In our last post, we went into pretty specific detail about the underlying causes for Louisiana’s very poor scoring in a recent Commonwealth Fund analysis. The analysis showed Louisianians spend a larger average percentage of our household income on health insurance premiums and deductibles than residents of any other state. In other words, we finished last in this important affordability category. And as I explained, the reason why is as much about the average Louisiana household’s income as the cost of health insurance or deductible size. In Straight Talk, I showed three major root causes of why Louisiana scored so poorly in the analysis. To recap:
- Lower Household Income: Louisiana households on average are getting by on $20,000 a year LESS than the average American household.
- Fewer Employer Contributions to Family Coverage: Employed Louisianians covering their families with health insurance through their jobs were asked to contribute more than employees in 48 other states.
- Historically Poor Health Status: Our state ranks at or near the bottom in most health status rankings, driving many other trends that affect how much we pay for healthcare.
As you saw last time, I drilled down into each of these. The more I looked into it, the more I discovered the WHY behind each of these factors. And I wanted to share information with you while seeing which solutions present themselves. Let’s be clear, though — there is significant overlap, and Louisianians’ lack of income floats to the top of all three. So, let’s start there.
Why Do Louisianians Have Lower Average Incomes?
This problem is not a new one. When you examine Census Bureau and Bureau of Labor Statistics data, you see we’ve lagged the national average income for at least 50 years. It’s not cyclical; it’s embedded.
Let’s start with labor and jobs. Fewer Louisiana adults on any given day are working than in just about any other state. Our employment numbers are below the national average. In the United States, roughly 63% of eligible adults are working on any given day. In Louisiana, that number is only about 58%. Fewer people working means fewer people earning, and that contributes to other factors that suppress household income in Louisiana:
- Fewer Dual-Earner Households: We have almost the lowest percentage of dual-earner households in the nation. A big contributor to this is our very high percentage of single-parent households. Currently, over 27% of all Louisiana households have children under age 18 with only one parent/guardian present. This ranks us 49th in the dual-earner household Only Washington, D.C., and Mississippi have similar rankings. Obviously, in households where only one adult is supporting the children and dependents, overall household income is lower.
- Higher Rates of Disability: Fully 16% of Louisiana’s adult population is unable to work on any given day because they have a permanent or semipermanent disability. The national average is about 12.5%. Again, we rank near the bottom among the 50 states for our rate.
- Lower Educational Attainment: Louisiana has nearly the lowest percentage of residents who are college graduates in the nation. When we examine the population of people older than age 25 in all states, the national average is over 36%. Louisiana hovers around 27%. Fewer people reaching higher levels of education suppresses earnings because it limits the categories of higher-paying jobs they qualify for. In addition, Louisiana has a lower percentage of white-collar jobs (those that require a college degree) than at least 42 other states (perhaps more). That means our college graduates are more likely to leave the state for better job opportunities elsewhere.
On the plus side, we are making improvements in the rate of high school graduates in our state. People who do not complete their K-12 education have even fewer well-paying job opportunities available to them. Although progress here is promising, it comes after decades of lagging in this measure. We still have catching up to do!
These items are real, tangible, measurable barriers to increasing household incomes in our state, which would make everything more affordable and likely drive meaningful improvement on our health costs and quality of life.
How Do Employers Affect This Ranking?
The second contributor to our poor results was connected directly to employer contributions to family health insurance coverage. In the private health insurance market, easily 85% of people are covered because they have a job or are related to someone who has a job that offers them subsidized healthcare coverage.
When we look at the private health insurance market in Louisiana outside of coverage provided by government agencies or unions, Louisiana’s employers finish just about last nationally in their average contributions for family coverage. The reasons for this are very straightforward. This isn’t because Louisiana employers are less generous — it’s all about employer size.
On average, smaller employers — especially those with fewer than 100 employees — have lower revenues than larger firms. They are taking less money in, so they have significantly less to contribute toward family coverage than larger employers.
Since over half of Louisiana’s workforce is employed by smaller companies — another metric where we have almost the highest ranking in the nation — our employers have less they can contribute to health insurance, and families are forced to dedicate larger shares of their income to get coverage.
