Without a Safety Net: Abandoning Louisiana's Uninsured

The opposition to the two major programs that would ensure health care to much of the country's unhealthiest states, and how it now matters for the entire country

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Louisiana Governor Bobby Jindal [NatiHarnik/AP]

Earlier this year an uninsured patient at Lallie Kemp Medical Center, a small safety net hospital operated by LSU, suffered a subdural hematoma -- bleeding between the brain and the skull that is treatable if given prompt attention. The hospital attempted to transfer the patient to LSU's referral facility in New Orleans, but the hospital, with shrunken capacity, already had seven patients in the emergency department awaiting ICU beds. The doctor called 17 other hospitals that day, including some with neurosurgeons, operating rooms, and ICU beds available. None accepted the patient. He died that evening.

Unfortunately, examples like these are becoming easier to identify in Louisiana. The Institute of Medicine reports that 18,000 people a year die in the U.S. for lack of health insurance. When Louisiana's Health Secretary, Bruce Greenstein, was asked about the patient at Lallie Kemp in testimony before the legislature a few months ago he explained that the patient could not get care because of a shortage of neurosurgeons in Louisiana. That, of course, sounded better than the fact that it is more essentially due to the state's approach to the uninsured.

Louisiana has some serious health care challenges, with the fourth highest uninsurance rate in the country, among the highest cost and lowest quality outcomes for patients with Medicare, and among the highest rates of tobacco use, obesity, poverty, and infant mortality, to name a few. For health status and outcomes, Louisiana is among the worst in the country.

Like in other states, the health care system in Louisiana is an amalgam of private and public providers and programs loosely woven with some attempt to care for the entire population. The solutions are not simple, but in Louisiana we have perhaps the most qualified governor to address them: McKinsey consultant, Secretary of Health for Louisiana, executive director of the Bipartisan Commission on the Future of Medicare, and assistant secretary of the U.S. Department of Health and Human Services. However, instead of providing desperately needed leadership and clarity for his constituents, Bobby Jindal continues to confuse us.

Two recent reports in the New England Journal of Medicine indicate that Medicaid coverage results in better preventive care and is associated with lower mortality. Implementation of the Affordable Care Act's Medicaid expansion would provide Medicaid insurance to 456,000 Louisianans and reduce the uninsured in the state by 60 percent. Gaps in Medicaid coverage and care for the uninsured (350,000 of whom would remain after the expansion) are addressed by safety net systems which, according to the journal Health Affairs, can provide care at half the cost of providing insurance, an assessment consistent with an Urban Institute study done in Louisiana in 2007. The Louisiana State University Health Sciences Centers operate the statewide safety net system, serving over half a million people annually through which the uninsured and underinsured receive care from immunizations to neurosurgery, with outcomes on par with national norms for people with insurance.

Presented by

Frederick P. Cerise, MD, MPH, is an associate clinical professor of medicine at Louisiana State University.

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