Wednesday, February 25, 2015

Wednesday, February 25, 2015

More evidence that Obamacare is working; Louisiana’s $1.6 billion problem: How did we get here?; Medicaid coverage and emergency room use; and Louisiana college graduation rate trails nation


More evidence that Obamacare is working

It’s now been more than a year since the Affordable Care Act took full effect, and results are starting to pour in. And the news is good: The percentage of Americans without health coverage hit a seven-year low in 2014.


The Gallup-Healthways Well-Being Index found that the trend appears likely to continue this year, since 55 percent of those who remained uninsured told the pollster they plan to get coverage rather than face escalating tax penalties.


The news, however, is better in states that elected to extend Medicaid coverage to the working poor than those, like Louisiana, that did not.


Ten of the 11 states with the biggest declines in their uninsured rates accepted the health care law’s Medicaid expansion, which provides safety-net coverage for low-income residents, mainly adults with no children living at home. Topping the list were Arkansas and Kentucky, with double-digit decreases.


Louisiana’s uninsured rate declined 4.5 percentage points last year – from 21.7 percent to 17.2 percent. But it would have dropped even more dramatically had Louisiana moved forward with Medicaid expansion. A new report by Families USA estimates 362,000 adults would have gained coverage, with 56 percent of that population currently in the workforce.


Louisiana’s $1.6 billion problem: How did we get here?

In two days Gov. Bobby Jindal will lay out his plans for bridging the $1.6 billion gap between projected revenues and expenses in next year’s state budget. To hear the governor and his allies tell it, the shortfall is mainly due to the falling price of oil. But LBP’s Steve Spires, in a new blog, attempts to set the record straight.


The structural deficit existed before oil prices dropped, when the state was already facing a $1.2 billion shortfall. That’s because the real culprit for our budget woes is the historically large amount of “one-time” or “nonrecurring” revenues used to pay for recurring expenses. The recent plunge in oil prices just made a bad situation worse. In recent years, Louisiana has drained multiple trust funds, sold property, refinanced debt and relied on tax amnesty programs and piecemeal money from legal settlements to pay the annual cost of keeping colleges and hospitals open, pave roads and pay police. This has led to yearly scrambles to find new ways to fill ever-growing budget holes.


Medicaid coverage and emergency room use

In barely a month the emergency department that serves the heart of Louisiana’s capital city will close, leaving behind a shallow network of “urgent care” clinics with irregular hours in its place. In making the decision to close its ER, the leaders of Baton Rouge General Medical Center claimed that 80 percent of the patients who came through its doors were there for non-emergencies.


But a new study of emergency room use from Pew Charitable Trusts suggests that people who have Medicaid coverage – a solution Louisiana has thus far rejected – leads to far less misuse of emergency services.


Nationally, only 8 percent (one-tenth the alleged level in Baton Rouge) of emergency room visits are for non-emergencies. For Medicaid patients the figure is only slightly higher at 9.6 percent. But even that number appears to be inflated:


A 2013 study in the Journal of the American Medical Association found that of the 6.3 percent of emergency room visits later determined to have been unnecessary, 89 percent of them were cases in which the patient had exactly the same complaint—chest pains, for example—as somebody who truly needed to be in the ED. Without an emergency department examination, it was impossible to determine who really needed to be there and who didn’t.


The moral of the story: If you want to reduce the number of unnecessary visits to the emergency room, make sure people have coverage. And that includes Medicaid. Because the alternative is for your local emergency room to close, leaving everyone in the area – with or without insurance – farther from the doctors who might save their lives in a true emergency.


Louisiana college graduation rate trails nation

About 56 percent of students who start a four-year college program in Louisiana manage to graduate within six years. And only about 40 percent graduate from the same school where they started. Both figures are below the national average of 63 percent and 50 percent, respectively, according to a new study by the National Student Clearinghouse reported on


But Louisiana showed a comparatively high rate of students who, after entering a public four-year college, graduated from a different four-year college within six years. That rate was 11 percent, higher than the national average of 9.5 percent.


Number of the Day

$382 million – combined drop in the forecast for severance and royalty forecasts for the 2015-16 budget year. (Source: LBP blog via Legislative Fiscal Office)