« July 2016 Issue

A New Day for Medicaid Coverage Is Born on the Bayou

One of the main priorities of Community Catalyst’s Affordable Care Implementation Fund is supporting efforts to close the coverage gap in the remaining 19 states that have not accepted Medicaid expansion. After victories in Montana and Alaska, our focus is on making meaningful progress in the Deep South. Ninety percent of people in the coverage gap live in the South, and nearly 50 percent live in either Florida or Texas. People of color have been disproportionately impacted by their state’s decision to not expand Medicaid: 55 percent of those caught in the gap nationwide are people of color, including 74 percent in Georgia, 67 percent in Texas, and 57 percent in Florida. And in many Southern states, opposition to closing the coverage gap is fierce. State leaders loudly proclaim their refusal to provide affordable health coverage to their constituents, and there is no shortage of attempts to demean low-income people while refusing to consider the moral and economic benefits of closing the gap.

Until recently this was the case in Louisiana, a state that had been steadfast in its refusal to accept increased federal funding for Medicaid. Louisiana’s rejection of these funds left 330,000 people in the coverage gap. As a state struggling with health disparities (that could be reduced by closing the gap) and a high uninsured rate, Louisiana represented a stark example of what happens when state leaders allow ideological opposition to drive their decision making. During his final years in office, former Gov. Bobby Jindal made his rejection of Medicaid expansion the centerpiece of his losing presidential campaign and invoked metaphors that likened low-income people to oxen, saying “We should design our policies so that more people are pulling the cart than riding in the cart.”

However, the election of Rep. John Bel Edwards in late 2015, who made closing the coverage gap a key campaign promise, suddenly meant expansion would be a reality – and quickly. On January 12, on his second day as governor, Gov. Edwards signed an executive order expanding Medicaid eligibility. Gov. Edwards set an ambitious goal of kicking off the new program, called Healthy Louisiana, on June 1, 2016.

At Community Catalyst, a core part of our work is facilitating connections between advocates in states and encouraging them to share best practices with one another, in addition to providing targeted technical assistance and expertise on communications and campaign strategy. We worked with the Louisiana Budget Project and a team of local partners to provide funding for a communications campaign to lift up the voices of people in the coverage gap and share best practices from other states that had successfully closed the gap. These activities created a steady drumbeat in the weeks leading up to Governor Edwards’ inauguration and kept opposition at bay.

A high level of coordination between advocates, government officials and health care stakeholders led to efforts such as a whistle stop tour by Gov. Edwards and significant media outreach to promote the benefits of Healthy Louisiana. We also connected stakeholders and staff in Louisiana with advocates in Montana and Pennsylvania who made the successful transition from being non-expansion to expansion states.

Everyone worked together to kick things into high gear as we rolled towards the June 1 kickoff. Finally, in early June, Community Catalyst staff helped coordinate and execute a full-day event aimed at empowering and preparing the enrollment community for the work ahead. Staff from Community Catalyst travelled to Baton Rouge for Healthy Louisiana: Kicking off New Coverage Opportunities, an event that had over 250 people in attendance from community health centers, hospitals, managed care organizations, faith-based organizations and consumer health advocacy groups. The administration, benefiting from the incredible leadership of Secretary Rebekah Gee and Medicaid Expansion Director Ruth Kennedy, is fully committed to partnering with all the stakeholders needed to make enrollment a success and remain committed to ensuring Louisianans can take advantage of their new coverage options.

Just as the opportunity came quickly, success has been swift, as well. By examining existing limited coverage programs to identify those who could be automatically “flipped” into Medicaid and the innovative use of SNAP data to determine eligibility for people who were already receiving federal benefits, enrollment in Healthy Louisiana stands at over 225,000 low-income adults as of June 15. For all its early success, it’s also clear that strengthening the advocacy infrastructure in Louisiana will be important as Healthy Louisiana moves forward to make sure Louisianans can continue to access the care they need.

Closing the coverage gap in Louisiana is a huge victory. But beyond Louisiana, pushing to close the coverage gap is an urgent social and economic justice issue, especially when it comes to health equity. As long as of the majority of Southern states refuse to expand, large numbers of people of color with low incomes will be denied affordable health coverage, which will further perpetuate disparities in health equity across the region and the country. While the fight to close the coverage gap may take more time in other states, state consumer health advocates are working hard to bring change as fast as they can. And Community Catalyst will be there to support them every step of the way. 

Lucy Dagneau, Associate Director of Communications