NEW ORLEANS—Louisiana's nine safety net hospitals are bracing for big state funding cuts as lawmakers in a special session remain deadlocked over new Democratic Gov. John Bel Edwards' request for tax increases to fund healthcare and higher education.
Meanwhile, the state is racing to enroll low-income adults in its new Medicaid expansion that starts July 1, which Edwards implemented through executive order and which the Republican-controlled Legislature did not try to block. State officials say they've already signed up more than 200,000 of a projected total of 375,000 people since enrollment started June 1.
Observers say the expansion could at least partly offset the effect of the state funding cuts on the nine privately run safety net hospitals around the state, which are the main facilities serving the poor and uninsured.
As of Monday, lawmakers had reached tentative agreement on raising only about $200 million of the projected $800 million budget shortfall.
While hospitals are warning of dire effects of the potential cuts, the Medicaid expansion is likely to bring them lots of new money, said Jan Moller, director of the Louisiana Budget Project, a nonpartisan watchdog group. The safety net hospitals got used to guaranteed state money, but now they'll have to compete with other hospitals for Medicaid patients and dollars, he said.
Medicaid expansion advocates hope Louisiana's expansion under the Affordable Care Act will prod other Southern and conservative-led states to follow suit. But some observers wonder whether Louisiana's long-standing social welfare tradition going back to the Huey Long era makes the state an outlier in the South.
“There is the Deep South and the Deep Deep South,” said David Becker, an associate professor of public health at the University of Alabama at Birmingham, who studies Medicaid policy. “In Louisiana there was a governor who ran on this issue and demonstrated leadership. I don't know if there is the same opportunity in a place like Alabama.”
Jared Stark, CEO of University Hospital and Clinics in Lafayette, projects that the Medicaid expansion will reduce his 116-bed safety net hospital's bad debt by about $6 million a year. At the same time, he's worried about cuts in the $126 million his hospital was expecting from the state for the next fiscal year.
On balance, he's optimistic. The Medicaid expansion “is something we were pushing for. We are extremely excited about it. It's the right thing to do for patients, and it allows us to provide needed care.”
Enrollment counselors say low-income patients are thrilled about the opportunity to receive Medicaid coverage. Louisiana has an estimated 192,000 residents who had incomes that were too high to qualify for the state's traditional Medicaid program, and too low to qualify for premium subsidies to buy private plans through the Affordable Care Act insurance exchange.
On Monday, a steamy, rainy day in Southwest Louisiana, outreach counselor Tama Stears helped several previously uninsured patients fill out Medicaid applications while she fielded phone calls from other interested people. Stearer, who works at Southwest Louisiana Primary Healthcare Center, a federally qualified community health center in rural Opelousas, said some of her clients have a hard time believing the expansion is actually happening. “A lot of people ask, 'Is it real Medicaid? Will it cover the services I need?' ”
Joshua Guillory, a 32-year-old Opelousas resident who's been uninsured since losing his job in January, said he applied for Medicaid so that he could get specialized care for several conditions, including newly diagnosed sleep apnea and long-standing nerve pain in his leg from a fracture he suffered several years ago. “It's a blessing,” he said.
