Almost a third of people in Louisiana are on Medicaid. And hundreds of providers rely on federal reimbursements to operate.
But funding for the program is under threat. The Trump administration—and a majority of Republican lawmakers—say they want to cut funding for Medicaid to help pay for tax cuts. Many providers and patients in Louisiana are watching this funding debate closely.
Host Bob Pavlovich spoke with two Louisiana Medicaid providers—Alice Riener, Chief Executive Officer of Crescent Care and Dr. Peggy Honoré—about how they've been preparing for potential cuts.
The interview was edited for length and clarity.
BOB PAVLOVICH: Alice, let's start with a little background. What do we know about the population who is on Medicaid in Louisiana?
ALICE RIENER: So, there are 1.6 million individuals in Louisiana who are currently on Medicaid. That's 32 percent of the state's population. Forty-two percent of those individuals are children. And so when we think about who's on Medicaid, it's moms with young children, it's caregivers, it's Uber drivers, it's delivery people, it's our culture bearers.
Most people on Medicaid actually are working, and it plays a really key role in providing health care for our people.
PAVLOVICH: Peggy, I hear most of our musicians are on Medicaid.
PEGGY HONORE: Yes, we do have a considerable population of musicians on Medicaid, and one of the primary reasons for that is Most of them operate and earn a living on a gig economy, so they don't make a lot of money. A lot of it is cash, so they don't get paid according to, you know, published law. So it really is difficult for them.
PAVLOVICH: Louisiana expanded Medicaid under Gov. John Bel Edwards. Peggy, what have been the impacts been for you and the musicians?
HONORE: Before Medicaid expansion, which didn't happen in Louisiana until about 2016, 50 percent of our population was uninsured. Fifty percent. Currently, we have 16.5 percent who are uninsured, which is still higher than the state uninsured rate, but still there's a gap of people who are still not on Medicaid and who don't have coverage.
RIENER: For the state, the uninsured rate dropped after Medicaid expansion from 22%.
PAVLOVICH: There's been a lot of hand wringing, Alice, about potential Medicaid cuts. The most recent short term spending bill does not include Medicaid cuts, but are you making preparations for a future one?
RIENER: Yes, I think we are still concerned that, uh, that Medicaid cuts are on the table and the impact to patients to our health care infrastructure in the state would be deeply profound if they go through. The spending proposal of $880 billion would slash the state's funding to all the agencies, rural hospitals, and all health care providers in the state.
PAVLOVICH: Peggy, what would that look like if cuts were to happen? How would it play out for your organization?
HONORE: It would be dramatic. We would probably have to add another 300, 350 people onto our uninsured roles and that would be just a daunting challenge to meet the needs of that population of musicians and culture bearers that we care for.
PAVLOVICH: Alice or Peggy, critics say there's a lot of waste in Medicaid. A recent audit from the Louisiana Legislative Auditor found that one program spent more than half of expenses on administrative costs. Is there any validity to the critiques?
RIENER: Fraud against Medicaid is mostly committed by bad actors in the healthcare space. The beneficiary fraud for those individuals on Medicaid is really negligible. It's less than one percent. I think when we're talking about the proposed changes, all of them are really going to impact and reduce access and reduce coverage for individuals.
PAVLOVICH: What types of care or service would you lose at Crescent Care?
PAVLOVICH: If Medicaid cuts go through, what would happen is that we would go back to folks being uninsured. And when people are uninsured, they delay getting preventative care, which means they wait until things are really bad, and then they go to the emergency room.
The emergency rooms are not set up for primary care or preventative care. So it's also a very expensive way of getting care. And it prevents other trauma and other emergencies from being attended to when our emergency rooms are filled with things that could have been addressed in an outpatient primary care setting. It means that cancer screenings don't happen. Um, it means that people are sicker and when people are sicker, they also don't go to their jobs. And so it has a whole ripple effect on our entire economy and our community.
PAVLOVICH: What would you say to your patients who are worried about losing coverage? Peggy?
HONORE: Well, first and foremost, I would make sure that they had at hand, um, important documentation about their personal financial situation, tax returns, pay stubs, anything like that, because that is so important when you're determining eligibility. For Medicaid or any kind of insurance, actually, and a lot of times our patients don't have that readily available.
So to save time and reduce anxiousness on their part, I would say to make sure to have that information available. We want patients to know what's at stake and how important it is to share their story and that they have a voice.
RIENER: I would encourage patients to make sure that their elected officials know how important and impactful Medicaid has been for them.
PAVLOVICH: Alice Reiner, Chief Executive Officer of Crescent Care, a Medicaid provider in New Orleans, and Peggy Honoré, Board Chair of the New Orleans Musicians Clinic. Thank you for your time and joining us today.
RIENER: Thank you.
HONORE: Thank you.
