What Louisiana Tells Us About the ACA Medicaid Expansion.

O ne of the biggest health care stories these days doesn’t get nearly the attention it deserves. It is the slowbut-steady expansion of Medicaid, the program that’s been providing insurance to the poor since the 1960s, as part of the Affordable Care Act (ACA). If you follow the political debates about “Obamacare,” chances are you hear much more about changes to the private insurance market and what those changes mean for consumers. But the number of people who have coverage thanks to the law’s Medicaid expansion (roughly 15 million as of 2016) is actually a bit larger than the number getting coverage through the exchanges (roughly 13 million).1 The Medicaid expansion’s impact on economic security and public health is probably larger too. In June, I got an early glimpse of what a bigger Medicaid program could mean for Louisiana, thanks to a group visit for journalists organized by the Henry J. Kaiser Family Foundation. Until recently, Louisiana was among the states whose officials were refusing to expand Medicaid eligibility as the ACA’s architects had originally envisioned. But in 2015, John Bel Edwards ran for governor on a promise to join the expansion—that is, to make Louisiana’s version of Medicaid available to all people in households with incomes below 133% of the poverty line. (In 2016, that’s $15,800 for an individual and $26,813 for a family of 3.) Edwards won and on January 12, 2016, one day after taking office, he signed an executive order implementing the expansion. The ink was barely dry when state agencies began trying to sign up as many people as possible—by automatically enrolling those who were already receiving other forms of state assistance and by conducting outreach efforts through health clinics and other venues that serve lowincome communities. Coverage was set to begin paying for services on July 1, 2016. By the time of my visit, roughly 2 weeks before that start