In The Spotlight

State fiscal situation is an embarrassment

The governor's fiscal year 2019 budget should be taken as a very serious warning of what can happen to vital state investments in health care, education and social services if the political deadlock in Baton Rouge is not broken.

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Medicaid Work Requirements Don’t Work

While the idea of a work requirement may sound good to some, the reality is that it would take away health coverage, create more red tape and make it harder for many people who want to work to find employment.

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Louisiana families continue to struggle

The poverty rate in Louisiana for adults and children remained unacceptably high in 2016 even as other states saw significant improvements. New U.S. Census data released Thursday also show that Louisiana continues to have one of the highest rates of income inequality in the United States.

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The Daily Dime

One of the few bills that advanced out of committee this week is a dangerous proposal from House Speaker Taylor Barras to change the formula that governs the state spending cap.

Number of the Day

$40 million - amount of additional state funding requested by two education advisory groups this week, the equivalent of 1 percent of the state’s current allocation to public schools. (Source: The Advocate)

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Our Two Cents Blog

Republican leaders in the state House of Representatives are seeking to add out-of-pocket costs to Louisiana’s Medicaid program as a condition of agreeing to replace some revenue from expiring taxes. While it may seem sensible at first blush to require small copays or premiums from Medicaid recipients, an abundance of research shows that these payments don’t actually work. Still, Gov. John Bel Edwards included “a copayment requirement under the Medicaid program” in his list of what may be considered during the special legislative session that begins on Feb. 19.

Many states have enacted copays and premium requirements in their Medicaid programs, only to find that those requirements do not have the intended effects of reducing costs or curbing the use of unnecessary health services. Instead, the implementation of copays and premiums in Medicaid often have myriad unintended negative consequences, including higher costs to the state and reduced access to necessary health care services. That’s why, in previous sessions, the Louisiana Legislature has voted down nearly all of the Medicaid cost sharing proposals included in the latest GOP proposal.

In a letter to the governor, House Speaker Taylor Barras proposes the following Medicaid changes:

  1. A co-payment requirement for non-emergency use of the emergency room
  2. A co-payment requirement for non-preferred drugs
  3. Premiums for Medicaid enrollees who earn above 100 percent of the federal poverty limit

Medicaid families are, by definition, living near or below the federal poverty line. The income limit for the vast majority of Medicaid enrollees is 138 percent of the federal poverty limit, which is just $34,600 per year for a four-person family. According to the Louisiana Association of United Ways’ ALICE report, a four-person family in Louisiana with two parents and two young children needs $46,240 per year to afford a basic survival budget. Families who earn at or below the Medicaid eligibility limit are already having great trouble making ends meet; adding out-of-pocket costs for health care will only make it harder to afford basic necessities.


Research findings and state experiences related to cost-sharing requirements include:

  • Even relatively small out-of-pocket costs in the range of $1 to $5 are associated with reduced use of care, including necessary services.
    • A comparison study of Medicaid patients in different states found that copayments for prescription drugs were associated with poorer outcomes for patients with hypertension and hypercholesterolemia.
    • Another study found that increased cost sharing is associated with reduced asthma treatment for children, forcing families to put off doctor’s visits or use less medicine than prescribed.

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