Louisiana: Gov. Edwards launches PreExisting Condition Protection Task Force to come up with...something.
With the idiotic #TexasFoldEm lawsuit scheduled for oral arguments by the 5th Circuit Court of Appeals this summer, many states have been scrambling to replicate ACA protections for those with pre-existing conditions at the state level, including California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Mexico and more.
In a red state like Louisiana, unfortunately, it's not so easy...the state has a Democratic Governor, but both the state House and Senate are solidly controlled by Republicans. In addition, the Governor, John Bel Edwards, is up for re-election this November, making everything politicized, thus making it likely impossible to get anything useful through this year. Still, Gov. Edwards is trying to do something to mitigate the problem:
On Tuesday, May 21, Governor John Bel Edwards issued an executive order launching the Protecting Health Coverage in Louisiana Task Force after efforts to have protections offered to Louisianans with preexisting conditions repealed.
“Protecting coverage for the 850,000 Louisiana residents with preexisting conditions is a top concern of mine and should be a top concern for all lawmakers. Unfortunately, the attorney general opted to join Louisiana into a lawsuit that threatens the coverage protections offered under the Affordable Care Act. One of the discussed solutions includes taking Louisiana back to the days of the high-risk pool, which only covered around one percent of people prior to the ACA. While we must take any step possible toward protecting our people, we can’t falsely claim we’ve completely solved this problem and risk tragedy for vulnerable people. Louisianans deserve better,” Edwards said.
Good for him, and he's correct about this: "High-Risk Pools" were always a terrible "solution" to the issue of people with expensive medical conditions. It's also pretty late in the game to be just starting to brainstorm ideas, given that the #TexasFoldEm oral arguments are scheduled for July, although a final ruling by the U.S. Supreme Court might not happen until as late as a year from now.
However, there's one serious problem with this Task Force:
The task force is made up of the governor, the head of the Louisiana Department of Health (LDH), the insurance commissioner, the attorney general, various members of the Louisiana Legislature, representatives of the insurance industry and healthcare consumer groups, as well as experts in economic and fiscal modeling.
Yes, that's right: The Attorney General would be on it. The same Attorney General, Jeff Landry, who helped bring the Texas Fold'em lawsuit in the first place.
Of course the obvious solution would be for Landry to pull out of the lawsuit and urge the other GOP Attorneys General to do the same, but failing that, the steps which could be taken at the state level include things like:
- Passing a Guaranteed Issue law at the state level
- Strengthen Louisiana's existing Community Rating law. Right now Louisiana apparently has a CR law in place, but insurance regulators have the authority to grant insurers "transitional relief" from it.
- Strengthening Louisiana's existing Essential Health Benefit law. Right now Louisiana apparently prohibits insurers from imposing pre-existing condition exclusions on the 10 ACA EHBs...but they can add exclusions for conditions not on the ACA list, and of course if the ACA is repealed, there would no longer be federal EHBs anyway.
- Passing a law mandating at least 60% Actuarial Value at the state level
- Passing a law eliminating annual or lifetime coverage caps at the state level
- Passing a law mandating a Maximum Out of Pocket cap for enrollees for in-network care at the state level.
- Passing a law mandating the ACA's no-cost preventative services at the state level.
- Strengthening Louisiana's existing Young Adult law. Right now Louisiana apparently allows young adults to stay on their parents plan until they're 24 (not 26)...but only if they're unmarried and in school.
While I'm on the subject, another thing which would help drop those premiums by a good $700 or more per year per enrollee would be...
- Passing an individual mandate bill at the state level as Massachusetts, New Jersey and DC have (or, alternately, following Maryland's lead and at least adding a checkbox to the state tax forms so people can be auto-enrolled into Medicaid...oh, wait, repealing the ACA would also mean repealing Medicaid expansion...)
Of course, doing all of these things while the ACA's financial subsidies are repealed would also make the premiums for such policies pretty unaffordable for most lower- and middle-class enrollees, which is why the state would also presumably have to replicate the ACA's financial subsidies as well. As far as I can tell, to perfectly replicate existing ACA subsidies at the state level, Louisiana would have to come up with around $385 million/year. Reinstating the mandate penalty should reduce unsubsidized premiums by around $700 apiece, which would save perhaps $55 million/year in subsidies, bringing the total down to around $330 million/year.
Right now, Louisiana has around 466,000 residents enrolled in Medicaid via ACA expansion, and is covering just under 10% of the cost, with the federal government covering the other 90% or so. According to their latest Medicaid budget/finance report, the expansion population specifically costs around $3.2 billion/year. Since the state is already covering 10% or so, that means they'd have to come up with another $2.88 billion/year to replicate the cost at the same level.
So there you have it...if Louisiana were to do all of the above, including raising state revenue by around $3.2 billion per year, they could pretty closely replicate the ACA's individual exchange and Medicaid expansion programs. For what it's worth, LA's current total state budget is around $30 billion, give or take. So, you know...just increase that by 11% and you're good to go.
Or...they could just drop the g*ddamned lawsuit.