Louisiana’s high Medicaid reliance places state on frontlines of health care cuts

Geoff Bennett:

President Donald Trump's big budget law is expected to make the largest cuts ever to Medicaid, a program that currently provides health insurance for some 70 million Americans.

As Lisa Desjardins reports, those effects will be felt in House Speaker Mike Johnson's home state of Louisiana, which has one of the highest rates of enrollment in the country.

Rita Noel, Medicaid Recipient:

I bet you can't swing higher than me.

Lisa Desjardins:

A show of joy. Rita Noel and her son, Reese (ph), who's autistic, have a close bond. But, for Rita, neither happiness nor health are givens.

The single mom of three in Morgan City, Louisiana, works part-time and depends on Medicaid for health care.

Rita Noel:

This is home for my primary care. I come here for all sorts of health care needs.

Lisa Desjardins:

Her family gets care here at Teche Health, where doctors say Rita is becoming a healthier patient.

Woman:

Next thing you know, I'm going to be saying, I will see you back in a year, because you're doing all…

(Crosstalk)

Rita Noel:

I'm doing good. But, sometimes, it took me repeat business, because I, sometimes, I a hardheaded.

Woman:

Yes.

Lisa Desjardins:

She's among some 1.4 million Louisianians on Medicaid, the joint federal and state health program for low-income people and the disabled.

The Republicans' big tax cut and spending cut law puts more of the Medicaid load on states and requires more of patients, from work hours to more frequent eligibility checks.

Do you think that your Medicaid is at rescue yourself?

Rita Noel:

I do, and I often worry about that.

Lisa Desjardins:

She's worried about the additional paperwork falling through the cracks, and then:

Rita Noel:

And my grandbaby doesn't get the proper vaccinations she needs to be able to survive by here. My son won't be able to get the services he needs to thrive. I won't be able to get the services I need in order for me to be healthy. I have to be healthy in order to make sure my family is healthy. And so I'm very concerned.

Lisa Desjardins:

But Republicans counter:

State Sen. Heather Cloud (R-LA):

Here in Louisiana, it's not our intent to just pull people off of Medicaid rolls.

Lisa Desjardins:

Republican State Senator Heather Cloud, who grew up low-income and without health insurance herself, says what she is trying to do is keep Medicaid stable financially. In 2016, Louisiana launched its Medicaid expansion, adding nearly 800,000 people to the rolls, but also increasing costs to the state.

This spring, Senator Cloud sponsored a bill to increase eligibility and residency checks starting in January. That passed unanimously. She also backed separate legislation called One Door, that aims to keep the vulnerable from falling through the cracks. That package also passed with overwhelming bipartisan support.

Dr. Gary Wiltz, CEO, Teche Health:

We're monitoring everything closely to see.

Lisa Desjardins:

But in clinics across the state, they're worried federal cuts mean at least some people will lose coverage in the next two years.

Fewer people with health care coverage, does that concern you in terms of the health care itself of the state?

State Sen. Heather Cloud:

Absolutely. Yes, that absolutely can. I can't tell you that it doesn't concern me. And I think that is why we're being so careful in how we manage this. We don't want to put anybody in a position that they don't have access to health care, critical, life-sustaining care, particularly in my district, in rural Louisiana.

Lisa Desjardins:

The stakes are especially high here in Louisiana, which is one of the most reliant states on Medicaid and, by almost any measure, one of the least healthy.

Dr. Gary Wiltz:

If you take away that Medicaid support, then it's going to really cripple us.

Lisa Desjardins:

Dr. Gary Wiltz Teche Health, which operates 10 community clinics in the state. It provides care in rural areas, where patients face significant challenges accessing larger hospitals. The clinic depends on Medicaid, which covers about half of the patients here, young and old.

But Dr. Wiltz can't make related decisions like cutting back on future plans, yet because the Trump administration won't finalize some key specifics, like for work requirements, until next summer. He does feel sure of one thing.

Dr. Gary Wiltz:

I do expect that some people will get kicked off the rolls, because they won't know how to navigate or they may not have we have a — we have a — we have deal with a population that's not always the easiest to access. The practicality is the implementation of how that's going to play out. And, to be frank with you, you don't know.

Lisa Desjardins:

The clinic's trying to reach patients to explain the potential changes, but, still, patients like Brenda Harris don't know what to think.

Brenda Harris, Medicaid Recipient:

It's all a puzzle because you're hearing one thing. You see another thing on Facebook. Then the TV say another thing. So it's all confusing. So it's like, I will just sit and wait.

Lisa Desjardins:

Mom Rita Noel has more clear thoughts. She supports the idea of some work requirements, but with flexibility. She's still worried about what will happen to her and also about how the world sees people on Medicaid.

Rita Noel:

I do believe that people think that most people that are on Medicaid, they don't work, that they're just kind of, sort of looking for a handout. And that's definitely not the case. In many situations, I know many people that are on Medicaid and they work, and they work hard every day.

Lisa Desjardins:

Major Medicaid cuts and reform are coming. Louisiana needs to keep working hard to get ready.

For the "PBS News Hour," I'm Lisa Desjardins in St. Mary Parish, Louisiana.