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Long before the onslaught of Hurricane Katrina or the chaos of evacuation, New Orleans' social infrastructure was failing. News coverage of the overcrowded Superdome and the city's flooded streets exposed the poverty and vulnerability of many residents, especially African Americans. As New Orleans begins to rebuild, can the city avoid the mistakes of the past, instead creating more effective social support for low-income and minority residents? Innovation and experience from other U.S. cities offer promising strategies for reducing the risks of poverty and opening up opportunities for economic security and success. This essay is from an Urban Institute collection that addresses employment, affordable housing, public schools, young children's needs, health care, arts and culture, and vulnerable populations. All these essays assess the challenges facing New Orleans today and for years to come and recommend tested models for making the city's social infrastructure stronger and more equitable than it was before Katrina.

Hurricane Katrina destroyed much of the New Orleans health care system. With more than a dozen hospitals damaged and thousands of doctors dislocated, virtually all New Orleanians lost access to their usual health care providers. Individuals with acute or chronic conditions were particularly hard hit. According to U.S. government officials, 2,500 hospital patients in Orleans Parish alone were evacuated (Nossiter 2005). In addition, dialysis centers across Louisiana with caseloads of between 3,000 and 3,500 patients were destroyed, and only half of these patients were accounted for several weeks after the storm hit (McCarthy 2005).

The devastation of New Orleans' health care system was especially profound for the low-income uninsured, most of whom depend heavily on a handful of providers, especially Charity Hospital, one of the nation's oldest health facilities dedicated to treating the poor and disadvantaged. In many ways, however, the uninsured were no different from insured New Orleanians: both lost access to their usual sources of care. Importantly though, those with either private or public coverage were able to see providers elsewhere in the country and could be confident that, at least temporarily their care would be covered. By contrast, the low-income uninsured could not.

Although the immediate crisis has subsided, state and national officials, employers, and insurers must confront a wide array of difficult health care challenges in Katrina's aftermath. In particular, what happens to the individual who had insurance through an employer that is now out of business? How should care for uninsured individuals be financed? What happens to a Louisiana Medicaid beneficiary who evacuated to another state? How should the New Orleans's health care system be reconstructed, especially the safety net?

Focusing on the low-income population, we examine some of the early responses to the many health care issues that surfaced in Katrina's wake. We also discuss some of the emerging issues that both private and public decisionmakers will face. We present background on basic health status indicators for Louisiana and an overview of health care use and patterns of health insurance in the state. We also highlight basic features of the state's Medicaid program and discuss some of the early health care policy actions by state and federal officials. We conclude with ideas about rebuilding the health care system for low-income people in New Orleans.

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.