Roughly 11,000 children in Louisiana lost their health insurance last year, the largest single-year drop in over a decade and an alarming reversal of years of progress getting kids covered.
About 50,000 children, or 4.4% of children in Louisiana, were uninsured in the state in 2019, according to an analysis of U.S. Census data by the Louisiana Budget Project, compared to 39,000 children who lacked health insurance in 2018. In 2016, the number of uninsured children was even lower, at 36,000.
The data in Louisiana mirror a nationwide trend that experts fear will worsen amid job losses and an unstable economy due to the coronavirus.
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“This reflected 2019, which was a year in which we had record low unemployment and a decade of strong economic growth,” said Stacey Roussel, policy director for the Louisiana Budget Project and author of the report. “Still, we were seeing the uninsured rate for children rising across the country as well as here in Louisiana.”
“It also means a record increase in the number of families without insurance for their children as we were going into the largest public health emergency we’ve seen in our generation,” she added.
Access to health care is critical for young brains and bodies, according to researchers and medical experts.
In the first few years of life, over 80% of brain development takes place and the foundation is laid for growth of major body systems.
Interventions are most effective when doctors can spot conditions at a young age before they become a bigger issue.
“Preventative care is the hallmark of pediatric care,” said Dr. Ryan Pasternak, an adolescent medicine specialist and associate professor at LSU Health New Orleans School of Medicine. “Our goal is not only to identify and treat acute and chronic illnesses, but also to address and identify lifelong illnesses.”
Even short gaps in care can allow things to slip through. Pasternak said he saw a young patient this month who lost Medicaid and put off care for seven months. When the patient regained coverage, it was a two and a half hour visit.
“There were just a plethora of issues that had not been addressed,” Pasternak said.
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It’s not yet clear exactly why Louisiana’s number of uninsured children has grown so much in a year.
In 2016, Louisiana expanded Medicaid to include those making up to 138% of the federal poverty level, or about $36,000 for a family of four as of 2020. By April 2019, the expansion provided coverage to more than 500,000 additional people.
But in May of last year, Medicaid enrollment dipped after wage checks that automatically kicked off people appearing to make too much money to qualify, dropping by about 50,000 enrollees by the of 2019. But in January, enrollment started to climb again, with 550,000 people covered by the expansion as of Sept. 2020.
Providers searching for a rationale for the decline in insured patients point to complicated paperwork and threats to the Affordable Care Act as possible issues.
Many patients eligible for Medicaid or LaCHIP, the state’s health insurance program for low- and moderate-income families, are not enrolled even though they qualify.
“Even in some of my patients who have Medicaid, to have to renew is a huge process,” said Dr. Kimberly Mukerjee, Tulane pediatrician and medical director of the New Orleans Children’s Health Project, a clinic that provides care to children without access to insurance, many of whom come from immigrant families. “We’re seeing this cumulative effect of all these different policies playing a role, and children are taking the brunt.”
Mukerjee says some of the most common issues she sees among uninsured children are mental health issues and extreme dental decay, both of which snowball into more disruptive problems as a child grows.
“It is a lot of cavities, whole molars that are rotted out, whole sections of their teeth rotted,” said Mukerjee. “They have chronic tooth pain, which is a factor impacting their ability to do well in school. It also puts them at a huge infection risk.”
Mukerjee sees children who go for years without diagnoses for conditions that improve tremendously with intervention: autism, hearing loss, seizure disorders, asthma. Often, uninsured children are several years into a developmental delay or chronic condition before they seek care.
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“The hardest part is knowing that had we been able to intervene years earlier, we could have changed the outcome entirely for that child,” said Mukerjee. “These are kids who go through childhood living with these conditions and they’re going to have long-lasting impacts into adulthood.”
Historically, Louisiana has had better rates of insurance among children than the U.S. average. But with a one-year, 28% increase, the state has now moved to the middle of the pack, ranking 22nd among all states, according to an October report from the Georgetown Center for Children and Families.
In 2016, the state ranked 17th.
Parishes with the highest increase were East Baton Rouge, Caddo, Bossier and Lafayette. Although low-income families suffered the biggest loss in coverage, the increase was not limited to age group or income.
“It was across the board that we saw an increase in the number of uninsured children,” said Roussel. “That suggests there may be multiple things happening that we need to address to help re-instill that culture of coverage.”
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