant for the program to be available nationwide, but the U.S. Supreme Court later granted states the choice to opt out. At first, Louisiana did so, when former Gov. Bobby Jindal joined many of his fellow Republican governors in saying thanks, but no thanks.

The good news is that Gov. John Bel Edwards reversed course, and that fateful decision is paying off during the ongoing public health and economic crisis.

The most obvious plus is that in Louisiana, unlike in neighboring Texas, Mississippi and quite a few other southern states, health insurance is available to those with household incomes of up to 138% of the federal poverty level. State figures show that enrollment has grown by more than 32,000, from 472,434 to 505,168, in the two months since the world turned upside down.

It’s not just the newly unemployed who are benefiting. As Edwards pointed out repeatedly during his reelection campaign last fall, the expansion has helped rural hospitals keep their doors open by providing income for previously uncompensated care. Elsewhere in the country, these locally vital institutions have been shutting down at an alarming rate, and a study released just before the pandemic hit the United States found that the most at-risk hospitals are in nonexpansion states.

Edwards supporters tout Medicaid expansion benefits

There’s more. Medicaid expansion has given its customers a way to seek health care outside emergency rooms, which has helped reduce the burden at a time when they’re understandably focused on potential COVID-19 cases.

“Imagine having the situation we have with COVID, and having emergency rooms flooded with primary care complaints other than COVID,” said Rebekah Gee, the former state health secretary who oversaw the expansion and who now heads LSU’s Health Care Services Division.

Gee said that Medicaid expansion has also helped the state build a behind-the-scenes infrastructure to handle the virus’s quick spread. The state Office of Public Health, which has been front and center during the crisis, was already well versed in the sort of sophisticated data analysis and reporting that have helped people understand the scope of the problem, and helped the state successfully lobby for needed resources.

This paper supported Medicaid expansion since well before anyone ever heard of COVID-19, and considered it an important part of the safety net even during good economic times. Now that so many more people are struggling, the decision to sign up has never looked so wise.