EDITORIAL: A dollars-and-cents argument for John Bel Edwards' Medicaid expansion

Advocate, The (Baton Rouge, LA)

Mar. 13—We've backed Louisiana's Medicaid expansion under the Affordable Care Act from the beginning, and the program's track record since Democratic Gov. John Bel Edwards reversed Republican Bobby Jindal's rejection of the enhanced federal health coverage has only reinforced our support.

Nearly 600,000 Louisianans are now enrolled in expanded Medicaid, according to the state's latest numbers, giving them access to preventive care, screenings to detect and manage health problems, and other services that save both money and lives. Medicaid expansion has been an important part of the safety net as the coronavirus pandemic led to job losses in hospitality and other hard-hit sectors. The federal match under expansion is significantly higher than it is for traditional Medicaid, making it a better deal for the state. Rural hospitals have been beneficiaries as well; they've survived as their peer hospitals in nonexpansion states have struggled or even shut down.

A new study highlights yet another advantage. Researchers at the Tulane School of Public Health and Tropical Medicine found that Medicaid expansion in Louisiana coincided with a 33% reduction in the share of hospital operating expenses attributable to uncompensated care, with rural and public hospitals (including those formerly under the Charity system) seeing the greatest impact.

According to a paper in the March issue of the journal Health Affairs that examined the years immediately before and after Edwards' 2016 executive order to expand, Louisiana and nonexpansion states with similar population characteristics diverged when the state adopted the program.

The study found a greater reduction in uncompensated care costs than prior studies of all Medicaid expansion states, which authors Kevin Callison, Brigham Walker, Charles Stoecker, Jeral Self and Mark Diana attribute to Louisiana's relatively large uninsured population before expansion. But because Louisiana is the only state in the Deep South to expand and nearby states share significant characteristics, they believe those states could see similar results.

That fits with what we know, that Medicaid expansion in Louisiana has led to sharp reductions in the uninsured population, and that the pluses were so obvious as far back as 2015 that even Edwards' Republican opponents were prepared to take the plunge. Unfortunately, the discussion over expansion nationally and in other states has been politicized, and Republican governors elsewhere in the South have rejected expansion.

With the ACA as a whole having survived numerous repeal drives, perhaps the time is ripe for them to take another look at the program. If they do, the study's authors suggest they don't need to look far.