As a prosecutor in the Supreme Court case against the Affordable Care Act, and a heavily conservative Southern state, Louisiana has not met Obamacare with the kindest welcome. The state could certainly use it, however: Louisiana was ranked 49th in the country for overall health, and the percentage of uninsured residents was over 20 percent in 2012, according to America’s Health Rankings. Mandatory health insurance and an array of new benefits should bring some enthusiasm to those Louisianians who were rejected by insurers due to the state’s rigid laws. If eligible for a subsidized health plan, some residents may be able to get their health under control for a decent cost. While some may be opposed to the legislation, or the administration implementing it, it should not obscure the fact that thousands of people in Louisiana are now able to obtain coverage.
The health reform law gives plan members more liberties, more benefits and better coverage. Though the state is not expanding its Medicaid program, New Orleans officials discussed the immense need for it, and may expand the program locally, if nothing else. The state also decided to use a federally-run health insurance exchange rather than setting up a state-level organization, another decision typical of red states during Obamacare implementation. Governor Jindal also made special state rules regarding the health insurance exchanges.
Health Reforms in Louisiana: 2010-2013
Notable changes were established in health insurance and care for insured and uninsured Louisianans since 2010, when the law was signed. After the law’s implementation, insurers were not permitted to rescind health insurance plans without good reason, somewhat similar to the HIPAA provision of guaranteed renewability. After issues with cancer patients being labeled as fraudulent and getting their benefits canceled, rescissions are now illegal – unless you do try lying on your application. Louisiana health insurers also cannot impose a lifetime benefit limit, and annual maximums were phased out during this period, increasing from $1 to $3 million until eliminated in 2014.
Young adults in Louisiana were given more time to stay insured beginning in March 2010. Individuals who are child dependents under their parent’s group or individual policy can stay insured until age 26. In Louisiana, 53,000 people between ages 19 and 25 gained insurance as of December 2011 due to this provision, and a total of 3.1 million young adults nationwide.² Access to preventive care has also improved under the ACA, as certain services must be free under every health plan. Additional services were added to the mandatory coverage list for prevention in August 2012, including prenatal care, contraceptives, and cancer screenings.
Insurers are now accountable to the medical loss ratio, in place to make sure the company spends its premium income on more quality improvement measures for consumers, and fewer internal costs. Companies that fail to adhere will cut rebate checks to their policyholders to compensate for the percentage they did not spend on patient-related services. Underwriting changed slightly during this time, as the federal law required children up to age 19 with pre-existing conditions to apply for individual health plans and not be turned down. Not much else changed in Louisiana underwriting, because of which adults with pre-existing conditions were offered a new option in addition to the state high risk pool, the PCIP.
Louisiana Health Reform: 2014 and Later
Major Obamacare changes begin in 2014, when all residents are required by the individual mandate to enroll in some form of coverage. For many, that coverage is most accessible through the Affordable Care Act’s exchanges, as subsidies are offered to lower-income members. Based on income, coverage is reduced in cost on a sliding scale, and some individuals also receive discounts on cost sharing, making it easier to receive care. The health insurance exchange is operated by the federal government, with plans sold by Louisiana insurers for individuals and small businesses. Obamacare plans are required to cover certain benefits and aim to insure a larger number of people through this new addition to the private individual market.
“Every governor’s got two critical decisions to make. One is do we set up these exchanges? And, secondly, do we expand Medicaid? And, no, in Louisiana, we’re not doing either one of those things,” Governor Bobby Jindal told NBC in July 2012 after the Supreme Court ruling. Jindal’s decision left over 895,800 uninsured residents in the low-income percentage without coverage in years to come. Though New Orleans discussed implementing its own localized Medicaid expansion, the city must receive state approval.
Guaranteed Issue and Rating
Private individual health insurers such as Blue Cross and Blue Shield of Louisiana, Humana, and UnitedHealthcare — on and off the exchange — must accept all applicants under this law. Health conditions cannot be considered during the application process. Premium rating requirements are also different due to community rating and nondiscrimination laws, and can only increase based on location, age and tobacco use. Gender, occupation and health status are not current rating factors for individual health insurance plans.
Obamacare also requires plans inside and outside of the marketplace to include ten categories of Essential Health Benefits (EHBs) in certain plans. These groups include prescriptions, maternity care, mental health care, emergency and hospital services, and office visits, but cost sharing will vary based on the plan you choose.
1. UnitedHealthcare. “2012 Louisiana Health Statistics.” http://www.americashealthrankings.org/LA.
2. Healthcare.gov. “How the Health Care Law is Making a Difference for the People of Louisiana.” http://www.healthcare.gov/law/resources/la.html.
3. The Advisory Board Company. “Where each state stands on ACA’s Medicaid expansion.” http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap.