Louisiana and Medicaid are inextricable. In 2023, 32% of the state’s population was on Medicaid, second only to private health insurance, which covered 40%, according to KFF. KFF estimates that under the proposed Medicaid cuts included in the "One Big Beautiful Bill Act," over 200,000 Louisianians would be uninsured by 2034. That’s 5% of the state population.
Now that the cuts have been approved, here are some ways people in Louisiana could be impacted.
Work requirements
Republicans said they wanted to implement tighter work requirements to weed out people who are taking advantage of the system.
The bill requires certain adults enrolled in Medicaid to meet minimum work requirements in order to keep their coverage. Those between the ages of 19 and 64 must work, study, or volunteer at least 80 hours per month. There are exemptions for people who are pregnant, disabled or caring for children under age 14. States are required to verify individuals' work status once every six months starting Dec. 31, 2026. If they’re not meeting work requirements or actively looking for a job, they’ll be sent a notice of noncompliance, and have 30 days to prove they’re either employed or job searching.
KFF notes that this policy, along with the long list of exemptions, will be challenging for states that have already implemented it, such as Arkansas, where 18,000 people lost coverage without seeing a significant increase in employment.
And this is all assuming the Medicaid infrastructure systems work as they should.
“Look, it’s understandable why the government wants to support work,” Joan Alker, CCF Executive Director at Georgetown University, told WWNO earlier this year. “That makes sense. But this policy is not going to achieve that. In fact, it’s probably going to have the opposite effect.”
“Unfortunately, these government systems don’t work well, and a lot of times when people are trying to do the right thing, if they even know what they’re supposed to do, it just doesn’t work, the computer or the website doesn’t work. So unfortunately, this policy is going to result in lots of eligible people losing their Medicaid.”
U.S. Rep. Julia Letlow (R-Louisiana) told Talk 107.3’s Mornings’ Brian Haldane that the legislation promotes family values and community well-being.
“I support strengthening Medicaid for those who need it the most – the disabled, the elderly, children, expectant mothers, people who truly cannot work. We need to root out the waste, fraud, and abuse that hurts the program. The only Medicaid enrollees losing coverage from this bill are illegal immigrants, people defrauding the system, or healthy young people who choose not to work,” Letlow said.
Sarah Collins, senior scholar for improving coverage and access and tracking health system performance with the Commonwealth Fund, said it’s not that simple.
”Obviously, any government program may have some fraud in it, and that's a separate issue, but it doesn't require a solution like the one that we've seen, which are these major cuts to Medicaid and the marketplaces that will leave up to 17 million people nationwide without [health] insurance coverage. … The claims of fraud were way overblown, and the response to this was taking the hatchet to something that was actually functioning quite well in terms of getting people covered and getting people the healthcare that they need,” she explained.
Rural hospitals could lose key revenue
Alice Burns, associate director of KFF’s program on Medicaid and the Uninsured, said these cuts mean less people will be insured, and less revenue will go to physicians, pediatricians and other providers.
“But the difference between those providers and hospitals is that hospitals have an emergency department,” she explained. “They can't send away people. If someone walks in the door, they're required by federal law to treat that person if they need emergency care. If those people no longer have health insurance, the hospital is expected to absorb those costs.”
Rural hospitals have more patients on Medicaid who will be less able to absorb the costs of health care, according to a study by Georgetown.
Even if a rural hospital remains open, the closure of just one department can have devastating effects on the community. Across the U.S., rural hospitals have been closing maternity wards, significantly affecting the women who rely on them for care. A Georgetown study found that 52% of rural hospitals no longer have an obstetrical care unit.
Take, for instance, Our Lady of the Angels in Bogalusa. It’s the biggest employer in a rural area besides the paper mill, and it barely turns a profit. Georgetown estimates the payer mix is 85% government funded — 45% Medicaid, 40% Medicare. It’s also the only hospital in the area with an obstetrical care unit. If Our Lady of Angels shuts down even just its obstetrical care unit — and under the Medicaid cuts, that’s not a far-fetched idea — the nearest hospital with an obstetrical care unit is 45 minutes away, which Georgetown health experts say puts women already in a vulnerable state in an even worse position.
“The effects on rural communities of a hospital closing its labor and delivery unit, or closing altogether, cannot be overstated,” said Alker. “Every person and family in a community is affected by the loss of birth in that community. It can change the way a community sees itself when it's a place where babies can no longer be born.”
Impacts on maternal and infant health
Women of childbearing age rely on Medicaid for healthcare and prenatal care, and, according to KFF, Louisiana has some of the highest reliance. About 2 in every 5 urban Louisiana women of childbearing age rely on Medicaid for healthcare, which jumps to about 1 in every 3 rural Louisiana women.
“Nearly half of all births in rural areas are covered by Medicaid [nationally], and less access to obstetrical care leads to worse outcomes for both mom and baby,” said Alker. “If we see more hospital closures and loss of labor and delivery units, all women living in rural areas are at risk of losing out on the care they need, regardless of who is their insurer, if that care is just not available. So these communities will not be able to grow and thrive without a robust system to support women and families.”
Plus, every issue that others on Medicaid have with the system and work requirements becomes harder when you’ve just had a baby, she said.
