Louisiana politicians, including Governor Bobby Jindal, continue to resist all programs associated with the Affordable Care Act, which is scheduled to go into full effect in 2014.
The Act would require everyone in the US to have health insurance and would also open new avenues for becoming insured. The City of New Orleans is already preparing for the Act to move forward with a campaign to get people enrolled in the online Health Insurance Marketplace.
Political controversy has not deterred the City of New Orleans from educating people about the federal subsidies that the Affordable Care Act will make available to low income residents. Dr. Karen DeSalvo, New Orleans Health Commissioner and leader of the city’s outreach efforts, says medical insurance is a public health issue first and foremost.
"We know that there are a lot of people who could take advantage of it," says DeSalvo. "We want to make sure that they know that this is a federal program that's going to provide subsidy and support for health insurance, and we know that when you have good health insurance and good access to care that you're healthier."
Basic health services remain out of reach for many of Louisiana's 800,000 uninsured adults.
Last month, about 800 people flocked to the fourth free CARE clinic in New Orleans since 2009. The National Association of Free and Charitable Clinics (NAFC), which runs the day-long event, turned the Ernest N. Morial Convention Center into a massive makeshift doctor's office. Volunteers screened patients for a wide range of medical conditions, refilled prescriptions, and offered information on where to receive follow-up care.
Nicole Lamoureux, Executive Director of the NAFC, says the need for medical care in Louisiana has made it the only state her organization has chosen to visit more than once.
"You're pretty low when it comes to health outcomes," says Lamoureaux. "You know, you're looking at high number of diabetes, high number of hypertension, high number of teen pregnancies, high number of HIV cases. It's between Texas, Mississippi and Louisiana. You're always fighting for the bottom rank of the 50 states in America. So, we need to get here and help people."
Elvira Gallo, a seamstress and mother of three, commuted from her home in Marrero to get free treatment at the CARE clinic. Because the Gallo family's income is less than twice the national poverty line, her children are insured under the Louisiana Children's Health Insurance Program until they turn 19. But Gallo has been without health coverage ever since her husband lost his job last year.
"I don't receive Medicaid insurance because I don't qualify for it," Gallo explained. "And it's expensive to get insurance because of my diabetes, you know, and that's why I came to see what they could do for me."
Gallo has a common problem. She says she makes too much money cleaning houses and altering dresses to get Medicaid in Louisiana, but not enough to afford private health insurance.
The Affordable Care Act's Medicaid Expansion program would have covered an additional 400,000 Louisiana residents with federal funds, according to a report by the Louisiana Department of Health and Hospitals. But the DHH and many state lawmakers have backed Governor Bobby Jindal in his rejection of Medicaid expansion.
Although she still won't qualify for Medicaid, Gallo may find new health insurance options within her reach when the Health Insurance Marketplace opens for business in October.
The marketplace — often referred to as the "health care exchange" — may come as a surprise to those who have heard Governor Jindal repeatedly say that he would not create one in Louisiana.
"Every governor's got two critical decisions to make. One is, do we set up these exchanges? And secondly, do we expand Medicaid? And no, in Louisiana, we're not doing either one of those things," Governor Jindal told Meet the Press in 2012.
Health Commissioner DeSalvo says Louisianans may be confused about whether they will be able to access to the health insurance marketplace.
"I think we have a lot of work to do to be certain that everyone understands that it's coming in October," she says.
Louisiana has opted not to build its own health insurance exchange, but uninsured state residents can simply visit the national marketplace at healthcare.gov instead.
The federal government also aims to get more small businesses to band together for group rates on employee health insurance. Dr. DeSalvo has reached out to groups like the Louisiana Restaurant Association and the Hotel and Lodging Association about participation.
**Editor's note: The original text of this story has been altered, to reflect the intention of some of Commissioner DeSalvo's comments.