By Elmore F. Rigamer, M.D.
The (Baton Rouge, La.) Advocate, Letters, October 16, 2020
Outcome studies of the Affordable Care Act contradict Attorney General Landry’s critique, recently published. Landry is wrong on several points.
He is wrong about access to care. In Louisiana the uninsured rate dropped from 19% to 10% after Medicaid expansion, which is part of the ACA, providing 445,800 people with health insurance. This is significant. In Louisiana this means one in five adults between the ages of 19 and 64 now can see a physician when sick and not have to go to the emergency room.
He is wrong about public opinion. Nationally, 75% have favorable views of the ACA (85% Democrats, 65% Republicans).
He is wrong about physician choice. If you have insurance, you go where the insurer tells you to go. With Medicare choice, which is also part of the ACA, you see physicians the insurer contracts with. If you see a physician who is out of network, you pay. If the insurer does not renew your physician’s contract, you have to change physicians. Only with traditional Medicare — not Medicare Advantage — is there free choice of physicians. The ACA contracts with a network of private insurance companies, and the physicians work for themselves.
He attacks the ACA for being bloated with regulations. The health insurance industry is responsible for 25% of hospitals’ administration expenses. For example, Duke University Hospital has 900 beds and 1,600 billing clerks.
He is partially right about costs. Some have seen an increase in premiums, but the majority report overall decrease in healthcare costs. There is an increased sense of financial well-being because there is no longer the worry about medical bankruptcy. This is especially important for people in Louisiana, where 38% live at or below the federal poverty level.
Lower copays and deductibles increase the likelihood of getting care. The percentage of adults foregoing medical care because of cost has decreased, the percent who had a routine visit to the doctor has increased, and mortality rates have dropped among Black and White American males in states with Medicare expansion.
He is wrong about costs to the state. The federal government covers 90% of the cost of Medicaid expansion, state hospitals have reductions in uncompensated care, and there are gains in the labor market as people become healthier and go to work.
To date the GOP has not presented credible alternatives to the ACA. Until they do it is dangerous and inhumane to deprive people in Louisiana the healthcare they have received since 2016.