“Women who are in their childbearing years, they’re doing a lot of things, and oftentimes they’re caregiving, both for their children and or sometimes an aging parent, and so they’re in and out of the workforce,” Alker told WWNO earlier this year. “They’ve got a lot going on in their lives, so requiring all of this paperwork to document, possibly every month [documenting] what they’re doing. First of all, it’s pretty invasive for [the] government to get in their business that way. But also, I can tell you, when you’ve just given birth and have a baby, filing regular paperwork is going to be extremely challenging.”
There’s a very real chance that these cuts will cause some women and newborns — two groups Letlow highlighted in her defense of the cuts — will lose access to Medicaid, she said.
People with HIV and other chronic conditions would be affected
Medicaid is a lifeline for low-income individuals who need medication for chronic conditions and illnesses.
Take HIV-positive individuals, for example. Louisiana has some of the highest rates of HIV in the country. Nationally, about 388 out of every 100,000 people are living with HIV, but in Louisiana, that number rises to 568 per 100,000, according to Emory University’s Rollins School of Public Health.
HIV is manageable with proper medication, but when patients can’t treat their symptoms, it can be deadly.
Not to mention, the U.S. is facing something completely new: people living with HIV are growing old, Carl Baloney Jr., Vice President of Policy for AIDS United, noted.
“We're approaching a tipping point where nearly 50% of folks living with HIV are in that 55+ category, and are gonna need specialized services as they age and live long lives with HIV,” he explained. “But this is unprecedented, that folks are growing old with HIV because if you have access to care and treatment, you can live a long, healthy life.”
And if you don’t have access to care and treatment?
“ People are gonna pay with their lives,” said Baloney. “And I think Louisiana's gonna feel this first.”
Health disparities and inequities could worsen
There has always been disparity in health care, but experts say these cuts could make it worse.
“So what we're gonna see is a return to that widening divide that the Affordable Care Act, [sic] the Medicaid expansion, the marketplace expansion, really did narrow in terms of there being a lot less disparity in the United States in terms of health care coverage. And now we're gonna see that widening as a result of this bill,” Collins explained.
According to KFF, the national uninsurance rate among people under 65 who identify as white was 9.8% in 2014, when the Affordable Care Act expanded Medicaid coverage. In 2023, that number dropped to 6.5%. Compare that to the rate among people who identify as Black — which dropped from 14.9% in 2014 to 9.7% in 2023 — rates among people who identify as Asian American Pacific Islander — which dropped from 26% in 2014 to 18.7% in 2023 — or rates among people who identify as Hispanic — which dropped from 25% in 2014 to 18% in 2023 — and it becomes clear that racial inequity in access to health care was an issue that expanded Medicaid coverage helped solve.
Even under expanded Medicaid coverage, Louisiana still struggles with racial equality in access to health care. In 2023, the Commonwealth Fund found that a higher percentage of Louisiana adults between 19 and 64 who identify as Indigenous American and Hispanic were uninsured than the national average. Across the board, minority communities in Louisiana sought treatment less, suffered from more preventable or treatable conditions and relied on Medicaid more than both majority communities in Louisiana and the national average.
Or, as Baloney put it, “ This is a test whether our country believes that southern lives, that Black lives, queer lives, rural, HIV-positive lives are really worth protecting.”
Older adults could be disproportionately affected
In her statement, Letlow said the elderly and those who “truly cannot work” deserve Medicaid coverage.
And the elderly do use Medicaid. According to KFF, Medicaid covers 74% of Louisianians in nursing homes, and is primary payer for long-term care in the U.S., according to Medicaid.gov.
Medicaid covers long-term nursing home care for low-income individuals with limited assets, paying for 60% of extended stays nationwide and supporting nearly 1 million people. It also pays wages to caregivers. Plus, older adults are more likely to have health issues that need care, meaning they rely more on Medicaid, according to a KFF study.
“ I don't think people understand that the second biggest source of savings [from cuts to Medicaid] is something that really disproportionately affects older adults and people with disabilities, especially those who also have Medicare,” Burns explained.
The greater impact
Medicaid is considered a lifeline for some of Louisiana’s most vulnerable people. It’s what enables Louisianians who are low-income, in rural areas, disabled, elderly and more to seek and afford health care.
Since almost a third of Louisianians are on Medicaid — as well as 21% of the American population — it’s likely that you know someone on the program.
“ Over half of Americans either know someone on Medicaid or have been on Medicaid themselves,” said Burns. “It is a huge part of our health care system. One in five people currently enrolled in Medicaid [nationally], one in five health care dollars are paid for by Medicaid. Taking that out of the health care system will have effects that we are all going to experience, particularly in long-term care.”
Though the idea of taking Medicaid away from those who don’t need it is nice, health advocates say the cuts could end up taking Medicaid from those who need it the most.
The most recent state scorecard that the Commonwealth Fund released shows that Louisiana ranks 47th in the nation in premature deaths from treatable illnesses and 45th in premature deaths from preventable causes.
“ As many as 300,000 could lose their health insurance coverage in Louisiana, either from losing Medicaid or coverage through the marketplaces,” Collins explains. “People can't afford to take care of their health without health insurance, and doctors and hospitals need the payments from insurance to be able to provide good care to people.
“This bill really takes Louisiana in exactly the wrong direction, and essentially all other states of the United States. It will gut Medicaid and gut the marketplaces, making it really hard for people whose employers don't offer them coverage to afford insurance and get the health care that they need.”
