Expanding Medicaid in Louisiana has driven the uninsured rate to historic lows, but it has failed to address the state’s infant mortality crisis. Many providers do not treat patients on Medicaid because of the low reimbursement rates paid by the private insurers that operate the program. This can create barriers to coverage for thousands of pregnant women and new mothers. The Times-Picayune |Baton Rouge Advocate’s Andrea Gallo examines why Medicaid expansion hasn’t led to improved health outcomes for newborns and babies. 

Theoretically, a low-income woman could use Medicaid for primary care to stave off conditions that later make pregnancy high-risk, like uncontrolled diabetes or high blood pressure. But “coverage is not care,” said Susan East Nelson, the executive director for the Louisiana Partnership for Children and Families. [former Louisiana Department of Health secretary Rebekah] Gee said some clinics and hospitals have a “Third World mentality,” designating specific days for Medicaid patients so their privately insured patients do not have to interact with them. 

The coverage gaps lead to negative outcomes for both mothers and babies. 

“Women would go in for appointments and the person that delivered their baby was someone they’ve never seen before,” [Amandla Group founder and president Frankie] Robertson said. Pediatricians say they will spend weeks or even months taking care of babies in a neonatal intensive care unit, but once the babies get well enough to go home, Medicaid won’t pay to manage their conditions. 

The 2023 constitutional amendments 
Early voting in the Nov. 18 runoff elections starts today, and among the choices facing voters is four proposed changes to the state constitution. A new report by the Louisiana Budget Project explains and analyzes each amendment so voters can make their own decisions when they head to the polls. 

The first two proposals will have no practical significance for anyone in Louisiana, as they clarify the rules and timing for overriding a gubernatorial veto and eliminate six funds in the state constitution that are not in use. The third amendment would authorize local authorities to create a new tax break for police and other first responders, while the final proposal is designed to make it harder for the Legislature to tap a new state savings account. 

The Public Affairs Research Council of Louisiana offers its own analysis here, and the Council for a Better Louisiana offers its thoughts as well

Entergy bills rising at historic rate
Entergy New Orleans customers are seeing historic increases on their monthly bills as the corporation is paying record dividends to its shareholders. The company says the increases are due to factors out of its control, while still claiming it offers some of the lowest rates in the country. But new reporting from Verite News’ Michael Isaac Stein refutes those assertions. 

The average New Orleans resident in 2019 paid $1,345 for a year of electricity, or about $112 per month. In 2022, that same customer using the same exact amount of electricity would pay $2,148, or $179 per month — a 60% increase, Verite’s analysis found. If you add gas charges, average monthly bills rose from $135 to $215. Bills will would rise even higher if the New Orleans City Council approves Entergy’s controversial $1.3 billion proposal for storm resilience upgrades, which calls for another 20% bill hike over the next decade. 

Verite’s reporting helps highlight Entergy’s unusual business model that insulates the company from paying for routine maintenance of equipment and other normal operating costs. 

[Alliance for Affordable Energy’s Logan] Burke and other advocates have long warned that the company has effectively shifted most of the risk of the business onto the shoulders of customers, who have to deal with erratic bills while shareholders enjoy steady, rising profits. … And Burke and [Deep South Center for Environmental Justice’s Monique] Harden agree that some of the items Entergy is asking customers to pay for, like routine operations and maintenance, are things the company should already be doing with the money they’re collecting from customers. 

California and Florida’s home insurance crisis
Natural disasters in the United States are becoming more frequent and costly due to the effects of a changing climate. California and Florida have experienced many of these disasters and a resulting insurance crisis. These two states, which have traditionally managed their home insurance markets in different ways, are starting to use similar tactics. But as Route Fifty’s Liz Farmers explains, this includes keeping the state’s insurer of last resort solvent by passing on costs to homeowners:

It remains to be seen whether California’s new rules help stabilize the insurance market there, or whether rising prices will prompt more homeowners to go without coverage. But in Florida, there is some movement: Last month, Citizens shrank for the first time in years as five private insurers assumed just under 100,000 policies. The shift, though, means that the cost of home insurance in the Sunshine State—which was already more than twice the national average last year—is becoming unaffordable for many. 

Farmer explains the pros and cons of the two state’s market-based approach, an approach newly-elected Louisiana Insurance Commissioner Tim Temple supports to address unaffordable premiums in his state. 

On the one hand, the change could potentially discourage building in disaster-prone areas—something neither state’s previous approaches fully accomplished—and encourage more risk-mitigation activities like fire-resistant roofing or creating firebreaks around communities. Or, on the other hand, the approach is just a temporary Band-Aid. Some fear that global warming and the resultant natural disasters are too big for any one geographic area to insure against.

Number of the Day
60% – Percentage increase in cost of electricity for the average New Orleans resident from 2019 through 2022. Customers are paying significantly more for using the same amount of electricity while Entergy pays record dividends to its shareholders. (Source: Verite News)