Thursday, January 25, 2018

Louisiana Dept. of Health Secretary Rebekah Gee: Sen. Sharon Hewitt prescribes wrong approach to fixing Medicaid

Author: Dr. Rebekah Gee, MD, MPH, secretary of the Louisiana Department of Health

Gov. John Bel. Edwards and I have long believed in smart, innovative policies that engage Medicaid recipients in their communities, either through job opportunities, volunteering or skill improvement and education. We believe that a healthier workforce is a more productive workforce. I know business leaders agree. Once we improve people’s health, we can better expect them to engage in their communities in a productive manner.

Recently, state Sen. Sharon Hewitt offered suggestions for the state’s Medicaid expansion. Unfortunately, despite her admirable interest in evidence-based policy, she prescribes the wrong approach to inspiring work opportunities for the people of Louisiana.

First, Hewitt provides a misdiagnosis. Of Louisiana’s 1.6 million residents receiving care through Medicaid, more than 800,000 are children and 300,000 have a disability or are elderly. Even if these individuals didn’t receive Medicaid, almost all of them are unable to work because of their age or disabling condition.

Regarding the 457,000 Louisianans eligible through expansion, Hewitt also doesn’t give the full story. Throughout its history, Louisiana’s leaders recognized the need to provide care for all citizens, traditionally through the charity hospital system. Recently, however,  Edwards took the bold step to expand health insurance coverage to people struggling to make ends meet. Thanks to his leadership, we’re now providing preventive care so that people will not have an illness that interrupts their job.

Today, more than 150,000 people had a new doctor’s visit for preventive care, with thousands of people getting an early, life-saving diagnosis of cancer, diabetes or heart disease. With this care, most will remain in the workforce. Contrary to Hewitt’s claim, the vast majority of newly insured Louisianans are accessing this important care. During the last fiscal year, 75 percent of those who had Medicaid expansion as their insurance visited a doctor. Hewitt correctly notes more than two-thirds of people with care through expansion are already employed. Previously, they were unable to afford insurance or their job did not offer coverage. In reality, they were one illness away from unemployment and financial ruin.

What about those with no earned income? Studies consistently find these “nonworking” Medicaid recipients are either disabled or too ill to work (36 percent), homemakers, family caregivers (30 percent), or in school (15 percent).

The same studies indicate that less than 10 percent of these citizens are eligible for work but unable to find it. It is this group that we want in the workplace and will seek changes to ensure they are connected to work opportunities that help them rise out of poverty.

On this, Hewitt and our administration agree. We want all Louisianans to have the opportunity to advance themselves and their families’ well-being through the dignity of work. We intend to fashion a Louisiana-specific Medicaid work-engagement program to do just that. We are now developing a plan to require smart community engagement, focused on reasonable ways to incentivize and support work, volunteering or self-improvement through education or skill building.

Finally, Medicaid expansion is a great deal for Louisiana. Contrary to Hewitt’s premise, Louisiana taxpayers provide zero state general fund dollars to finance Medicaid expansion. In fact, we’re saving state taxpayers hundreds of millions of dollars by enacting the expansion, while also saving lives.

Rebekah Gee
Secretary, Louisiana Department of Health
Baton Rouge

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