548 LOUISIANA LAW REVIEW [Vol. 76
it is a rural location, its residents find it difficult to access healthcare.2 They
must travel down miles of bumpy country roads to reach the nearest
hospital. Few here possess the luxury of private insurance, and Louisiana
maintains some of the strictest requirements for Medicaid eligibility,
leaving many without any healthcare coverage at all.3 In the 1920s, some
Arkansas families crossed the border and relocated from southern
Arkansas to Kilbourne to take advantage of Huey Long’s program that
provided free textbooks to students.4 Now, in 2015, a few families in
Kilbourne might look to move a few hundred feet north to take advantage
of Arkansas’s expansion of Medicaid that covers many of the working
poor Louisiana currently leaves behind.5
Louisiana, like Arkansas, is a state that has long struggled to provide
its citizens with access to adequate healthcare, but, with the passage of the
Affordable Care Act (“ACA”),6 these two states have taken radically
different approaches to healthcare policy. Louisiana has steadfastly refused
/qfd/states/22/22123.html [http://perma.cc/NS6K-R79E] (last updated Aug. 31,
2015, 1:06 PM).
2. A Health Professional Shortage Area (“HPSA”) encompasses all of West
Carroll Parish according to the Health Resources and Services Administration on-
line data warehouse. See HPSA Find, HRSA, http://hpsafind.hrsa.gov/HPSA
Search.aspx [http://perma.cc/PXA4-MFPK] (last visited Sept. 18, 2015) (select
“Louisiana” for state; then select “West Carroll Parish” for county; then select
“Primary Care” for HPSA discipline). An HPSA is determined by the Secretary
of Health and Human Services based on data provided by the state governments.
See 42 C.F.R. § 5.3 (2014). An HPSA is an area that has a ratio greater than or
equal to one primary care physician per 3,500 residents, or one primary care
physician per 3,000 residents if the area’s population has an unusually high need
for service. Id.
3. See Medicaid Income Eligib ility Limits for Adults as a Percen t of the Federal
Poverty Level, KAISER FAM. FOUND., http://kff.org/medica id/state-indicator/Medicaid
BZ] (last visited Sept. 18, 2015); Understanding the Impact of a Medicaid Expansion
in Louisiana: Considerations, Assumptions and Uncertainties, DEP’T HEALTH &
HOSPS. (2013), http://dhh.louisiana.gov/assets/medicaid/docs/mdcdexpntnimpct_mr
4. This author’s grandfather, the youngest of 10 children, moved from
Arkansas to Kilbourne with his family, because his father could not afford to send
his children to school if he had to purchase textbooks.
5. See ARK. CODE ANN. §§ 20-77-2401 to 20-77-2408 (West Supp. 2015).
Arkansas is the only Deep South state to expand Medicaid. Status of State Action
on Medicaid Expansion Decision, KAISER FAM. FOUND., http://kff.org/health-
able-care-act/ [http://perma.cc/69FS-8LN2] (last updated Sept. 1, 2015).
6. ACA refers to the Patient Protection and Affordable Care Act of 2010, as
amended by the Health Care and Education Reconciliation Act of 2010. Patient
Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010),
amended by Health Care and Education Reconciliation Act of 2010, Pub. L. No.
111-152, 124 Stat. 1029.