Aug 13 2019

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Louisiana health insurance

Three insurers are offering 2019 plans through state’s exchange. Individual market health premiums have dropped 6.4 percent on average.

  • Louise Norris
  • Health insurance & health reform authority
  • December 16, 2018

Health insurance in Louisiana

  • Louisiana has a federally facilitated health insurance exchange and enrolls through HealthCare.gov.
  • Open enrollment for 2019 coverage in Louisiana ended on December 15, but enrollment is still possible for residents who have qualifying events.
  • Short-term health plans are available in Louisiana with initial plan terms up to six months.
  • Three carriers are offering 2019 plans in Louisiana’s individual market (but two are under the same parent company).
  • The average premiums for 2019 are 6.4 percent lower than they were in 2018.
  • About 110,000 Louisianans enrolled in 2018 coverage through the state exchange.
  • Louisiana adopted the ACA’s Medicaid expansion in 2016.

Louisiana’s health marketplace

Louisiana operates a federally facilitated health insurance exchange, so residents use HealthCare.gov to enroll in exchange plans. Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for residents who have qualifying events.

Three insurers – Blue Cross and Blue Shield of Louisiana, HMO Louisiana, and Vantage Health Plan – are offering plans through the state’s exchange for 2019 (HMO Louisiana is a subsidiary of Blue Cross Blue Shield of Louisiana). After years of rate increases, the average individual market health insurance premium is 6.4 percent lower for 2019 than it was 2018.

Louisiana enrollment in qualified health plans

Nearly 102,000 Louisiana residents signed up for a qualified health plan (QHP) through Louisiana’s federal exchange during 2014 open enrollment. Eighty-eight percent qualified for tax subsidies to reduce their premiums. The average premium, after subsidies, for Louisiana residents was $83 a month in 2014.

By the end of 2016 open enrollment, the number of Louisiana exchange enrollees reached 214,148 – more than double 2014 enrollment. As of March 2016, nearly 93 percent of Louisiana’s 184,403 effectuated enrollees had premium subsidies.

But Medicaid was expanded in Louisiana in mid-2016, resulting in many lower-income enrollees becoming eligible for Medicaid instead of premium subsidies. The result was much lower enrollment in the exchange for 2017, with 143,577 enrollees by the end of open enrollment.

Enrollment continued to decline for 2018, however, with just 109,855 people enrolled as of December 23, 2017. Effectuated enrollment stood at 93,178 as of early 2018, but enrollment in expanded Medicaid has continued to grow, with more than 481,000 people enrolled as of November 2018.

Medicaid expansion in Louisiana

In 2015, there were 192,000 Louisianans in the Medicaid coverage gap, meaning they didn’t qualify for Medicaid or Obamacare subsidies to help make health insurance affordable.

But Louisiana implemented the Affordable Care’s Medicaid expansion in June 2016 and as of November 2018 – almost two and a half years after the state expanded Medicaid – there were 481,500 Louisiana residents enrolled in expanded Medicaid. In 2018, more than 1.4 million people were covered by Medicaid/CHIP in Louisiana (that includes the Medicaid expansion population as well as the groups that were already eligible prior to 2016; total enrollment had been at a little over 1 million in 2013).

In early 2018, Louisiana Gov. John Bel Edwards announced that his administration was “actively working” on ideas for implementing a work requirement for the state’s Medicaid program. Bel Edwards, a Democrat, was the prime mover in the state’s expansion of Medicaid in 2016. Lawmakers did consider legislation that would have directed the state to seek federal appoval for a Medicaid work requirement, but it did not pass in 2018.

Short-term health insurance in Louisiana: duration limit depends on how far back the insurer looks for pre-existing conditions

New federal regulations allow short-term plans to have initial terms of up to 364 days, and total duration – including renewals – of 36 months. But the regulations are clear in noting that states may continue to have more restrictive rules.

In Louisiana, state insurance regulations limit initial duration of short-term plans to six months, but only if the insurer looks back more than 12 months to determine whether the applicant has pre-existing medical conditions. If the insurer only considers the applicant’s past 12 months of medical history, the plan can have an inital duration of up to 364 days (ie, following the new federal guidelines). If the insurer looks back more than 12 months, however, the short-term plan can’t have a term of more than six months. The majority of the insurers that offer short-term plans in Louisiana do look back more than 12 months when considering an applicant’s medical history, so their plans are capped at six months.

The state does not, however, limit or prohibit renewal of plans, nor subsequent purchases of additional short-term coverage.

Has Obamacare helped Louisianans?

At the start of 2014, amid the first ACA open enrollment period, the Kaiser Family Foundation estimated that 866,000 Louisianans did not have health insurance. The analysis indicated that about 298,000 of them would qualify for tax credits to purchase health insurance through the marketplace, although many people who are eligible for subsidies in the exchange have opted to remain uninsured or have found other sources of coverage.

