By David Jacobs
The Center Square
At the request of the Louisiana Department of Health, three LSU professors attempted to predict how many people will enroll in Medicaid over the next few years. A draft report completed in June predicted enrollment growth of about 1 percent, which could mean increased costs to taxpayers, but the final version delivered to LDH in August deleted those numbers.
A fiscally conservative think tank has accused the department, whose leaders answer to Gov. John Bel Edwards, of censoring the report and withholding public documents.
“The behavior of LSU and the Department of Health suggests that both continue to hide inconvenient truths from the taxpaying public,” said Chris Jacobs, senior fellow with the Pelican Institute for Public Policy.
Medicaid is a taxpayer-funded health insurance program for low-income residents. Under the federal Affordable Care Act, also known as Obamacare, states could decide to extend Medicaid to people making up to 138 percent of the federal poverty level, which this year means up to $17,236 for an individual or $35,535 for a family of four. The federal government covered the full cost initially and, barring a change in the law, will pay 90 percent of the cost for the expansion population next year and beyond.
Though his predecessor opted against expanding Medicaid under Obamacare, Edwards had Louisiana join the expansion at the beginning of his term in 2016. He has since touted his decision to extend coverage to more than 450,000 working people and cut the state’s uninsured population in half. The change also saves the state money, he says, because the federal reimbursement rate for Medicaid members is higher than for health services for the uninsured.
But the Pelican Institute has been critical of the state’s handling of Medicaid expansion and the overall cost of the program, including reports showing more than 1,000 individuals earning six-figure incomes enrolled in Medicaid under Edwards’ expansion.
An institute report also noted that tens of thousands of Louisianans who were already enrolled in private health insurance plans left those plans and enrolled in Medicaid, a phenomenon called “crowd out.” Crowd out costs federal and state taxpayers as much as $146 million every year, according to the report.
Now, the institute says, LDH is withholding information about expected Medicaid expansion growth from taxpayers.
But one of the professors involved in the study said the reason for withholding the numbers is simple: They didn’t have much confidence in their projections, especially when it comes to participants in the expanded version of Medicaid. The Louisiana Department of Health says the researchers were working with outdated data that skewed their projections.
“You don’t have a long line of data to work with,” said Jim Richardson, a professor in LSU’s public administration and economics departments and until recently was a member of the state’s Revenue Estimating Conference.
The researchers’ preliminary projections for Medicaid enrollment from 2019 through 2022 were, according to the LSU documents obtained by the Pelican Institute:
• Aged enrollees: projected to increase from 59,692 to 67,257.
• Blind and disabled enrollees: projected to increase from 169,820 to 170,737.
• Child enrollees: projected to increase from 693,833 to 699,035.
• Parent enrollees: projected to increase from 106,369 to 107,143.
• Medicaid expansion enrollees: projected to increase from 567,965 to 571,368.
• Total enrollees: projected to increase from 1,658,577 to 1,677,427.
LDH did not release the LSU enrollment report to the public; officials say it was an internal working document meant to inform their projections. But the Pelican Institute’s Jacobs says the decision is part of a pattern of secrecy around the state’s Medicaid program.
As for the enrollment study, the department did not write or edit the report but did provide feedback, and “observed that the enrollment projections relied on base data that predated certain administrative changes which had a significant downward effect on enrollment,” such as quarterly wage checks to determine eligibility, Johannessen said.