Medicaid expansion is here to stay

Medicaid expansion is here to stay

Louisiana’s Medicaid expansion, which extended the program’s eligibility to adults earning below 138 percent of the federal poverty line, has been a resounding success: Nearly 500,000 people are newly covered by health insurance, and federal funds have generated at least $1.85 billion in direct economic impact for the state. That’s probably why – despite criticizing some aspects of the program – neither of the GOP gubernatorial candidates is proposing to roll back a policy that helps thousands of low-income people in Louisiana. The Advocate’s Stephanie Grace has more:

This really shouldn’t surprise anyone. Although former Gov. Bobby Jindal refused to adopt expansion, originally a key part of President Barack Obama’s Affordable Care Act but later deemed optional by the U.S. Supreme Court, Jindal’s opposition was clearly aimed at a national political audience. By the time he was ready to leave office, even the Republicans running against Edwards to replace Jindal agreed that expansion was a good deal for the state, although none quite so enthusiastically as Edwards. Since the governor took office, he’s frequently touted the benefits of the program — not only the influx of federal money and the economic growth it’s fueled but also individual stories of Louisianans who are getting preventive care, discovering diseases while they’re treatable and getting chronic conditions under control. He obviously feels a good deal of pride in what’s happened on his watch, as he should.


Helping people protect themselves from suicide
Suicide is often an impulsive act. Survivors who attempted suicide by jumping from San Francisco’s Golden Gate Bridge reported to the New Yorker that their first thought on letting go of the bridge railing was regret at their decision and a wish for a second chance. But guns are uniquely lethal tools for self-harm, and access to a firearm can mean the difference between a person dying by a fatal impulse or surviving to get help. Now, a bill pre-filed in the state Legislature would allow people concerned about their own potential for suicide to place themselves on a list that would prevent them from purchasing a firearm. The Editorial Board weighs in on how this bill can save lives:

Katrina Brees lost her mother last year to suicide. Donna Nathan, who had been in and out of psychiatric hospitals three times in 2018, was able to buy a .38-caliber revolver the day she died. Eight hours after she bought the gun, she was found dead from a gunshot wound in Audubon Park. Now, Ms. Brees is trying to keep other families from suffering that kind of loss. Her legislation to allow people to put themselves on a voluntary “do not sell” list for guns was pre-filed Thursday (March 21). This is a rare chance for the Legislature to come together around a bill that can truly be life-saving. [….] This issue is not about Democrats or Republicans, it’s about saving lives, [said Rep. Jimmy Harris, one of the bill’s co-sponsors]. Donna’s Law is not an intrusion on gun rights, either. It is a life raft for people who need something to stop them from their impulse to commit suicide.


A smart way to pay for coastal restoration
There are no shortage of reasons for Louisiana to restore its vanishing coastal wetlands: from hurricane protection, to water quality promotion, to the protection of wildlife diversity, Louisiana’s marshes serve the state as both wild lands and vital infrastructure. But how we pay to restore our marshes matters too. George A. Howard, writing in the Hill, argues that as important as coastal restoration itself is to the state, it’s the Coastal Master Plan’s “pay-for-success” procurement system that may mark the Bayou State’s most significant innovation:

Currently there is little incentive to optimize time and talent. Baton Rouge and its federal partners enter into a multitude of separate government contracts defining the many tasks and responsibilities of marsh restoration as separate “deliverables” to the government. Planning, surveying, engineering, dredging; monitoring or mud buggies; all the many tasks of restoring the coast are purchased separately with no financial incentive for quick action, long-term responsibility, or creativity on the part of the contractor. All are paid by the “hour,” or “yard,” and the government bears the risk of ecological failure, which is more likely without a better, more accountable approach. In the new procurement system payment is made on a different unit of measure: Acres. Only upon the delivery of thriving acres of restored marsh and new land over a five-year period will the government pay the contractor. As with Eads, the return to the provider comes in increments directly associated with successful production for the public good.


A new model for addressing homelessness
Chronic homeless comes with substantial costs, both to the individual without housing and to society as a whole. People with no access to stable housing often come in and out of jail, emergency rooms, and treatment centers, at a significant cost to local governments, and to their own further disadvantage. So Denver, where high housing prices have driven a surge in the long-term homeless population, is trying out a new model to pay for high-impact, housing-first solutions that provide more than a quick fix, but that come with their own high initial price tags. The Urban Institute explains how the city is employing Social Impact Bonds (SIBs) to combine a pay-for-success model with private financing to address what has long seemed an intractable problem:

Denver Mayor Michael Hancock and his administration knew they had to stem the growth in chronic homelessness and break this homelessness-jail cycle. But nationwide funding shortfalls for housing programs meant Denver had to be prudent with its spending to make sure it was paying for a program that worked. So Denver took a less common approach and entered its first SIB. The SIB uses the pay for success funding model, in which investors commit to paying for improved social outcomes that save the city money. Only about 25 such projects have been implemented in the US. The program requires payments to investors only if the SIB meets its goals. Denver hopes to save money by shifting away from the common approach of applying short-term band-aid fixes to social problems, instead pursuing a new model of implementing a long-term, evidence-based program that emphasizes outcomes. So far, the results are positive.


Number of the Day
9.7 percent – Louisiana’s uninsured rate, down from 20.3 percent in 2010. (Source: Center on Budget and Policy Priorities)