More than a half-million Louisianans have signed up for health coverage in the six years since the federal Affordable Care Act took effect – about 200,000 through the health insurance marketplace and another 351,000 via the expansion of Medicaid that took effect July 1. But the election of Donald Trump means that coverage is now under imminent threat, as repealing the ACA is at the top of Washington’s agenda after Jan. 1. As The New York Times reports, the GOP’s plan is to hold a repeal vote as early as mid-January, using a budgetary maneuver known as “reconciliation,” but push the effective date beyond the 2018 elections to give conservatives time to craft a replacement plan that has yet to take shape.  

But health policy experts suggest “repeal and delay” would be extremely damaging to a health care system already on edge. “The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

While the details of a replacement plan are in flux, it’s no mystery who will be leading the charge: House Speaker Paul Ryan of Wisconsin and Tom Price, the Georgia surgeon tapped by Trump to be health secretary. As Edwin Park of the Center on Budget and Policy Priorities notes, that likely means the new administration will try to transform the Medicaid program from an entitlement to a block grant. This would be disastrous for the millions of low-income, vulnerable citizens of Louisiana and elsewhere who rely on the safety net.

A Medicaid block would institute deep cuts to federal funding for state Medicaid programs and threaten benefits for tens of millions of low-income families, senior citizens, and people with disabilities.  To compensate for these severe funding cuts, states would likely have no choice but to institute draconian cuts to eligibility, benefits, and provider payments.  To illustrate the likely magnitude of these cuts, an analysis from the Urban Institute of an earlier block grant proposal from Speaker Ryan found that between 14 and 21 million people would eventually lose their Medicaid coverage (on top of those losing coverage if policymakers repeal the ACA and its Medicaid expansion) and that already low provider payment rates would be reduced by more than 30 percent.

The Advocate’s editorial page reads the tea leaves and urges caution.

The investment of millions of families in the insurance exchanges and in Medicaid plans cannot be lightly disrupted. As an administrative matter, rushing into repeal invites a chaotic situation for the health care industry. As president elected by a minority of the voters, Trump must always beware of pushing too fast, because parts of Obamacare remain popular. Trump should also be aware of his thin majority in the U.S. Senate.

“Street medicine” in New Orleans

It’s not a secret that people who live on the street – many of whom suffer from mental health and substance-abuse issues – are some of the largest consumers of health-care services, yet least likely to afford the cost of care. In New Orleans, a “street medicine” program launched by a doctor-in-training aims to change that by bringing medicine directly to those who need it instead of waiting for them to show up in the emergency room. Nola.com/The Times-Picayune’s Jed Lipinski:

The group is part of an all-volunteer outfit called Street Medicine New Orleans, one of around 70 similar programs in cities around the world, including Boston, Geneva and Calcutta. Its main goal is to connect the homeless to housing, health insurance and social services, reducing their reliance on high-cost emergency services. But just as importantly, participants say, street medicine affords those in the medical field a window into life on society’s fringe. At a time when health care has become mired in reimbursement rates and performance reviews, the program offers a return to the simple act of caring for the sick.

Flooding dollars will come up short

Louisiana is almost certain to get shortchanged by Congress on the money that’s needed to recover from the devastating August floods that hit Baton Rouge and surrounding areas. As Nola.com/The Times-Picayune notes in a Sunday editorial, Louisiana will be lucky to get $2.5 billion of the $4 billion requested by Gov. John Bel Edwards.

The $2.8 billion in damage to homes doesn’t include rental housing. FEMA estimates that more than half of the homes that were damaged weren’t in the 100-year floodplain. It should be no surprise that 78 percent of those owners didn’t have flood insurance. The damage to businesses and farming operations is expected to top $3.2 billion. Gov. Edwards asked for $120 million to prevent “widespread closure” of small businesses. FEMA estimates 6,000 businesses were hit by the flooding, he said in his updated request to President Obama. But with a smaller appropriation from Congress, most aid likely would go to homeowners with little left for businesses. The breadth of the damage in Louisiana will make full recovery difficult without significant help from the federal government. The aid that seems to be headed to Louisiana is greatly appreciated, but the governor is right to push for more.

Financial literacy starts early

In a high-poverty state like Louisiana, the ability to stretch a dollar is critically important. That’s one reason why the Louisiana Legislature made financial literacy instruction mandatory for public elementary and secondary schools starting this fall. Jesse Hardman, reporting for National Public Radio’s Marketplace program, has the story.

Jamie Doming is project manager for Junior Achievement, the organization that designed today’s curriculum. She said reaching eighth graders is key to this process. Louisiana’s high school dropout rate is around 25 percent. “Your highest risk students  — they won’t even be there by ninth or 10th grade,” Doming said. Which means they will be out in the real world, dealing with real financial issues. Like formal banking, something many of their parents struggle with according to Jan Moller, director of the Louisiana Budget Project, a nonprofit focusing on public policies that impact low- and middle-income residents. “We know there are four times as many payday lending storefronts in Louisiana as there are McDonald’s restaurants,” Moller said.

Number of the Day

25 percent- Cuts to federal Medicaid funding over 10 years under House GOP’s budget plan, which doesn’t include the cuts related to the repeal of Medicaid expansion (Source: CBPP)