Association for Public Policy Analysis & Management

Affordable Care Act: A Policy Analysis, Louisiana 2017

By

Anita Feist

Introduction

Louisiana, overall ranked 50^th out of 50 states regarding health outcomes, even greater than the District of Columbia, which ranked last in 2010. Additionally, a 2017 Louisiana State Scorecard, published by the Commonwealth Fund, shows the state ranked 49^th overall and 45^th in prevention in treatment (Cantor, 2010; United Health Foundation, 2017). This report cited both high incidents of substance abuse and high rates of mental illness. Furthermore, Louisiana State ranked 48^th overall in preventive healthcare treatment.

Louisiana, has been shown to have high levels of uninsured populations. In a study from the Urban Institute and Kaiser Permanente, at least 25% of adults age 19-64 in Louisiana were uninsured in 2013 (Urban Institute and Kaiser Commission on Medicaid and the Uninsured, 2014-2015). Additionally, the Kaiser Family foundation found Louisiana to have the 10^th highest rate of uninsured, non-elderly residents, more than one in every five persons lacking health care insurance. More than a quarter of Louisiana’s population receives health care coverage through Medicaid.

In preparing to implement Coordinated Care Networks, also lower the state’s healthcare expenditures, DHH introduced a policy that reorganized the services provided by parish health units throughout the Louisiana parishes. The reorganization included the closure of Orleans Parish Clinic and termination of other services by the state in St. Bernard Parish. Public clinics were consolidated state wide, changing from a 5-day schedule to a 3/2-day schedule, where specific clinics would open 3 days others in the parish would open for 2 days. Clinics were chosen for consolidation based on factors, such as geography and available providers in the area, particularly the number of FQHCs, private providers, and Rural Health Centers.

The Department of Health and Hospitals (DHH) proposed transforming Medicaid from the current fee-for-service system to Coordinated Care Networks (CCNs). In an effort to increase overall health outcomes and prepare the state for major changes in health care delivery due to the Affordable Care Act, the purpose of this dissertation is to review the implementation method used and to analyzed what type of short-term affects will occur due to change in policy. Specifically, what types of changes o occurred to some preventive indicators used throughout Louisiana’s public clinics from a parish level. The technique used is an interrupted time series analysis to measure the degree of impact to OPH/public health services has been effected by the new policies put in place.

Research Questions

To fulfill the goal of this study in describing the changes in preventative care as services move from public clinics to private clinics, there are two specific research questions:

1) What are the immediate impacts of clinic closure and consolidation policies on the following preventative practices within Louisiana state parishes?

Breast Cancer Screening

Cervical Screenings and Pelvic Examinations

STD Screenings

2) Is there a significant difference in the immediate impacts of clinic closure and consolidation policies between rural and metropolitan communities?