Louisiana’s uninsured rate dropped from 16.6 percent in 2013 to 10.3 percent in 2016, but it was still above the national average at that point, which was 8.6 percent as of 2016. But Medicaid expansion took effect in mid-2016, and by 2017, Louisiana’s uninsured rate had dropped to 8.4 percent — below the national average of 8.7 percent at that point (the nationwide uninsured rate experienced a slight uptick in 2017, after the Trump Administration took office).

For those who have purchased health insurance in Louisiana, the ACA has helped make coverage more affordable. Of those enrolled in 2018 Louisiana exchange plans, 92 percent were receiving subsidies. And Medicaid expansion has helped hundreds of thousands of low-income Louisiana residents obtain coverage and life-saving treatment: 481,500 people had enrolled in expanded Medicaid by November 2018, and nearly 258,000 of them had obtained preventive care under their new coverage.

Louisiana and the Affordable Care Act

Louisiana’s Senate delegation is currently entirely Republican — Bill Cassidy and John Kennedy, both of whom are opposed to the ACA. Cassidy in particular, played a pivotal role in 2017 in the GOP’s ultimately unsuccessful efforts to repeal the ACA. In the House of Representatives, Louisiana has just one Democrat (Cedric Richmond), who supports the ACA. All six of Louisiana’s House representatives (five of whom are Republican) easily won re-election in 2018, but Republicans will no longer control the US House when the next session starts in January 2019.

At the state level, Louisiana’s legislature is dominated by Republicans, and the ACA has not gained traction. While legislation to establish a state-run exchange was considered, it did not pass.

Former Gov. Bobby Jindal, whose term ended in January 2016, strongly opposed the Affordable Care Act. He returned a $1 million federal planning grant for exploring a state-run insurance marketplace, defaulted to the federally facilitated marketplace, and rejected Medicaid expansion. Four years after the ACA was signed into law, Jindal continued to call for repeal of the health reform law.

But Jindal was replaced in 2016 by John Bel Edwards, a Democrat who supports the ACA. One of Edwards’ first actions as governor was to expand Medicaid in Louisiana.

Does Louisiana have a high-risk pool?

The Louisiana Health Plan was created in 1992 in order to provide a coverage option for state residents who couldn’t get private plans in the individual market because of their medical histories.

But Obamacare’s guaranteed issue provision means that pre-existing conditions are now covered on all policies, and are no longer factored into the application process. As a result, the need for high-risk pools no longer exists the way it once did. The Louisiana Health Plan terminated all coverage on December 31, 2014, per the terms of House Bill 638 (passed in June, 2013). Members were able to transition to new ACA-compliant plans instead.

Other ACA reform provisions

The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program was established to promote market competition through nonprofit, consumer-run health insurance companies. Twenty-four CO-OPs received loans totaling $2.09 billion as of January 2014. See where CO-OPs were launched and where they ceased operations — only four are still offering coverage for 2018.

Louisiana Health Cooperative received a $65.8 million start-up loan. Louisiana Health Cooperative competed against Blue Cross and Blue Shield of Louisiana, Vantage Health Plan, and Humana during 2014 open enrollment, but struggled with its enrollment goals.

On July 24, 2015, Louisiana’s CO-OP announced it would continue to cover enrollees until the end of the year but would not sell plans in 2016.

Medicare in the state of Louisiana

As of September 2018, there were 847,969 Medicare beneficiaries in Louisiana. That’s about 18 percent of Louisiana’s population, which is on par with the percentage of people enrolled in Medicare nationwide.

Medicare is funded by the federal government (along with premiums paid by beneficiaries). In 2016, Medicare’s per-enrollee spending in Louisiana amounted to $11,399. That was the highest in the country, and 20 percent higher than the national average. Louisiana was one of just three states where per-enrollee spending exceeded $11,000 in 2016 (the other two were Texas and Florida, both of which had lower pre-enrollee Medicare costs than Louisiana).

Louisianans can enroll in Medicare Advantage plans instead of Original Medicare if they want additional benefits and are ok with the limited networks that go along with private Medicare Advantage plans. About 33 percent of Louisiana’s Medicare recipients selected a Medicare Advantage plan in 2017, which was the same as the national average Medicare Advantage enrollment.

Stand-alone prescription drug plans are available to Medicare enrollees. About 42 percent of all Louisiana enrollees also chose Medicare Part D plans. The national percentage is 44 percent. Most Medicare Advantage plans include built-in Part D coverage; stand-alone Part D plans are designed to supplement Original Medicare, which doesn’t include outpatient prescription coverage.

Louisiana health insurance resources

Louisiana’s state-based reform legislation

Scroll to the bottom of this page to see a summary of recent Louisiana legislation related to health care reform:

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