Patients burst into tears at this city’s glistening new charity hospital when they learned they could get Medicaid health insurance.

In Baton Rouge, state officials had to bring in extra workers to process the flood of applications for coverage.

And at the call center for one of Louisiana’s private Medicaid plans, operators recorded their busiest day on record.

The outpouring began in June, when Louisiana became the 31st state to offer expanded Medicaid coverage through the Affordable Care Act, effectively guaranteeing health insurance to its residents for the first time.


Now, as Republican presidential nominee Donald Trump promises to repeal the healthcare law, Louisiana is emerging as a powerful illustration of the huge pent-up demand for health insurance, particularly in red states where elected officials have fought the 2010 law.

“People have needed coverage here for a long, long time,” said David Hood, who served as state health secretary under a Republican governor from 1998 to 2004. “This is long overdue.”

As of the beginning of August, 265,723 low-income Louisianians have newly signed up for Medicaid, according to state officials.

Other states that have expanded Medicaid through Obamacare are seeing a similar flood of low-income patients seeking insurance. Medicaid sign-ups in Montana are already double what the state expected, just seven months after expansion began there. In Michigan, enrollment last year surpassed what state officials projected it would be in 2020.


More than 15 million people across the country have enrolled in Medicaid and the related Children’s Health Insurance Program since the health law’s coverage expansion began in 2014, federal data show. That has accounted for much of the historic decline in the nation’s uninsured rate since the law went fully into effect in 2014. Historically, the program was limited to certain vulnerable populations, including low-income children, pregnant women, people with disabilities and the elderly.

The expansion has not been cheap, and many states are seeing costs surpassing estimates, even though the federal government is picking up almost all of the tab.

But supporters note that these costs only underscore how great the need was.

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In Pennsylvania, for example, nearly 10% of the more than 650,000 people who have enrolled in Medicaid since the state expanded last year have gone into treatment for drug and alcohol abuse, with three-quarters getting services in the first two months they were enrolled.

“When people get that treatment, they can keep working, stay out of the hospital, remain a part of their families’ lives,” said Pennsylvania Human Services Secretary Ted Dallas, who has overseen the Medicaid expansion. “Folks have to weigh the costs for everyone if these people didn’t have coverage.”

Nevertheless, opposition to the law remains stiff in many red states where Republican politicians have called expansion of Medicaid, jointly funded by federal and state governments, unaffordable and ineffective.

Nineteen states have rejected federal aid made available under Obamacare to expand their Medicaid programs, a key pillar of the law’s program for guaranteeing health coverage. Medicaid allows adults making less than 138% of the federal poverty line, or about $16,000 a year, to get insurance.


Rejection of the expansion has left nearly 3 million low-income Americans without health insurance in those states, according to an analysis by the nonprofit Kaiser Family Foundation.

Many of these states, including most of the Deep South, have among the highest rates of poor health, including chronic illness and deaths from diseases that could be prevented or treated with timely medical care, such as diabetes and childhood measles.

Louisiana was among them.

Residents of the state, which has the nation’s fourth-lowest life expectancy, live nearly six years less on average than residents of the healthiest states, according to federal data. And Louisiana had among the highest uninsured rates.


The state’s former governor, Republican Bobby Jindal, was a fierce foe of expanding Medicaid eligibility, however, calling universal health coverage a “liberal shibboleth” and warning that expansion would “jeopardize the care of the most vulnerable in our society.”

But Jindal’s mismanagement of the state’s budget helped Democrat John Bel Edwards sweep into office in November on the promise to reverse Jindal’s policies and expand Medicaid eligibility.

The outpouring since sign-ups began in June has surprised even the program’s biggest advocates.

Though Louisiana set up a system to automatically enroll thousands, many more low-income Louisianians came forward on their own, seeking help that many had put off for years because they couldn’t afford it.


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At CrescentCare, a New Orleans clinic serving low-income patients, people have been calling to ask how they can get dental care and help with mental health, officials there said.

Dr. Sarah Candler, who worked as a primary care physician at another safety-net clinic in the city, said she cried with one of her patients who recently learned she would get the new Medicaid coverage.

“It was like I got to tell her I cured cancer,” said Candler, who said the woman had routinely postponed recommended screenings and put off filling her prescriptions because she couldn’t afford them. “It was so powerful to be able to say that I could fix at least one of the things that was making her sick.”


For Cherry Jackson, a 55-year-old New Orleans native who had been living in a homeless shelter, the Medicaid coverage has helped her get medicines she needs to control her high blood pressure and diabetes.

I thank God for this program. Cherry Jackson

“Every time my doctor would give me a prescription, I couldn’t pay for it,” Jackson said. “I thank God for this program.”

There is growing evidence nationally that Medicaid coverage is affecting patients, as previously uninsured Americans like Jackson begin to get recommended medical care and more routinely take their medications.


After Kentucky and Arkansas expanded their Medicaid programs in 2014, for example, researchers found poor patients there skipped fewer medications and were more likely to get regular care if they had a chronic illness such as diabetes.

By contrast, the researchers found little improvement in Texas, which continues to oppose the Medicaid expansion.

In Louisiana, Edwards and other state official say they are looking for even longer-lasting results.

“This isn’t just about getting health insurance,” the governor told a group of reporters visiting Baton Rouge recently. “You get people health coverage for a reason. You want better health.… We want healthier people.”


Twitter: @noamlevey

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