Healthcare compromise is not frozen

By Christopher Tidmore,
Associate Editor

Louisiana benefited from the Medicaid expansion under the Affordable Care Act more than just about any other state, mainly due to our largely impoverished population, yet we may have created an unintentional medical divide at the same time.

Many doctors simply do not accept Medicaid as payment, due to the lower reimbursement schedules, as a result refuse even to examine poorer patients. The Pelican State has gotten around that liability, to some extent, thanks to managed-care deals with Blue Cross and Humana, but the problem remains that the 20 percent of the Louisiana population on Medicaid still lacks the broad range of medical access enjoyed by the majority.

The answer may lay in an initiative currently underway far to the north, one to which the Louisiana legislature – and Gov. John Bel Edwards – should pay attention. Alaska’s new GOP Governor Mike Dunleavy started out as an opponent of Obamacare, initially resisting the Medicaid expansion undertaken by his Independent predecessor.

Like many Republicans, Dunleavy quickly changed his opinion; however, his outsider perspective noted that those insured in the ACA ‘Healthcare.gov’ exchanges enjoy a greater breath of medical access than those in Medicaid. Moreover as a worker improves his or her financial situation, he or she would be forced off Medicaid and into government-provided subsidies on the ACA Exchange. As government pays for both was such a jump even necessary?

Since both programs offered essentially free medical coverage for those making less than $50,000 per year, with the ACA providing tiered subsides continuing above that income, such a mandated switch seemed repetitive and punitive. It even left some without healthcare coverage when they would have otherwise qualified due to simple regulatory idiocy.

The Dunleavy Administration has petitioned Donald Trump to be allowed to place Medicaid recipients in the ACA Exchanges, with the current amount spent for the program block-granted to Alaska to pay for their private insurance premiums. In fact, the addition of thousands of the relatively-healthy into the ACA insurance pool would provide the added effect of lowering overall premiums – especially for those in the middle-class paying the full cost of insurance in the exchanges – as well as providing better and more continuous medical access for the poor. The problem is that the resulting ACA subsidies would cost more per recipient than Medicaid, creating some budgetary challenges in Alaska (continuing preventative dental care being one of them).

Still, Dunleavy’s proposal may serve a pragmatic method to improve healthcare for the working class that we in Louisiana may wish to heed. Employing subsides in Affordable Care Act for private health insurance would end most discussions about a “work requirement,” as the ACA rules simply grant all incomes up to a middle-class threshold vouchers for free health insurance, with few strings attached as the exchanges are designed to help self-employed or occasional workers lacking a conventional employment schedule. Consequently, the goal of universal standard coverage without exception would come one step closer.

Dunleavy’s plan is not perfect, yet his willingness to spend more to achieve better healthcare outcomes for the poor, appears to create a vital middle ground.

Bereft of ideas, the Trump Administration seems eager to give Dunleavy a waiver to conduct his experiment, but not additional funding to underwrite it, engaging the GOP Governor in a funding battle with his own state legislature to make up the difference. Still, Dunleavy’s idea creates a practical middle ground for better health care. He embraces the Obama Administration‘s greatest achievement, quality insurance coverage in the exchanges for all Americans, while defending the idea that a private solution may work better than a government takeover.

This article originally published in the April 22, 2019 print edition of The Louisiana Weekly newspaper.