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Medicaid Expansion: Louisiana’s
Multifaceted Decision
Elizabeth Scheer RN, MN, MBA
Vice President, Health Grants
Baptist Community Ministries
Societal Dimensions of This Discussion
• Political
• Financial
• Moral
• Socioeconomic
• Historic
Short-term Financial Implications:
BCM study developed by Dr. John Holahan, Urban Institute (June, 2013)
• Reduce the uninsured by 515,000 in 2016; 60% drop, including all of ACA
• Increase federal payments by $1.6 billion in 2016 and $15.8 billion
between 2013 and 2022; state spending by $17 million and $1.2 billion in
2016 and 2013-2022 respectively
• $6.7 billion in hospital payments between 2013 and 2022, offsetting ACA
cuts to Medicaid DSH, Medicare DSH, and Medicare fee-for-service
• State can offset new Medicaid spending through savings elsewhere in
budget and increased revenue
• Federal payments dwarf new state spending and will have positive effects
on state GDP, employment, and tax revenue
Medicaid Expansion and Improved Maternal
Child Health: One Insight Into a Vexing
A Few Facts:
• LA:70% of all births are to Medicaid insured
• LA ranks 49th in the country for Infant Mortality,
Preterm Births, and Percentages of Low
Birthweight (LBW) and Very Low Birth Rates
Local Birth Outcomes and Issues of Disparity
NO Low Birthweight: 11.4%
Statewide Average: 10.6%
US Average: 8.2%
Regionally African-American Women:
14.2% vs. 7.4% for Caucasians
LBW: Tragic, Expensive and Preventable
• Average pre-term birth costs LA Medicaid $33,433 in
the first year of life vs. average costs of only $3,671 for
a term birth
• Prematurity is a leading cause of neonatal and infant
• Lifetime consequences of prematurity often include
struggles with physical, intellectual and behavioral
difficulties vs. babies born full-term
Public Private Partnership to Reduce Poor
Birth Outcomes
• Interpregnancy Care Project: Women with a previous poor birth
outcome will be targeted for referral to selected primary care
• DHH, LPHI, City Health Department & national experts are
• regional primary care clinics capacity to implement
evidence based care protocols that reduce subsequent preterm deliveries
• Include the added component of social services support
(housing assistance, transportation, food stamps, etc.) to
address social determinants of health