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Update on Medicaid expansion in LA

By Heidi Sinclair, MD, MPH

In 2008 Governor Jindal had proposed his own “Louisiana Health First” Medicaid expansion program.  Four years later however, he had reversed course and, along with most other “Red State” Governors, was standing opposed to Medicaid expansion in Louisiana,

While the Affordable Care Act has provided many benefits beyond extending coverage to the poor through Medicaid expansion, most of the patients and families that I see and work with, live at or below the Federal Poverty Level, and therefore have been unable to obtain coverage through the ACA marketplace or exchanges.  Meanwhile, unlike some states that already extend Medicaid benefits to adults up to 133% of Federal Poverty Level, the working poor in Louisiana are generally not eligible for Medicaid at all, leaving hundreds of thousands uninsured.

The Legislative session in Louisiana is short - only from March or April until first week of June. I attended my first legislative Health and Welfare Committee Hearing in Spring of 2013.  Like most Americans, I didn’t know that these legislative committee hearings are open to the public!  Citizens are invited to fill out cards pro or con on bills being presented to be voted on during each hearing.  These cards are counted and comments included are often read into the record.  There are usually members of the public or government officials scheduled in advance to speak on the issue before the committee, but anyone present can also, on their submitted card, request to speak. I was not prepared or planning to speak that first day but I was asked to, and did. I have since been invited to present in favor of Medicaid Expansion, among other things, at other House and Senate Committee Hearings.

I joined the Campaign for Healthcare for Everyone Louisiana on meeting the Campaign Organizer, Alma Stewart, at that first legislative hearing.  There are over forty local or state-wide organizations that are endorsed members of this campaign and over one hundred organizations and five hundred individual signed on to HCEL’s initial 2013 public letter to Governor Jindal asking him to support of Medicaid Expansion. In addition to letter’s to editors and op-eds penned by members of HCEL and others, there has been editorial support for Medicaid Expansion from all of the major local newspapers. HCEL set up separate committees to focus on legislative matters, media, education and grass-roots organizing which I think has been effective in providing a “multi-pronged” approach.  As it became clear Medicaid expansion was not going to happen in 2013, HCEL developed a longer-range, eighteen month plan, with focus on making Medicaid expansion and important issue for the Gubernatorial election of 2015.  Meanwhile, HCEL continued to partner and network with other groups working in support of Medicaid expansion, meeting with legislators, promoting letter writing campaigns, organizing or participating in press conferences or interviews on radio or TV, organizing or participating in rallies and “Dying for Coverage” candlelight vigils at the capital, visiting churches, health fairs and enrollment events, etc.  In the Fall of 2014, in coordination with the American Public Health Association’s annual meeting in New Orleans, HCEL organized a Day of Action in support of Medicaid expansion and both Alma Stewart and I were invited to present at the conference as well.

Each legislative session, more and more regular people from all over the state were coming to Senate and House committee hearings to show their support for Medicaid Expansion.  The last hearing I attended required two additional over-flow rooms to accommodate everyone!

In 2015, in coordination with Dillard University, New Orleans, HCEL organized a televised Gubernatorial Candidate Forum on Healthcare in Louisiana.  Despite the legislature’s continued refusal to advance any bills in support of Medicaid expansion in Louisiana, all three Gubernatorial candidates had expressed at least willingness to consider some version.  Representative John Bel Edwards was the only candidate, however, to make Medicaid Expansion a corner-stone of his campaign. I believe Governor Edwards’ strong support for Medicaid expansion played an important role in his election and the Governor was true to his word, signing in support of Medicaid Expansion his first day in office!

Beyond HCEL, I have also been networking with Tulane students and residents who are part of Tulane University School of Medicine’s Advocacy Track as well as other physician-advocate friends and, following the lead of Tulane resident, Sarah Candler, have been involved in efforts to revive the Louisiana Chapter of the American College of Physician’s Health and Public Policy committee.

Most recently, as State Director for Doctors for America in Louisiana, I was invited to participate in Louisiana Public Broadcasting’s Public Square program on Medicaid Expansion in Louisiana and was able to bring other DFA members to participate in the discussion as well.  Meanwhile. HCEL, in collaboration with Louisiana Public Health Institute and the Department of Health and Hospitals - Office of Public Health, has also organized a state-wide Health Summit which will be held in Baton Rouge this Tuesday, March 29th.

There is still a lot of work left to do!  Louisiana is struggling with an unprecedented budget crisis and some legislators have already filed bills to block or limit expansion, despite the obvious overall fiscal benefits to the state. Dr. Rebekah Gee, the new secretary of the Department of Health and Hospitals, is optimistic however, citing support even from many conservative legislators previously opposed.  Another important point to keep in mind, is that access to health insurance does not always translate into access to care.  While Rebekah Gee and others cite “new models” of care in development and while community clinics and even private hospitals are adding new primary care positions specifically for those newly insured under Medicaid expansion, a key to attracting and retaining providers will be ensuring adequate and reliable reimbursement.  Medicaid Pay Parity, which would put Medicaid reimbursement on par with Medicare reimbursement rates, has been discussed by DHH and was part of the recommendations of Governor Edwards’ newly created Healthcare Advisory Panel.

As a member of Doctors for America, I pledge to continue collaborating with dedicated community partners and fellow healthcare advocates in working towards a more equitable, healthier future for the people of Louisiana.

DFA Louisiana Dr.'s representing at filming of LPB Louisiana Public Square Jule Asserq, Heidi Sinclair and Sarah Candler (not pictured Dr. Christy Valentine)

Dr. Heidi Sinclair is the Louisiana State Director.

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