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“Having insurance is not the same as having access to health care,” Mentesane said.
The center is bracing for a potentially huge change — a requirement that it take Medicaid patients — if the Affordable Care Act stands. Mentesane said she’s heard through the National Association of Free Clinics that some states are considering that to help meet increased demand for doctors if Medicaid rolls increase. Taking Medicaid would require clinics to add a new layer of administration and more employees.
“We’re community- and family-oriented, with as little red tape as possible,” Mentesane said. “We’d like to stay that way.”
Louisiana put the groundwork for Medicaid expansion and low-cost health insurance exchanges on hold after joining the lawsuit challenging the Affordable Care Act in 2010.
Gov. Bobby Jindal, along with Florida Gov. Rick Scott, returned $1 million in federal grants to jump-start the health exchange planning process.
However, a couple of key provisions in the federal health insurance reform plan may remain. Louisiana lawmakers in 2010 increased the age limit for coverage of dependent children to 26, mirroring the age limit in the Affordable Care Act. They also barred insurance companies from denying coverage because of pre-existing conditions.
A study by advocacy group Families USA in 2011 estimated that 59,300 young adults in Louisiana were eligible for coverage through their parents’ insurance because of the dependent coverage change.
A health insurance survey conducted every two years indicates that young adults in Louisiana may be taking advantage of the dependent coverage change.
The rate of uninsured people ages 22 to 29 actually declined 1.3 percent between 2009 and 2011 while rising in other age groups. The uninsured rate also increased only slightly, about a half-percent, in the 19 to 21 age group, compared to increases of 1 percent to 3 percent among people in the three categories spanning the 30 to 64 age groups.
Another change — reviews of proposed health insurance rate increases of more than 10 percent — could become reality independently of the federal law. The U.S. Department of Health and Human Services started advisory rate reviews this year, but that agency can only comment. It can’t reject proposed increases. Louisiana Insurance Commissioner Jim Donelon is pushing for a rate review process that would let him deny increases considered unreasonable. His rate review bill is competing with one backed by the insurance industry.
Donelon said he believes a review process is needed because one insurer, Blue Cross and Blue Shield of Louisiana, dominates the state’s health insurance market. Like other state health insurance commissioners, he’s awaiting the Supreme Court’s cue on which way to jump. The decision hinges on whether the government can force people to buy insurance or face fines.
“There are other ways to do this, such as by having a limited enrollment period, but that’s not in the law and would have to be done in the aftermath of a decision from the Supreme Court rendering the penalty unconstitutional,” Donelon said.
Connect with Melody Brumble on Twitter @mbrumble.
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