The Louisiana Conundrum
Finally, a word about our health status in Louisiana and how it affects the affordability of health insurance premiums and deductibles for the average family.
As healthcare prices increase and more people need more healthcare services, every single family trying to protect themselves from financial ruin finds that task harder and harder.
Think about what we’ve said above, and the Louisiana conundrum now:
Imagine you wanted to buy something that costs $9,000 each year in other states, but you have to pay $10,500 for it. Now imagine all the households in those other states making $20,000 per year more than you. This is essentially what is happening in Louisiana vs. the other 49. Our poorer health status means we need more healthcare than people in other states, but we have LESS money to buy it with. Doesn’t sound good, right?
Solutions? What Now?
The Straight Talk is, you can see from all the data I’ve presented above that we are not merely facing an insurance problem, or a hospital problem or a government problem. Our state’s issues are best described as deriving from our Louisiana-specific situation and our way of living, plus the resultant lower household income.
This means we are all affected every single day — even those of us in higher-paying jobs and in better health. That is tough to hear, but it means that anything we can do on a day-to-day basis to improve our workforce, to encourage education, to strengthen families, to improve our own health, to embrace better industries and jobs will have an impact on our relative cost of health insurance.
Do you care about your personal health? Do you make an effort to adopt healthy habits that lower your risks for long-term illnesses? Do you have a primary care provider whom you see regularly vs. going to urgent care when you feel sick? Are we supporting people around us when they want to improve their health or wellness?
Our Chief Medical Officer Dr. Dee Barfield always reminds us not to underestimate the power of small steps. Simple things like scheduling a yearly checkup to look at your numbers and go over your health status with your primary care provider, quitting or cutting back on smoking or doing light exercise a few days a week are all pretty easy to do and can have a HUGE impact on your health outcomes. And doing small things to lower your risk of long-term health conditions can also affect your healthcare costs. The healthier you are, the less medical care you’ll need to pay for.
And our health is not just about our insurance coverage, which doctors we see and which medications we take. As I’ve shown with this topic, social factors make a big difference, too. What can we do there?
Do you support and encourage education and job training within your family? Do you emphasize the importance of health and financial wellness among your family members? Are you taking steps to build savings so you can pay for medical care and stay independent as long as possible as you age? Are we making it easier for the people around us to work and keep working? Are we supporting community organizations addressing these social factors through our volunteer time, donations or advocacy?
Here at Louisiana Blue, we ask those same questions of ourselves day in and day out. Through our Louisiana Blue Foundation and Community Relations Department, we’ve increased our grant funding, sponsorship and support of Louisiana organizations doing good work in these areas. We recognize that people need access to healthy food, green spaces to exercise and educational opportunities if we’re going to truly fulfill our mission to improve the health and lives of Louisianians. I encourage you to look for organizations in your community that work toward causes you care deeply about. We have many great nonprofit groups in our state doing good deeds, and they can use our help.
It’s a tall order, Louisiana! But we’re not reinventing the wheel here. Plenty of other states have already invested the time, money and effort into improving their income drivers, and they’re reaping the rewards of higher household incomes and lower spending on healthcare. One thing I know as a lifelong resident is that when Louisianians decide to show up for each other, we can get things done. We just need to be serious about it and try. I’m in. Join me?
Here are some links for those who want to see more data about the sources I referenced in this post:
- https://www.commonwealthfund.org/blog/2026/is-employer-coverage-affordable-how-states-stack-up
- https://www.census.gov/library/publications/2025/acs/acsbr-025.html
- https://www.kff.org/private-insurance/state-indicator/family-coverage/
- https://www.americashealthrankings.org/publications/reports/2025-annual-report/state-rankings
- https://www.kff.org/private-insurance/state-indicator/family-coverage/
- https://www.kff.org/private-insurance/state-indicator/average-annual-deductible-per-enrolled-employee-in-employer-based-health-insurance-for-single-and-family-coverage/
I voted for this, but it certainly is not helping me stay off Medicaid.