The Obama administration announced last week that, in total, 8 million Americans have signed up for health insurance coverage on the private marketplaces established by the Affordable Care Act. That number doesn’t include the approximately 3 million people who have signed up for Medicaid since last October, the first month for open enrollment. Not all of those folks found coverage under increased eligibility under the new health care law, but a decent amount did.
Those are the big stories; last week’s health care reform headlines. Yet the small stories matter too, of those left behind, whose circumstances won’t warrant as many ledes about enrollment numbers and CBO projections.
Like Donna Risso. She lived in Louisiana, and was the beneficiary of a state Medicaid program for the disabled who are waiting for federal benefits to kick in — until Republican Governor and sometimes thought-of presidential contender Bobby Jindal eliminated the program in January. Donna fell into the coverage gap; too poor to qualify for private coverage assistance on the federal marketplace and now bereft of the exception to Louisiana’s general policy of not covering childless adults.
So this is what happened.
For many of the state’s most vulnerable residents, the failure to expand Medicaid has left a dangerous gap between a shrinking Medicaid program and the coverage provided by private insurance exchanges. Living in this gap is not a policy abstraction. Donna was dying. She was dying at home without the means to pay for all of her prescriptions. She was homebound without a wheelchair. With no home attendant, she could not bathe herself. She had no bedside commode. When Michael went out, she was left completely helpless.
A hospice service agreed to help Donna until she received federal disability benefits, but her social worker said, “We had to beg them to take this risk, and not everyone will be so lucky.”
Without the Disability Medicaid Program, Donna’s visits to the emergency room cost $1,000, which as the state Department of Health and Hospitals notes, is “much more than a visit to a primary care provider for the same symptoms.”
When it comes to health care decisions, Louisiana is moving in the wrong direction — leaving more people without health coverage and ultimately costing the state more in dollars and lives. This can be fixed. The Legislature is in session, and members are considering bills that offer several options for ways to expand Medicaid.
On April 1, Donna died.
She was one of more than 9,000 disabled Louisianans who lost coverage after the state’s Disability Medicaid was shuttered in a flurry of changes that went into effect at the beginning of this year. It was accompanied by eligibility reductions for pregnant women. More lost coverage this year from other requirements being tightened. As a July memo from the Louisiana Developmental Disabilities Council noted these policy changes would leave many disabled residents uninsured. That prediction came true for Donna, unable to afford the care she needed, who ultimately died.
The excuse, generally, is that most of these folks can simply sign up for private insurance on the exchanges, or otherwise wait to re-qualify for similar programs after jumping a few more bureaucratic hurdles. But thanks to the coverage gap many can’t afford the former, and people like Donna don’t always have enough time, or the institutional support, for the latter. For all intents and purposes, in states that haven’t expanded Medicaid, the post-ACA reality is much the same as before the law for those in the coverage gap. Which is to say, the oft-cited conservative objective to reduce “waste, fraud, and abuse” in programs that serve the poor is still mostly an exercise in reducing the number of poor people who benefit from such policies.
So while reform advocates are celebrating (and rightly so) the achievement of expanding coverage to the most vulnerable in states that have expanded Medicaid, it’s worth remembering that in Louisiana that protection is actually shrinking — and they’re using Obamacare as an excuse to do it.