While some in Washington debate massive health care expansions that risk growing government and further burdening taxpayers, Louisiana has an opportunity to lead with a different approach that harnesses market forces to deliver better care at lower cost.
The Program of All-Inclusive Care for the Elderly – in place here in Louisiana and across the country – offers an all-too-rare example of how private innovation within a government program can solve public problems without expanding bureaucracy or breaking state budgets.
PACE succeeds because it takes a market-based approach often missing from government health care programs. Private organizations assume full financial risk for patient outcomes under fixed capitated payments. This creates powerful incentives to innovate, eliminate waste, and focus on prevention rather than expensive interventions. Studies have shown these programs deliver better health outcomes at 15-20% lower cost than traditional fee-for-service models.
To date, PACE has been limited to our last-line safety net, frail, impoverished seniors. Expanding PACE to additional populations is an affordable way to meet important reform goals.
Louisiana’s rural parishes face significant health care challenges that government programs have failed to solve. Provider shortages and limited access persist despite decades of federal intervention. PACE offers an alternative that works with existing infrastructure rather than requiring new public investment. This is critical, especially as the state faces ongoing budget pressures from a variety of fronts, especially in health care.
Keeping people in their homes is a cornerstone of the recently-passed One Big Beautiful Bill Act, and it’s a value most families deeply share. PACE already makes that possible for some. Its in-person, in-home, and day-center-based services keep seniors healthier and more connected, while reducing reliance on institutions. It brings families into the care team, respects personal choice, and meets the home-first mandate not as a slogan, but as a standard. They succeed by meeting market demand – keeping seniors healthy and independent – rather than chasing bureaucratic metrics or political mandates.
Expanding PACE eligibility would also increase competition among providers, giving seniors more choices about how to receive care. Market competition drives innovation, improves service quality, and keeps costs in check; these are benefits that regulatory mandates and government-run programs struggle to deliver.
Alongside his colleagues at other state agencies, Secretary Bruce Greenstein, a proven reformer, is already leading the nation in innovation with the implementation of the recent “One Door” initiative to streamline workforce and safety net programs. Now, while other states go down the path of costly health care mandates and expanded government programs, our state is well-positioned to lead once again by demonstrating how market-based solutions can deliver better results.
To see the full benefits, Louisiana has the opportunity to expand PACE eligibility beyond current income restrictions, allowing middle-class seniors to choose this market-based alternative. The state can and should also streamline regulatory approval for new PACE organizations, encouraging competition and innovation rather than just protecting existing providers. Most importantly, state government should resist the temptation to over-regulate PACE expansion. The program succeeds precisely because it operates on market principles within a flexible framework. Excessive state oversight or mandates would undermine the very qualities that make PACE effective.
The vision of reformers and the principles embedded federally in the OBBB are noble: more care, closer to home, at lower cost. But it can’t succeed without implementation models that already work. Our previous experiences with PACE prove that private organizations can deliver what government programs promise but rarely achieve: better care, lower costs, and genuine choice for consumers, especially the state’s most vulnerable seniors. In a state that values fiscal responsibility, limited government, and individual liberty, PACE expansion represents the kind of policy leadership Louisianans should continue to embrace.
