Sep 13, 2014 19:17 Our Views: Split verdict on insured Our Views: Split verdict on insured Advocate story Sept. 13, 2014 Comments If the goal of the Affordable Care Act was to promote insurance, the initial reports are mixed. More than 300,000 consumers who signed up on the exchanges still had, in July, delays based on questions about citizenship and immigration status. Those consumers have until Sept. 5 to upload their documents to HealthCare.gov or mail them in. These are probably not huge numbers, given that about 8 million people signed up for private coverage under Obamacare. As many as a fourth of those signing up had some problems, probably involving paperwork. Are those now being notified of sign-up problems likely to stay on the rolls of the insured? Perhaps not, as the government has attempted to contact them earlier and for whatever reason could not reach them. As with the 8 million, the 300,000 number is a pretty solid one as the data goes, but the larger question of whether more people are insured is still being chewed over. One element of the problem, though, is already clear enough: expanded Medicaid coverage. The 24 states, including Louisiana, that refused to expand Medicaid are keeping an estimated 6.7 million residents out of the insured ranks. A study by the Urban Institute and the Robert Wood Johnson Foundation also noted that the number of uninsured in Medicaid-expansion states fell by 38 percent but just 9 percent in non-expansion states. At this early stage, we are not sure if some of this data is conclusive, based as it is in part on surveys, but there is certainly the common-sense conclusion that Medicaid — an existing program that was readily expanded elsewhere — could have made a serious dent in the uninsured population in the 24 just-say-no states, including our own Louisiana. We have many poor families who work every day, sometimes adults working two jobs, and they still aren’t financially in the ballpark for Obama’s exchange policies. Again, it’s early yet. We’ll know more as the flood of data, the truly inevitable product of a government-managed program, comes in over the next couple of years. Yet aside from the early studies, there is powerful anecdotal evidence that Louisiana’s approach to this issue has been problematic. With a compliant LSU board, Gov. Bobby Jindal replaced the old charity hospitals with public-private partnerships with major hospitals. A Jindal critic, state Rep. John Bel Edwards, said hospitals left out of the deals suffer and are seeing poor patients but don’t get the top-line reimbursements their peers get. Those hospitals are in a situation of “more care and less reimbursement,” Edwards told the Press Club of Baton Rouge. As the Urban Institute study suggested, some of those costs might have been met by Medicaid expansion, but Jindal and the Legislature blocked it. That will cost insured consumers more, as costs must be made up somewhere.