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SB 682 is NOT Medicaid Expansion

Posted on May 27, 2014

HCEL Concerns Regarding SB 682


Ensuring Affordability for Louisiana

In the Affordable Care Act, the federal government subsidizes the cost of health insurance for citizens who meet certain income requirements. Does Louisiana have the resources to provide sufficient subsidies to its citizens? If Louisiana expects to receive federal funds to assist with these subsidies, please outline the federal funds and amount of subsidies expected to be available. How will the state ensure sufficient funds are available to ensure health insurance and health care remains affordable?

How will the state ensure it has adequate long term resources to guarantee health care for its citizens if health care costs remain high despite plans to lower costs?

Prior to implementation of health insurance reforms related to the Affordable Care Act, Louisiana had a high risk insurance program that was set up in 1991 called the “Louisiana Health Plan”. How will the state fund and sustain a discernable encumbrance to the health care delivery system for a high risk pool?

How will the state address the revenue uncertainty of allowing tax credits for certain plan participants that won’t result in determinable loss in revenue to the state general fund?

How will the state ensure it has adequate resources to provide health care as its population ages and the need for more costly health care increases?


Ensuring Affordability for Participants

Louisiana’s previous high risk insurance program, “Louisiana Health Plan” was expensive and unaffordable for low income individuals. Premiums in that plan were required to be 10 percent higher than the average of the top 5 private health insurance carriers. How would a high risk plan ensure affordability for consumers, particularly low-income families?

On Page 5, Lines 6-9 of SB 682, the legislation outlines the use of cost subsidies and premium support for LA’s senior citizens only. Later on Page 6, Lines 20-22, the legislation states that the plan may include premium support or premium subsidies for eligible individuals. It fails to address the potential burden of deductibles or co-pays for low income individuals and individuals with significant disabilities. How will the state insure that deductibles and co-pays, if included, are affordable for these individuals?


Ensuring Coverage

What is the potential for there to be a “race to the bottom” in terms of what is covered by health insurance plans and what isn’t? Does this plan ensure that there will be no denial of coverage for pre-existing conditions? Could this have the unintended consequence of putting certain treatments out of financial reach for many Louisianans and harm people with disabilities and chronic health conditions?


Ensuring Protections for People with Significant Disabilities and Low Income Health Insurance Participants

The current Medicaid program provides limits on cost sharing measures (co-pays, deductibles and other out of pocket costs) for many participants. Will the proposed health insurance block grant program retain these protections to access to healthcare that is truly affordable?

The current Medicaid program provides for a number of protections for participants including notices of denials that are understandable and access to independent appeals procedures that may not be afforded to individuals with private health insurance. Will the proposed health insurance block grant retain these protections?

Will the proposed health insurance block grant create regulatory uncertainty by allowing DHH to cut benefits with little more than a warning beforehand?

Does the proposed health insurance block grant centralize authority with the governor’s office thereby granting broad, vague, and politically motivated rule making authority with DHH?

Will a quarterly report be sufficient enough to establish proper over site and accountability for something as critical as a state operated health care program?


Addressing the “Coverage Gap” in Louisiana’s Health Insurance System

Over 240,000 Louisianians are currently in the “coverage gap” because they make too much to qualify for Louisiana’s current Medicaid program, their employer may not offer it, and they do not earn enough to qualify for the ACA insurance subsidies and marketplace. This problem exists because Louisiana has rejected Medicaid expansion. How will the Louisiana First America Next Plan address this group of uninsured adults and offer assistance to the “working poor” of the state?


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