The report only got mentioned as
an aside this week in the New
Orleans Times-Picayune – which until then never even acknowledged the
existence of the law or the bill that became it despite its potential
far-reaching impact because editorially
the newspaper supports the alternative of Medicaid expansion under the
Patient Protection and Affordable Care Act (“Obamacare”) – in an article that
in part continues that outlet’s campaign to expand Medicaid. The law required
the Department of Health and Hospitals to issue a report about what policies
had to be enacted at all levels of government in order to expand insurance to
all citizens using market-based rather than government- and politically-based
principles.
DHH already has issued two
reports
explicating why Medicaid expansion is inferior and undesirable policy. Rigorous
methodology showed that, under four different scenarios with differing
assumptions, within a decade the state would be paying hundreds of millions of
dollars more annually for care under expansion than under the current
uncompensated care system. In addition, but not covered by these reports, are
the results from academic research known as the “Oregon Experiment” that demonstrated
people eligible for Medicaid but without health insurance have no worse and
even better health outcomes than those utilizing Medicaid, and follow-ups
that noted even when the previously uninsured begin using Medicaid they
continued to utilize emergency room services for their primary care at
significantly higher rates than the population – disproving a key Obamacare
selling point that primary care would be more efficiently delivered if more of
the uninsured were insured by Medicaid or other form of provision.
Given that expansion would cost
the state more and, if anything, prevent better care outcomes, it’s a
no-brainer to reject Medicaid expansion under Obamacare. However, Gov. Bobby
Jindal had presented the outlines of a plan
at the national level to extend health care insurance to all using radically different
principles, and one frustrated member of the minority expansion crowd in the
Legislature, state Sen. Ben Nevers,
decided to see what of that could be adapted at the state level. His bill, now Act
783, mandated this reporting (even as he now, reverting to form, discounts
this product).
Not surprisingly, it revealed
that hundreds of federal laws and regulations, many having to do with
Obamacare, act as impediments on implementing this. In conjunction with that, it
also details how Obamacare generally has failed to fulfill, if not actually
cause the opposite of, what Obamacare was sold on. Nevertheless, it does
provide some answers as to what the state could do unilaterally to make for
lower health care costs both for families and the state, which include tax
deductions for insurance in the individual market to match those in the group market,
improving transparency on pricing, allowing for increased pooling capacity for
insurance purposes, authorizing cross-state purchasing of insurance (known as “portability”),
and broadening the scope of practice for some health professionals, such as
nurse practitioners.
Still, for substantial progress
to be made, changes at the federal government level would have to occur, and
with a stubborn ideologue in the White House who seems more
interested in wealth redistribution rather than in improving health
outcomes and undoubtedly would use his veto power to prove it, that seems
unlikely for the next couple of years. But at least Louisiana could make some progress
by doing what it can, as according to the report.
Thus, the state faces three
choices in moving forward on broadening health care insurance provision: expand
within an unreformed Medicaid system and make matters worse, do nothing and do
no harm, or embark upon the report’s recommendations and create some
improvement. The last of these choices is the obvious one to make.
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