Health Overhaul Signups

A federal freeze on risk adjustment payments to insurers raises further questions about the health of the Affordable Care Act’s individual market in Louisiana, where premiums have risen sharply and insurers have fled the market in recent years.

Congress failed to repeal the Affordable Care Act despite muscular efforts by U.S. Sen. Bill Cassidy and many other Republicans, but President Donald Trump's administration is still doing its best to undermine the law from within. One strategy has been to cut back on efforts to help people sign up for plans on the law's individual marketplace. The administration has reduced its own outreach efforts as well as aid to outside groups that have been working with customers since the law took effect. The enrollment period has been cut in half.

It's almost as if its leaders don't want people to sign up.

Yet the opening days of enrollment, which started Nov. 1, brought some not-so-surprising news. People signed up in record numbers anyway. It's almost as if this insurance, for which many customers qualify for subsidies, is something really people want.

That message still doesn't seem to be getting through to the administration or to Congress, which is reportedly mulling the idea of repealing the law's individual mandate as part of its big tax rewrite. The mandate is designed to bring young, healthy customers into the system, which in turn helps cover the cost of insuring patients who need more costly treatments and services.

Maybe after Tuesday, it finally will. There was no national election, but the results from several states suggest the desire for more affordable care is a top concern of many Americans. 

In Maine, voters easily approved the nation's first referendum on accepting Medicaid expansion, after the state's Legislature backed the move five times, only to see it vetoed each time by Republican Gov. Paul LePage. Maine is the home state of Susan Collins, one of the few Republican senators who has stood up strongly against efforts to strip the law and its benefits, and you can bet the vote will only strengthen her resistance.

Medicaid expansion was also an issue in Virginia, where outgoing Democratic Gov. Terry McAuliffe has tried to implement the program but faced opposition from the Republican legislature. Tuesday, Democrat Ralph Northam won the governor's race handily, and Democrats made huge gains in the House of Delegates. Observers there now expect expansion to finally happen.

Louisiana's already had this fight, of course.

Gov. Bobby Jindal had refused to accept the expansion, which allows people who make too little to qualify for subsidies on the private exchanges to get insurance. Democrat John Bel Edwards ran on a promise to reverse Jindal's decision — a stance echoed, although not as enthusiastically, by his three Republican primary opponents. He quickly followed through, and more than 440,000 Louisianans who did not have insurance before now do.

Edwards considers this one of his proudest accomplishments, and makes a point in public speeches of recounting how many people have been screened for serious conditions under the expansion, and how many are now getting treatment. And when Republicans who hope to make Edwards a one-term governor look for issues to highlight, they rarely pick this. That's one of many signs the policy is widely accepted despite Louisiana's Republican leanings.

One exception is Attorney General Jeff Landry, who rarely skips a chance to take partisan shots at Edwards.

On Tuesday, as all those voters in Maine and Virginia were casting ballots, Landry unveiled a new prescription take-back box at the Baton Rouge Police Department headquarters Tuesday — and took a moment to launch an disingenuous allegation that, by expanding access to prescription coverage, Edwards' initiative has compounded the opioid problem. This isn't an original idea, but a Washington talking point that's been circulating among opponents of the ACA. According to the Associated Press, the notion came from a report for Republican Wisconsin U.S. Sen. Ron Johnson. The AP added that researchers who study the drug epidemic see no evidence of causation.

In fact, there's a much more convincing argument that Medicaid expansion helps fight the problem by paying to treat addiction. About 13,800 expansion patients in Louisiana have received inpatient or outpatient substance abuse treatment in the last year, according to the state Department of Health. The department has also worked to reduce the possibility of abuse by imposing limits on availability of drugs in question. As of July, Medicaid patients suffering acute pain can only get a seven-day supply.

Like his counterparts in Washington, Landry is clearly hoping for the return of the days when railing about Obamacare worked. But Tuesday's results underscore how much the ground has shifted.

And the sooner they finally accept that, the sooner they can stop all this nonsense about undermining the law, and finally get to work fixing its shortcomings.

Follow Stephanie Grace on Twitter, @stephgracela.