by Steve Spires
While the fate of the LSU public hospital system will be front-and-center when legislators begin their review of Gov. Bobby Jindal’s executive budget next month, another health care issue looms that could have long-term implications for New Orleans-area patients and health-care providers.
More than 52,000 adults in the four-parish New Orleans metro area (Jefferson, Orleans, Plaquemines and St. Bernard parishes) currently receive primary care services through a Medicaid “waiver” developed after Hurricane Katrina that has helped foster a network of neighborhood health clinics. Adults with incomes up to 200 percent of the federal poverty line (around $22,250 for an individual or $38,180 for a family of three) who have been uninsured for six months are eligible for coverage through the waiver, with limited cost-sharing based on income. But the waiver is set to expire on December 31, and there are no provisions in the executive budget to maintain funding for the clinics.
The Greater New Orleans Community Health Connection (GNOCHC) waiver has played a crucial role in the post-Katrina rebuilding effort by providing access for uninsured adults and giving financial support to community health clinics. By emphasizing primary care, the waiver helps reduce the burden on area emergency rooms, which often served as primary clinics for the uninsured.
The original plan was for the waiver to be a “bridge” to health care reform. The expectation was that low-income adults who use the neighborhood clinics would become eligible for Medicaid as part of the expansion, or receive federal tax credits to buy private health insurance in the Obamacare exchange beginning on January 1, 2014.
Now, the Jindal administration’s opposition to Medicaid expansion has thrown a wrench in that plan.
At least 7,000 clinic patients will still be able to buy private insurance with federal tax credits. But the other 45,000 patients—who should be eligible for Medicaid expansion—will instead be cut off from services beginning on Jan. 1. This will not only be a significant hardship for thousands of residents who depend on the neighborhood clinics for routine care, but will be a financial disaster for the clinics themselves, who will no longer have a way to get paid for their services.
The governor’s executive budget proposal does not include any money to continue the waiver services. But there is an obvious solution to this problem: Accepting the billions of federal dollars being offered to Louisiana and other states to expand Medicaid coverage. An estimated 400,000 adults statewide, including most of the New Orleans-area patients now getting care through the waiver, would be covered by the expansion. Accepting the money would also make sure that doctors and clinics are paid for their services, while boosting the state’s economy and creating jobs.
Without Medicaid expansion, tens of thousands of Louisianans will lose access to preventive health services next year and many of the major gains and improvements made to primary care in the New Orleans area since Hurricane Katrina will be lost.
