1. Medicaid Expansion is Right Choice
for Louisiana
Steve Spires
Louisiana Budget Project
stevespires@lano.org
225.236.1401
www.labudget.org

2. About Louisiana Budget Project
Provides independent, nonpartisan research and
analysis of public policy issues and their impact
on low- and moderate-income Louisiana families
Visit www.labudget.org
www.labudget.org

3. Health reform is needed
• 1 in 4 non-elderly adults in Louisiana is uninsured
• LA has some of the strictest Medicaid eligibility for
adults in the nation, income limit around 15 percent FPL
—or less than $3,000 a year for a family of three
• Employer-sponsored insurance coverage has been
declining for years
• Only 5 percent of children are uninsured due to success
of LaCHIP (we know that Medicaid expansions work)
www.labudget.org

4. Eligibility is generous for children and pregnant
women. Could be expanded for adults in 2014
250%
Medicaid expansion eligibility:
200%
$14,850 for an individual
$25,390 for a family of three
150%
100%
50%
0%
Children Pregnant Parents Adults People with Nursing
Women without Disabilities Home/ Long
Children Term Care
Current Eligibilty (as % of Federal Poverty Level) 2014 Expansion up to 133% FPL

5. Key Findings from Our Research
• Of estimated 330,000 uninsured people who
would qualify for Medicaid expansion, the
majority—200,000—are working
• Major coverage gains in important economic
sectors: construction, entertainment/tourism
and retail
• Other results: major gains among health care
and child care employees
www.labudget.org

6. Medicaid Expansion is Critical for Low-Income Working People
Where Do Uninsured Louisianans
Who Could Gain Medicaid Coverage Work?
Restaurants and Food Service 33,900
Construction 24,300
Grocery Stores 8,400
Nursing Homes 6,300
Hotels and Motels 6,100
Landscaping Services 6,000
Professional Building Services 4,450
Elementary and Secondary Schools 4,400
Home Health Care Providers 4,100
Hospitals 4,050

7. Medicaid Expansion is Critical for Low-Income Working People
Occupations w/ Average Wages That Could Make a Family
Eligible for Medicaid Expansion
(Source: Louisiana Workforce Commission)
Occupation Avg. Hourly Wage Annual Full Time Wage
Child Care Worker $9.00 $18,730
Construction Laborer $12.80 $26,600
Hairdresser $12.00 $24,920
Home Health Aide $9.30 $19,380
Hotel Desk Clerk $9.40 $19,530
Landscaper $10.85 $22,570
Maid/Housekeeper $8.80 $18,340
Restaurant Cook $10.60 $22,060
Retail Salesperson $11.10 $23,110
Waiter/Waitress $9.10 $18,990

8. Expansion = More Health Security
• More than 50,000 uninsured Louisianans who would be
expansion eligible were working in the last few years—
many are unemployed due to the still weak economy.
Louisiana's Unemployment Rate Number of Uninsured Adults
9.0 750,000
8.0
730,000
7.0
6.0 710,000
5.0
4.0 690,000
3.0 670,000
2.0
1.0 650,000
0.0
630,000
2008 2009 2010 2011
www.labudget.org

9. Medicaid expansion will benefit Louisianans
in every parish
Shreveport
Monroe
Alexandria
Baton Rouge
Lake Charles
New Orleans
Lafayette

10. Medicaid Expansion is a GOOD DEAL!
• Federal government will pay 100% of the cost
for the first three years
• State will slowly chip in after that, but never
have to pay more than 10% of the cost
• By comparison, today the feds pay for around
65% of Louisiana’s Medicaid program, with the
state responsible for 35%
www.labudget.org

11. State cost has been exaggerated
• Jindal administration is often quoted saying
expansion will cost $3.7 billion over 10 years
• More credible estimates closer to $1 billion
• Actual cost is much lower, as there will be
offsetting savings due to reform
• In return, Louisiana will receive $15.8 billion in
new federal money through 2022
www.labudget.org

12. We are already paying
• Louisiana already spends hundreds of millions
each year on health care for the uninsured. So
do private and non-profit providers
• Families and businesses with private insurance
pay higher premiums due to “cost shifting”
• Reform will improve the health care system and
result in some savings that can be used to help
cover the cost of Medicaid expansion
www.labudget.org

13. Positive Health Impacts
• Louisiana ranks near the bottom on national
health indicators
• Medicaid expansion would improve access to
care, reduce financial stress on families and
result in better overall well-being
• New research shows that Medicaid
expansions even reduce state mortality rates
www.labudget.org

14. Positive Economic Impacts
• Medicaid currently supports an estimated 50,000
health-care jobs and thousands more “indirect”
jobs across the state
• Influx of new federal health-care dollars will
stimulate state economy, create jobs and
generate additional state revenue
• Expansion means a more competitive market for
health care services
www.labudget.org

15. Direct Benefits for Employers
• Healthier workforce is a more productive
workforce
• Access to insurance results in fewer
missed days of work and better health
management for employees
• Less “job lock” means more efficient labor
market and better employees
www.labudget.org

16. Keeping the cost in perspective
• Louisiana already pays for high cost care for the
uninsured
• Reform will bring significant health care savings
elsewhere in the state budget that can be used
to pay for most of Medicaid expansion
• Medicaid expansion will also result in new
economic activity that will generate additional
state revenues
www.labudget.org

17. Favorable timeline for Louisiana
• The state won’t have to pay ANY expansion
costs for the first 3 years. By 2017:
• State revenues will likely have increased due to
economic growth
• State will have a clear idea of the costs and
savings and can plan accordingly
• The state always reserves the right to “opt out” in
the future if needed
www.labudget.org

18. What is the alternative?
• Dollars that the state currently use to fund
public hospitals and care for the uninsured are
going away
• Without federal Medicaid expansion dollars,
providers may not get paid, clinics could close
and patients will be harmed
• Accepting Medicaid expansion revenue is the
responsible path forward
www.labudget.org

19. We can’t afford to NOT expand Medicaid
The need for Medicaid expansion is clear. Without
expansion:
• Poor health outcomes will continue to affect our
workforce and diminish productivity
• High cost of uninsured care will increase financial
pressure on the state and health care providers
• Continued “cost shifting” will affect those with
private insurance
www.labudget.org