Article misjudges salutary LA Medicaid changes

Naysayers resist this truth, but the facts point to Medicaid reductions in Louisiana as a consequence of beneficial policy for all concerned.

 A recent media piece, for some reason, decided to publicize that in 2025 Louisiana saw about 200,000 people drop off Medicaid rolls and wanted to figure out why. Unfortunately, the effort largely was ineffective, as it only cursorily investigated the question but principally because it accepted implicitly a canard.

The article accurately notes that this is part of a trend prior to Republican Pres. Donald Trump assuming office last Jan. 20, but neglects to provide crucial context. The Wuhan coronavirus pandemic provided the excuse for Washington Democrats essentially to suspend eligibility checks for those already enrolled, and nationwide rolls exploded in size including in Louisiana. Eventually, the unwinding of that started and that process mostly was completed in 2024, but with the state’s dragged out further by Democrat former Gov. John Bel Edwards’ stonewalling. As well, the noticeably better economic situation nationally under Trump also contributed to shrinking rolls, encouraging people to switch to other sources of insurance.

Besides larger overall trends, more specifically GOP Gov. Jeff Landry pointed out that job creation in the state had picked up part of the slack. While the article does point out that the state had only 13,000 more jobs at the end of last year than the previous so that could not take up all of the slack, it neglects to mention that more employers under better conditions could be offering health insurance, the top income tier of Medicaid expansion (from where the lion’s share of any reduction likely should emanate) also is eligible for subsidized health exchange insurance and could have switched, and the improved economy and personal situations could prompt others to switch from government to employer insurance.

This carelessness points out the canard running throughout the piece that rendered it largely uninformative: that necessarily a large chunk of those who dropped out don’t have some other kind of insurance. Never explicitly said, nevertheless it promoted this through the attention given to pronouncements of proponents of that view and an uncritical acceptance of it.

As a result of this incuriousness, important contextual information didn’t come to light. It did explicate the new determination process more willing to verify information, bringing it more in line with more heavily-vetted benefits programs, which appears to have precipitated a good portion of the drop off. In other words, the improved process is finding people who should not have qualified to be on the rolls in the first place.

Even a complainer like Democrat state Sen. Regina Barrow admitted this, saying that eligible people that she knew of who dropped off because of inattentiveness were restored quickly once they submitted their information. In fact, the Louisiana Department of Health in recent years has bent over backwards to ensure that existing clients get in their recertifications (as my family experienced first-hand up to this year) in timely fashion to not lose coverage. (However, LDH only belatedly has begun checking on those who don’t use services – which the state still pays for their enrollment – which could indicate an ineligible enrollee).

That wasn’t always the case. Under Edwards, until pandemic disenrollment started at the tail end of his terms, LDH asked for next to no information for recertification and made little effort to verify it. Simply, it’s almost certain that the bulk of the enrollment drop came as a consequence of ineligible recipients being caught out.

And it’s likely that most who did maintained some kind of insurance afterwards. Either they moved into the exchanges or they picked up insurance from their employers (indeed, when expansion came along somewhere between 35 and 47 percent dropped private insurance to have taxpayers pick up the tab).

However, some portion may have lower resources so they won’t have any health insurance, pushing them into the uncompensated care system based on emergency room visits. The piece notes this could increase those costs to taxpayers, but that is unlikely. Expansion backers ran this same argument a decade ago, but after its implementation in the state the surge of new clients caused wait times to see a doctor spike much higher despite an initial increase in new providers (which, year later, still saw limitations on providers and acceptance of new Medicaid patients delaying care), prompting many to continue using more expensive ERs that ate into the “savings” expansion was supposed to bring. Thus, additional costs from this segment won’t be too much off the current baseline.

In short, the available evidence suggests that most of those disenrolled won’t go without health insurance; indeed, the incentives are such that many will take more personal responsibility in doing the things necessary to have insurance. The money that taxpayers will save from this rearrangement should be more than enough for the fewer that will end in uncompensated care. Regrettably, the article doesn’t convey this conclusion, if not tries to convey the opposite.