Two years ago, Donna Risso and her friend Michael were living under a bridge in New Orleans. They were struggling not only with homelessness, but also with Donna's mounting health problems, which included hepatitis C, cirrhosis of the liver, encephalitis, pancreatitis and chronic anemia. Donna was a "frequent flyer" at the emergency room, often five to 10 times a month, but her health was getting steadily worse.
Social workers using federal and state resources helped Donna find housing and got her on a state program called "disability Medicaid," which covers health care costs for people who meet federal disability criteria but are not yet on the federal program. This important initiative, common in many states, is a bridge to health services for people applying for federal benefits, which can take years.
Although the program was a lifesaver for Donna, Gov. Bobby Jindal terminated "disability Medicaid" in Louisiana as of Jan. 1, leaving 9,200 people across the state with no coverage.
It's well known that Gov. Jindal steadfastly opposes expanding Medicaid in the state under the Affordable Care Act, and that the Legislature voted against expansion in 2013. This is misguided, as Medicaid expansion would cover as many as 300,000 uninsured residents, with 100 percent of the costs picked up by the federal government through 2016 and at least 90 percent thereafter.
But less widely known is that Medicaid in Louisiana is actually shrinking, through termination of programs and tighter eligibility requirements. In the state's view, since the Affordable Care Act's private insurance marketplace will cover people earning more than the federal poverty level, many people on Medicaid should pick up insurance on marketplace exchanges.
But it's not that simple. According to the Kaiser Family Foundation, most Louisianans who need health insurance have incomes below the federal poverty level, which is $11,490 a year for an individual. These folks, an estimated 242,000 people, fall into an enormous coverage gap in states that are not expanding Medicaid and taking people off Medicaid only adds to this group.
On Louisiana's Medicaid Purchase Plan, for example, people with disabilities who were working could receive Medicaid benefits if they earned no more than $25,000 per year. Now the program is available only to those who make less than $11,490, making half of the program's 2,300 participants no longer eligible.
But the marketplace under the Affordable Care Act was not designed for the poor, the sick or those with disabilities, since fees and deductibles on the private marketplace plans still place health insurance out of reach for many low-income people. Medicaid also covers the personal assistance, transportation, home care and other services needed by many people with disabilities, while most private plans don't. And if an enrollment deadline is missed, that leaves people with no health insurance for a year -- which is not a viable option for folks who live with chronic medical or mental health challenges.
Louisiana is also cutting benefits for pregnant women. Thinking that pregnant women cut from the program could join the exchanges, the state drastically reduced eligibility for the "LA moms" program, which seeks to address the state's alarming infant mortality rate, the second-highest in the nation. Pregnant women who miss the enrollment deadlines can fall back on the state Medicaid program for children, but they will miss out on post-partum care and other vital support.
For many of the state's most vulnerable residents, the failure to expand Medicaid has left a dangerous gap between a shrinking Medicaid program and the coverage provided by private insurance exchanges. Living in this gap is not a policy abstraction. Donna was dying. She was dying at home without the means to pay for all of her prescriptions. She was homebound without a wheelchair. With no home attendant, she could not bathe herself. She had no bedside commode. When Michael went out, she was left completely helpless.
A hospice service agreed to help Donna until she received federal disability benefits, but her social worker said, "We had to beg them to take this risk, and not everyone will be so lucky."
Without the Disability Medicaid Program, Donna's visits to the emergency room cost $1,000, which as the state Department of Health and Hospitals notes, is "much more than a visit to a primary care provider for the same symptoms."
When it comes to health care decisions, Louisiana is moving in the wrong direction -- leaving more people without health coverage and ultimately costing the state more in dollars and lives. This can be fixed. The Legislature is in session, and members are considering bills that offer several options for ways to expand Medicaid.
On April 1, Donna died. It's too late for her, but perhaps not for others. It's time to move Louisiana forward toward a healthy and financially sound future.
