The gains in health insurance coverage Louisiana experienced after expanding Medicaid three years ago—leading to about half a million people getting coverage—made the state an exception to a national trend of stalling or even eroding insurance coverage.

A new report from the Commonwealth Fund, a New York health care think tank, shows Louisiana’s drop in uninsured from 2016 to 2017 came as 16 other states experienced upticks of at least one percentage point in their uninsured rates. Low-income people made the largest gains in health coverage in Louisiana, as Medicaid expansion drove down the state’s uninsured rate.

The findings, outlined in the Commonwealth Fund’s 2019 Scorecard on State Health System Performance, track with what LSU researchers found in an annual survey released last year: Medicaid expansion drove down the uninsured rate dramatically in the year after Gov. John Bel Edwards expanded the program.

The LSU survey found the uninsured rate fell by half–from 22.7% to 11.4%–from 2015 to 2017, almost entirely because of the expansion of Medicaid. The expansion began offering Medicaid coverage to adults whose incomes were under 138% of the federal poverty line, or about $34,638 for a family of four as of 2018. 

The new report shows Louisiana’s expansion came at a time when more than half of states simply held onto earlier gains in insurance coverage. Louisiana was “one notable exception” from the trend, the authors wrote, experiencing a 3 percentage-point drop in its adult uninsured rate—from 15% to 12% from the end of 2016 to the end of 2017. 

17,000 people must prove they qualify for Medicaid or be kicked off the program

But Louisiana still has glaring problems with health insurance and outcomes. While the state posted gains in some areas tracked by Commonwealth, it ranked 45 out of 51 states and the District of Columbia in the scorecard, which evaluates states on 47 health indicators, like insurance rates, health spending and premature deaths. The data is for 2017.

Workers in Louisiana paid more for employer-sponsored health insurance than any other state in the country, when compared to median income. Far more adults in Louisiana went without the appropriate flu and pneumonia vaccines than in other states. And Louisiana ranked last for the number of adults who went without an annual dental visit.

“There are a mix of things Louisiana needs to address but Medicaid expansion was a very important first step for the state,” Sara Collins, a co-author of the report, said in a conference call with reporters.

Among people who get their health insurance through an employer, Louisiana workers paid premiums that amounted to about 10% of median income, the highest rate of any state. Other southern states also performed poorly in that metric.

Louisiana’s overall ranking of 45 is slightly better than the previous two years, when the state ranked 49 in the scorecard.

The federal government pays most of the costs associated with Louisiana’s Medicaid expansion, with the state paying a relatively small share with money from a tax on providers. The insurance is the second-most common type of insurance coverage in Louisiana, according to the LSU research, covering about 21% of adults. More than half of adults get coverage from their employers. 

Republicans in the Louisiana Legislature have taken aim at the Medicaid program amid critical reports from Legislative Auditor Daryl Purpera. Meanwhile, Gov. Edwards has touted Medicaid expansion as a life-saver for the working poor as he runs for re-election this fall. 

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Medicaid expansion made Louisiana an outlier in national trend of stalling insurance coverage – The Advocate